Low income, high risk: the overlapping stigmas of food allergy and poverty

Abstract

The aim of this study was to explore experiences and coping strategies of low-income families affected by food allergies. Of particular interest were experiences of allergy-related stigma within the context of poverty stigma. A secondary objective was to offer suggestions for refining a conceptual model of disease stigma. In-depth interviews with 23 individuals (10 key informants and 13 low-income adults affected by food allergies in southwestern Ontario, Canada) were conducted in 2012–2013. Participants reported feeling forced to adopt income-related stigmatized behaviors to obtain food and perceived difficulty in obtaining medication. Participants adopted cognitive distancing strategies to separate themselves from other low-income families affected by food allergies. Key informants frequently perceived low-income allergic individuals to be less vigilant than higher income individuals and attributed higher rates of allergy among higher income individuals to fewer unhygienic exposures and infections in early childhood. Both low-income participants and key informants perceived that inadequate education was a barrier to allergy management: key informants perceived a lack of education as an individual-level failure, while low-income participants perceived the lack of education as a system-level failure. Our findings revealed intersections between allergy stigma and poverty stigma. Results can be used to suggest additions to a conceptual model of disease stigma. Differing perspectives between key informants and low-income individuals have implications for strategies to improve access to education, safe food, and medication for low-income families affected by food allergies.

Keywords:

• stigma
• food allergy
• low income
• allergy management

Funding

This work was supported by AllerGen NCE Inc, the Allergy, Genes and Environment Network [grant number 12CanFAST1].

Notes

1. Of note, individuals with anaphylactic allergies are recommended to carry two EAIs and there is a normative practice of having extra injectors in school or day care settings. Therefore, this participant’s comment about $300 or $400 implies the availability of at least 3–4 EAIs.