The first and the obvious one as well, main concept of the article is structural violence. The term comprises of the structural features, which the society consists of and which the individual has no power over. Social features harm the individual, which makes it violent. The article states that the social factors determine who gets ill and who has access to treatment. The social, such as political, economical, legal, cultural and religious, structures strains an individual or a society from being the best they can be. The unfulfillment of needs brings social injustice, which can be created by uneven access to resources and education, political power etc. Structural violence can be caused by the historical “legacy”, which has created racism, environmental degradation, poor standard of living and poverty. Social and environmental factors restrict the efficiency of health care.[1]

 

Another and closely linked to structural violence, relevant concept in the Farmers article is social disease. Social disease has different interpretations, but the main idea is that the illness has been caused by social structures or social behavior. HIV/AIDS is perhaps the best known disease, which has been regarded as a social disease.[2] As HIV/AIDS spread vigorously in the North America in the 1980`s[3], it was considered a disease of the minority which was caused due to their lifestyle and behavior. Nowadays it is seen as a disease of the poor and especially a disease of the Sub-Saharan Africa. Regardless of the interpretation of HIV/AIDS as a social disease, the diagnosis, progress and treatment are all affected by social structures such as poverty, racism and gender equality.[4]

 

Contrary to my first impression, social violence as a concept is not a new invention- instead it was defined already in 1969[5]. What is relevant in the article is the observation that the health professionals are not able to act on the structural violence, which causes additional desocialization. As the medical professionals are trained only to treat the diseases, they don’t recognize the symptoms of social violence. Or even if they do, they are not trained and authorized to act on it. The article makes also a notable statement that even though the causes of ill health are often due to poverty, poverty reduction actions such as education and promotion of equality should not displace helping the already sick. Social safety nets, such as education, water and food, should be seen as basic individual rights instead of as commodities of the affluent.[6] As Amartya Sen has noted, individual freedom and capabilities to influence your life matters. Political and social freedom promotes economical status, and vice versa. “Freedoms of different kinds can strengthen one another”. [7]

 

Purely changes in the health care system don’t help the poor. Targeted improvements, which take into account local conditions instead of treating the poor as one homogenous group, need to be made, in order to develop access to health care and lower the bar to seek treatment by e.g. improving attitudes towards the poor.[8] By participating the poor, valuable information concerning the local conditions are gathered but also they are given a voice, possibility to influence their lives and they are respected.

By better health, social capital is built, productivity is increased and therefore economical improvements made. Hereby promoting health should be included in the core of decision-making and politics, and seen as a cross-sectoral issue of e.g. education, labor and environment. [9]

 

While considering structural violence and its affects on the individual or society, one (though I’m sure there are many) challenge comes to mind. How do we, the western world, make sure that we define and act on structural violence without practicing a form of neo-colonialism? Social exclusion is a term, which is referred to marginalized people who are e.g. unemployed, landless or part of ethnic minority, and therefore victims of deprivation. Sen states that’s social exclusion can lead to e.g. lack of self-reliance and deteriorated physical health.[10] But who defines which people are socially excluded or victims of structural violence for that matter? In the research by UNDP, none of the Indian or Peruvian groups saw themselves as socially excluded.[11] What if a person doesn’t consider his/herself as a victim? Do we force him/her to treatment by structural intervention in the name of global health? Or where do we draw the line of practicing natural healing or seeing rather traditional healers as a form of indigenous culture, which should not be westernized?