Form Of Structural Violence Research Articles

Assessing the Universality of Universal Health Coverage: Israel and the Occupation of Palestine

Abstract Universal health coverage (UHC) is founded on a commitment to health coverage for all. Israel claims to have achieved UHC, while public health services in the Occupied Palestinian Territories (OPT) are left primarily to the Palestinian Authority (PA). In this article, we assess Israel’s responsibility for health in the OPT by examining Israel’s sovereignty over the OPT. We argue that Israel legally and practically remains the sole sovereign entity in the OPT, and then assess the health disparities faced by Palestinians. We conducted a side-by-side comparison of indicators and inputs of the Israeli and PA health systems, including health expenditure and the density of healthcare professionals and facilities, using data from the World Bank, Physicians for Human Rights, the World Health Organization, and the Palestinian Central Bureau of Statistics. On all selected measures, Israel reports better outcomes. Nearly 20% more of the Israeli population has essential service coverage; fewer Israeli citizens report catastrophic health expenditure. Israel reports more than double the proportion of beds and physicians and more than 10 times the health expenditure per capita. Life expectancy is eight years greater for Israelis. We conclude that these disparities amount to systemic exclusion of Palestinians from health services by Israel, undermining Israel’s claim to have achieved UHC. This has important implications for Palestinians, as it reveals Israel’s systematic neglect of the health of Palestinians as a form of structural violence, on top of which it inflicts frequent escalations of violence against Palestinians. It also highlights the importance of looking beyond aggregated indicators to expose the exclusion of marginalized communities.

Women die here too: maternal mortality as gender‐based violence in Texas

AbstractMortality rates among Latin American women reflect the disproportionate exposure to gender‐based violence in the global south. The United States has been critical of national governments in Latin America for their response to prevent and address feminicidios, or gender‐based violence. Yet, data show that women in the United States also die at alarming rates. The United States is facing a maternal mortality problem. Evidence suggests that the maternal mortality rate in the United States is higher relative to other high‐income countries and in Texas the rate is higher than the national average. This paper has three aims. First, I contextualize my discussion of maternal mortality as structural violence within the broader discussions of feminicidios. Second, I outline how state policies in Texas that regulate access to Medicaid and target reproductive rights are a form of structural violence against women because they negatively impact maternal mortality. Finally, I conclude by noting how data visualization that more directly connects the relationship between policies and maternal mortality can expand our understanding of the different ways in which women are systematically harmed.

Gender violence, emotion, and the state symposium commentary

AbstractFeminist anthropologists have long emphasized the cultural, social, economic, and political contexts of gender violence rather than only focusing on interpersonal relationships between intimate partners or within the family. This commentary situates the five articles in the Gender Violence, Emotion, and the State Symposium within that context while noting their “evocative ethnographic” approach as a vital contribution to feminist anthropological thought, paying particular attention to power and its exercise within institutions and various forms of structural violence.

Marital Rape as Structual Violence in the Legal System

Intimate Partner Violence (IPV) stands as a significant concern for mental health professionals and advocates for women's rights. In this realm, marital rape is identified as the unwelcome sexual acts a husband imposes on his wife, frequently accompanied by physical violence and threats, instilling fear and injury in women. Despite the profound trauma it causes, marital rape is not universally illegal or considered a severe crime in some areas. The lack of attention to marital rape by society and the legal frameworks, especially in the context of increasing awareness of women's health, warrants a closer look. This study seeks to explore the influence of societal views on marital rape on the seeming leniency of the legal system and proposes possible remedies. It is clear that in societies with deep-rooted patriarchal values, where a husband's authority is prioritized, marital rape is normalized as a form of structural violence, thereby undermining the legal system's response. Addressing this issue requires strict legal reforms, including joining international frameworks and comprehensive public education to raise awareness.

Who Lies Beneath? Reflections on Scotland’s Unseen Change Makers

Who Lies Beneath? Reflections on Scotland’s Unseen Change Makers

The Clinical Evolutions of Surveillance and Violence During Three Contemporary US Crises: Opioid Overdose, COVID-19, and Racial Reckoning

In 2020, three crises coalesced to transform the clinical care landscape of addiction medicine in the United States (US). The opioid overdose crisis (crisis #1), which had been contributing to excess US mortality for over two decades, worsened during the COVID-19 pandemic (crisis #2). The racial reckoning (crisis #3) spurred by the murder of George Floyd at the hands of police impacted clinical care, especially in safety net clinical settings where the majority of people targeted by police violence, and other forms of structural violence, receive healthcare to mend both physical and psychological wounds. Collectively, the three crises changed how providers and patients viewed their experiences of clinical surveillance and altered their relationships to the violence of US healthcare. Drawing from two different research studies conducted during the years preceding and during the COVID-19 pandemic (2017–2022) with low income, safety net patients at risk for opioid overdose and their care providers, I analyze the relationship between surveillance and violence in light of changes wrought by these three intersecting health and social crises. I suggest that shifting perceptions about surveillance and violence contributed to clinical care innovations that offer greater patient autonomy and transform critical components of addiction medicine care practice.

How laws are interpreted can make a positive difference in de-normalizing violence: Revisiting the Hart-Dworkin debate

There are several long standing and interesting efforts to work for democratization in Latin America, including in public services sectors such as education. This includes notably efforts in which successful developments have drawn on the use of principles that align with post-structuralist discourses and interpretivist traditions in legal adjudication. The analysis presented in this article elaborates on the Hart-Dworkin debate in US legal philosophy and implications of positivist versus interpretivist approaches to legal decisions and education policy for professionals such as teachers in Latin America. The research question pertains to how two distinct approaches of legal interpretation impact the reproduction of cultural and structural forms of violence in societies. As a concrete example of this is discussed the impact that positivist and interpretivist legal traditions have by framing possibilities and limitations in the work of professional practitioners such as teachers. The analysis is contextualized using self-reported descriptive education data from Latin America and the Caribbean. Recent examples of empirical case studies relevant for education governance in Brazil and Chile are also noted. The analysis presented raises a few points about how effective organizations and professionals are constructed as an outcome of how laws are interpreted. This is explained as a contributing factor to normalizing practices in which the broader citizenry is excluded from deliberative practices. Such forms of exclusion have in the context of education been critically defined by scholars as a form of cultural violence. The article concludes by highlighting the role that interpretivist, negotiated and participatory approaches can play in enabling professionals involved in the everyday of citizens in local communities. An example of this is how teachers can work for de-normalizing socio-political forms of violence. Specifically, this article considers the normalization of structural violence that manifests itself in how we conceptualize what is an effective organization and what is the legitimate role of public service representatives such as teachers in de-normalizing structural violence.

“A program works better when the people using it help build it:” Co-Designing for Organizational Change with a Trauma-Informed Advisory Committee of Service Users 

Introduction: In Canada, as in many parts of the world, people with disabilities experience structural violence; they are more likely to face social exclusion and stigma and to live in poverty than their peers without disabilities. March of Dimes Canada (MODC) is transforming its programming by centering service users’ voices in decision-making, including program design, moving forward through an organizational initiative to emerge from this study. This paper focuses on a participatory action research project nested within a larger study Empowering Client Voices. The first half outlines what trauma-informed means in the context of a large cross-disability national advisory committee. How do we build awareness and sensitivity with senior-level management and staff about ableism and systemic barriers people with disabilities and frontline workers face daily? The second half focuses on operationalizing trauma-informed practices by working alongside March of Dimes Canada’s clients to co-design community engagement principles. 
 Method: As part of a larger participatory action research project, we have assembled an advisory committee to co-design community engagement principles to inform MODC’s transformation. We conduct monthly co-design workshops and focus groups. A researcher and facilitator with lived experience of caregiving/advocacy guides the discussion alongside service users taking leadership roles. All participants receive an honorarium in recognition of their efforts. 
 Results: As the project progresses (data collection begins in January 2023), we will have preliminary findings relevant to researchers and practitioners engaging through co-design in academic and community fora. We have already learned that being trauma-informed in our transformational initiative with a cross-disability community means 1) co-designing with service users as partners, 2) co-creating fully accessible spaces, and 3) understanding the impacts of navigating the daily trauma of structural violence brought about by ableism and lack of access to essential supports. Beginning in January, we will be unpacking the role of language by attending to questions such as: what language do we use when approaching our service users’ complex and intersecting identities? What language do we use when approaching diagnosis, service user feedback, goal setting, and well-being in client-facing materials and staff training? 
 Discussion and Conclusion: In running the advisory committee, at the heart of the study, we are developing and operationalizing a set of best practices to guide organizational trauma-informed practices in the context of community engagement. These best practices include 1) Community-based (co-designed) research, 2) strengths-based approaches, and 3) trauma-informed practices. MODC is intentionally shaping the advisory committees through well-established best practices of trauma-informed care in an organizational (rather than clinical) setting. These best practices along with the co-designed community engagement principles will anchor our organizational transformation in suggestions from MODC’s service users.
 Lessons and Future Research: In assembling our advisory committee, we are learning that (for MODC’s service users) accessibility, and universal design for access, are the foundations of trauma-informed care in the context of a cross-disability advisory committee. Future research should build on this finding by examining the implications of dis/ability, and (normalized) forms of structural violence, such as poverty and ableism, within the context of co-design with service users.

The gendered violence of injecting-related stigma among relatively affluent, suburban women who inject drugs.

In honouring the legacy of Jude Byrne's life-long advocacy for women and mothers who use drugs, this paper presents a case study of a group of women about whom we know little about and hear even less from: women who inject drugs in relatively affluent suburbs. Based on a 2020 qualitative study of people who inject drugs in an affluent area of Sydney known as 'The Beaches', we use in-depth interview data to thematically explore the lived experiences of gendered stigma among women who inject drugs. Even when women occupy the 'ideal' social position in terms of class (middle-class) and race (White) they remain subject to harmful forms of gendered stigma related to injecting drug use. Participants had internalised negative attitudes around injection drug use as a form of failed femininity and, despite being part of 'good' families and neighbourhoods, participants experienced forced child removal. Taking the lead from feminist intersectionality scholarship, our data illustrate how stigma and discrimination act as a form of structural violence against women who inject drugs in affluent communities. While the social relations of gender provide some degree of protection by 'performing proximity to Whiteness', gendered stigma and violence persist.

Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report.

People who inject drugs are experiencing syndemic conditions with increasing risk of infection with hepatitis C (HCV) and HIV. However, rates of accessing HCV and HIV testing and treatment among people who inject drugs are low for various reasons, including the criminalization of drug use, which leads to a focus on treating drug use rather than caring for drug users. For many people who inject drugs, health care becomes a form of structural violence, resulting in traumatic experiences, fear of police violence, unmet needs, and avoidance of medical care. There is a clear need for novel approaches to health care delivery for people who inject drugs. This study aimed to analyze the process of a multidisciplinary team-encompassing health care professionals, community representatives, researchers, and people with lived experience using drugs-that was formed to develop a deep understanding of the experiences of people who inject drugs and local ecosystem opportunities and constraints to inform the cocreation of low-barrier, innovative HCV or HIV care in a rural community. Given the need for innovative approaches to redesigning health care, we sought to identify challenges and tensions encountered in this process and strategies for overcoming these challenges. Analysis was based on an in-depth review of meeting notes from the project year, followed by member-checking with the project team to revise and expand upon the challenges encountered and strategies identified to navigate these challenges. Challenges and tensions included: scoping the project, setting the pace and urgency of the work, adapting to web-based work, navigating ethics and practice of payment, defining success, and situating the project for sustainability. Strategies to navigate these challenges included: dedicated effort to building personal and meaningful connections, fostering mutual respect, identifying common ground to make shared decisions, and redefining successes. While cocreated care presents challenges, the resulting program is strengthened by challenging assumptions and carefully considering various perspectives to think creatively and productively about solutions.

'Our hands are bound': Pathways to community health labour in Kenya

An ideal model of Community Health Worker (CHW) selection has existed since long before Alma Ata catalysed the community health approach, dating to late colonial times. In this model, a willing, trusted, relatively well-educated and secure member of the community with proven aptitude is openly elected by their leadership, peers or relevant committee. Their participation is entirely voluntary and that voluntarism is symbolic of their community's participation as a whole. While this imagery is long-embedded in CHW storytelling, such practice is rare. While elements of this ‘model pathway’ exist, a myriad of structural and agential factors shape who becomes a CHW, how and why. Through life history interviews over twelve months 2022–2023 with 68 CHWs in Isiolo, northern Kenya (known as CHVs), we explore predominant pathways to community health labour as told through stories. We articulate five such pathways: model, handpicked, shadow, outsider and, most importantly, dispossession. Through telling five CHVs' stories, we present each ‘ideal type’ but also explore how each pathway is not singular, rather overlapping in complex, context-specific ways. These pathways confound Western-centric, Western-promoted notions of voluntarism and indeed community health, which cannot explain why such labour endures. We conclude that our findings provide a timely commentary on how voluntary labour within health continues to tax structural poverty and frustrated life chances in lieu of concrete and expansive investments in human resources for health by governments and health agencies both North and South. In understanding voluntary labour as a form of structural violence, we can better elucidate the historical dependency on this work in impoverished regions and how the undervaluing of such work persists over time.

Structural violence and the subversion of participatory planning—the struggle for the Warwick Market in Durban, South Africa

Deprivation, poverty, inequality, forced displacement, psychological harm, lack of public participation in planning and benign neglect are examples of structural violence in cities. In the case of benign neglect, public facilities are deliberately neglected in terms of maintenance and provision of basic facilities—a form of ‘slow violence’. Drawing from qualitative data sources that included participant observation, consultations with legal advisors and court hearings, this paper analyses the different forms of structural violence that were used in early 2009 in the city of Durban to try to replace the century old Early Morning Warwick Market which catered for the poor working class, with a mall. The Municipality’s participatory and consultative approach to upgrade the Warwick Avenue Triangle in the first democratic decade (1994–2004) is contrasted with the subversion of participatory planning in the second democratic decade (2004–2014), as Durban prepared for FIFA 2010. The mall development would have resulted in the loss of an important part of Durban’s history, heritage and culture. A key contention of this paper is that the fatally flawed neoliberal planning fiasco in Warwick Avenue was driven by a top-down process which favoured private corporate interests. The mall project was presented as a public–private partnership. However, in such partnerships local democracy is compromised as the fiscal prospects of local governments become dependent on the business decisions of the private sector. There were serious contradictions evident in the juxtaposition of large-scale public-private partnerships such as the mall, and the threats to displace low-income traders, a process which David Harvey called ‘accumulation by dispossession’. The historical and political processes of accumulated and incremental neglect and stigma which encapsulate ‘slow violence’ contributed to the decay and decline of the Early Morning Market. Attempts to displace traders and replace the market with a mall was basically a political decision, aided and abetted by some senior members in the ruling ANC government hierarchy—a shameful period in Durban’s democratic history. The threats to displace the traders in the Early Morning Market was a form of structural violence, which was reminiscent of the apartheid era. The structural violence of apartheid-capitalism continues at the level of outcomes (non-participation and displacement) even under a changed political structure (democracy), as the ANC government pursues a neoliberal agenda.

Early warnings and slow deaths: A sociology of outbreak and overdose.

In this paper, we offer a sociological analysis of early warning and outbreak in the field of drug policy, focusing on opioid overdose. We trace how 'outbreak' is enacted as a rupturing event which enables rapid reflex responses of precautionary control, based largely on short-term and proximal early warning indicators. We make the case for an alternative view of early warning and outbreak. We argue that practices of detection and projection that help to materialise drug-related outbreaks are too focused on the proximal and short-term. Engaging with epidemiological and sociological work investigating epidemics of opioid overdose, we show how the short-termism and rapid reflex response of outbreak fails to appreciate the slow violent pasts of epidemics indicative of an ongoing need and care for structural and societal change. Accordingly, we gather together ideas of 'slow emergency' (Ben Anderson), 'slow death' (Lauren Berlant) and 'slow violence' (Rob Nixon), to re-assemble outbreaks in 'long view'. This locates opioid overdose in long-term attritional processes of deindustrialisation, pharmaceuticalisation, and other forms of structural violence, including the criminalisation and problematisation of people who use drugs. Outbreaks evolve in relation to their slow violent pasts. To ignore this can perpetuate harm. Attending to the social conditions that create the possibilities for outbreak invites early warning that goes 'beyond outbreak' and 'beyond epidemic' as generally configured.

The World as Existential Security: The Concept of Peace of Third Generation

The relevance of the topic is due to the fact that traditional social disciplines have not been able to solve the most important problems of humanity – the elimination of destructive forms of social interactions. The article deals with the problem of conceptualization of the concept of “peace”, the stages of formation of the disciplinary field of peace research. The hypothesis of the study is that understanding the initial intention that prompts the formation of new value orientations in human populations makes it possible to base the modern theory of the world on the concept of existential security. The purpose of the article is to analyze approaches to one of the basic concepts of social and humanitarian disciplines ‒ the category of peace. The use of methods of categorization, retrospective analysis and systematization allowed us to discover the paradigmatic dependence of the content of the concept peace on objective technological and socio-cultural circumstances. The results of the discussion were the following provisions. The first concept of peace, called the negative peace, could not be used as the basis for social construction programs, since it carried all the limitations of the classical paradigm of science, which was formed to serve natural science. The modern, third generation of the concept of peace, which has received the complex name of a multi-inter-transcultural world, is generated by the dangers associated with globalization and entry into digital civilization. Understanding the initial intention that encourages the formation of new value orientations in human populations allows us to base the modern theory of the world on the concept of existential security. The concept of existential security is formulated, which should be understood not as the physical security of an individual, but as the security of the existence of a population that allows preserving the population gene pool. A society that has provided existential security corresponds to people’s ideas of peaceful existence and does not create conditions for war, as one of the forms of violence, or for other forms of structural violence that reduce the adaptive potential of the population. Due to the fact that the adaptability and security of the digital society is ensured by the integrative and communitarian properties of the social system, post-material values are put forward in the first place in the value system in the modern world. They should be the basis of the concept of the existential world.

University Student Food Insecurity as a Form of Structural Violence

Studies of college student food insecurity emphasize the personal characteristics of students and their individual health outcomes, reflecting trends in public health to encourage individual lifestyle changes. More recent work in public health diverges from this focus to encourage conceptualizing health issues not as individual failings but rather as failures of larger systems that are necessary to support health and well-being, implicating the availability of grocery stores, adequate wages, and other contextual barriers to healthy eating. We argue that college student food insecurity should not be conceptualized in terms of the factors affecting individual students but in terms of how the institutional context of the university both creates the conditions under which some students are more likely to be food insecure and also neglects to address these structural failures. Using the framework of structural violence to examine specific ways that these failures occur and are made invisible in the case of college student hunger, we examine recent changes in universities. Unfortunately, these efforts support the focus on individual efforts and success, which contribute to higher rates of food insecurity for students than the general population.

Locating agency at the urban grassroots: Resistance and reworking in the everyday politics of informal settlements

Agency of the urban poor living in informal settlements in Southern cities can manifest in numerous ways in their encounters and negotiations with the formal state and various other actors located in the hierarchy of power relations. A certain form of agency rooted in oppositional consciousness can emerge from their everyday experiences of various forms of structural violence and oppression. Drawing on ethnographic case studies carried out in two informal settlements in Dhaka city, this article examines a range of oppositional acts carried out by the settlements’ residents against various formal and informal actors to understand how grassroots agency is manifested and negotiated in such acts. It utilises Katz’s conceptualisation of resistance and reworking as expressions of agency in interrogating the strategies and practices informal settlement residents use in order to negotiate with and reformulate the conditions and possibilities of their everyday lives. Findings elucidate their capacities and modalities of collective resistance against acts of repression carried out by formal and informal actors as well as against the dominant, vilifying discourses of informal settlements. It further illustrates how they can rework the law to negotiate and claim space within structures of domination. The article concludes by arguing that these acts of resistance and reworking are not just a coping response to constant repression and domination, but a means of claiming a more secure citizenship in the city.

Travel for later abortion in the USA: lived experiences, structural contributors and abortion fund support

As abortion restrictions expand in the USA, pregnant people will continue to experience delays and be forced to travel for abortion. The study aims to describe later abortion travel experiences, understand structural factors influencing travel, and identify strategies to improve travel. This qualitative phenomenological study analyses data from 19 interviews with people who travelled at least 25 miles for abortion after the first trimester. Framework analysis used a structural violence lens. More than two-thirds of participants travelled interstate, and half received abortion fund support. Key considerations of travel include logistics, challenges during the journey, and physical and emotional recovery during and after travel. Restrictive laws, financial insecurity and anti-abortion infrastructure are forms of structural violence that created challenges and delays. Reliance on abortion funds facilitated access but also entailed uncertainty. Better resourced abortion funds could organise travel in advance, facilitate the travel of accompanying escorts, and tailor emotional support to reduce stress for those travelling. Clinical and practical support systems must be prepared to support people travelling for abortion, as later abortion and forced travel is increasing since the constitutional right to abortion in the USA was overturned. Findings can inform interventions to support the increasing number of people travelling for abortion.

Danger Zone or Newfound Freedoms: Exploring Women and Girls' Experiences in the Virtual Space during COVID-19 in Iraq.

During the COVID-19 pandemic, women and girls across the globe faced increased reliance on the digital space to access education, social support, and health and gender-based violence (GBV) services. While research from the last three years has explored how women and girls navigated and responded to their new virtual reality, minimal evidence has been generated from low-resource settings where access to technology may be limited. Further, no studies to date have examined these dynamics in Iraq, where women and girls already face numerous threats to safety due to various forms of structural violence and patriarchal family structures. This qualitative study aimed to examine women and girls' experiences in the digital space during COVID-19 in Iraq, including the benefits and risks of engagement as well as how access to the digital space was controlled. Data for the present analysis come from the authors' larger multi-country study investigating women and girls' safety and access to GBV services in the context of the COVID-19 pandemic and related public health measures employed to control the spread of the virus. In Iraq, semi-structured key informant interviews were conducted virtually with fifteen GBV service providers. Following the translation and transcription of interviews, the thematic analysis highlighted several benefits and challenges women and girls experienced as they tried to access and utilize technology for schooling, support services, and obtaining and spreading information. While many women and girls increasingly and successfully relied on social media to spread awareness of GBV cases, key informants noted that women and girls also faced increased risks of experiencing electronic blackmail. In addition to a substantial digital divide in this context-which manifested as differential access to technology by gender, rural/urban status, and socioeconomic status-intrahousehold control of girls' access to and use of technology left many adolescent girls unable to continue schooling and contributed to their further marginalization and consequent decline in well-being. Implications for women's safety and mitigation strategies are also discussed.

Debating structural violence in European heritage diplomacy

ABSTRACT The article focuses on difficult heritage associated with three forms of structural violence in European history – the Communist and Nazi regimes and the former European colonies. We scrutinize how these three sources of difficult heritage are used in heritage diplomacy in the EU’s flagship heritage action, the European Heritage Label (EHL). On the one hand we analyse ‘diplomacy’ as principles and practices aimed at creating and maintaining peaceful and working relationships between actors both within and beyond the EU. On the other hand, we build on the related adjective ‘diplomatic’ as a tactful, delicate, and sensitive way of maintaining human relations. Our empirical data consists of interviews conducted at three EHL sites (Historic Gdańsk Shipyard (Poland), Camp Westerbork (the Netherlands) and Sagres Promontory (Portugal). We argue that unlike in the heritage of Communist and Nazi regimes, the potential for societal heritage diplomacy remains largely unrealized for colonial regimes.

Economic threat, new nationalism and xenophobia in South Africa: Some reflections

ABSTRACT The perceived economic threat has given rise to narrow nationalism in South Africa, which has given birth to direct, cultural and structural forms of violence, commonly referred to as xenophobia, which is actually Afrophobia. The main argument is that in as much as there is evidence of the influx of mainly African migrants in South Africa, and these have been largely accused of various crimes and contributing to rising unemployment, this perception trivialises the need for a multipronged and people-centred approach to South Africa’s and Africa’s underlying domestic challenges. Xenophobia should not be seen as only a South African but also an Africa problem, which consequently requires a national and continental response strategy. This then implies that South Africa has a role in stemming the challenges that have given impetus to a new form of narrow nationalism. On the other hand, the article attempts to explain what a continental response strategy might entail. In fact, the narratives of African migrants as pervasive criminals and job snatchers conveniently relieves the post-apartheid government which is expected to enhance service delivery and create opportunities for the locals, as well as giving dignity to the immigrants.