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Getting Started: Dismantling Diabetes Stigma


This year at the d20 Executive Innovation Lab, the dNetwork has taken on the ambitious goal of dismantling diabetes stigma.

If you want to get involved in disrupting diabetes stigma, please see the five-step primer below for videos to watch and assignments to complete. We have adapted and consolidated the learnings from d20’s pilot program to provide this foundational knowledge and actionable information for anyone to begin this work with us. For more information, please refer to the d20 Executive Summary


Diabetes stigma and discrimination work to prevent people with and at risk for diabetes from seeking and receiving necessary treatment. Stigma also contributes to a lack of openness about having diabetes, which impacts public perception of the severity of the problem and our ability to mobilize for collective action and policy solutions.

Therefore, our theory of change for d20 and beyond is that working together to address diabetes stigma is crucial to catalyzing the changes needed across all parts of the diabetes ecosystem — from food and healthcare policy to treatments and behavior change interventions among patients, those at risk, and healthcare providers.

Our first step is to create a shared narrative — a cross-sector understanding — of how to think and talk about diabetes in order to reduce stigma and promote better health. However, to truly change the narrative around diabetes in the US, it will require the power and commitment of us all. Join our movement.


Getting Started: Dismantling Diabetes Stigma

1. LEARN about the science of stigma and of changing norms through changing the stories we tell. 

Watch the three ‘Lightning Talks’ below to learn about the impact of stigma on people with diabetes and their health outcomes, and how narrative changes can transform public perception and treatment of people with diabetes. We also invite you to read diaTribe's article, Diabetes Stigma is Everywhere, But You Can Do Something About It

Rebecca Puhl: Research shows that diabetes stigma exists and worsens health outcomes
Nat Kendall-Taylor: How to use strategic framing and language to influence behavior, medicine, and policy
Joan Garry: Case study: how the LGBTQ+ community successfully reduced stigma through media advocacy

Optional: To watch all five Lightning Talk speakers, see here

2. SHAPE shared language – a new narrative – to shift how Americans think, talk, and act about diabetes that will help reduce stigma, increase health, and amplify impact.  

Watch the Framing Workshop with Marisa Gerstein Pineau from The FrameWorks Institute to learn about common communications traps and five major frames to reduce diabetes stigma.

After watching the workshop, answer the discussion questions below – try jotting them down on a piece of paper for future reference. Your thoughts and answers to these questions will help inform the third part of the course below.

What excites you? 

  1. Which frame or frames had the biggest impact on your thinking about combating stigma in your communications?

  2. What do you find useful or compelling about this frame or part of the framing strategy?

  3. For each of these, how or with which audience do you see using it?

What are you questioning?

  1. Which frame or frames do you have questions about or find challenging when you think about your communications? 

  2. [For each frame]: What do you find challenging about this?

  3. What would be helpful when it comes to using this part of the strategy? (Adjustments, customizations, supplemental resources, etc).

3. COMMIT to testing these new frames in your personal and professional lives. 

Thinking about the frame(s) you found most compelling, work on customizing 1-2 talking points that you want to use or test. Then, go out and test these customizable frames and talking points in your life – starting with the dinner table and taking it into your professional spheres of influence. Fill in the blank below and commit to trying it out for at least four weeks. 

One key place I plan to test some new frames in the coming weeks is ______.

4. SHARE your discoveries, challenges, and questions with diaTribe. 

After spending at least four weeks testing these frames, you will likely run into challenges and push backs in your conversations. We have already identified five major challenges that d20 participants ran in to while testing these frames:

  1. Keeping the conversation focused on diabetes, not obesity. Participants found that once diabetes was brought up in conversations, people often shifted the conversation to obesity and weight stigma. How might we refocus conversations on diabetes, specifically?
  2. Combatting the blame and shame 'individual responsibility' frame. In America, individualism is a core value, and many people believe that personal choice and lack of willpower are the sole causes of diabetes. How might we pivot/reframe when people come back to blaming ‘bad behavior’?
  3. Introducing the health equity frame where it’s not already understood/believed among the audience. The health equity frame presented two challenges for frame-testers: (i) the difficulties around explaining health equity to audiences who don’t resonate with that concept, and (ii) the phenomenon where the concept of health equity often triggered thoughts around race and gender, but not diabetes. How might we bridge the gap in people’s understanding of the link between equity and health?
  4. Inspiring healthy habits without shaming. People are often told to ‘make healthy choices,’ but the dichotomy of ‘unhealthy’ versus ‘healthy’ is often oversimplified and even stigmatizing. How might we inspire behavior change without being stigmatizing n the process?
  5. Getting attention for diabetes without crisis messaging. Frame-testers found difficulty in communicating urgency around diabetes without sparking fatalism. How might we get attention to this issue without adding to our society’s crisis-driven media?

Have you experienced similar challenges? What other diffculties have you run into while testing these frames? Please SHARE your fieldwork insights with diaTribe. 

5. CREATE your personal action plan.

On your own, create and fill in a table like the example below to identify three specific areas in your life where you can use frames to reduce stigma. Focus on these areas as you continue your stigma-dismantling work. You can download a blank copy of this table here.


Once you finish crafting your personal action plan, share it with the diaTribe team! Send us a picture of your action plan or share a document with us. We want to hear how you plan to test these new frames and talking points in your life. Now get out there and help us start the work to dismantle diabetes stigma!


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