We talk about stigma as a barrier to people getting treatment for addiction, but it’s a problem in other areas of healthcare, too.

There’s one day a year when volunteer physicians, nurses, and dentists provide free care in an open field in rural Virginia. Thousands line up for hours for treatment of their many health problems (this is coal mining country, and you know what that means). Some 70% are there for free dental care, up to and including removal of all their teeth and replacement with dentures. Poor dental hygiene is a major factor in susceptibility to a host of infections, and many of the young people have never seen a dentist. They just suffer.

It’s easy to assume that if healthcare were available, many of the problems that afflict these folks would be remedied. But though enormously grateful to the volunteers, a considerable number of the attendees opposed the governor’s plan to expand Medicaid. As one woman put it: “We don’t want no government handout.”

To her, taking something from the government, no matter how much it was needed, was beneath her dignity.

That stigma seems peculiar to healthcare. Lots of people in the community depend on government checks for other needs. Somehow, they’ve been taught to see healthcare as a privilege rather than a right.

This is the sort of reasoning¬†that leads legislators to chop funds for substance abuse services whenever there’s a budget shortfall on the horizon. It’s not based on return on investment from treatment, which research demonstrates is phenomenal. It’s based on the assumption that addiction treatment is something that in a pinch, the community can do without. It’s not a priority.

So they cut. Then they wonder why drug and alcohol problems never seem to improve very much.

More on stigma and its damage.