Structural violence

Structural violence is a term first used in the 1960s commonly ascribed to Johan Galtung. It refers to a form of violence based on the systematic ways in which a given social structure or social institution harms 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. Structural violence and direct violence are highly interdependent. Structural violence inevitably produces conflict and often direct violence, 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
'Cultural violence' refers to aspects of 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 way in which 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 colour" of an act from "red/wrong" to "green/right," or at least to "yellow/acceptable."

International scope
In 1984, Petra Kelly wrote (in her first book, Fighting for Hope):

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:

This perspective has been continually discussed by Paul Farmer, as well as by Philippe Bourgois, and Nancy Scheper-Hughes.

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 has affected health care availability in the sense that physicians need to pay attention to large-scale social forces (racism, gender inequality, classism, etc...) to often determine who falls ill and who will be given access to care. 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.

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 the development of social safety nets. These examples 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 a task. Unfortunately, many of these professionals are not trained to perform structural interventions.