- 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. Because 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" refers to aspects of a 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 ways 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".
In 1984, Petra Kelly wrote in her first book, Fighting for Hope:
A third of the 2 Billion people in the developing countries are starving or suffering from malnutrition. Twenty-five per cent of their children die before their fifth birthday […] Less than 10 per cent of the 15 million children who died this year had been vaccinated against the six most common and dangerous children's diseases. Vaccination costs £3 per child. But not doing so costs us five million lives a year. These are classic examples of structural violence.
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:
Their sickness is a result of structural violence: neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.
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 affects the availability of health care in the sense that physicians often need to pay attention to broad social forces (racism, gender inequality, classism, etc.) to 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. The concept of 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 the social determinants that alter access to care, and as a result, medical interventions are significantly less effective in low-income countries. Structural violence is an issue not only 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. A 1990 study by Moore et al. 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 developing social safety nets. These initiatives 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 tasks. Unfortunately, many of these professionals are not trained to perform structural interventions. Aside from not being trained in structural intervention, medical professionals continue to operate under conventional clinical intervention because physicians can rightly note that structural interventions are not their job. It falls more on political and other experts to implement such structural changes. As noted, structural forces account for most if not all epidemic diseases (e.g., HIV). Medical professionals still continue to operate under the downstream phenomenon, with a focus is on individual lifestyle factors rather than general socio-economic, cultural, and environmental conditions. This paradigm obscures the structural impediments to changes because it tends to avoid the root causes that should be focused on. One response is to incorporate medical professionals and to acknowledge that such active structural interventions are necessary to address real public health issues.
The lessons that have been learned from successful examples of structural interventions in these countries are fundamental. Although health disparities resulting from social inequalities are possible to reduce, as long as health care is exchanged as a commodity, those without the power to purchase it will have less access to it. Biosocial research should be the main focus. 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 behavior and habits. Although some 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 access.
Structural violence also exists in the area of mental health, where systems are designed to ignore the lived experiences of people with mental illnesses when making decisions about services and funding without consulting with the ill, including those who are illiterate, cannot access computers, do not speak the dominant language, are homeless, are too unwell to fill out long formal surveys, or are in locked psychiatric and forensic wards. Online-only consultation may be inappropriate for people with a lived experience of mental illness. Structural violence is also apparent when consumers in developed countries die from preventable diseases 15–25 years earlier than do people without a lived experience of mental health.
- Galtung, Johan. "Violence, Peace, and Peace Research" Journal of Peace Research, Vol. 6, No. 3 (1969), pp. 167-191
- Johan Galtung, "Kulturelle Gewalt" (1993) Vol. 43 Der Burger im Staat p. 106 in Ho, Kathleen "Structural Violence as a Human Rights Violation" (2007). Essex Human Rights Review Vol. 4 No. 2 September 2007
- Farmer, Paul E.; Nizeye Bruce; Stulac Sara; Keshavjee Salmaan (October 24, 2006). "Structural Violence and Clinical Medicine". PLoS Medicine 3 (10): 1686–1691. doi:10.1371/journal.pmed.0030449. PMC 1621099. PMID 17076568. Retrieved August 2014.
- Galtung, Johan. "Cultural Violence," Journal of Peace Research, Vol. 27, No. 3 (Aug., 1990), pp. 291-305
- Galtung 1990, p. 291
- Galtung 1990, p. 292
- Johan Galtung, "Violence, Peace, and Peace Research," Journal of Peace Research, Vol. 6, No. 3. (1969), pp. 167–191.
- Robert Gilman: "Structural violence. Can we find genuine peace in a world with inequitable distribution of wealth among nations?" (1983)
- Kathleen Ho: "Structural Violence as a Human Rights Violation", Essex Human Rights Review, Vol. 4 No. 2, September 2007 (ISSN 1756-1957)