Structural Violence and Clinical Medicine

Farmer, Paul; Nizeye, Bruce; Stulac, Sara; Keshavjee, Salmaan

doi:10.1215/9781478004363-024

Cited by 73 publications

(88 citation statements)

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“…The findings of this study, which drew on structural violence, have exposed the interplay of the social arrangements that led to the delays of women's deliveries. Previous research shows that structural violence is the major cause of premature deaths and disabilities among the vulnerable population (Farmer et al., 2006). The failings of the society at the family, community and political levels highlight the structural violence.…”

Section: Discussionmentioning

confidence: 99%

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Insights from birthing experiences of fistula survivors in North‐central Nigeria: Interplay of structural violence

et al. 2020

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Obstetric fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour that can cause substantial, long-term physical and psychological harm to the woman (Bangser, 2006; Wall, 2006). The most common cause of fistula in developing countries is due to the obstruction of labour and delayed delivery (Wall, 2006). The inability of a woman to deliver her baby through the birth canal is caused by a discrepancy in the available space in the pelvic region and the foetal size or when the foetus' head or body is too big to pass through the mother's pelvis opening (Abrams, 2012; Wall, 2006). The obstruction leads to a prolonged pressured contact of the foetal head in the birth canal area, causing a loss of blood flow to the soft tissues of the woman's bladder, vagina and rectum (Arrowsmith, Hamlin, & Wall, 1996; Wall, 2012). Consequently, ischaemic injury leads to massive tissue necrosis in the woman's pelvis, which results in the fistula being formed (Wall, 2006). Numerous studies have described women with obstetric fistula as within the age range of 9-65 years, with the mean age usu

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Section: Discussionmentioning

confidence: 99%

“…The concept of ‘structural violence’ is a way of describing social organizations that place individuals and populations in harm's way (Farmer, Nizeye, Stulac, & Keshavjee, 2006; Galtung, 1969). The organizations are ‘structural’ because they are entrenched in the political and economic structure of our social world.…”

Section: Introductionmentioning

confidence: 99%

Insights from birthing experiences of fistula survivors in North‐central Nigeria: Interplay of structural violence

et al. 2020

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“…Racial and economic inequality was a major theme from the interviews that is not adequately addressed in the NSP. As a social disease, TB is highly sensitive to structural violence [39]. With South Africa's overall state of economic development, the country should not be burdened by TB at this rate.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the chronically underfunded public sector which serves about 84% of the population, is staffed by only 30% of doctors in the country [43]. In fact, this persistent structural violence [39] might explain South Africa's poor health outcomes in the post-Apartheid era, despite considerable evidence of economic growth [43,44]. It was agreed that TB largely affects the poor and/or those marginalized in society, a sub-population that also receives a lot of attention in the NSP.…”

Section: Discussionmentioning

confidence: 99%

Towards TB elimination: how are macro-level factors perceived and addressed in policy initiatives in a high burden country?

2021

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Background Notwithstanding extensive general discussion of the effects of upstream forces on health, there has been limited empirical examination, let alone systematic evidence documenting policy responses to such pathways in the area of tuberculosis (TB) management and control. Our study aimed to gain insight into how macro level drivers of TB are perceived by key stakeholders involved in TB management and control in a high-endemic country, and to assess how such concerns are being addressed in policy initiatives in this setting. South Africa was chosen for this case study due to our team’s long-standing collaborations there, its very high burden of TB, and its introduction of a strategic plan to combat this disease. Method Semi-structured interviews were conducted with 20 key informants who were purposively selected for their knowledge and expertise of TB in South Africa. South Africa’s National Strategic Plan for HIV, TB and STIs 2017–2022 was then reviewed to examine how identified themes from the interviews were reflected in this policy document. Results A history of colonization, the migrant labour system, economic inequality, poor shelter, health system challenges including TB governance, the HIV epidemic, and pertinent socio-cultural factors were all perceived to be major drivers of the epidemic. Although South Africa’s current National Strategic Plan makes a firm discursive commitment to addressing the structural or macro-level drivers of TB, our analysis revealed that this commitment was not clearly reflected in projected budgetary allocations. Conclusion As in many other high burden settings, macro-level drivers of TB are widely recognized. Nonetheless, while micro-level (biomedical and clinical) measures, such as improving diagnostic procedures and investment in more efficacious drugs, are being (and well should be) implemented, our findings showed that macro-level drivers of TB are underrepresented in budgeting allocations for initiatives to combat this disease. Although it could be argued that structural drivers that undermine health-promoting actions are beyond the purview of the health sector itself, we argue that strategic plans to combat TB in high burden settings need more attention to directly considering such drivers to prompt the necessary changes and reduce the burden of this and other such diseases.

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“…2) 레슬리는 이를 "지속되고 있는 고대 과학의 사유 방식"이라고 표현하고 있다 (Leslie, 1976:1 (Banes, 2005), 멕시코의 동종요법 (Whiteford, 1999), 일본의 동아시아의학 (Lock, 1980)과 복수 의료 체계 배경에서 사회구 성원들의 의료관련행위를 통해 그 행위들에 내재한 "돌봄 구하기 과정을 가 이드하고 치료적 접근을 평가하는 일반적 가이드" (Kleinman, 1980: 71) (Lock, 1990;Janes, 1999 (Janes, 1999;Langwick, 2011;Lock, 1990;Scheid, 2002 (Galtung, 1969). 그는 구 조적 폭력을 "자원의 분배에 대한 결정권"의 불평등으로 구체화했으며, 그것 이 가져오는 "불평등한 생의 기회"가 물리적 폭력보다 더 많은 죽음과 고통을 야기한다고 지적했다 (Galtung, 1969:171 (Lee, 1996;Geiger, 1997;Brown, 1989;Morgan andBjörkert, 2006:442, Kim et al, 2002 (Farmer, 1997;Farmer et al, 2006 (Fassin, 2009;Miller and Rasmussen, 2010;Quesada, 2009 (Inhorn, 2003;Rapp, 1997;Taylor, 2008;Wentzell, 2013;Lock, 2001;Kaufman, 2005 (Rabinow, 1996;Sunder Rajan, 2006;Patryna, 2002 이현정, 2018;Clemente, 2015;Denham, 2017;Desjarlais, 1992Desjarlais, , 2003Kleinman, 2015Kleinman, , 2019Shohet, 2013;Throop, 2010 (Desjarlais, 1992;Kleinman, 2019…”

Section: 의료다원주의가 본격적으로 대두된 이후 복수의 의료체계라는 상황 속에unclassified

Research Trends and Prospects of Medical Anthropology: Concepts and Their Intersection with History of Medicine

Yoon¹,

Kim²

2020

Korean J Med Hist

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This study explores the history of research in Medical Anthropology by examining key concepts in the field with a focus on their relevance with findings from the field of History of Medicine. The concepts discussed in this paper are Medical Pluralism, Social Suffering, Biopolitics, and Care. Since concepts internalize the ethnographic gaze, what this paper aims is to trace the development of the gaze on a historical axis. Although concepts come from a specific historical period, they are by no means exclusive to it, as they are revisited again and again through various discourses. In other words, the insight that the previous meaning of a concept has grasped is instilled into the revisited concept. In this way, concepts engage in historical communication, create intersections with the interests of History of Medicine. By discussing these intersections with each concept, this paper suggests the complementary roles of the two fields and their approach to historical events and phenomena.

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Structural Violence and Clinical Medicine

Cited by 73 publications

References 1 publication

Insights from birthing experiences of fistula survivors in North‐central Nigeria: Interplay of structural violence

Insights from birthing experiences of fistula survivors in North‐central Nigeria: Interplay of structural violence

Towards TB elimination: how are macro-level factors perceived and addressed in policy initiatives in a high burden country?

Research Trends and Prospects of Medical Anthropology: Concepts and Their Intersection with History of Medicine

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