Intended for healthcare professionals

Letters Face coverings for covid-19

Sociocultural reflections on face coverings must not ignore the negative consequences

BMJ 2020; 371 doi: (Published 01 October 2020) Cite this as: BMJ 2020;371:m3782
  1. Esmée S Hanna, reader in health and wellbeing in society1,
  2. Robert Dingwall, professor of sociology2,
  3. Margaret McCartney, general practitioner3,
  4. Robert West, emeritus professor of health psychology4,
  5. Ellen Townsend, professor5,
  6. Jackie Cassell, deputy dean6,
  7. Graham Martin, director of research7
  1. 1De Montfort University, Leicester LE1 9BH, UK
  2. 2Nottingham Trent University, Nottingham, UK
  3. 3Glasgow, UK
  4. 4University College London, London, UK
  5. 5Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
  6. 6Brighton and Sussex Medical School, Brighton, UK
  7. 7THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
  1. esmee.hanna{at}

Much comment by advocates and opponents of face coverings has focused on the quality of the evidence base and whether this justifies widespread use.1 Advocacy for face coverings has primarily drawn on research conducted in biomedical settings, and some scholars have explicitly invoked their medical credentials to justify claims to scientific authority.2 Disciplines such as the social sciences and engineering have consequently had limited input into policies on face coverings. Given the challenges that covid-19 has created for society, never has there been a greater need for meaningful interdisciplinary dialogue.

Van der Westhuizen and colleagues’ engagement with ideas beyond the biomedical is heartening,3but their social and cultural analysis is problematic. In particular, they ignore or discount important matters relating to the unintended negative consequences of face coverings. In endorsing the characterisation of those who cannot wear face coverings as “deviants,” they risk reinforcing a troubling trend towards stigmatisation of people who cannot use face coverings for a variety of legitimate reasons.4 Early findings from an ongoing study of people’s experiences of face coverings5 indicate that the prospect of stigma owing to not wearing a face covering (even with a valid exemption) limits some people from conducting essential daily activities. Encouraging a view of face covering wearers as “altruistic or even as protectors”—and those who do not wear face coverings, by implication, as selfish or self-centred—fosters a divisive and damaging binary.

Any shift from the medical to the sociocultural aspects of face coverings must engage with inequality and social exclusion.6 This also means viewing the public as stakeholders with legitimate input into these debates, not just as adopters, resisters, or deviants to be persuaded, coerced, or compelled into compliance. Consideration of the sociocultural influences on face covering uptake must not ignore the negatives, and thorough assessment of the balance between potential benefits and harms is essential.7 Without a full and reasoned assessment of face covering policy, that justification has yet to be made.


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