Structural Violence and Clinical Medicine

Background: Haiti’s 2010 earthquake devastated social, health, and economic infrastructure and left 2 million persons homeless. Over 6 years later 61,000 people remain displaced, most lacking protection, services, and durable solutions. Structural contexts elevate risks of gender-based violence (GBV) targeting internally displaced (ID) girls and women. Objective: We used an intersectionality framework to explore lived experiences and understanding of violence among ID young men and women in Leogane, Haiti. Methods: We conducted six focus groups, three with ID young women (n = 30) and three with ID young men (n = 30) aged 18–24 years, and 11 in-depth individual interviews with frontline workers in Leogane. Focus groups and interviews were conducted in Kreyol, transcribed verbatim, translated into English, and analyzed using narrative thematic techniques. Results: Findings revealed violence experienced by ID youth was (re)produced at the intersection of gender, poverty, displacement, and age. Multi-level forms of violence included structural (e.g. poverty), community (e.g. gender norms, and interpersonal (e.g. family expectations) dimensions. Coping strategies spanned intrapersonal (hope), community (social support), and structural (employment/education) dimensions. Conclusions: Interventions to reduce violence should be tailored to address the social inequities that emerge at the intersection of youth, poverty, displacement, and hegemonic gender norms.

Section: Introductionmentioning

confidence: 99%

‘Life under the tent is not safe, especially for young women’: understanding intersectional violence among internally displaced youth in Leogane, Haiti

Logie

Daniel

Ahmed

et al. 2017

“…He is trapped in a vicious cycle which makes managing his pain almost impossible. From a public-health and human-rights perspective, what is at stake for R (and for many people in similar circumstances) is that contextual factors – factors which health or psychological interventions as commonly understood cannot ameliorate – loom very large in the maintenance of ongoing symptoms, including the experience of physical pain [29]. …”

Section: Discussionmentioning

confidence: 99%

Chronic pain as a human rights issue: setting an agenda for preventative action

Frenkel

Swartz

2017

Background: Historically, chronic pain has been viewed primarily as a medical issue, and research has been focused on the individual and predominantly on pain sufferers in high-income countries. Objectives: This article argues the need for a broader understanding of the context of chronic pain and its complex aetiologies and maintenance. It is suggested that the interaction between chronic pain and social context has been inadequately explored. Methods: A single case study is used of a man living in a violent urban environment in South Africa accessing a pain clinic at a tertiary hospital. Following the case-study approach, as used in the chronic traumatic stress field by Kaminer et al., the case material is utilised to develop an argument for a new research agenda. Results: Analysis of the case material demonstrates the complex interplay between bodily and psychological experiences, with chronic pain being contextually maintained and exacerbated by very difficult life circumstances, ongoing violence, and marginalisation. Conclusions: It is suggested that a research agenda be developed which explores the links between chronic pain and ongoing chronic traumatisation in contexts of continuous violence, oppression, and disempowerment – common features of much of the contemporary majority world.

“…Advocates such as Farmer have used the concept of structural violence to understand and address health inequities [11–14]. Through this lens, modern communicable epidemics such as HIV/AIDS and tuberculosis are positioned as inseparable from, and a result of, ‘violent’ socioeconomic structures [12,13].…”

Section: Designmentioning

confidence: 99%

“…Structural violence is a comprehensive framework to explain the mechanisms through which social forces such as poverty, racism and gender inequity become embodied as individual experiences and health outcomes [11–14]. The term ‘structural violence’ refers to institutionalized social structures, such as poverty, racism and gender inequity, that prevent people from meeting their basic needs [11,15].…”

Section: Introductionmentioning

confidence: 99%

¿Somos iguales? Using a structural violence framework to understand gender and health inequities from an intersectional perspective in the Peruvian Amazon

Shannon

Motta

Cáceres

et al. 2017

Background: In the Peruvian Amazon, historical events of colonization and political marginalization intersect with identities of ethnicity, class and geography in the construction of gender and health inequities. Gender-based inequalities can manifest in poor health outcomes via discriminatory practices, healthcare system imbalances, inequities in health research, and differential exposures and vulnerabilities to diseases. Structural violence is a comprehensive framework to explain the mechanisms by which social forces such as poverty, racism and gender inequity become embodied as individual experiences and health outcomes, and thus may be a useful tool in structuring an intersectional analysis of gender and health inequities in Amazonian Peru. Objective: The aim of this paper is to explore the intersection of gender inequities with other social inequalities in the production of health and disease in Peru’s Amazon using a structural violence approach. Design: Exploratory qualitative research was performed in two Loreto settings – urban Iquitos and the rural Lower Napo River region – between March and November 2015. This included participant observation with prolonged stays in the community, 46 semi-structured individual interviews and three group discussions. Thematic analysis was performed to identify emerging themes related to gender inequalities in health and healthcare and how these intersect with layered social disadvantages in the reproduction of health and illness. We employed a structural violence approach to construct an intersectional analysis of gender and health inequities in Amazonian Peru. Results: Our findings were arranged into five interrelated domains within a gender, structural violence and health model: gender as a symbolic institution, systemic gender-based violence, interpersonal violence, the social determinants of health, and other health outcomes. Each domain represents one aspect of the complex associations between gender, gender inequity and health. Through this model, we were able to explore: gender, health and intersectionality; structural violence; and to highlight particular local gender and health dynamics. Intersecting influences of poverty, ethnicity, geography and gender served as significant barriers to healthcare in both rural and urban settings.