Structural violence in Haiti: Difference between revisions

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===Access to healthcare===
===Access to healthcare===
Being serviced by a mixture of the public sector, the private sector and the non-profit sector, and religious institutions, the health system in Haiti faces the challenge of establishing efficient health coordination.<ref name=earthquakehaiti>{{Cite report |author=World Health Organization |date=January 2010 |title=Public health risk assessment and interventions. Earthquake: Haiti |url=http://www.who.int/diseasecontrol_emergencies/publications/haiti_earthquake_20100118.pdf |publisher=World Health Organization |accessdate=16 March 2014 }}</ref> This is further compounded by the presence of more than 250 additionally implementing partners within the health sector.<ref name=earthquakehaiti /> Coupled with a continuing series of political upheavals that led to a unending social instability, Haiti's inefficient healthcare framework has crippled the nation's ability to provide good healthcare access to its people.<ref name=worldbank1993>{{Cite report |author=World Bank |date=1993 |title=World Development Report 1993. International Bank for Reconstruction and Development |publisher=The World Bank, Washington, DC |accessdate=16 March 2014 }}</ref> Presently, the ability of the Haitian government to provide and maintain health services has remained limited, where about 55% of health care is being provided by missionary or other non-governmental organizations.<ref name=harvard>{{Cite report |author=Harvard Center for Population and Development Studies |date=1993 |title=Sanctions in Haiti: Crisis in Humanitarian Action. Harvard School of Public Health, Program on Human Security Working Paper Series, Cambridge, MA |publisher=Harvard Center for Population and Development Studies |accessdate=16 March 2014 }}</ref> While there are a small number of physicians who operate for-profit clinics, most are found in the larger cities. Additionally, medical services, whether public or private are disproportionately located in the metropolitan Port-au-Prince area.<ref name=threedelays>{{cite journal|last=Barnes-Josiah|first=Debora|coauthors=Myntti, Cynthia; Augustin, Antoine|title=The “three delays” as a framework for examining maternal mortality in Haiti|journal=Social Science & Medicine|date=April 1998|volume=46|issue=8|pages=981–993|doi=10.1016/S0277-9536(97)10018-1}}</ref> Obstetric facilities also follow a similar trend as hospitals outside the Port-au-Prince area typically only provide limited obstetric services. In rural areas, many prenatal care services are delivered either by outreach teams or from small clinics that do not have formal maternity wards or delivery capabilities.<ref name=threedelays /> This physical separation of adequate medical facilitates from many parts of rural Haiti makes access to healthcare by those living away from the city very difficult. Although most medical infrastructure are concentrated within Port-au-Prince, hospitals and clinical facilities are often in very dilapidated states, where they are often compromised by infrastructural deficiencies and electrical blackouts. This lack of medical infrastructure was further exacerbated by the 2010 Haiti Earthquake.<ref name=earthquakehaiti /> In 2007, 47% of the population lack access to basic health care, with majority of the population still turning to traditional healers for various forms of treatment <ref name=earthquakehaiti /><ref name=folkhealinghaiti>{{cite journal|last=Coreil|first=Jeannine|title=Parallel structures in professional and folk health care: A model applied to rural Hati|journal=Culture, Medicine and Psychiatry|date=June 1983|volume=7|issue=2|pages=131–151|doi=10.1007/BF00051846}}</ref> A study on Haiti's prosthetic situation also revealed that only 25% of all amputees are able to obtain a prosthetic limb.<ref name=prostheticlimb>{{cite journal|last=Bigelow|first=J|coauthors=Korth, M; Jacobs, J; Anger, N; Riddle, M; Gifford, J|title=A picture of amputees and the prosthetic situation in Haiti.|journal=Disability and rehabilitation|date=2004 Feb 18|volume=26|issue=4|pages=246-52|pmid=15164958}}</ref>

Access to healthcare also includes perceptual issues like perceived quality of care.<ref name=armstrong>{{Cite report |author= World Health Organization |coauthors= Erica Royston & Sue Armstrong |date=1989 |title=Preventing maternal deaths |url=http://apps.who.int/iris/bitstream/10665/39933/1/9241561289_eng.pdf?ua=1 |publisher=Geneva : World Health Organization |accessdate=16 March 2014}}</ref> While well known national maternity hospitals located in Port-au-Prince are over-utilized, rural maternity beds outside of Port-au-Prince, even where they exist, are poorly utilized, with utilization rates of about 30 and 35%.<ref name=SantéPublique>{{Cite report |author= Ministère de la SantéPublique et de la Population |date=1985 |title=Recherche Operationelle sur les Etablissements de Santéavec Lits |publisher=Ministère de la SantéPublique et de la Population. Port-au-Prince, Haiti |accessdate=16 March 2014}}</ref> However, evidence suggests that pregnant women want competent care, and that this under-utilization of existing services is directly tied to the perceived and actual quality of the facilities.<ref>{{cite book|title=Childbearing, Sickness and Healing in a Haitian Village|author=Gerald F Murray & Maria D Alvarez|coauthors=Haiti. Département de la santé publiqaue et de la population.}}</ref><ref>{{cite book|last=Koblinsky|first=edited by Marje|title=The health of women : a global perspective|date=1993|publisher=Westview Press|location=Boulder, San Francisco|isbn=978-0813316086|edition=[Pbk. ed.].|coauthors=Timyan, Judith; Gay, Jill}}</ref> A widespread tendency to avoid government-run public facilities is frequently credited to these institutions’ low quality of care, such as a lack of equipment and services, and unfriendly attitude of the medical staff.<ref>{{cite journal|last=Sundari|first=T. K.|title=The Untold Story: How the Health Care Systems in Developing Countries Contribute to Maternal Mortality|journal=International Journal of Health Services|date=1 January 1992|volume=22|issue=3|pages=513–528|doi=10.2190/91YH-A52T-AFBB-1LEA}}</ref><ref>{{cite journal|last=Thaddeus|first=S|coauthors=Maine, D|title=Too far to walk: maternal mortality in context.|journal=Social science & medicine (1982)|date=1994 Apr|volume=38|issue=8|pages=1091-110|pmid=8042057}}</ref>.


===Health Outcomes===
===Health Outcomes===

Revision as of 23:43, 16 March 2014

Haitians walk by damaged buildings in downtown Port-Au-Prince, Haiti, after the 2010 Earthquake.

Definition of Structural Violence

As defined by Medical Anthropologist Dr. Paul Farmer, structural violence is way by which social arrangements are constructed to put specific members of a population in harms way.[1] According to Dr. Farmer, social inequalities are at the heart of structural violence, where the prevailing societal framework imposes invisible barriers that perpetuates the suffering of certain groups of people.[2] The term structural violence was first coined by Johan Galtung, the founder of the peace and conflict studies, in 1969. The term further gained exposure when it was used by Latin American liberation theologians.[2] These social arrangements are term structural as they are embedded into the cultural, political and economic realms of society. The term violence highlights the fact that these structures cause injury or inequality to certain groups of peoples and constrain individual agency in the society in which they operate.[1] While structural violence exist in many parts of the world, its effects is heavily felt within Haiti.[3]

Compounding Factors

While the negative effects of Structural Violence effects almost everyone in the nation of Haiti, there are a number of social factors that render certain demographics of the population to experience a more severe form of human suffering.[3] These included gender, ethnicity and socioeconomic status.

Gender

Haitian girls

While structural violence impacts Haiti as a whole, due to the presence of gender inequality, women within Haiti tend to be more heavily impacted by structural violence than men.[3] In the 2004 United Nations Development Fund for Women report, Haitian women were found to remain as the target of oppression, independent of any political change within the nation. Among the 43% of households which are headed by women, more than 80% are reported to be living in poverty.[4] Moreover, according to the 2000 UN Special Rapporteur on Violence against Women, a report on Haiti noted that structural gender disparities has made Haitian women not only disproportionately susceptible to physical violence, but also excluded from many forms of protection.[5] For example, spousal rape is not regarded as a crime under Haiti's judicial system.[6] Other forms of legal discrimination against women and girls include differentiated wage levels, as well as unequal penalties for both adultery and divorce.[4]

Race / Ethnicity

Racial or ethnic differentiation has been well acknowledged as a means of depriving certain racial or ethnic groups of basic human rights, or from receiving the same quality of resources as others.[3][7][8][9][10] In Haiti’s context, such social discrimination exists predominantly from two areas: Antihaitianismo, which is the racial bias against Haitians and descendants of Haitians by Dominicans, and remnants of the Haitian colonial hierarchy via caste discrimination.[11] While Haitian mulattoes only make up 5% of the Haitian population, they are regarded as the upper class and control approximately 44% of the national income.[12]

Socioeconomic Status

Coming from a lower socioeconomic background can also render individuals and groups to be more vulnerable to extreme human suffering.[7] This is because economic and political structural barriers tend to have a greater impact on those who are lower down on the social ordering or are stricken by poverty.[1][3] This stems from the fact that those who are of lower classes often have limited access to resources or do not shared quality of resources that those of higher socio-economic classes have access to.[3][13] UNICEF statistics shows that while less than 10% of births among poorest 20% in Haiti has a skilled attendant present, 78.1% of all births had a skilled attendant present for the richest 20%.[14] Underweight prevalence among the poorest 20% is 4.7 times greater than that of the richest 20%.[14] Economically, the poorest 40% only make up 8% of the nation's total household income while the richest 20% of make up 63%.[14]

Impacts of Structural Violence

The impacts of structural violence is far reaching, affecting not only on the level of an individual, but also overall social outcomes.[3]

Poverty

Slums in the area of Bas-Ravine, in the northern part of Cap-Haïtien

Poverty is one of the biggest by-product of structural violence as structural violence inhibits individuals and communities from achieving basic human rights, such as access to healthcare and education. As identified by the 2012 World Development Report, health and education are two key human capital endowments that can influence an individual’s ability to reach his or her full potential in society.[15] Due to this inability to receive proper education and maintain good health, individuals impacted by structural violence often are less well-positioned to receive better socio-economic opportunities to be upwardly mobile. Today, Haiti is the poorest nation in the Western Hemisphere, with approximately 77% of its population is currently living below the nation's poverty line.[16]

Education

Haitian school children attending class

Structural violence impacts one's ability to receive education.[3] Presently, education standards in Haiti are extremely low, where its literacy rate is only about 53%, well below the 90% average literacy rate for Latin American and other Caribbean countries.[17] Due to the oppressive political and economic structures that is plaguing the nation, the educational sector in Haiti has very limited financial support. The quality of education is also low due to the lack of organization, expertise and resources, where there is currently a shortage of school supplies and qualified teachers. This problem is particularly prevalant in rural areas. Many schools use either outdated curricula or a partially implement framework of the 1997 National Plan of Education and Training (NPET) curriculum.[18] Due to the state's lack of institutional strength and capacity to provide basic education to general Haiti population, the education sector is now predominantly privatized.[19] A 2006 World Bank Study on the private education in Haiti found that 92% of all Haitian schools to be privately own, tuition-based institutions.[20] Due to Haiti's widespread economic hardship, majority of the nation's population are unable to meet the cost of education. This has led to low enrollment levels, as well as high dropout and withdrawal rates, where only 55% of children aged 6 to 12 are currently enrolled in school, with less than 20% reaching fifth grade.[18] Those who were able to receive and complete secondary schooling were also unable to find a place in universities.[21] However, the 2006 World Bank report notes that "the high dropout rate is generally not reflective of a Haitian disregard for or disinterest in education; rather, it is an unfortunate consequence of limited family resources".[22] In the poorest 20% of household in Haiti, schools fees can represent up to 25% of a family's annual household income per child.[20]

Access to healthcare

Being serviced by a mixture of the public sector, the private sector and the non-profit sector, and religious institutions, the health system in Haiti faces the challenge of establishing efficient health coordination.[23] This is further compounded by the presence of more than 250 additionally implementing partners within the health sector.[23] Coupled with a continuing series of political upheavals that led to a unending social instability, Haiti's inefficient healthcare framework has crippled the nation's ability to provide good healthcare access to its people.[24] Presently, the ability of the Haitian government to provide and maintain health services has remained limited, where about 55% of health care is being provided by missionary or other non-governmental organizations.[25] While there are a small number of physicians who operate for-profit clinics, most are found in the larger cities. Additionally, medical services, whether public or private are disproportionately located in the metropolitan Port-au-Prince area.[26] Obstetric facilities also follow a similar trend as hospitals outside the Port-au-Prince area typically only provide limited obstetric services. In rural areas, many prenatal care services are delivered either by outreach teams or from small clinics that do not have formal maternity wards or delivery capabilities.[26] This physical separation of adequate medical facilitates from many parts of rural Haiti makes access to healthcare by those living away from the city very difficult. Although most medical infrastructure are concentrated within Port-au-Prince, hospitals and clinical facilities are often in very dilapidated states, where they are often compromised by infrastructural deficiencies and electrical blackouts. This lack of medical infrastructure was further exacerbated by the 2010 Haiti Earthquake.[23] In 2007, 47% of the population lack access to basic health care, with majority of the population still turning to traditional healers for various forms of treatment [23][27] A study on Haiti's prosthetic situation also revealed that only 25% of all amputees are able to obtain a prosthetic limb.[28]

Access to healthcare also includes perceptual issues like perceived quality of care.[29] While well known national maternity hospitals located in Port-au-Prince are over-utilized, rural maternity beds outside of Port-au-Prince, even where they exist, are poorly utilized, with utilization rates of about 30 and 35%.[30] However, evidence suggests that pregnant women want competent care, and that this under-utilization of existing services is directly tied to the perceived and actual quality of the facilities.[31][32] A widespread tendency to avoid government-run public facilities is frequently credited to these institutions’ low quality of care, such as a lack of equipment and services, and unfriendly attitude of the medical staff.[33][34].

Health Outcomes

Life Expectancy

According to the 2011 World Health Organization data on health indicators, the average life expectancy in Haiti at birth is 61 years for males and 64 years for females, both of which are lower than the global average of 70 years.[35][36] In the global life expectancy at birth ranking conducted by the CIA in 2014, Haiti was ranked 186 out of the 223 countries studied.[37] In terms of healthy life expectancy, a 2013 study funded by the Bill & Melinda Gates Foundation, found Haiti’s health life expectancy for males and females to be 27.8 and 37.1 years respectively, both of which are ranked as the lowest out of the 187 countries studied.[38] Haiti’s overall low ranking for life expectancy stems from a multitude of factors that include high HIV/AIDS prevalence, lack of access to basic healthcare services, malnutrition, and poor sanitation.[39]

Mortality Rates

Risk to Diseases

Sexually Transmitted Diseases

Causes

Colonialism

Social Inequalities

Political & Legal Corruption

Caste (Cultural) Discrimination

Management

Policy Measures

Grassroots & Community Activism

Empowerment & Agency

References

  1. ^ a b c Farmer, Paul E. (2006). "Structural Violence and Clinical Medicine". PLoS Medicine. 3 (10): e449. doi:10.1371/jou.pmed.0030449. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: unflagged free DOI (link)rnal
  2. ^ a b Farmer, Paul (June 2004). "An Anthropology of Structural Violence". Current Anthropology. 45 (3): 305–325. doi:10.1086/382250.
  3. ^ a b c d e f g h Sen, Paul Farmer ; foreword by Amartya (2004). Pathologies of power : health, human rights, and the new war on the poor : with a new preface by the author (2° édition. ed.). Berkeley: University of California Press. p. 42. ISBN 978-0-520-24326-2.{{cite book}}: CS1 maint: multiple names: authors list (link)
  4. ^ a b UNIFEM (July 2004). UNIFEM in Haiti: Supporting Gender Justice, Development and Peace (PDF) (Report). UNIFEM Caribbean Office. Retrieved 15 March 2014.
  5. ^ Radhika Coomaraswamy (27 January 2000 2004). Report of the Special Rapporteur on Violence against Women, Its Causes and Consequences, Radhika Coomaraswamy, submitted in accordance with Commission on Human Rights resolution 1997/44. Addendum: Report on the mission to Haiti (Report). UN Commission on Human Rights. Retrieved 15 Mar 2014. {{cite report}}: Check date values in: |date= (help)
  6. ^ Bureau of Democracy, Human Rights, and Labor (11 March 2009). 2009 Human Rights Report: Haiti (Report). U.S. Department of State. Retrieved 15 March 2014.{{cite report}}: CS1 maint: multiple names: authors list (link)
  7. ^ a b Farmer, Paul (2001). Infections and inequalities : the modern plagues (1. paperback print. ed.). Berkeley [u.a.]: Univ. of California Press. ISBN 9780520229136.
  8. ^ Sen, Amartya (July 2005). "Human Rights and Capabilities". Journal of Human Development. 6 (2): 151–166. doi:10.1080/14649880500120491.
  9. ^ Poverty and inequality (Orig. print. ed.). Stanford, Calif.: Stanford Univ. Press. 2006. ISBN 9780804748421. {{cite book}}: |first= has generic name (help); |first= missing |last= (help)
  10. ^ Robeyns, Ingrid (January 2003). "SEN'S CAPABILITY APPROACH AND GENDER INEQUALITY: SELECTING RELEVANT CAPABILITIES". Feminist Economics. 9 (2–3): 61–92. doi:10.1080/1354570022000078024.
  11. ^ Sagás, Ernesto. "A Case of Mistaken Identity: Antihaitianismo in Dominican Culture". Webster University. Retrieved 16 Marc 2014. {{cite web}}: Check date values in: |accessdate= (help)
  12. ^ Library of Congress. "A Country Study: Haiti". Library of Congress. Retrieved 16 March 2014.
  13. ^ Farmer, Paul (2009). "On Suffering and Structural Violence: A View from Below". Race/Ethnicity: Multidisciplinary Global Contexts. 3 (1): 11–28. doi:10.1353/rac.0.0025. {{cite journal}}: |access-date= requires |url= (help)
  14. ^ a b c UNICEF. "At a glance: Haiti". UNICEF. Retrieved 16 March 2014.
  15. ^ Revenga, [this report was prepared by a team led by Ana (2011). Gender equality and development : world development report 2012. Washington. DC: The World Bank. ISBN 978-0-8213-8825-9. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  16. ^ The World Bank. "World Development Indicators: Haiti". The World Bank. Retrieved 16 Marc 2014. {{cite web}}: Check date values in: |accessdate= (help)
  17. ^ Library of Congress - Federal Research Division (May 2006). Country Profile: Haiti (PDF) (Report). Library of Congress. Retrieved 16 March 2014.
  18. ^ a b Ketty Luzincourt; Jennifer Gulbrandson (August 2010). Education and Conflict in Haiti: Rebuilding the Education Sector after the 2010 Earthquake (PDF) (Report). United States Institute of Peace (USIP). Retrieved 16 March 2014.
  19. ^ Salmi, J. (June 2000). "Equity and Quality in Private Education: The Haitian paradox". Compare: A Journal of Comparative and International Education. 30 (2): 163–178. doi:10.1080/03057920050034101.
  20. ^ a b World Bank: Caribbean Country Management Unit (27 April 2006). Social Resilience and State Fragility in Haiti: A Country Social Analysis (PDF) (Report). The World Bank. Retrieved 16 March 2014.
  21. ^ Ministry of Planning and External Cooperation (November 2007). Making a Qualitative Leap Foward: Growth and Poverty Reduction Strategy Paper (PDF) (Report). International Monetary Fund, Washington, D.C. Retrieved 16 March 2014.
  22. ^ World Bank: Poverty Reduction and Economic Management Unit (01 Jun 2006). Haiti - Options and opportunities for inclusive growth : country economic memorandum (PDF) (Report). The World Bank. Retrieved 16 Mar 2014. {{cite report}}: Check date values in: |date= (help)
  23. ^ a b c d World Health Organization (January 2010). Public health risk assessment and interventions. Earthquake: Haiti (PDF) (Report). World Health Organization. Retrieved 16 March 2014.
  24. ^ World Bank (1993). World Development Report 1993. International Bank for Reconstruction and Development (Report). The World Bank, Washington, DC. {{cite report}}: |access-date= requires |url= (help)
  25. ^ Harvard Center for Population and Development Studies (1993). Sanctions in Haiti: Crisis in Humanitarian Action. Harvard School of Public Health, Program on Human Security Working Paper Series, Cambridge, MA (Report). Harvard Center for Population and Development Studies. {{cite report}}: |access-date= requires |url= (help)
  26. ^ a b Barnes-Josiah, Debora (April 1998). "The "three delays" as a framework for examining maternal mortality in Haiti". Social Science & Medicine. 46 (8): 981–993. doi:10.1016/S0277-9536(97)10018-1. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  27. ^ Coreil, Jeannine (June 1983). "Parallel structures in professional and folk health care: A model applied to rural Hati". Culture, Medicine and Psychiatry. 7 (2): 131–151. doi:10.1007/BF00051846.
  28. ^ Bigelow, J (2004 Feb 18). "A picture of amputees and the prosthetic situation in Haiti". Disability and rehabilitation. 26 (4): 246–52. PMID 15164958. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  29. ^ World Health Organization (1989). Preventing maternal deaths (PDF) (Report). Geneva : World Health Organization. Retrieved 16 March 2014. {{cite report}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  30. ^ Ministère de la SantéPublique et de la Population (1985). Recherche Operationelle sur les Etablissements de Santéavec Lits (Report). Ministère de la SantéPublique et de la Population. Port-au-Prince, Haiti. {{cite report}}: |access-date= requires |url= (help)
  31. ^ Gerald F Murray & Maria D Alvarez. Childbearing, Sickness and Healing in a Haitian Village. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  32. ^ Koblinsky, edited by Marje (1993). The health of women : a global perspective ([Pbk. ed.]. ed.). Boulder, San Francisco: Westview Press. ISBN 978-0813316086. {{cite book}}: |first= has generic name (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  33. ^ Sundari, T. K. (1 January 1992). "The Untold Story: How the Health Care Systems in Developing Countries Contribute to Maternal Mortality". International Journal of Health Services. 22 (3): 513–528. doi:10.2190/91YH-A52T-AFBB-1LEA.
  34. ^ Thaddeus, S (1994 Apr). "Too far to walk: maternal mortality in context". Social science & medicine (1982). 38 (8): 1091–110. PMID 8042057. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  35. ^ World Health Organization (2011). Haiti: Health Profile (PDF) (Report). World Health Organization. Retrieved 16 March 2014.
  36. ^ World Health Organization. "Life Expectancy at Birth". World Health Organization. Retrieved 17 March 2014.
  37. ^ Central Intelligence Agency. "The World Factbook: Life Expectancy at Birth". Central Intelligence Agency. Retrieved 16 March 2014.
  38. ^ Salomon, Joshua A (December 2012). "Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010". The Lancet. 380 (9859): 2144–2162. doi:10.1016/S0140-6736(12)61690-0. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  39. ^ McMichael, Anthony J (April 2004). "Mortality trends and setbacks: global convergence or divergence?". The Lancet. 363 (9415): 1155–1159. doi:10.1016/S0140-6736(04)15902-3. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)