Shame as a Determinant of Health: A Christian Public Health Perspective

Shame is a neglected but pervasive psychosocial factor with profound implications for health across the lifespan. This review synthesizes evidence from psychology, sociology, public health, and theology to examine how shame emerges from early attachment, trauma, and adverse childhood experiences, and how it contributes to mental health challenges including depression, anxiety, addiction, eating disorders, and post-traumatic stress disorder. Biological research further demonstrates links between shame, stress physiology, neuroendocrine responses, and intergenerational epigenetic transmission. At the societal level, shame intersects with stigma, poverty, cultural norms, and systemic exclusion, disproportionately affecting marginalized populations and reinforcing health inequities. From a Christian perspective, shame distorts human dignity and relationships with others and serves as a barrier to relationship with God. The literature also points to the value of shame-informed care, which emphasizes awareness of shame’s impact, promotes compassion and connection, and builds resilience. Framing shame as a determinant of health underscores its ethical and human rights significance and calls for its recognition within health systems and policy to reduce stigma, promote dignity, and advance equity.