CATALYST PLANET - Structural Violence: How Societal Factors Affect Health

Income, race and geographic location are often weaponized against communities, preventing them from accessing and achieving health and wellness.

A routine doctor’s appointment may be rare for those living in poverty, causing them to not seek treatment for incipient medical issues. #PACOM. CC BY-NC-ND 2.0.

Income, geographical location, climate and access to resources all affect people’s health in various ways. Indeed, it is rare to get malaria, a mosquito-borne disease in the Arctic. It is also comparatively easier for a wealthy person who has access to top-notch treatments to recover from cancer than a disadvantaged person who cannot afford a routine doctor’s appointment. These societal factors have a proven link to health outcomes, and they are usually not controlled by individuals. To fully foster public health, it is necessary to eliminate those societal factors that precipitate health concerns.

There are both biological and societal factors that affect health. Biologically, genetics can affect one’s health, as the causal relationship between genetics and diseases such as cystic fibrosis have been demonstrated through medical research. However, biological factors are not the only thing that affects health; societal factors do as well. The World Health Organization (WHO) defines social determinants of health as:

The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

Sometimes, the system itself is rigged against a substantial part of the population from attaining complete physical, social and emotional well-being. That is called structural violence. These arrangements are ‘structural’ because they are “embedded in the political and economic organization” of society, and they are ‘violent’ because they harm people, whether physically or not.

Lowndes County, Alabama, where the low-income Black population suffers disproportionately from hookworm infections due to structural violence. jimmywayne. CC BY-NC-ND 2.0.

One example of these biosocial determinants and structural violence in play can be found in rural Alabama, where hookworm, a disease thought to be eradicated years ago, is making a resurgence in Lowndes County. That county is 72% Black and has a poverty rate of 21.9%, almost double the national average of 11.4% in 2020. Low-income Blacks in the county are more prone to hookworm because they live next to pools of raw sewage, the perfect breeding ground for the worms.

Structural violence is also at play here, as the Black population live near the pools of raw sewage because they cannot afford proper sewage systems. The local and state government, in turn, perpetuates this problem by turning a blind eye on the issue and not providing any assistance to the residents. Through no fault of their own, Blacks in Lowndes County have a heightened risk for hookworm due to the circumstance in which society makes them live.

Cultural practices can also precipitate or hinder disease. West African countries that already had fragile healthcare systems were particularly affected by the 2014 Ebola outbreak because of cultural practices regarding funerals. In those cultures, funerals involve washing the dead body by hand before burial and paying respect to the dead through physical contact, both of which are exceptionally high-risk activities with regards to the spread of Ebola, since the virus is still present in the corpse. Controlling the Ebola outbreak must address these cultural issues.

Finally, around the world, food deserts are scattered around urban centers, usually located in areas of poverty. Food deserts are areas with a dearth of supermarkets and other sources of healthy foods, forcing people living there to travel further for quality foods or to settle for cheaper unhealthy foods. Since many food deserts are in areas of poverty, the people living in those areas usually have no choice but to buy cheap foods with subpar qualities. The unhealthy diet of many in those areas lead to higher rates of obesity and cardiovascular disease.

Structural violence affects food deserts, as the economic disincentives for healthy food sources to serve low-income areas show that society does not provide adequate support to them. In northern Ireland, food deserts are especially pronounced since 32% of households do not have a car. Some food deserts are the result of years of neglect of marginalized communities. Failure of the UK government to provide adequate public transportation in northern Ireland demonstrates that neglect.

Simply treating disease without regard for the underlying causes of it will not eliminate the issue. To eliminate hookworm, proper sanitation services must be implemented. Containing Ebola means educating local communities about safe methods to bury the dead in a way that does not denigrate their culture. To eliminate obesity, focus should be on providing access to healthy foods instead of just telling people to change their diet. It is important to treat diseases as complex issues instead of having a singular focus on the cure. Removing societal barriers to good health is instrumental in ensuring the physical, social and emotional health for all.

To Get Involved

The organization Partners in Health serves to improve healthcare in developing countries through patient-provider partnerships. Partners in Health works to create sustainable healthcare systems that serve all, emphasizing healthcare as a human right.

Often, the best way to remove the societal factors that affect health negatively is by advocacy. Writing to your elected officials is a good way to draw attention to those issues, which may spur them to act on your recommendations. To find your representative in Congress, click here.