Stigma and the Inverse Care Law: Experiences of ‘Care’ for People Living in Marginalised Conditions

Addison, Michelle; Scott, Steph; Bambra, Clare; Lhussier, Monique

Abstract

This paper explores the connection between stigma and the Inverse Care Law (ICL) by focussing on the idea that people who have the greatest needs often have the least support from healthcare services. Twenty‐four semi‐structured interviews were undertaken with people who used class A & B illicit drugs, in the northeast of England. Many of the people in this study who used illicit drugs were not able to access quality healthcare in a timely way to meet their needs because of structural and relational stigma. We discuss four themes: (i) pressure on health services and long waiting lists, (ii) sensitivity to compassion fatigue from staff and impacts on engagement, (iii) complex systems that are difficult to navigate and (iv) stigma and drug use. These themes illuminate the harms of stigma and support Tudor Hart's ICL. Stigma is a key contributor to the inverse experience of good quality healthcare and requires greater attention from policymakers and practitioners. The structural and relational aspects of stigma embedded in healthcare are central to the ICL and reproduce inequities in access to and experience of good quality healthcare, which in turn impacts health inequalities.

Citation

Addison, M., Scott, S., Bambra, C., & Lhussier, M. (2025). Stigma and the Inverse Care Law: Experiences of ‘Care’ for People Living in Marginalised Conditions. Sociology of Health & Illness, 47(1), Article e70000. https://doi.org/10.1111/1467-9566.70000

• Journal Article Type: Article
• Acceptance Date: Dec 17, 2024
• Online Publication Date: Jan 19, 2025
• Publication Date: Jan 1, 2025
• Deposit Date: Dec 17, 2024
• Publicly Available Date: Jan 23, 2025
• Journal: Sociology of Health & Illness
• Print ISSN: 0141-9889
• Electronic ISSN: 1467-9566
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Issue: 1
• Article Number: e70000
• DOI: https://doi.org/10.1111/1467-9566.70000
• Keywords: health inequalities, marginalisation, illicit drugs, stigma, healthcare, inverse care law
• Public URL: https://durham-repository.worktribe.com/output/3222680