Epistemic Injustice and its Connection to Healthcare Stigma

Epistemic Injustice is a term which was coined by Miranda Fricker in 2007, which labels occurrences of being disregarded in your personal lived experience. You aren’t treated as if you are a knower, regardless of your knowledge of an experience, you are brushed off. There are two types of Epistemic Injustice: Testimonial, and Hermeneutical. With Testimonial Injustice, you are not listened to due to prejudice, “surely you can’t know that because you’re too young!”. Hermeneutical Injustice is the label given to the idea that you haven’t been given the correct tools by society to express your experience. A really good way to explain this is when women didn’t have the label “sexual harassment” to explain the unwanted attention they were receiving from people in the workplace. There was a time where the term was unheard of, giving rise to Hermeneutical Injustice. This is the example that Fricker gave in her book Epistemic Injustice: Power and the Ethics of Knowing.

So how does this relate to Healthcare Stigma? Canonically, people in social minorities have been treated with stigma in their healthcare. This means that patients are judged, disbelieved, and treated unequally by healthcare professionals and the wider healthcare system. It can show up in countless ways: women are routinely undiagnosed with Endometriosis; racial stereotypes see Black and Hispanic patients labelled as “less educated”; people experiencing mental illness experience pervasive stigma from the very people who are supposed to heal them. Regardless of the type of social minority a person is in, it seems that they will experience some kind of healthcare stigma. Aren’t healthcare professionals there to treat people with kindness during their care?

This stigma doesn’t just create bad experiences, it causes significant harm. People delay care. They stop trusting providers. Their conditions worsen. All because their knowledge of their own bodies and experiences is treated as less credible than that of the healthcare professional. Aren’t healthcare professionals there to treat people with kindness during their care?

Whether they experience Testimonial or Hermeneutical Injustice during healthcare, it is a wholly inappropriate and unnecessary experience for people to suffer. By giving people the tools and language they need to communicate their experience, we can help to combat Hermeneutical Injustice. This might mean creating space for new terminology, validating stories that don’t fit in the textbook, or developing systems of care that reflect diverse ways of expressing pain, distress, or need. Testimonial Injustice is tougher to tackle because it requires the listener (the healthcare provider) to confront their own bias and choose to listen differently. It demands humility. It demands change. But it’s not impossible.

Understanding epistemic injustice doesn’t just help us describe the harm. It gives us a way to reflect on how we listen, how we care, and how we value the people at the heart of healthcare. Healthcare shouldn’t only be about treating symptoms. It should be about seeing people for who they are and recognising that patients aren't just passive recipients of care, but knowledgeable individuals who understand their own bodies, histories, and lives. That knowledge deserves to be taken seriously.

Looking at healthcare stigma through the lens of epistemic injustice helps us see that the issue isn't just clinical: it’s ethical. That’s important, because if something is socially constructed, then it can also be socially challenged and changed. Each of us has a role to play in creating that change. Whether it's through questioning our assumptions, listening more openly, or advocating for others to be heard, we can all help move healthcare closer to what it should be: compassionate, equitable, and grounded in trust.

Dignity is not an extra, it’s part of what healing requires. And everyone deserves to be recognised not only as a patient, but as someone who knows.