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December 5: Health Inqualities Part 2, Structural Violence

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ANTH 3330
Christianne Stephens

HEALTH INEQUALITIES PART 2: STRUCTURALVIOLENCE The concept of structural violence • Johan Galtung developed a typology that distinguishes the various forms of violence (physical/psychological; direct/indirect; intended/unintended) ◦ break down what violence • he first coined the term 'structural violence' to describe "forms of violence created by inequalities where some social structure or social institution may harm people by preventing them from meeting their basic needs ◦ innovative way of looking at violence ◦ we think face to face, armed, domestic violence, psychological abuse, but never thinking institutions that have some form of agency that can effect individuals ◦ basic needs: everything from affecting one's access to education, financial resources, healthcare, etc ◦ there are things in society that affect people's well-being, and these forces are invisible • Structural violence: social structures – economic, political, legal, religious, and cultural – that hinder individuals, groups, and societies from reaching their full potential • An "avoidable impairment of fundamental human needs" ◦ power, institutions of power, who makes decisions and who doesn't, bureaucratic instruments that shape society ◦ politicize one's experience in the world by evaluating the structures that affect them • Unlike physical violence, structural violence is difficult to see/discern • Structural violence and direct violence are highly interdependent (e.g. family violence, racial violence, genocide) ◦ physical manifestations of physical violence that are rooted in structural violence ◦ Galtung gave us this term, seemed to be picked up here and there, but it wasn't until the work of Paul Farmer that it became operationalized and used in an applied anthropological context • In the context of health, structural violence refers to the differential distribution of health risks and diseases within different populations (i.e. visible minorities, the poor, the marginalized and the disenfranchised) Structural Violence and Health • in the field of health, addressing the issue of structural violence involves advocacy about the importance of addressing teh social determinants of people's health • Western medicine is dominated by a focus on individual level risk factors for disease (e.g. the effects of health of genetic make-up or personal behaviours such as smoking, drinking, or sexual activity) ◦ bio-reductionist, giving little regard to the social determinants of health • Patterns of health around the world are shaped by social, political, and economic conditions ◦ analytic review of Righteous Dopefiend, suffering from specific health conditions • Poverty, gender inequality, and marginalization on account of "racial discrimination" (all forms of structural violence) – determine wellbeing and access to health-sustaining services ◦ still see many of these in the developed world ◦ persecution of those who are not heterosexual (HIV/AIDS epidemic) ◦ we can't look at the final outcomes of disease; have to look upstream • as a result, there is increasing focus on these 'upstream' causes of disease. You'll recall the following diagrams from our previous class on this topic: ◦ looking "upstream" ◦ social determinants of health ◦ dynamic interplay that goes on between all those components ◦ syndemics: sy
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