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    The article: “Structural Violence and Clinical Medicine” was written by Paul E Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee. Paul Farmer is an anthropologist and physician who works professionally as a humanitarian healthcare worker in impoverished nations, physician at Brigham and Women’s Hospital Division of Social Medicine and Health Inequalities, Professor at Harvard University, and cofounder of Partners In Health. Bruce Nizeye is a Director of the Program on Social and Economic Rights. Sara Stulac is a Director of Pediatric Programs at Inshuti Mu Buzima, in Rwanda, and Partners In Health’s deputy chief medical officer. Salmaan Keshavjee is also a physician at Brigham and Women’s Hospital, an instructor at Harvard’s Department of Medicine, and a specialist at Partners In Health on tuberculosis.

                It is important to understand the work of Partners in Health (PIH) is to assist underdeveloped countries build high quality healthcare systems, when talking about the authors’ work.

The article seeks to broaden the vision of the current medical system and structures by acknowledging and delivering care with the knowledge of biosocial effects.

This study was published in PLOS Medicine, and publishes studies across the spectrum of medical science. It is peer-reviews, and authors pay a publishing fee. It goes against the “cycle of dependency that has formed between the journals and the pharmaceutical industry.” In 2014, PLOS Medicine was given an impact factor (which measures how often studies published in the journal are cited in other studies) of 14.429, ranking 7th out of 153.

The authors received no special funding for this article.

This article draws mainly from Partners In Health projects in Rwanda and Haiti, using them as case studies to support their argument.

Social forces such as racism, gender inequality and poverty impact health issues, determining who becomes ill and who can access proper healthcare. This interaction is imperative to understand when looking at broader public health. While understanding the molecular basis of disease will help us prevent illness, addressing biosocial phenomena is critical to public health

The entire study is focused on vulnerable populations – particularly those who due to racial or economic divides, do not have proper access to healthcare, or may be affected by factors such as poor housing and malnutrition.

1) “…what would happen if race and insurance status no longer determined who had access to the standard of care?

…in addition to removing some of the obvious economic barriers at the point of care, the clinicians and researchers considered paying for transportation costs and other incentives as well as addressing comorbid conditions ranging from drug addiction to mental illness. They also implemented improvements in community-based care, conceived to make AIDS care more convenient and socially acceptable for patients. The goal was to make sure that nothing within the medical system or the surrounding community prevented poor and otherwise marginalized patients from receiving the standard of care.

The results registered just a few years later were dramatic: racial, gender, injection-drug use, and socioeconomic disparities in outcomes largely disappeared within the study population [35].”

2)            “This model [PIH’s model], with conventional clinic-based (distal) services complemented by home-based (more proximal) care, is deemed by some to be the world's most effective way of removing structural barriers to quality care for AIDS and other chronic diseases.”

3)            “While some interventions are straightforward, we also have to recognize that there is an enormous flaw in the dominant model of medical care: as long as medical services are sold as commodities, they will remain available only to those who can purchase them.”

1) “When tuberculosis treatment fails. A social behavioral account of patient adherence.” By Sumartojo E. Describes the demographic and cultural factors in monitoring and improving adherence to TB regiments.

2) “Racial differences in the use of drug therapy for HIV disease in an urban community.” By Moore RD, Stanton D, Gopalan R, Chaisson RE. Blacks were found to be less likely to receive therapy than whites even when gender, social status, age, and place of residence had no effect on variation in treatment. In emergency response, a similar issue is possible.

3) “Women's voices rise as Rwanda reinvents itself” by Lacey M. This article helps in understanding the long term effects emergencies leave on a country, namely the Rwanda Genocide of 1994. 

On a day to day basis as a healthcare professional, this isn’t very important outside of a teaching and understanding standpoint. A disease is, first and foremost, a disease, and needs to be treated accordingly. While healthcare professionals should educate their patients about risk factors that could lead to their increased likelihood of illness, as well as understand and appreciate why some populations are more vulnerable than others, it does not assist in direct disease treatment.