University of Washington: http://www.washington.edu/omad/ctcenter/projects-common-book/mountains-beyond-mountains/explaining-difference/
The Society Pages: https://thesocietypages.org/sexuality/2010/01/18/thinking-about-haiti-structural-violence-through-the-lens-of-m-l-k/
Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn
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 article draws mainly from Partners In Health projects in Rwanda and Haiti, using them as case studies to support their argument.
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.
1) Factors affecting disease (HIV/AIDS) outcome in different biosocial settings are radically different despite similar, established “risk-factors” in lifestyles/behaviors for individuals. This is because biosocial factors play an important role that is far often overlooked by current medical systems and policies.
2) mother-to-child transmission (MTCT) of HIV, antiretroviral therapy (ART) and infant formula (preventing pediatric aids transmission through mother). MTCT of HIV is driven through universal breastfeeding being mainly pushed by the existing medical structures of the local and international healthcare policy makers. They claimed that the difficulty giving access to infant formula in rural areas and stigma around signing up for an HIV project doomed it to failure; however the projects in Rwanda and Haiti proved otherwise, when the structural “violence” was addressed. This was done mainly by giving both distal and proximal support and care as well as addressing the other social-economic barriers to good medical care in these communities.
3) When locals, who are much more aware of the areas biosocial setting, implications and problems, are utilized in the medical system, the results are multifold. Proximal care provided by an accompagnateur not only reduces barriers to care such as traveling to a hospital for basic medicine, but also creates jobs that contribute to raising the quality of life which is another major factor when examining structural “violence”.
Virtually all of the references include in their title “social”, “structural violence”, a mention of poverty or underdeveloped country/community, or gender/social-status/race. The nature of the references concur with the nature of the article and references mainly other research articles which portray some aspect of the authors’ argument.
The article: “Structural Violence and Clinical Medicine” is about the social structures that play into “violence” (anything that causes harm physically, socially, or otherwise). The research seeks to establish the importance of biosocial understanding in the medical field when trying to understand medical problems.