Mid-Term Question #3
Consider the nature of structural violence as it affects health and mental health services internationally. What might you as a social worker do, in your community, that could have an impact on this problem in a global perspective?
Castro & Farmer (2005) state that every society is shaped by large-scale forces, such as racism, sexism, political violence, poverty and other social inequalities, which contribute to structural violence. These inequalities are ingrained in both the historical and economic roots of the community. Internationally, structural violence has impacted countries such as Rwanda, Eastern Europe and the Middle East. Specifically, the genocide in Rwanda was precipitated by a deep-rooted structural violence that has characterized Rwanda’s history for the last half a century and continues to be embedded in formal and informal policies. For centuries, Hutus and Tutsis lived relatively peacefully: intermarrying, speaking the same language and sharing a national identity. The Belgian colonial government, however, went far to stress the differences between the two peoples, believing the Tutsis to be a superior race. This example of structural violence shows the importance of not judging a society on its surface before providing intervention.
ReplyDeleteSpecifically, in the community I work in, structural violence contributes to the lack of quality health and mental health services for clients. As a social work intern in the Garfield Park neighborhood on the west side of Chicago, it is important to give the community members a say on what services are offered. Services which are run by community members have the most impact on the community. Programs such as Cease Fire, where ex gang members interrupt the violence and Safe Passages, where parents volunteer as crossing guards during school arrival and dismissal have both shown to decrease the violence in the neighborhood. However, the stigma of social work services in the community I work in is very present. The most accessible mental health clinics are designed to serve clients with disabilities or addiction problems and what I have found is that the general community has a fear of social workers since they are often linked to probation officers or DCFS cases.
Thus, by using a model where community members have an active say and presence in the design and delivery of the mental health programs would help give ownership to the individuals in the community. Through community meetings, surveys, interviews or a task force composed of community members, professionals and stakeholders, this model can help bridge the gap to lessen the stigma of mental health services. If community members are fearful of mental health services due to legal ramifications, then this is important to recognize before developing a plan on how to provide services.
This model can impact the problem of mental health services on a global perspective by understanding what the needs are from the specific communities social workers are working with. While qualitative research through interviewing is often time consuming and expensive, the model that Castro and Farmer (2005) used when working with the Asian women’s perceptions of mental health can be replicated in several other communities to give a better understanding of what the needs are of a society and how to provide a successful intervention. Rather than assuming that Westernized interventions are the most effective, using a community based approach where interventions are provided after listening to the input from those who will be receiving them can be very effective on a global perspective. This model gives individuals ownership of the services that are provided within their community.
Karen,
DeleteThis is a great proposal for getting generalist mental health services into the hands of people who could use them. Communities which experience violence have obvious needs for trauma-related mental health services. But, as you rightly point out, fear of legal ramifications are a significant barrier that are not present in other communities around Chicago.
It is so important to check our Western perspectives, as you also mention. I think people are able to define mental health for themselves and may just need tools, not a whole new definition of what "healthy" means which may not resonate with their own experiences or culture. As you again so rightly pointed out, individual ownership is key!
I love the idea of giving individuals ownership of the services that they will receive, creating a sense of empowerment within the community who is affected by services to help individual problems. Every community is different and it is so important to create programs that will accept and encourage that. It is difficult sometimes to accept the fact that we might not have all the answers and we (as a Western society) need to humble ourselves to embracing that societies work differently than we do.
DeleteFor this question, I find the article “Understand and Addressing AIDS – Related Stigma: From Anthropological Theory to Clinical Practice in Haiti” most helpful because it shows how structural violence feeds into the AIDS- related stigma. The definition of an AIDS-related stigma is a“…stigma exists when the following interrelated components converge. In the first component, people distinguish and label human differences. In the second, dominant cultural beliefs link labeled persons to undesirable characteristics- to negative stereotypes. In the third, labeled persons are placed in distinct categories so as to accomplish some degree of separation of ‘us’ from ‘them’. In the fourth, labeled persons experience status loss and discrimination that lead to unequal outcomes. Finally, stigmatization is entirely contingent on access to social, economic, and political power that allows the identification of differentness, the construction of stereotypes, the separation of labeled persons into distinct categories, and the full execution of disapproval, rejection, exclusion, and discrimination” (Castro & Farmer, 2004, p. 54). A stigma may disable members of a community from attaining medications, which are necessary for caring for themselves, and as a result, their lives are at risk. In other words, “[e]very society is shaped by large-scale social forces that together define structural violence. These forces include racism, sexism, political violence, poverty, and other social inequalities that are rooted in historical and economic processes…” (Castro & Farmer, 2005, p. 54-55). Structural violence disables individuals from attaining such services as mental health counseling and impedes on their basic human rights. In regards to the Castro and Farmer article, they explain that structural violence can dictate who has access to treatment if they have HIV/AIDS. In other words, it controls who lives and who dies from the disease.
ReplyDeleteMy overall goal would be on how to get the basic needs met for those who are being stigmatized. In regards to this article, I would start out by educating about structural violence related to HIV/AIDS and the affects it can have on people’s lives. I could try to work my way through various communities, whether it is in Haiti or in the United States, and try to teach them about equality and the negative affects that structural violence and stigma can have in providing mental health and health services. I would discuss how access to such services could determine whether a person lives or dies. If I can change the mind of one man, I have accomplished something.
Danielle,
DeleteYour last sentence was so inspiring-in my opinion, every social worker should think, that changing mind of one man is already a big result ! We should change our stereotypes about people step by step, and I agree with you, that education can help us to do that. Thank you for your very clear explanation what is stigma and how it asserts.
I agree with Indre and Danielle, changing the mind of one person is such a big step. But in addition, I believe it takes much more than just one person. Changing one persons mind about receiving services and education will only make a difference in that one person's life, and in the long run he may reverse back to his old way of think due to influence from his community. It is a big step to change one mind, but it is only the first step, and a good one. If you can change one mind, you will change others, and that's what is important. Creating a change in the cultural way of thinking towards treatment in the long run will help to eliminate structural violence. Large scale community outreach is needed to achieve this. Community education, workshops, and rallying can help change the effects of structural violence on a larger scale.
DeleteStructural violence surrounds us everyday as Social Workers. Working at a community hospital on the northwest side of Chicago, I see everyday how so many patients are using the emergency room as their only source of survival sometimes. Of course, we know if the patient had access to the proper care, a critical trip to the emergency room would not be necessary. This effects us not only as social workers who empathize with this situation, but as tax payers as well. I see first hand how some of these patients do receive minimal health care at a public health clinic but receive no mental health resources. Often, many of the patients I assess who have had some sort of suicide attempt or suicidal ideation such as an overdose are patients who are uninsured. This is living proof that patients who are insured will receive the necessary health and mental health needs unique to the patient far before an uninsured individual because the resources just are not out there.
ReplyDeleteIt is very important to work at a grassroots level when attempting how to alter a global perspective. In the article “Globalisation of consciousness and new challenges for international social work” by Ahmadi (2003) the idea of working cohesively with the emergence of welfare states is crucial. “Stressing the concepts of citizenship and citizens’ rights, the welfare state developed a clear societal and governmental responsibility for persons in vulnerable positions within the context of the nation-state” (p.19). Ahmadi also writes “An appropriate model for social work under these new conditions might be the re-centralisation of social work and the creation of solutions based on regional needs that extend beyond the borders of the individual nation-state” (p.21). What is recommended is we as Social Workers and agents of change investigate further into what is the cause of the structural violence to the individual with being mindful of the individuals environment. Structural violence can also be translated sometimes unfortunately as a social norm. Sometimes what I view as a situation that could be deemed as structural violence is often their cultures social norm. For example, since a young teenager never was educated in sex education she got pregnant at 13. Can this be used as structural violence? The individual got pregnant because of lack of education and resources. But, to that individuals culture, this could be the norm.
Gina,
DeleteIts very ingage my your proposition that "structural violence can also be translated sometimes unfortunately as a social norm". I would like ti agree with you. Only we uderstand that structural violence exits perforce, than we can thik how to enpower our clients to live in this kind of society and not afrait fight for their human rights.
Zivile L.
The impact of structural violence on access to mental health and health services for the poor is extremely large and remains unnoticed by many developing countries. Castro and Farmer define structural violence as any social inequality that has been rooted in historical and economic processes (2005). The authors also mention that structural violence determines who has access to equal and affordable healthcare and who will suffer from health and mental health inequities (2005). It is this type of extremely deeply rooted violence and inequality that continues to affect individuals, especially those who are low-income, in a large scale way.
ReplyDeleteSocial work as an international profession addresses structural violence on a daily basis. However, it is difficult to believe that an individual social worker or individual community could have a positive impact on such a worldwide issue that seems to contain so many impossible factors. It is here that the power of community comes to mind. As a social worker, I would absolutely utilize the power of community in attempting to bring awareness to and overcome the issue of lack of access to healthcare for low-income individuals on an international scale. Communities possess within them the power to change systems, so as a social worker dealing with structural violence I would first work to equip and educate the community I was working with to learn how to create change and advocate for change by using the resources that are already available for specific communities. I think it’s important to focus on what an individual community has to offer and the characteristics specific to that culture in order to implement real change, so services offered would vary by country or culture. I completely believe in the idea of a virtuous social cycle, as defined by Castro and Farmer (2005), in which people who have been affected in a negative way are able to turn their experiences into positives for others. As a social worker, I would take on this responsibility and do my best to educate and empower others in the community in order to create the most positive change possible for those communities affected by structural violence.
Kristi,
DeleteI appreciate your emphasis on a community-based, pragmatic approach in dealing with structural violence. Castro and Farmer's virtuous social cycle seems like an imaginative and inclusive way of empowering individuals who might otherwise feel isolated and too ashamed of participating in a community group. As social workers, we can perhaps reduce structural violence through offering space for individuals to come together and learn, as a group, to create and advocate for change. In the process of creating conditions for people to participate in positive actions as an emboldened community, we can also deepen each person's sense of self-determination.
Structural violence, as a concept, was first posited by Johan Galtung (1969). Galtung expands the definition of violence to more than direct personal violent contact, noting that “violence is present when human beings are being influenced so that their actual somatic and mental realizations are below their potential realization” (p. 168). There exist structures in society that prevent certain groups of people from this “potential realization.” Structural violence is fueled by inequality, especially as related to the distribution of power (Galtung, 1969). Anthropologist and physician, Paul Farmer (1996), further clarifies Galtung’s conceptualization as he states that structural violence is created by “historically given (and often economically driven) processes and forces that conspire…to constrain agency” (p. 263). Structural violence puts certain individuals at risk for poor health and mental health outcomes. These individuals tend to be those who experience devastating poverty, racism, sexism, and political violence (Farmer, 1996).
ReplyDeleteIn his work in with HIV in Haiti, Farmer (1996) has witnessed the social forces of inequality which structure people’s risk for infectious and parasitic diseases, as well as risk of hunger, torture, and rape. In noting the commonalities between those who are victims of extreme suffering, Farmer notes “what they share is the experience of occupying the bottom rung of the social ladder in inegalitarian societies” (p. 263). Structural violence increases a person’s vulnerability in disease contraction and progression, as well as determining access to treatment. Stigma further inhibits access to treatment for both health and mental health concerns. Castro and Famer (2005) note that not only do the interlocking axes of inequality, poverty, sexism, racism, and political violence determine an individual’s risk of HIV infection, but also establish his or her level of stigmatization. Thus, structural violence can include the disproportionate effects of stigma to further disadvantage populations that are already at risk.
It is difficult to see what can be done in a community setting in a U.S. city to begin to address this enormous, entrenched global issue. A start might be raising awareness around structural violence, in whatever context a social worker practices. Farmer (1996) notes that we are more likely to be moved and influenced by the suffering of those to whom we most easily relate. It is much easier to psychologically distance ourselves from those who suffer in far away places. In order to raise awareness about structural violence on a global scale, social workers in the United States can begin by raising awareness of the structural violence that operates within their own cities and communities. When community members are better able to understand the dynamics and injustice that occurs in their own backyard, they may then be better prepared to empathize with the plight of those in international settings as well.
Another means of dismantling structural violence is through dismantling the impact of stigma through accurate education around diseases such as HIV, directed toward both stigmatized populations and the population at large. Working to banish stigma would help to remove one of the layers of oppression that seeks to constrain the agency and health of stigmatized groups. However, these endeavors must be undertaken in tandem with increasing people’s physical access to health and mental health services. As Castro and Farmer (2005) note, the cost of drugs and access to drugs are the most significant barriers to obtaining treatment for HIV. Social workers should strive to establish mental health and health services in communities that lack adequate proximity to these services and advocate for policies that promote equitable distribution of these resources.
(Part II)
ReplyDeleteIt is important to bear in mind that we, as mental health professionals, may be helping to perpetuate structural violence by failing to give full credence the perspective of societally undervalued groups. Wong (2004) notes that, when considering mental health in cross-cultural contexts, “the intersection of culture and gender weaves a tapestry that reflects the political realities of a discourse dominated by Eurocentric and patriarchal imaginations” (p. 457). When mental health is understood from the perspective of a dominant group, failing to offer room for elucidation through the eyes of oppressed cultural groups, practitioners and theorists are at risk of perpetuating patterns of structural violence in the very arenas that seek to remedy these inequities. Let us be attentive to our own culpability in these systems of constraint and purposefully seek to dismantle the inequalities by which they are fueled.
You are so right about being aware of our capacity to perpetuate structural violence even if we are working to end it. I think it's easy for us as social workers to think that we have all the answers and that we know how to create change. This mindset can be so dangerous and I'm learning how important it is to constantly remind myself that I have things to continuously learn as well and that I do not have all the answers. It's a scary reality that we could be instruments in the continuation of structural violence, but it is important to keep this in mind in all that we do.
DeleteStructural violence emerges within the deeply rooted concepts of discrimination and stigma. According to Farmer and Castro, public health is negatively affected by the social inequalities erupted from discrimination and stigma. The AIDS-Related stigma epidemic offers a perfect example of how discrimination results in structural violence. Our societal victim blaming notion supported “the lack of solidarity in providing appropriate care to people living with HIV” causing HIV infected people to die (2005, p 58). By associating AIDS with a negative label, society literally constructed a means of exploitation leading to death. As our society becomes educated on the AIDS crisis, the destruction of organized violence will paramount. However, I know the stigma still lingers within my community and people are still fearful of searching health care because of that stigma. In class we discussed how the women who live in the Southside of Chicago have a higher mortality rate due to not receiving health care services for breast cancer. Our society has deprived that community access to health care services in order to treat the cancer that causes death. This is a form of structural violence. It is a form of genocide and it is happening right here in the United States.
ReplyDeleteBy educating society on how our health care system is a form of structural violence, social workers are able to make a difference. The Health care system in the United States needs to be reformed. Social workers are able to lobby for policy reform and write letters to congress addressing the severity of the problem. On a global perspective, social workers are able to research and study other forms of health care service. By analyzing other countries’ health care programs, social workers are then able to pull together ideas for a new health care system in the United States. Health care is a basic need of life, but today the system is flawed and people are dying. In order to save lives, social workers can participate in public demonstrations and exchange ideas in order to change policy.
Michelle, you bring up a good point about the stigma of living with AIDS in our country and internationally. This summer, I will be traveling to China and stumbled upon the list of travel restrictions that are in place for those living with HIV or AIDS. Until recently, China did not allow people to enter the country who were HIV positive and it was not until 2010 when the US removed its entry restrictions for people living with HIV. Today, there are still thirteen countries not allowing those living with HIV to enter their country, with the closest to America being the Bahamas. Even more disheartening, over 20 countries are deporting people living with HIV. These countries perpetuate stigma and discrimination against people living with HIV by singling out HIV as a dangerous disease. This example of structural violence affects individuals and families living with this disease. By restricting mobility, these restrictions may jeopardize individual’s professional career as well as limit his or her access to quality care. This example of structural violence shows how the stigma of those living with HIV or AIDS is present in our society with the policies that are currently in place.
DeleteI appreciate this point of view! We really do need to take a step back and evaluate our own social situation before we an attempt to comprehend what constitutes structural violence. Sometimes it can be something as simple as phrasing that changes the meaning of what we are intending to say! I like the example you give about how China identifies and treats people living with HIV! It is completely dependent on cultural norms and perceptions how stigma is perpetuated!
DeletePART I
ReplyDeleteHunger and poverty are two prime examples of what is described as "structural violence," that is, physical and psychological harm that results from exploitive and unjust social, political and economic systems. An American medical anthropologist and an assistant professor at Harvard Medical School, is recognized for his amazing contributions to the field of anthropology and also finding and also finding and developing a non-profit health organization that provides free treatments to patients, working largely in the third world countries. Farmer has focused primarily on the physical and mental suffering experienced by an individual. This particular article we read by Castro & Farmer really helped me solidify my understanding of Structural Violence. The article narrates the story of a young Haitian man who contracted AIDS in the mid 1990’s. He became very ill and eventually his wife and children had to leave to economic hardships. This young man and his family became the victims of social injustice and violence in Haiti. and that ultimately became the source of their death. The article looks deeply into the everyday structural violence perpetrated by the social forces in Haiti and how the fate and lives of millions of people are affected and suffered by the violence and fierceness of these forces. There is suffering in every part of the world caused by the political violence committed by the authoritarian governments. The article has shed a light on the then ongoing situation in Haiti where oppression and violence was rampant and the Haitians had to live in extreme poverty with fear and under repression.
I agree with the idea that structural violence is more than the actual act of violence. There are other systemic issues that contribute to violence experienced in national and global communities. Hunger and poverty are two factors that i too believe contribute to the act of violence which is ultimately a systemic issue of the world.
DeletePart II
ReplyDeleteThis article showed the stigma and distress of Haitian people who didn’t have access didn’t have access to medical treatment due to factors rooted in social injustice. The people of Haiti live in an extreme poverty and access to health care is quite expensive. Most of the Haitians are associated with agriculture from where they generate very low income. The government health services are in poor condition and lack basic health facilities. These have a direct impact on the population of local people. The lack of awareness is another issue which could be blamed on the governmental policies. Haitians were unaware of this deadly disease until early 1980’s. The economic system of the country also forces the people to take such steps in their lives that could be harmful for them. The writers conclude that suffering through structural and political violence exists everywhere but some factors do not allow them to be reported in an intelligible manner. It is quite daring and difficult job for anthropologists to explain suffering because they haven’t gone through that period themselves and the one who experiences it personally can describe it more efficiently. Farmer and Castro believe structural violence as a conceptual framework for understanding AIDS, related stigma. Every society is shaped by large-scale social forces that together define structural violence. These factors include racism, sexism, political violence, poverty and other social inequalities that are rooted in historical and economic processes that sculpt the distribution and outcome of HIV/AIDS. Structural violence predisposes the human body to pathogenic vulnerability by shaping or risk of infection and also rate of disease progression. Structural violence also determines who access to counseling, diagnostics, and effective therapy for HIV disease. Finally, structural violence determines who suffers from AIDS-related stigma and discrimination.” (Castro & Farmer, p. 54-55) One would think everyone would want to ease the sufferings of individuals who are helpless and hopeless. The idea of “virtuous social cycle” also seems like something everyone would benefit from.
PART III
ReplyDeleteWhen we look back at Samuel in the article the power of the example shows how access to comprehensive AIDS Care” saved Samuel’s life; returning to work and securing school fees for his children has allowed him to surmount some of the miserable conditions faced by the majority of Haitians. (Castro & Farmer p. 56) My current internship has allowed me to see structural violence right here in my own community. I currently have a case load with several young people from the Austin neighborhood in Chicago. By far Austin is one of the most impoverished communities in Chicago. These young people have many risk factors, but the current system in place allows young people very few options. In addition, there is a nationwide crisis where are Cook County Jail, Rikers, and LA County Jail are the largest provider of de facto facilities for the mentally ill in our country today. I am unemployed, I have exhausted my COBRA benefits, I have pre-existing conditions. I think it’s structural violence for healthcare to be tied to employment when the unemployment rate is at close to 12%. I realize during this semester that I have to continue to be an advocate in order to effect change. As I mentioned in my answer to my first question that it may even be a grassroots effort. I will continue to do small things which I have already done this semester. Working for NAMIGC I have attended the mental health summit in Chicago and I am continually writing letters and going to demonstrations in order to stop Illinois from closing half of the state mental health facilities. I have signed petitions, delivered flyers, and spent a lot of time and energy advocating this semester. I will continue to do so because my goal is to be able to relieve suffering just one person at a time. I am so impressed by all the answers to these questions. I must say that I have enjoyed this midterm very much. I have learned so much just from reading all of the answers. I am looking forward to further responses.
1. Structural violence occurs in countries across the world and in the United States. Structural violence is when an individual is harmed physically and mentally because of their poverty, lack of medical access, mental health, ethnicity, and race. To globally fight social workers need to use self-determination. Self-determination is defined “clients’ right to make their own decisions, their right to actively participate in the helping process, and their right to lead a life of their own choosing” (Weick and Pope, 1988). I believe this is true for any impoverish nation even in the United States.
ReplyDeleteIn working at Niles Family Services we started working with young women who were being human trafficked in the U.S. and were getting arrested from local police officers. I believe that this is part of structural violence that has occurred throughout the world. To globally help these women you have to create reintegration programs that help women be part of the program and provide assistance to women who have experienced domestic violence (Stevenson, 2005, p.86). As a social working and given the readings in class I wanted to expand and give these women the freedom to choose what they want to do with their life. I would create education programs that allowed them to get a basic skilled job. By informing them about their freedom and rights this can make these women appear to be less vulnerable (Stevenson, 2005). Given their circumstances they feel that there is no way out well as a social worker, working with this population I believe that they have the right to self-determine and make their own choice about their freedom with the proper resources. As a social worker I believe by using Stevenson’s tools of reintegration adding extra resources can help these women cross-culturally. The only difference when you are working with women that are being human trafficked abroad you have to adjust to the culture and see what resources they may already have for these women.
Susie, you bring up an important point about the perpetuation of structural violence. Structural violence not only seems to be at work when these woman are put in positions of oppression and inequity which increase their risk of being trafficked; the structural violence continues when they are not able to access healthcare, mental health care, and other helpful services in the United States. It is crucial for us as social workers, then, to address these issues wherever we may be practicing. We must pay attention to and work to change the conditions which put people at risk for trafficking while pushing for increased access to services and reintegration programs. I agree with you that it is important for social workers to help women to make their own choices. We must be careful that we are also fighting to dismantle the systems of structural violence which constrain their choices in the first place.
DeletePART 1
ReplyDeleteThe concept of structural violence has been defined by Castro and Farmer (2005) as discriminating large-scale social forces that have historical roots and lead to a cycle of poverty, violence, and stigma (p. 54). Structural violence essentially does not give people the chance to become something different than what they were born into and creates a perpetual cycle that is difficult to stop. While Castro and Farmer (2005) use the example of HIV/AIDS as a form of structural violence, it is evident in other ways such as through poverty resulting in lack of access to nutritious foods and therefore having a negative affect on health (p. 55). Without this access to proper foods the rates of many preventable diseases continue to grow throughout the world. This example of structural violence is also perpetuated by the stigma that makes it even more difficult for individuals to ask for the help that they may need because the stigmas surrounding structural violence perpetuates fear and shame for these people.
In order to change structural violence I think you need to start small and then build up to a larger scale. Structural violence is perpetuated not only by stigma, but by a lack of awareness or education, and as Castro and Farmer (2005) note, a constant sense of victim blaming that puts the responsibility on the victim rather than looking at the larger structural context in which this problem is taking place (p. 57). I think in order to change, social workers need to start at the community level and bring individuals together from the community so that they can begin to understand the injustices that are taking place. This helps to bring awareness and education to that community who may not otherwise understand this concept of structural violence. By starting on the community level we can then begin to branch out to larger macro levels in order to create broader change through awareness and education. Once social workers have brought awareness to a community, it is then important to see what change can take place by advocating for policy changes so that reductions in structural violence can occur. Then I think it can be brought to an even greater level because it can be used as an example of effective change.
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ReplyDeletePART 2
ReplyDeleteIf one community can create change it shows other communities and regions that it is possible to stop this cycle of structural violence and can then create the virtuous social cycle that Castro and Farmer (2005) discuss (p. 56). The virtuous social cycle is where people are connected with resources that they previously did not know were available, and they then in return connect and help with others experiencing the same problems ultimately creating a positive circle of change (Castro and Farmer, 2005, p. 56). I think by starting in one community this would create the virtuous social cycle because it would allow for that community to show others how they can reap the positive benefits of resources as well.
At my first level internship I worked at an agency which helped adults with developmental disabilities obtain jobs, rent their own apartments, and learn day-to-day skills that would allow them to live independently. I would often hear about the difficulties that these adults faced in many areas of their lives, but many of them found it most difficult to obtain a job. Many of them experienced a form of structural violence by being discriminated against because of their disability and the negative stigma that is attached to their disability within our society. As a result of not having a job they were forced to live off of disability and a majority of them lived in poverty. In order to change that stigma we started off with a small group of individuals from the disability community who wanted to create disability awareness at work places on the North Shore. Each individual was paired with a staff member and we worked with these clients on promoting disability awareness by sending letters and speaking in person to local businesses. By assisting these individuals in speaking to the owners of the businesses it not only provided them with skills that they can later use for applying to jobs and interviewing, but it also showed the businesses that these are individuals who are just as valuable of employees as anyone else. It was through these simple acts of awareness that other communities in the area became aware of the project and were interested in not only creating disability awareness, but in hiring adults with disabilities. I think this is a good example of showing how starting small in one community can help build change across many communities. This example of change I think would be effective not only in the United States, but on a global scale as well.
Structural violence impacts health and mental health services internationally in many ways. As Castro and Farmer (2005) describe in their article about HIV and AIDS, structural violence impacts who has access to services as well as determines who suffers stigma and discrimination related to those services. When applied to health and mental health, structural violence acts in the same way. In my own community as well as in communities all over the world, many people lack access to services they need. In addition, many people also suffer stigmatization and discrimination for receiving services or do not seek out services they need because of community perceptions about mental health.
ReplyDeleteIn order to combat structural violence related to health and mental health there are a number of things I would do in my role as a social worker. I would teach people about the detrimental effects of stigmatization as well as help people to understand the need for and nature of health and mental health services. In addition, I would encourage local services providers to continuously research their service areas to make sure that the populations needs are being met and people aren’t being left without much needed services.
In the organization that I work for now, we continuously survey and study our service areas to ensure that our clients as well as other people in the communities do not have any unidentified or unmet needs. In studying our service areas in this way we are constantly modifying our programs to ensure that we are serving our clients as best we can and ultimately, fighting the structural violence that so often effects populations and communities.
Your organization sounds great. I think it is extremely important to study our communities that we serve and find out what basic needs and services are not provided to those in need. In many impoverished communities, individuals do not know that they have access to services. Like you said, Heidi, many people lack access to services they need. My group presented on sex trafficking earlier today and stigmatization as well as sexually transmitted diseases comes into my head in relation to how it affects victims of sex trafficking. A comment was made in the discussion section of our presentation about how some victims of sex trafficking do not realize the services they have available or they may not take advantage of them even if they do know about them because of distrust, threat or problems involved. Some victims fear that they will be discriminated against because they do not understand that they are the victim. In a way, sex trafficking victims and the individuals described in the Castro and Farmer article are both restricted access to mental and health services which they need and are fearful of discimination. For example, a victim of sex trafficking could have contracted AIDS from one of the many individuals that they are forced to sleep with and do not have access to health services so they become sicker every day and spread the virus. I think it is important for us as social workers to find ways to help the various communities and victims that need aid and to help educate them on the importance of the resources can be provided to them.
DeleteStructural violence, as defined by Castro and Farmer in Understanding and Addressing AIDS Related Stigma (2005), are social forces including racism, sexism, classism, political violence, and poverty that are embedded within historical and economic systems. This is manifested in health and mental health services as the lack of or limited access to medical services readily available in other communities. Health discrepancies are exacerbated by the bias that providing high standards of care to those who cannot ‘afford’ it is not a positive cost benefit. Thus, a monetary value is placed on the treatment of life due to limited resources and access and not as a human rights issue. As a way to address these discrepancies, Farmer (Pathologies of Power, 2003) states the need to consider a biosocial modality when addressing structural violence; placing medical needs within the framework of social factors that prevent or limit medical access.
ReplyDeleteSocial workers are posed to address structure violence on several planes, however must acknowledge the need to work within its constraints. At the micro level, social workers can serve as an intermediary between medical professionals and clients, as an avenue for additional resources, reliable medical information, and as an advocate for further change. Social aspects of illnesses can be addressed through acknowledging the barriers to receiving or continuing medical attention including access to nutritious foods, reliable transportation, childcare, and healthy living environments, to name a few.
At mezzo and macro levels the key is to create enclaves within communities that address the aforementioned concerns. To accomplish this, social workers and their organizations can identify like minded agencies and practitioners within the community who address health concerns from a variety of perspectives. Rather than working in isolation, organizations can work in partnership to reduce duplicated services, better focus resources, and address issues on a broader scale. An integrated approach to health care with documented results would substantiate the feasibility and potential long-term economic benefits of this type of approach, thus encouraging replication on a larger scale.
Lisa,
DeleteI really enjoyed reading your opinion to the question. It's very nice that you share your ideas and you are talking about micro, mezzo and macro levels. As social workers we all need to look about some problems solving very broadly. Also talking about work in medicine I agree with you that social worker role could be as a mediator between medical professionals and clients because to get better understanding for each other. And the last thing it's very good that you touch economic and medical discourses.
As discussed in class, structural violence occurs when populations of people do not have access to services and care (class discussion, February 9 2012). This limited access can be due to a variety of factors including availability, affordability, and stigma. Stigma is the main barrier focused on in Castro and Farmers article about AIDS (2005). They describe stigma as a barrier, not only in wealthy nations but also in developing countries. It can hinder access to counseling and testing services. Cost of services is also considered an obstacle to needed care. The end result is that people who lack resources succumb to illness that they wouldn’t have if they had been able to get the care they needed (class discussion, February 9 2012). This structural violence is a vicious cycle that social workers can help break.
ReplyDeleteAs a social worker engaging with individuals who have, currently are or will be involved in the legal system, I observe structural violence almost daily. This structural violence is clearly apparent in the mental health and health services. Working with Mexican-American, gang involved, teenage boys to get much needed mental health services takes three months and dozens of phone calls. Assisting a recently released man in receiving affordable medical attention involves many favors to be called in and a financial pot collected in the office to fund his prescriptions. If the system is this bad for those with social workers and an entire legal team on their side, it is safe to say it is nearly impossible for those who are going at it alone. As discussed in class, social workers can battle structural violence in a variety of ways. Social workers can help people hook up with the resources they need and don’t currently have. They can also beneficially restructure recovery, in which they help those in need make it to the resources they require. But most important, especially on a global scale, social workers can fight to turn stigmas around. Castro and Farmer (2005) view stigma as the main contributing factor to structural violence. As such, allowing others to see beyond the stigma and stop blaming the victim would encourage those in need to seek out services.
Castro and Farmer suggest other ways of helping to change structural violence in a global way. One suggestion is to provide effective therapy for the issue, this can help diminish stigma that these patients are facing (Castro and Farmer, 2005). Another suggested approach is to provide education and sensitivity training to help people see beyond the stigma to the person with the disorder. This would be especially effective if you are able to change the beliefs of groups in power. All of these suggestions can be used in both a local and global context. By changing the outlook on a stigma, we can affect structural violence worldwide.
In this community, the City of Chicago, social workers can have an impact on structural violence by providing assistance and helping direct those in need towards the services they require. Stigma is a discrimination of human rights and requires change (Castro & Farmer, 2005). By changing stigmas in a positive way and making care more accessible, social workers can have a global impact on changing structural violence for the better.
I've always regarded changing stigma as a key element in my role as a social worker and as a peacemaker. It is so important to be as intentional as possible by helping others to think outside of stigma attached to any person or issue. Change can come when people are able to see themselves as important and individual, not just attached to a certain stereotype or to a stigma that comes with whatever it is that they are experiencing.
DeleteThe way in which we understand structural violence in the context of our class setting has been defined as illness due to lack of medical care due to poverty. When approached from a different framework, we can see structural violence play out in a number of different ways, for example gender based violence or race and ethnic inequalities that are institutionalized and perpetuated through policies, legislation or other social and economic means of control. As Farmer and Castro argue, structural violence limits access to health care, and perpetuates stigma associated seeking mental and physical health services. At an international level, idealized “globalized” health care continues to perpetuate structural violence in that not every has equal access to health care. What is considered preventable in one community is life threatening in another.
ReplyDeleteAs social workers, before we broaden our reach, we need to look at our local communities to understand what really constitutes structural violence. What we consider “healthcare disparities” is actually structural violence in our own communities. International social workers run the risk of underemphasizing the severity of local “healthcare disparities” in order to successfully emphasize the more obvious (and more shocking) elements of structural violence as they occur internationally.
To truly impact this issue globally, it is important to understand that our own perceptions can skew the language we use to discuss disparities in society. We must also understand that stigma as described by Farmer and Castro does not necessarily lead to lack of health care; it is dependent on community values. For example, in Malawi*, the stigma associated with HIV/AIDS status leads community members to gossip. The gossip alienates people, forcing them to seek medical treatment, or become outcasts in their communities. Without the stigma associated with gossip, individuals would continue to neglect their health care needs. While this example is not the norm, it is critical for international social workers to not overgeneralize the implications of stigma as exclusively negative.
If we start here, as social workers, it will be easier to engage others in our goal to end inequality in mental and general health care services.
(*Reference from This American Life radio show episode Gossip airing August 25, 2011)
I think you make an excellent point about stigma having a motivating effect on the individual. It seems counterintuitive, yet at the same time, it makes sense.
DeleteTo me, I still think stigma is negative and has negative repercussions; however, stigma can be reframed from a negative situation for an individual into a positive and motivating event. Which is what we try to do in therapy- help clients see their situation and circumstances differently and empower them to address their issues and advocate for themselves.
Structural violence affects people locally as well as globally. We in the United States may not call it structural violence or may view it as system failure; however, it is important to acknowledge that we as a society are both passively and actively disenfranchising people in need of health and mental health services on macro and meso levels. Castro and Farmer (2005) referred to structural violence as social forces, steeped in history, that affect individuals and community that perpetuates violence or aggression towards marginalized groups. This can be in the form of poverty, lack of education, stigma, and violence against women, to name a few. Simply put, social structures, both formal and informal, contribute to the oppression of and marginalizing of certain groups. As social workers, we are a part of this oppressive structure and are forced to work within it; we should acknowledge this. It is imperative that we as providers address the systemic issues while simultaneous addressing the needs of our clients.
ReplyDeleteIn class, we specifically discussed how structural violence influences health care services. This influence can be seen at a local level in Chicago communities, not just globally. For example, Castro and Farmer discuss HIV/AIDS care and how stigma prevents individuals from access care. This stigma affects one’s social standing, and in the article, one man lost his family, his job, and his life due to his diagnosis. This situation is not unique to Haiti or Uganda or India- access to health and stigma related to diagnosis affects individuals in Chicago. In Chicago, HIV is often associated with being minority, low-income, at-risk-of-homelessness, and individuals most likely have mental health and/or substance abuse issues. Being an individual dealing with multiple issues that are stigmatized greatly affects the individual physically, emotionally, and spiritually. It perpetuates the cycle and prevents individuals from accessing the care and services they need.
We as providers need to address these issues, and broaden our view of community. We need to look at addressing policy changes; confront stereotypes of HIV/AIDS and those who are affected by it; broaden our view of health to include individual and communal health; educate individuals about health and healthcare issues as well as the community about the myths and stereotypes of HIV/AIDS; we need to simultaneously address prevention issues and intervention issues. As Martin Luther King, Jr. once said, “injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.” What happens locally is often a symptom of larger systemic issues that will continue to directly harm individuals and our community.
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DeleteHeather Markey very clearly outlined the situation in the region, and also gave a robust assessment of what is happening. She also pointed to concrete steps to address. Quote from Martin Luther King's best shows the problem and motivate to improve the situation for the better. I think that Heather Markey has great the makings and she will be strong and courageous social worker.
DeleteThe forces that Castro & Farmer (2005) put forth as the causes of structural violence are all forms of inequality - racism, sexism, poverty - and we see right here in Chicago how apt the term structural violence is. So often, we see homeless individuals in wheelchairs - and whether the disability is a result of lack of health care access, or the aftereffects of disability have led to poverty, the truth is that there are people right here in our own country who have been displaced and dismembered by structural violence. Castro & Farmer point out that poverty is a nearly universal stigma, and that other inequalities, with their own associated stigmas, play into it. Indeed, it does seem a vicious cycle - someone with existing access issues related to poverty might become disabled from lack of treatment, and these disabilities then add another stigma to the mix, plunging the person further into poverty.
ReplyDeleteWe see in Castro & Farmer how necessary it is to recognize the variables that contribute to structural violence; the sequence of events is not uniform across populations affected by structural violence, but it is important to understand patterns and create strategies with the reduction of harm in mind. In many instances this is an issue of access; structures are in place to provide low-cost care, but the assumption persists that the cost of medical and mental heath treatment is prohibitive without insurance, and the reality exists that some necessary treatments come at a high cost even with all but the very best coverage. This is a concern that needs to be addressed at the government level; however, what we can do at the community level is provide education about what resources are available, and how to navigate them for maximum benefit. Furthermore, the needs of individuals already impacted by disease and disability need to be addressed at the community level; disability payments do not cover the cost of living even for a healthy person, let alone for a person with additional daily living costs that result from disability. Community resources can link these individuals with employment opportunities by reaching out to local employers, as well as locating low-cost, accessible housing and nearby service providers.
I believe that local actions have global effects. Such local actions can include the conceptualization of problems as well as policy formation. In class, we discussed the use of the term “structural violence” as it pertains to developing countries, and “health disparities” as it pertains to the United States. I believe that a reconceptualization of the issue of health disparities here at home could have global effects.
ReplyDeleteCastro and Farmer (2005) use the example of HIV/AIDS in Haiti to demonstrate how a lack of access to treatment affects stigmatization. In the US, HIV/AIDS rates remain high in certain populations, specifically low-income and minority populations. Human Rights Watch (2011) reported that Mississippi has one of the highest AIDS rates in the US, and the rate of treatment is equivalent to Botswana, Ethiopia and Rwanda. Mississippi fails to educate the public about effective HIV prevention, and provides little to no funding (nor does it accept its full allotment of federal funding) for treatment, testing, or housing for those living with HIV and AIDS (Human Rights Watch, 2011). Men who have sex with men and contract HIV have the added stigma of their sexual orientation, while being the population most at risk in the US of contracting HIV. Because of the added stigma and disinterest in disclosing their sexual orientation or HIV status, men who have sex with men are less likely to get HIV treatment when necessary (Human Rights Watch, 2011). The “health disparities” that exist in Mississippi are similar to other parts of the country where low-income and minority populations lack access to effect prevention, education, and treatment.
If these health disparities are treated as human rights abuses, the ensuing policies could have a positive impact by lessening HIV contraction rates and increasing treatment rates throughout the country. And because of the United States' role in global policy making, an awareness of the low levels of treatment and high levels of stigma here in the US could lead to more open discussions internationally about how to effectively combat the spread of infectious diseases.
Reference:
Human Rights Watch. (2011). US: Mississippi Policies Fuel HIV Epidemic. Retrieved from http://www.hrw.org/news/2011/03/09/us-mississippi-policies-fuel-hiv-epidemic.
Initially it was very difficult for me to conceptualize how one person may change the natural of structural violence, as it is a concept that is so pervasive it was overwhelming to think of how it may be solved. After some thought, I believe that raising awareness about structural violence may turn out to be a viable start to have a positive impact on global structural violence. Farmer (1996) wrote that “the suffering of the world's poor intrudes only rarely into the consciousness of the affluent, even
ReplyDeletewhen our affluence may be shown to have direct relation to their suffering”. I think this statement helped give me confidence in my earlier conclusion. I think that if people had a true, deep understanding of the kinds of structural violence going on in the global community today, they may be more inclined to get involved.
When thinking about raising awareness about structural violence, rather than jumping straight to solving the issue itself, it became easier for me to think of ways how I as a social worker could impact this issue. A good start to tackling this issue would be to begin raising awareness in my community, making information about this phenomenon more accessible to the public. Ideally if my methods of raising awareness were successful, other members of my community would be wanting to get active. Now as a community I believe that it would be possible to achieve tangible results. One person can start raising awareness, but it’s difficult to achieve great change without the help of others, so as a community I think that we could band together to start making a difference in the system to stop structural violence.
Gabrielle, I had the same initial reaction to the issue of structural violence. The more I thought about it the more I realized how so many of the institutions in the world perpetuate this issue. I think that knowledge is a powerful tool and when people are able to have a better understanding of structural violence, especially as it exists in their own communities, it becomes harder to ignore. People tend to get involved when an issue strikes close to home and I think your ideas of how to tackle this very challenging issue are an excellent place to start.
DeleteHi Heidi!
DeleteThanks for your feedback :) It's nice to know I wasn't the only one who was initially struggling with the idea of taking on structural violence. I also appreciated your validation on where I thought it might be best to get started. I wasn't sure if the idea was too simple, but I suppose if I think about it, even simple ideas can bring change if there are people dedicated to making it happen!
The intentional community I belong to is a part of a larger community effort trying to address the upcoming NATO/G8 rally in May. Specifically, we have been engaging in conversations about how we, as social workers, counselors, and social justice practitioners, can use this rally as an opportunity to educate people about the ways that these organizations have both local and global impacts. While much of the information around that rally focuses on the possible violence of protestors, we have been trying to educate ourselves on the impacts of these two groups worldwide and to connect with organizations who are working to help those impacted by their policies.
ReplyDeleteAnother type of work we do focuses on connecting the local and global impacts of the criminal justice and carceral systems in the US and US foreign policy. Last year, we held several events that tied together the John Burge trials on the use of torture by Chicago police officers with the torture and mistreatment of prisoners in Guantanamo Bay, Abu Ghraib, and other prisons operated by US military forces.
I think that structural violence is a new notion for many people (myself included) and taking action first requires getting comfortable with opposing or addressing some very big systems in our society. A social worker must be comfortable with conflict and with risk in order to impact structural violence.
I think it also requires asking questions about what you are told about how something works. For example, in the article on AIDS in Haiti, Paul Farmer and his colleagues had to ask “Does stigma around AIDS really seem to be what is keeping people from coming in to see us?” “What are other explanations?” “Who benefits from the system as it currently works? Who would benefit from making it better?” These are all tough questions but social workers are often in a great position to ask them.
In order to impact health and mental health systems in a structural way, I think social workers could work cross-culturally and globally to publicize the ways that health systems often keep ill people from being recognized as full members of a society. I think of the global phenomenon of institution or incarceration of the mentally ill or the many deplorable conditions that elders in our society live in, both in the US and abroad. Perhaps a media campaign through the UN or another international body publicizing the resource disparities and suffering of people with mental health issues globally would help generate some new ideas for models of care which then could be publicized and replicated around the globe.
Cat, you bring up an interesting point regarding the need to be comfortable with conflict and risk in reference to structural violence. Farmer, in several of his other writings, discusses the need for the developed world to reconsider their approach towards diseases like TB and HIV/AIDS. He has upset the status quo by refuting that it is too expensive to provide adequate treatment to people living in poverty. I agree with you that it require us to shift traditionally held perceptions and to continually question standards of practice. While the resulting conflict, both internal and external, may not be comfortable, it may be the only way to continually challenge structural violence, at local and global levels.
DeleteStructural violence is a term ascribed to Johan Galtung. It refers to a form of violence where some social structure or social institution purportedly harms people by preventing them from meeting their basic needs. Structural violence and direct violence are said to be highly interdependent, including family violence, racial violence, hate crimes, terrorism, genocide, and war.
ReplyDeleteWhile reading Pham, Weinstein and Longman article “Trauma and PTSD symptoms in Rwanda” I thought about my grand parents who exiled to Siberia in 1942. They had to leave Lithuania and all property, relatives, work and daily life. Just been exiled to nowhere. Because they were young and strong, they returned to Lithuania and created a new life from the beginning. When the Soviets attacked the capital in January 1991, grandmother wept and was convinced that the war started. Grandparents were afraid to tell their experiences of anguish, starvation, slave labor. In Lithuania we have many examples of repression that have been granted at least the minimum support. Lithuania there is a great lack of services for former soldiers, affected domestic violence, victims of discrimination and so on.
As a social worker in my community I would start talking with people about the violence. I speak not only about physical violence in the environment but also about psychological violence in society, in press, discrimination based on age, sex, sexual orientation. The more person knows that his/her views will be wider, he/she will adopt other person's differences. I am glad that the Parliament passed a law in December 2011 "Protection from violence in closest (nearly related) environment". When the law entered into force it has increased of people who apply for assistance. People are beginning to realize that this is not just a "family business", perhaps many years, having suffered violence, they are looking for help, because there are legal grounds for them to defend.
Every year in the world, more than 1.6 million people become victims of violence; murdered in armed conflicts, criminal activities, and domestic violence." The World Health Organization defines violence as: The intentional use of physical force or power, or as a real threat, directed against himself, against another person, group or community, which results in (or has a high probability of it) bodily injury, death, psychological trauma, developmental disorders, or various kinds of damage. In addition, according to the World Health Organization (WHO), millions more are injured and maimed.
ReplyDeleteViolence thrives in the absence of democracy, respect for human rights and good governance. To arrive at this conclusion, we often talk about how the "culture of violence" can take root.
Many people believe that only adults have problems, evoke violence and aggression, and thus forget about the fact that the child - is also a living creature, and, therefore, may also feel.
A child can observe what is happening in the world, particularly in the family, begins to remember and in the future, display this style of behavior. Parents set the example for us and no matter what, we start doing whatever we have been asked to do. Just like when my mother said that if I do sports, I will be as strong as my father and my father, in turn, insisted that the proper training and attitude will bring to her knowledge and a developed mind, like a mother. Therefore, getting used to quickly solve problems with physical violence, quarrels, the use of psychological abuse, the child thinks it is quite acceptable. After all, parents do so, then the copy their work will bear fruit, and their praise.
Structural Violence is defined by Castro and Farmer in “Understanding and addressing Aids-Related Stigma: From Anthropological Theory to Clinical Practice in Haiti” as social forces such as “racism, sexism, political violence, poverty, and other inequalities that are rooted in historical and economic processes that script the distribution and outcome” of a illness (p. 55-56).
On the other hand, 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.
Structural violence, however, is almost always invisible, embedded in ubiquitous social structures, normalized by stable institutions and regular experience.
How the violence can be prevented? Cooperation and information sharing at the global level can produce a large positive effect - the same as cooperation at the national and local levels. We can illustrate an example as the international fight against AIDS and cooperation in emergency situations.
Iana,
DeleteI agree with you, that in many areas of our life there are many types of violence. Also I agree that not only adults experience the violence but also children. And also I believe that dialogue is a superior way to do any changes, but for my its is difficult to understand for what reason You written that many people believe that only adults have problems, evoke violence and aggression? I can't agree with you in this sense because we have many examples that adults want to understand children and whole them problems. I think that many campaigns are organizing to support children in all world and it is the good reason to believe that many people understand children's and want to help them or not?
I have not a lot of practise in social work so my discource about this and other questions will be more theoretically way. I will share with you my founds about structual violence in articles during this course.
ReplyDeleteHealth and welfare in the ongoing negotiations between the means of social structures and personal life. Since most women in the study noted participant external, to achieve the objectives of social and mental health issues, they also realized that mental health is inseparable from the concept of personal well-being of perception and experience, which is related to concerns with identity, goals, ability to take care and development. Mental health is not only a collision with a number of objectively defined criteria, it will also include a relationship with the social environment have taken on a number of social roles, as well as the ability to maneuver between the personal and social needs of the environment, as well as the ability to achieve their goals, not socially acceptable ideals (Wong, Tsang, 2004). By social psychology perspectives stigmatization interpreted through cognitive processes that promote stereotype and tags gluing. Also, a lot of psychological research focuses on individual perception, paying attention to broader social phenomena, the perception will occur. Many psychological studies discuss the wholesale lack of unadvised and negative perceptions of stigmatization (Castro, Farmer, 2005). Structural violence, a term describes social structures—economic, political, legal, religious, and cultural—that stop individuals, groups, and societies from reaching their full potential. In its general usage, the word violence often conveys a physical image; however, it is the “avoidable impairment of fundamental human needs or…the impairment of human life, which lowers the actual degree to which someone is able to meet their needs below that which would otherwise be possible”. Structural violence is often embedded in longstanding “ubiquitous social structures, normalized by stable institutions and regular experience”. Because they seem so ordinary in our ways of understanding the world, they appear almost invisible. Disparate access to resources, political power, education, health care, and legal standing are just a few examples. The idea of structural violence is linked very closely to social injustice and the social machinery of oppression (Farmer, Nizeye, Stulac, Keshavjee, 2006).
Ukraine is a country with a most rapid spread of HIV infections. The public and the media are actively promoting the rejection of drugs, healthy lifestyles and so on.
ReplyDeleteAnd this is the result. The youth of today has revised his views on doping and drugs and more and more people every day give up drugs, starting treatment for addiction. But even after a person has decided to give up drugs,begin a new start and maintain a healthy lifestyle - this is not the end of the horror.
In society there are many stereotypes about HIV-infected people. And most people are afraid of them and try to protect themselves and their children from contact with such people. So these people are isolated in society. People even ignoring not only the HIV-people, but also their friends and relatives, since they think that they too may be infected. So most HIV positive people carefully conceal their diagnosis, so as not to be an outcast.
I heard about a woman who worked at the hospital and during an operation was accidentally exposed to HIV positive blood, and as a result contracted AIDS. After this her colleagues pushed her to resign, they were strongly offended and humiliated her. The woman had to resign, but then she has devoted her life to helping people with AIDS. This example shows that no matter how advanced society may be in other areas - there are specific issues which even mature adults need to be taught from scratch.
At this time, Ukraine has a lot of shelters for children with the HIV infection, which has created special conditions and care. Many monasteries and churches on the donations of the faithful arrange shelters for such children by themselves and care for them. But unfortunately there is a worse situation for HIV positive adults. They are in the hospital, and they are sorely lacking money for medical treatment. The state allocates almost no money. Occasionally inappropriate behaviors from patients occur, and they attack the hospital staff. The police do not react to it, as they too are afraid of becoming infected. But at the same time, more and more rich people donate money to the fund to fight AIDS, more and more volunteers are willing to help people with HIV. This occurs due to large public advocacy.
I think this propaganda needs to continue, you need to convince people of the need for patient care, the need for both care and services. First of all, they need material support, but also to a greater extent alerting their community with the knowledge that these people do not carry any risk, and that, they too, are entitled to a full life.
When I hear any discussion about structural violence in mental health care, I always start to think about human rights. In my opinion, mental health care institution is a place where human rights are so often violated. As I remember my own experience of practice in psychiatric hospital, people with mental disabilities were considered as persons who cannot decide nothing about their treatment, who does not understand anything and who are not able to do any decisions related with their treatment strategy, their own life. In mental health care system in Lithuania, professionals of medical care strongly believe in power of medicine, but with this, they consider social welfare as not so important as medicine, so, in my opinion, this approach of the professionals strengthens the stigma of people with mental diseases. This paternalistic model, when professionals think, that they know best what the patient needs, is further practiced in Lithuania, so social workers should do something to turn this paternalistic model into holistic model, in which biological, psychological, social and other fields of a person life is equally important and interdependent.
ReplyDeleteIn the article of Burns “Mental health and inequity: A human rights approach to inequality, discrimination, and mental disability” (2009), the author is talking about human rights approach. It is said in the article, that people with mental disabilities experience the violation of their rights in many levels of health care policy- they cannot get the services they need, and even funding of mental health care is very low. So social workers, in my opinion, should concentrate their efforts in changing and creating the legislation, related with the rights of people with mental disabilities. Social worker should initiate the projects of laws, that would help to implement the right of people with mental disabilities. Of course, social worker in this process can invoke international documents, for example, as I found in Burns article, United Nations Convention on the Rights of Persons with Disabilities, where it is said, that our approach about people with mental disease should change “ from viewing persons with disabilities as “objects” of charity, medical treatment and social protection towards viewing [them] as “subjects” with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent as well as being active members of society”. Furthermore, I believe, if the efforts of social worker does not work efficiently, social worker also should develop the international collaboration among agencies that are representing the rights of people with mental diseases. It is important to share experiences in international level. (Indre)
Reading through your post regarding access to mental health care in Lithuania and across the boarders into other nations instills in my mind a need not only for reform nationally but internationally as you pointed out at the end of your statement. Those who suffer from mental illness are often misunderstood, under treated and the ability for them to stand up for themselves can often be difficult. Thus, I agree that the social worker should work collaboratively with the individual (their client) in providing the best, most appropriate access to the mental health treatment necessary for them. This begins with the social worker but takes the power of nations to create global change in understanding and protecting those who suffer from mental illness.
DeleteWhen thinking of issues among structural violence, I like to consider it on a macro level and how institutionalized oppression contributes to the violence experienced in our nation and internationally. The idea of structural violence, itself suggests there are various assemblies that contribute to the violence. The fact that many people are denied their basic human rights and liberties appalls me and I believe that much of the violence is due to a lack of resources, poverty and a lack of education. According to Healy (2008) everyone is entitled to his or her basic human rights. These rights are not something that is earned or should be withheld from particular groups of people. In order to address the major issues of structural and global violence, as social workers we have to investigate the grass roots. Exploring the foundation to our populations concerns is part of meeting them where they are.
ReplyDeleteMy vested interest is working with children. The article by Garbarino, Bradshaw and Vorassi (2002) on the effects of gun violence on youth really grabbed my attention because it broke down many underlying concepts that contribute to the macro issue. In this article the authors break down risks factors of violence stemming from community and education oppression to media exposure. These systems of oppression generally result in participation in “high risk’ behaviors as well as uncontrolled emotional and psychological adaptations such as hopelessness and desensitization to violence. So as social workers I think that we must advocate globally for a more just and effective community resources that are purposeful to the populations within these communities. Once we tackle and improved the smaller systems, then we can grow and impact the greater issue of structural violence.
The root of structural violence can be explained by a stigmatic essentialization. Stigma is often noted as a negative label; it is thought of as being shameful and often times connected to the concept of mental disorder (class discussion, February 23, 2012). As Wong and Tsang (2004) define essentialization, it “is the reduction of the varied, multiple identities and characteristics of members of the group to a singular essential quality that they are all assumed to share, such as ethnicity.” In short, it is the generalization of a cultural group. These two definitions work together to demonstrate structural violence that occurs in other countries. For example, in Rwanda, structural violence was spawned from many political issues that surrounded the Hutus and Tutsis. The genocide that happened in Rwanda was caused by a stigmatic essentialization, or a shameful generalization of the two cultural groups.
ReplyDeleteAs a social worker in my field placement, I work birth mothers who are either voluntarily or involuntarily terminating their parental rights to their children. I have found that these birth mothers are often stigmatized by their particular lifestyles. Most of the birth mothers have been or are on illegal substances, which cause them to have health and mental health issues. These birth mothers generally do not access to those resources that are needed in order for them to get better and/or get custody of their children. This situation does not just happen in my field placement; it, unfortunately, happens in many cultures. It is up to the governmental body to supply the resources that birth mothers need and require, but often times, so many of those resources go overlooked by the governmental bodies. As a social worker, I would advocate for those birth mothers at my agency to have access to specific resources. In a global context, I would recommend and advocate for every adoption agency (national and international) to provide birth mothers with access to resources that will benefit and aid the well-being of the birth mother.
According to Castro and Farmer (2005) article “Understanding and Addressing AIDS-Related Stigma: from Anthropological Theory to Clinical Practice in Haiti” structural violence generates the social inequalities in which stigma is invariably rooted. Researches conceptualize when stigma exists: 1) when people distinguish and label human differences, 2) dominant cultural beliefs link labeled persons to undesirable characteristics – to negative stereotypes, 3) labeled persons are placed in distinct categories so as to accomplish some degree of separation of “us” from “them”, 4) labeled persons experience status loss and discrimination that lead to unequal outcomes, 5) stigmatization is entirely contingent on access to social, economic, and political power that allows the identification of differentness, the construction of stereotypes, etc. (Castro, Farmer, 2005) This definition can explain how stigmatization damage people who are vulnerable because of AIDS or HIV. Labeling people who need help, treatment is normal in Lithuania. Such a situation reveals how it damage social justice in community. Another view based on Castro and Farmer is that “every society is shaped by large-scale social forces that together define structural violence. These forces include racism, sexism, political violence, poverty, and other social inequalities that are rooted in historical and economical processes that sculpt the distribution and outcome of HIV/AIDS.” It shows that social worker should seek to work not only with the main problem (for example, HIV/AIDS prevention) but also with forces which related to HIV/AIDS. Prevention could be one of the part working with this problem in community. Another idea, which was mentioned in this article, is people who living with HIV could be integrate into workplaces of community health program. In my opinion, integration could be the main goal of working with such a problem in the community.
ReplyDelete“Structural violence” term was used by J. Galtung in 1960s. He is talking that structural
ReplyDeleteviolence “refers to a form of violence where some social structure or social institution purportedly harms people by preventing them from meeting their basic needs”. Structural violence consists of classism, racism, nationalism, sexism, terrorism, genocide and war. Another author Paul Farmer makes out “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”. As we can see structural violence is around all world and individuals who are suffering from structural violence cannot do anything to get under control the circumstance that have caused their suffering. The worst thing is that structure violence is always unseen, normalized by state institutions and regular experience.
In the article „Trauma and ptsd symptoms in Rwanda“ Pham and others are talking about structural violence which brings away many lives and after that people cannot trust in law enforcement and other goverment institutions also they do not believe in community and non-violence. What helps for these peoples? In this case here contributed the local court system. People can support the gacaca authority because they feltmore informed and involved in the process. That way people felt that they could have more control over the result. Citizens also felt involved and even sommited to this institution because it was based on community.
Reducing structure violence there can help voluntary organizations or like in Kuwait women’s associations which motivates to talk aloud about woman problems and encourage people for some changes (“Sex and violence: social reactions to economic restructuring in Kuwait”). In my opinion as a social worker seeing the real situation it is necessary to initiate legislation and to notice marginalized groups which the help needs most. In this case the most importance is prevention, that means not to let happens such a horrible things. Also we as social worker must try to vouch for people whom are needed health and mental health services are available.
According Castro& Famer structural violence includes racism, sexism, political violence, poverty and other inequality”. A. Žukauskaitė (2006) says that violence is physical or emotional harmful, the goal off harmful is to squeeze person freedom. Violence often is related with ones power against other. Talking about structural violence we face with another conception – stigmatization. Stigmatization can be explained as inequality. In Lithuania is a movie, which very clear shows stigmatization and inequality. In that movie women who is gipsy and addicted drugs, want go to hospital for rehabilitation. But the specialist doesn’t except her. Later social worker from social services organization tries to help her. But hospital worker don’t want expert her as well, they tell that she need more documents. But finally after some days because of hard social work proving the women is in hospital and gets treatment. In this case we can see that a woman was stigmatized because she was gipsy and addicted drugs. But we can blame workers whose didn’t want to accept her. In article Castro& Famer state, if we want better social services we should look at social worker’s psychological shape and also make better conditions. I total agree with this opinion. I think also this idea is useful and for others social worker areas, not only working with AIDS.
ReplyDeleteNext in my opinion trying to lower structural violence social worker who is working in micro, mezzo, and macro level should try more talk about this problem. Working with violence in global perspective is important prevention and information. I think usually society thinks violence see as a problem in family, than men abuse his child or wife. Social workers should speak that violence exist not only in micro level, but in global contest and in differences way. We social workers should to make this problem lower collectively.
Dovile Lapinskyte
The nature of structural violence are the stigma, discrimination related with gender, age, racism, mental and physical health, social status and so on. More information about the nature of structural violence we can find in the J. Gilligan book (1997), Castro and Farmer article (2005). In 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.
ReplyDeleteStructural violence has affected health care availability in the sense that physicians need to pay attention to large-scale social forces 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.
Now we can understand the nature of structural violence and only now I can start to think about my role as social worker to solving this problem not only in local but also in the international perspective.
In my opinions to solving problems of structural violence in local fields are important to realize that structural violence will not disappear any where if into the community and society will still exist social inequality, racism, stigma. So first of all I could to reduce inequalities in society in different field. For example: I work in Lithuania in NGO and support single mothers ant their children, so I can to inform the public about positive work experience with them, thus improving public attitudes to single mothers. Al so I can preparer some programs which can help my develop activities to mitigate social exclusion and so on. After some time, I can involved more and more people which can help me to work towards reducing inequalities in the community, city or country. And I think that step be step me social work in local region could have an impact on this problem in a global perspective.
Inga
Structural violence is when social institutions do not provide the access to beneficial services they actually are able to provide. Institutionalized discrimination could prevent people from reaching basic needs. This leads to effects on health and mental health services. For example, the stigma and discrimination associated with the AIDS epidemic are rooted in social inequalities; if we introduced quality HIV care, the stigma would be reduced (Castro & Farmer, 2005). When society labels people, they often ascribe negative stereotypes when it is not the dominant culture. This negative labeling leads to status loss, which then explains why stigma is based on access to services (Castro & Farmer, 2005). It does not seem justifiable to impose stigma on a group of people who might not get tested for an illness because there is no available care anyway. Another example of structural violence is the harmful military practices in Vieques, Puerto Rico. Bombing led to increased psychological stress and higher rate of health problems due to the contamination and environmental degradation (Torres, 2005).
ReplyDeleteAmong the aspects of community health education is fostering high levels of community participation (Torres, 2005). Castro and Farmer (2005) noted the need of all community health workers to join together to reach the most vulnerable areas for HIV prevention and care. In the United States, minority cultures, such as Hispanic/Latino, have difficulty accessing a plethora of services as a non-citizen. Access to citizenship is unequal and difficult, so they are not provided with equal opportunity for care, resulting in discrimination. As a social worker, I could advocate for this population in achieving citizenship by talking to government officials, which would be acting locally within a global perspective for another culture. In the neighborhood of my internship, there is a food desert. Residents do not have access to healthy food nearby, and as a result, have illnesses that would easily be manageable if given access to fresh food. The community also has a high rate of poverty, so it is more difficult for them to get affordable health care. Therefore, the residents in this neighborhood are stigmatized. As a social worker in my neighborhood, I could begin by advocating for the community residents to speak, such as signing a petition. Community meetings could inform them of the similar problems that occur internationally and prevent groups of people from receiving adequate care. Social and psychological change needs to happen at the grassroots level, in addition to awareness (Maoz, 2004). Involving other people in the arts and religion to raise awareness about our community’s issue would help spread the message to the public in a relatable manner (Torres, 2005). If we are able to provide access to fresh food in a local neighborhood, it may cause more to be aware of the global issue of structural violence. Stigma could be slowly reduced when health problems decrease.
Structural Violence is when a country or any governing system denies people basic human rights due to inequalities embedded within the system. This is demonstrated through “classism, racism, sexism, and other social inequalities rooted in historical processes” (Castro and Farmer, 2005). The inequalities in healthcare and mental health services are affected by structural violence. Throughout history, there have been stereotypes about those with mental illnesses: those with a condition such as schizophrenia or bipolar disorder are dangerous and should be avoided. They have also been denied access to necessary mental health services which would make them productive societal members, rooted in classism. A more recent example is the stigma of war veterans returning to the United States. Many will be facing Post-Traumatic Stress Disorder from combat stress, but access to mental health services will be difficult because of classism, and many veterans are denied benefits to help them. Regarding health, stigmas such as racism and sexism make accessing even basic healthcare difficult to do at best, and for many near impossible. Poverty is another great stigma many face in accessing health and mental health care: even though in America we technically allow healthcare for all, the quality of it goes lower depending on one’s income. Low-income citizens can have Medicare and Medicaid, but the quality of services are often questionable at best. Worse, these services are always facing cutbacks because many legislatures believe these services are an unnecessary tax burden on citizens. Many of those who rely on Medicare and Medicaid are non-whites from poverty-stricken communities who have no access to other forms of care. These cuts and threats in cuts demonstrate a reinforcement of structural violence through classism and racism.
ReplyDeleteAs a social worker, I could advocate for this population in achieving citizenship by speaking with community members to raise awareness of this disparity in health and mental health services. By educating community members on this disparity, I can raise awareness of the situation and engage community members in critical thought over how they are oppressed and what they can do to regain their rights. As Torres (2005) explained in her article, education is one of the key components in community involvement. Doing so will also encourage the community to become proactive and provide them with a voice of their own. Once awareness is given, the community can start taking a more proactive role in having more health and mental health services be available in their area. I would also get the government officials involved by demonstrating how their cutbacks are causing more harm than good to communities, and have them talk with community officials to reach an agreement to end the structural violence occurring in healthcare. Many officials may not be aware of the negative impact of their decision, as structural violence is more subtle and so deeply enrooted in culture that others may not be aware they are committing it. So having government officials and community members work together would be an important mechanism I as a social worker would do.
Kathleen Ho states that there are three categories of violence. Those categories are personal, structural and cultural. Personal violence is where there is a direct targeted individual such as a rape victim. Structural violence occurs when there is an inequality in the distribution of power. Kathleen Ho (2007), in her article “Structural violence as a Human Rights Violation”, defines this as, “how structures constrain agency to the extent that fundamental human needs are unattainable” (p. 3). These “structures include class and class coalitions, and institutions including business organizations, political parties and global institutions like the United Nations, World Trade Organization, and the General Agreement on Tariffs and Trade. Social structures include sexism and racism, as well as class-based structures” (Ho, 2007, p. 2).
ReplyDeleteA global example of structural violence is the availability of health care in nations around the world. Though there are some nations who have greater access to health care then other nations, there are still several nations in which access to health care is limited for certain members of that population. The United States is a great example of that. For instance, if you are not considered low-income you most likely will not qualify for government assistance in health care benefits. However, on the opposing side, if you have a high-income you are at a greater advantage for accessing top medical care. This social injustice puts the lower-class and the middle-class at greater risk for developing life threating diseases that could have been cured if access to medical care or top medical care was more accessible.
b) An example of structural violence in the United States is gender inequality in the workplace. Women have significantly made less than their male counterparts in the workforce. In fact, according to the International Labor Organization (2011) “In 2010, American women on average earned 81 percent of what their male counterparts earned” (para. 2). Not only have men and women been unequal in pay but also in obtaining higher positions within the company they work for. “In terms of women in leadership positions, in 2009 only 24 percent of CEOs in the US were women and they earned 74.5 percent as much as male CEOs” (International, 2011, para. 9) Although during the recession of 2007-2010 “men lost more jobs than women…(they) also experienced a steadier recovery” (International, 2011, para. 4). This inequality represents the structure in which violence persists against women in America suppressing women’s ability to be equal with their male counterparts.
c)The example of gender inequality that I gave above not only exists in the United States but occurs on a global scale as well. According to the International Labor Organization (2011) “public information collected by the International Trade Union Confederation (ITUC), the global gender pay gap ranges from 3 percent to 51 percent with a global average of 17 percent” (para. 1). Thus, as a globally-informed social worker, I would hope to see the pay gap in gender decrease thus helping more women to feel empowered to negotiate pay rates comparable to their male counterparts. Just as Seipel (2003) states on poverty that “poverty reduction strategies must consider several factors, since no single factor can resolve the problem” (p. 199), the same I believe is necessary for gender inequality. I would like to start by working with women and empowering them to recognize their abilities and qualities and helping them by giving them the tools necessary to negotiate appropriately for equal pay. Once women feel empowered I hope to be able to help them through this negotiation process. Though there are several steps, this may be a long process but I feel that we can bond women globally and take a stand against this form of structural violence.
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