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Western University
Health Sciences
Health Sciences 1002A/B
Jessica Polzer

HS 1002- Social Determinants of Health Class 21– Thursday November 15, 2012 Social Suffering & Structural Violence Instructor: Professor Jessica Polzer Bachelor of Health Sciences Program Key Concepts & People • Social Suffering • Structural Violence • Partners in Health • Paul Farmer • Multiaxial Model of Suffering • Pragmatic solidarity • Preferential optionfor the poor • Moral distress 2 Paul Farmer • Physician & anthropologist • Based in Boston (Brighma & Women’s Hospital, Harvard U.) and rural Haiti • Co-founder of “Partners in Health” • Pioneered the treatment of multidrug resistant (MDR) tuberculosis and HIV in Haiti • Community-based approach to 3 Partners in Health • Mission: provide a preferential option for the poor in health care • Mission is both medical and moral • Mission is based on the idea of solidarity rather than on charity alone. – “When our patients are ill … our team … will do whatever it takes to make them well—just as we would do if a member of our own families—or we ourselves—were ill.” v4 ‘Preferential Option for the Poor’ • Term stems from Catholic liberation theology • Special concern for poor and vulnerable persons • Guiding principles: – distributive justice – pragmatic solidarity • Role of health care workers and researchers – Understanding and action v5 Role of Health Care Workers • Not just experts and healers, also advocates • Those who hold positions of power (nurses, doctors, lawyers, professors, ect.) advocate for those with less power and access Pragmatic Solidarities • Solidarity having a fellowship with people who you have common responsibilities, goals, ect. • Pragmatic solidarity in medicine means– having a fellowship with people who have a common goal • Try to understand how disease is spread in communities (seek to understand distribution of disease because it is not random) • Seek out root of cause of problems looking to history how that village was colonized • How is this medical problem manifesting in communities • How quickly it manifests, what society/community institutes are available • Actively listen to the experiences of the people –how they understand and see it Farmer’s Concerns • “By what mechanisms do social forces ranging from poverty to racism become embodied as individual experience? ( p. 262) • “view from below” • Importance of eliciting human voices and stories • Describing vs. explaining suffering– why/how it happened 8 Structural violence • A form of violence which corresponds with the systematic ways in which social structures and/or institutions kill people slowly by preventing them from meeting their basic human needs • Inevitably causes conflict and direct violence • Cause by structural social inequalities that systematically denies some people thei
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