Abstract
Structural violence refers to the social structures that put people in harm's way. Farmer and colleagues describe the impact of social violence upon people living with HIV in the US and Rwanda.
Highlights
Because of contact with patients, physicians readily appreciate that large-scale social forces—racism, gender inequality, poverty, political violence and war, and sometimes the very policies that address them—often determine who falls ill and who has access to care
Can we speak of the “natural history” of any of these diseases without addressing social forces, including racism, pollution, poor housing, and poverty, that shape their course in both individuals and populations? Does our clinical practice acknowledge what we already know— namely, that social and environmental forces will limit the effectiveness of our treatments? Asking these questions needs to be the beginning
We describe examples of the impact of structural violence upon people living with HIV in the United States and in Rwanda
Summary
For practitioners of public health, the social determinants of disease are even harder to disregard This awareness is seldom translated into formal frameworks that link social analysis to everyday clinical practice. One reason for this gap is that the holy grail of modern medicine remains the search for the molecular basis of disease. Biosocial understandings of medical phenomena are urgently needed All those involved in public health sense this, especially when they serve populations living in poverty. Structural violence is often embedded in longstanding “ubiquitous social structures, normalized by stable institutions and regular experience” [59] Because they seem so ordinary in our ways of understanding the world, they appear almost invisible. Of a conversation within medicine and public health, rather than the end of one
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