Structural violence


 * Not to be confused with Structural abuse

Structural violence is a term commonly ascribed to Johan Galtung, which he introduced in the article "Violence, Peace, and Peace Research" in 1969. It refers to a form of violence where some social structure or social institution may harm people by preventing them from meeting their basic needs. Institutionalized elitism, ethnocentrism, classism, racism, sexism, adultism, nationalism, heterosexism and ageism are some examples of structural violence as proposed by Galtung. According to Galtung, rather than conveying a physical image, structural violence is an "avoidable impairment of fundamental human needs". As it is avoidable, structural violence is a high cause of premature death and unnecessary disability. Since structural violence affects people differently in various social structures, it is very closely linked to social injustice. Structural violence and direct violence are said to be highly interdependent, including family violence, racial violence, hate crimes, terrorism, genocide, and war.

In his book Violence: Reflections on a National Epidemic, James Gilligan defines structural violence as "the increased rates of death and disability suffered by those who occupy the bottom rungs of society, as contrasted with the relatively lower death rates experienced by those who are above them." Gilligan largely describes these "excess deaths" as "non-natural" and attributes them to the stress, shame, discrimination and denigration that results from lower status. He draws on Sennett and Cobb, who examine the "contest for dignity" in a context of dramatic inequality.

Cultural violence
'Cultural violence' refers to aspects of culture that can be used to justify or legitimize direct or structural violence, and may be exemplified by religion and ideology, language and art, empirical science and formal science.

Cultural violence makes direct and structural violence look or feel "right," or at least not wrong, according to Galtung. The study of cultural violence highlights the way in which the act of direct violence and the fact of structural violence are legitimized and thus made acceptable in society. One mechanism of cultural violence is to change the "moral color" of an act from "red/wrong" to "green/right," or at least to "yellow/acceptable."

International scope
In 1984, Petra Kelly wrote in her first book, Fighting for Hope:

The violence in structural violence is attributed to the specific organizations of society that injure or harm individuals or masses of individuals. In explaining his point of view on how structural violence affects the health of subaltern or marginalized people, medical anthropologist Paul Farmer writes:

This perspective has been continually discussed by Paul Farmer, as well as by Philippe Bourgois, and Nancy Scheper-Hughes.

Theorists argue that structural violence is embedded in the current world system. This form of violence, which is centered on apparently inequitable social arrangements, is not inevitable, they argue. Ending the global problem of structural violence will require actions that may seem unfeasible in the short term. To some this indicates that it may be easier to devote resources to minimizing the harmful impacts of structural violence. Others, such as futurist Wendell Bell, see a need for long term vision to guide projects for social justice. Many structural violences, such as racism and sexism, have become such a common occurrence in society that they appear almost invisible. Despite this fact, sexism and racism have been the focus of intense cultural and political resistance for many decades. Significant reform has been accomplished, though the project remains incomplete.

Access to health care
Structural violence has affected health care availability in the sense that physicians need to pay attention to large-scale social forces (racism, gender inequality, classism, etc...) to often determine who falls ill and who will be given access to care. It is more likely for structural violence to occur in areas where biosocial methods are neglected in a country's health care system. Since structurally violent situations are viewed primarily as biological consequences, it neglects environmentally stimulated problems, such as negative social behaviours or inequality prominence. If biosocial understandings are forsaken when considering communicable diseases such as HIV, for example, prevention methods and treatment practices become inadequate and unsustainable for populations. However, the challenge is obvious: many countries cannot afford to stop the harmful cycle of structural violence. Paul Farmer argues that the major flaw in the dominant model of medical care is that medical services are sold as a commodity, remaining only available to those who can afford them. Structural violence is used to show how medical professionals are not trained to understand the social forces behind disease, nor are they trained to deal with or alter them. Medical professionals have to ignore social determinants altering access to care and as a result, medical interventions are a lot less effective in low-income countries. Structural violence is not only an issue in developing countries, but also in North America. For example, it has had a significant impact on diagnosis and treatment of AIDS in the United States. In a study conducted in 1990 by Moore et al. it was found that blacks had a significantly lesser chance of receiving treatment than whites. Structural violence is the result of policy and social structures, and change can only be a product of altering the processes that encourage structural violence in the first place. Paul Farmer claims that "structural interventions" are one possible solution.

Countries such as Haiti and Rwanda have implemented these interventions with positive outcomes. Examples include prohibiting the commodification of the citizen needs, such as health care, ensuring equitable access to effective therapies, and the development of social safety nets. These examples increase citizen’s social and economic rights, thus decreasing structural violence. However, for these structural interventions to be successful, medical professionals need to be capable of executing such a task. Unfortunately, many of these professionals are not trained to perform structural interventions. Aside from being not trained under structural intervention, medical professionals continue to operate under conventional clinical intervention because physicians can rightly note that structural interventions are not their job. It is more towards a political and other expert to implement such structural changes. As noted, structural forces account for most if not all epidemic diseases (i.e. HIV). Medical professionals still remained to operate under the downstream phenomenon. That is, the focus is on individual lifestyle factors, but not general socio-economic, cultural, and environmental conditions. This paradigm, however, would obscure the overall structure impediment of changes because it tends to avoid the true root causes that should be focus in hand. The implication of this issue would be to incorporate medical professionals and to acknowledge that such an active structural intervention is necessary to oversee the real issue of public health.

The lessons we have learned from the successful examples of structural interventions in these countries are fundamental. Although health disparities resulted from social inequalities is possible to reduce, as long as health care exchanged as goods, those without power to purchase have less access to health care. Biosocial research should be the main focus at the moment. Sociology can better explain the origin and spread of infectious diseases such as HIV or AIDS. Research shows that the risk of HIV is highly affected by one’s own behavior and habits. ] Although some of the structural interventions can decrease premature morbidity and mortality, the social and historical determinants of the structural violence cannot be omitted. Although the interventions have enormous influence on economical and political aspects of international bodies, more interventions are needed to improve the access.

Additional Research
Peter Uvin's Aiding Violence should be studied to further develop this article.