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Friday, March 1, 2013

3.   Please consider the availability (and lack of availability) of health care in your country.  

Now please 

a) define structural violence (using our readings and also an excellent summary of Farmer and Sen's views on this by Kathleen Ho: http://projects.essex.ac.uk/ehrr/V4N2/ho.pdf)

b) give an example of structural violence in your country (supported by data)

c)  present your dream of what a globally-informed social worker could do about that example (remember to use the readings).

56 comments:

  1. Part I
    According to Kathleen Ho (2007) violence defined as impairment of human needs or human life. Violence is like an inequality and an injustice, which is used against another people. In our days, violence has new broad definition. It includes torture, rape against ethnic minorities, women, children, and people with disabilities and so on. Violence is all around us. Galtung constructs a typology of violence composed of three categories: personal, structural and cultural. On one hand, structural violence shows us unequal power and unequal life chances. On the other hand, structural violence is also discrimination, when one group of people does not allow others to enjoy the same opportunities. Castro and Farmer (2005) state that stigma and discrimination served as a means of giving short shrift to powerful social inequalities. Therefore, from Castro and Farmer research in rural Haiti we can see how structural violence is embodied and generates stigma (the story about patient in rural Haiti). In this story, the man’s access to comprehensive AIDS care saved his life. In addition, this example of structural violence shows the importance of assessing the treatment for all societies’ members.
    The researchers of Lithuanian Institute of Hygiene (2009) made a qualitative research about the people, who are living with HIV. The research shows that these people are divergent from society in these fields: labor, personal environment, education and health care. On one hand, people who are living with HIV, in the personal environment faced with such difficulties as separation of partners, good friends because of their preconceived negative attitudes and stereotypes. On the other hand, the person, who has HIV loss the joy of life, realizes his life limitations and imprisons himself in the psychological and cognitive captivity. The psychological stress do not allow to HIV affected person fell the comfort of life and it causes depressions and for some people it is the way for killing themselves. In labor field, people who are living with HIV do not openly discuss about their health situations with colleagues or employers, because they have a fear for social isolation, stigma and loss of work. Individuals who have a high financial status trying to treat their illness in others countries, because it is maintaining a confidence: employers will not know about his illness. The research shows that people, who are related with HIV, often do not go to the health experts because of their lack of financial resources. In Lithuania doctors and nurses are often act unprofessionally: they humiliate the human dignity of those who are living with HIV. In Lithuania, antiretroviral treatment is free, but person have to pay for others treatments, which are necessity for his life.

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  2. PART II
    My overall goal would be on how to get the basic needs met for those who are stigmatized. In regards to article about AIDS-related stigma and the Lithuanian research, first I would start out by educating. I think that persons who are living with HIV can help to increase the tolerance by sharing their experiences, sharing the latest information, participating in conferences on HIV problems and collaborating with organization working on HIV/AIDS, especially NGO’s. It is necessary to educate members of society, informing them not only about HIV/AIDS problems, but also about the tolerance, which reducing stigma and discrimination against HIV. I think that very important role of preventing HIV are international conferences where will participate social workers, health specialist, psychologist, society members. We need to not only discuss, but also take actions, when we are talking about those people and communities who are poorer. Therefore, for these actions we need to establish international NGO for people who are living with HIV. I agree with Castro and Farmer (2009) that on the international level the rich countries should finance the treatment of HIV in poor countries. Social workers can also analyze other countries’ practical experience, when working with HIV. In Lithuania, health care system is working not properly for those who are living with HIV. Health care is a basic need of life, so Lithuanians social worker should change experiences with other social workers, health care workers from other countries. Ahmadi (2002) state that international social worker should get new skills like social planning, formulation, implementation and evaluation of social policies and social projects. One of the main ideas, international social work should implement the idea of partnership and reciprocity. When we are talking about people who are living with HIV, social workers need to contribute to setting new global human values and ethics.

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    1. I found your response to be very interesting since I was surprised to learn that antiretroviral treatments for HIV are free in Lithuania, yet you described different situations where individuals either receive treatment in other countries or worse, receive no treatment at all for reasons related to structural violence. Initially, I thought people would receive adequate care considering they can receive these necessary medications for free, but stigma and fear of being “found out” to have HIV prevents people from receiving these essential medications. Your plan for beginning to eliminate HIV stigma by educating others and encouraging individuals to share their stories sounds like an effective way to teach others about the very human side to HIV rather than have people fear something they may simply not understand. I also found it interesting that you stated that Lithuania’s healthcare system is not effectively treating individuals with HIV, and that healthcare is a basic human right. In the United States, we are also experiencing many issues related to funding healthcare, and I am continually astounded when listening to some politicians speak about healthcare as if it is something that only the wealthy or privileged should have access to. It appears from a global perspective that governments struggle with the concept of healthcare as a basic right, and I agree with you that social workers must continue to work towards changing attitudes so policy makers and citizens appreciate this basic human right.

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    2. Hi Victoria,
      Thank you for your feedback. It‘s nice to know I wasn‘t the only who was thinking about stigma of HIV. I also appreciated your minds and I think, believe that good ideas of global social work can bring the change for those who are living with HIV!

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  3. Formally primary helthcare is accessible to all individuals that have citizenships in Lithuania. In practice medicines are expencive a lot of services should be extra payed and are not accessible to all peolple.

    Structural violence according to Galtung is indirect, there may not be any person who directly harms but the violence is built into the structure and shows up as inequal power and inequal life chances. This is applicable to a vulnerable society, according to Farmer which include „racism, sexism, politival violence and grinding poverty“. Structural violence as human rights violation introduce „tripartite typology of duties“ :
    • Respect – „to refrain from direct violation of the rights“
    • Protect – „ requires duty holders to prevent a right from being infringed by third parties“
    • Fulfill – „ duty to provide resource when individuals have no alternative ways to satisfy their basic needs“
    I would like to provide an example of structural violence in Lithuanian health care in institutionals homes for childern with developement problems. Children are the ones that are not able to stand and protect their rights. Lithuanian goverment by saving money prevent vulnerable population from basic need of helthcare. It is not easy to find data about medical helth care in Lithuanaian institutios for children, i have seen the procentage that only about 0,8 – 3% are provided for pharmaceuticals when comparing to 65 – 87 % are spent on salaries of the staff personnel in governmental institutions for children(http://www.sociologija.eu/media/file/svarbus%20kiekvienas%20vaikas.pdf)

    My dream is that as many social workers as possible could advocate for children rights to govenment by raising the voice and showing the situation to the society, not just acting as an individuals that are working for salary and not able to change the wrong system and approch of the govermental startegies concerning Lithuanaian children that are growing without parents. I would say it would be a good step to establish a association of social workers that represent, protect and advocate for children rights in Lithuania. Too few NGOs are doing so in Lithunia.

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  4. Structural violence can be defined as structural inequalities that systematically deny some individuals of basic human needs and human rights (Ho, 2007, p. 1). This is a form of violence which individuals confront barriers to, or are prevented from, having basic human needs met. Structural violence theory argues that disparities and the unequal share of power that decides the allocation of resources contributes to this violence (Ho, 2007). Factors such as institutionalized racism, sexism, political violence, hunger, poverty, and social inequalities are examples structural violence that people may face (Castro and Farmer, 2005). Additionally, structural violence is a direct consequence of “human agency”, meaning that the decisions of some (usually at the top) directly or indirectly cause inequality and structural violence (Ho, 2007, p. 4).

    Structural violence largely impacts access to health care both in the United States and globally. Structural violence creates numerous barriers to getting connected with health care and staying in care (remaining connected). In the article “Understanding and Addressing AIDS Related Stigma: From Anthropological Theory to Clinical Practice in Haiti” Castro and Farmer (2005) note that poor individuals are more likely to experience violations of human rights, which directly impact access to health care and HIV treatment. Unfortunately, I have found this also to be true in the United States. My current internship is in an infectious disease clinic and I work primarily with individuals with HIV and AIDS. Many times poorer patients feel the stigma related to HIV at higher rates. As a result of this stigma, these patients will choose to come to the clinic where I work, even though it is farther away, and less convenient than other clinics. Patients have shared that they would rather be inconvenienced than risk being seen and “found out” at a local clinic. While confidentiality is very important and ought to be respected, the need for confidentiality due to fears of stigmatization and discrimination often becomes a barrier to care. Many times I have witnessed a patient seeking care farther away from home, and then falling out of care and missing appointments due to difficulty getting to the appointments. An additional example is access to medication for those who face structural violence. There are a number of programs available to assist with HIV medications, but patients often fear being “discovered” through medications (for example fear someone will find their medications). This again creates a barrier to accessing health care, medications, and remaining healthy.

    As a global social worker, my dream to help alleviate the example of structural violence impacting access to HIV care in the United States is through education. An increase in educational initiatives about HIV, HIV transmission, and living with HIV could not only help reduced HIV transmission, but also could help reduce the stigma associated with HIV. Educational programs may also help reduce the impact of “blaming the victim”. As Castro and Farmer (2005) point out, blaming the victim often happens to people infected with HIV, which in turn can perpetuate structural violence and lead to discrimination. Programs could be easily accessible in areas which have high HIV rates, and also areas which have a high poverty rate. Additionally, if these programs were held with other non-HIV related programs, the stigma associated with attending would be reduced as well. Educational programs are an example of how a global-informed social worker can positively intervene to help alleviate the impact of structural violence.

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    1. Your example from your agency is something that really shows how structural violence influences the people we work with. It is sad that the stigma and discrimination that your clients currently face leaves them with inconvenient options. The things you talked about should not affect or be barriers to care. In a perfect world there would not be that stigma and discrimination surrounding HIV. I also think it is crazy that we have come quite far in that arena, but it is no where near far enough. I agree that educational programs are a good example of how a globally-informed social worker can make a positive impact on this structural violence issue.

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    2. In your example from the agency you work at is a great example how stigma "works" and damages all the posible ways for help to reach the recipients. This stigmatization and blaming the victim has come so far even for the patients to risk their lives and health just out of fear to be recognized.
      HIV related stigma is usually associated with marginalized groups, therefore increasing it's power.
      You really have great ideas about how to minimize the effect of stigmatization, and about how to help the people reach the services they need. They would definately help minimize the structural violence experienced by HIV / AIDS patients.

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  5. Structural Violence can be illustrated when the structure of a country or a system within a country has inequalities embedded in it that systematically denies people of their basic human rights. An example from the Castro & Farmer article is the stigma attached to those with AIDS. It discusses how the stigma and discrimination attached to AIDS can be a barrier to services that someone with AIDS might seek, like counseling or testing. This stigma can also lead to the decreasing interest in providing appropriate care to the AIDS community. The Ho article uses the example of starving children, diseased bodies, and desperate poverty as a way to show structural violence. It contrasts them with human rights violations that have a clear person or thing to point the finger at as the cause like, Guantanamo and Darfur. These are clear violations of human rights, with someone to blame, while the issues of desperate poverty or starving children on the streets has a less clear culprit. These issues have been around for a very long time, and not so easily seen as violations of human rights. The way they can be described as violations of human rights is when we look at them as issues of structural violence. An issue of human rights violations like starving children must come from the structure of the system.

    In the United States there are many examples of structural violence. One that comes to mind is the lack of affordable and accessible health care we have here. In a book by Butterfield, they discuss health care policies in the US. They explain Medicare and Medicaid and all of the options given to those with a low enough income to qualify. The options can be helpful to many, but there are some things that I would consider structural violence. The biggest example I can see is described in Butterfield as the “doughnut hole.” The doughnut hole is something that happens in Medicare Part D insurance. Part D provides assistance in paying for prescription medications. The doughnut hole happens because Medicare Part D requires a $250 deductible, and after that, it pays 75% of drug costs up to $2,250. After drug costs reach that amount, individuals must pay the next $2,850 before Medicare continues coverage. The issue with these benefits is that a chronically ill person may save money initially on out-of-pocket drug expenses. But 35% of seniors who take more than 3 medications per month will likely be forced to pay 100% of costs once they reach the doughnut hole. Someone who is utilizing the benefits of Medicare is because that is what they can afford, and additional expenses aren’t easy to come by. Because that is the policy and the way that the system is structured, there isn’t much that can be done, so the person stuck in the “doughnut hole” is a victim of structural violence. Those in poverty who cannot afford adequate healthcare are also victims of the structural violence of poverty.

    A globally informed social worker in this situation would look at the healthcare policies from other countries that do not have the same disparities as healthcare policies here in the United States. With this issue there is a huge opportunity to advocate for healthcare policy change. In a perfect world a globally informed social worker would be able to use aspects from healthcare policies around the globe and try to model policy changes around things that seem to be effective in other countries. You could look at it in the same way that I touched upon the United States creating our own Grameen Bank. By implementing something in our own country modeled after something that was effectively implemented in another country is a great way to incorporate global ideas into social work practice in the United States. Global social work should be integrative and ideas should be shared across a variety of contexts and cultures.

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    1. I have to agree with Devon. I believe that a structural violence example is the United State health care system. I think we are doing a horrible job with helping the poor receive proper health care. I know that Obama is trying to make it better with his Obama Care Act, but I feel that there is so much more we can do. I like that Devon used the Grameen Bank example. In the last part of the question she used it as a way to explain that the U.S. can branch off of other idea that have been successful in different culture and use them to improve our own. If the U.S. could work together with other countries and learn different types of health care systems, I believe this could be extremely helpful with saving our economy.

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  6. PART I
    Healthcare in the United States is seemingly available, especially in urban areas, but is not necessarily accessible to everyone. For individuals who have private insurance, healthcare is accessible but may be limited due to whether or not healthcare providers accept certain types of insurance. Paying for private insurance does not guarantee coverage for all of the types of services an individual may need, or there may be monetary limitations placed on the amount of
    services an individual is eligible to receive. Individuals who do not have insurance may be eligible for medical benefits through the Medicaid program which provides individuals with limited physical and mental health benefits, but individuals who have Medicaid benefits
    experience many limitations in terms of providers who accept these benefits as well as the types of services that are covered.
    Kathleen Ho defines structural violence using a structuralism theory based on the concept of interdependent relationships that transcend borders and occur at both domestic and global levels (Ho, 2007). Structuralism recognizes race, class, and gender as social constructs, and this theory states that individuals are not independent of certain structures and thus these structures impact an individual’s decision-making and overall identities (Ho, 2007). Ho summarizes Paul Farmer’s definition of structural violence as stemming from unequal distribution of power which results in an unequal distribution of resources which limits individual agency (Ho, 2007). Farmer views this avoidable exploitation to be at the core of structural violence since individuals who have little to no power in a society have limited or no access to resources which results in poverty and illness (Ho, 2007). Structural theorists further believe that individual agency may be increased for some, which are the individuals who have more power, but this happens as a result of minimizing the agency of others (Ho, 2007).
    An example of structural violence in the United States is access to healthcare since various structures inhibit individuals’ ability to access necessary services. For instance, the Commission on Social Determinants of Health found that gender bias exists starting with society’s gender norms which determine the value and roles of women and men, and this bias results in gendered health behaviors related to hygiene, nutrition, preventative health practices, and health-seeking behaviors (Sen, Ostlin, & George, 2007). Furthermore, gender inequality is also an issue at the policy level since women are underrepresented within policy-making governmental bodies within the United States (Scott-Samuel, Stanistreet, & Crawshaw, 2009).

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  7. PART II
    Additionally, citizenship and race are also structures that inhibit individuals’ access to healthcare in the United States. Studies indicate that immigrants to the United States access healthcare much less frequently than citizens due to fear of deportation if they are living in the country without documentation, lack of information as to where to receive care, and inability to pay for healthcare services (Konczal & Varga, 2012). Furthermore, immigration policy creates structural violence through limiting or prohibiting individuals who have immigrated to the United States from receiving healthcare benefits (Konczal & Varga, 2012). One study found that low-income Latino immigrants in Florida were unable to access healthcare services they were legally allowed to receive due to specific policies that were created to prevent abuse of services (Konczal & Varga, 2012). Additionally, immigrants who have been diagnosed with a serious medical condition can be denied visas since this is a criterion the United States Immigration and Naturalization Services uses to deny immigrants entry into the country which demonstrates structural violence on the basis of citizenship and health (Quesada, Kain Hart, & Bourgois, 2011).

    A globally-informed social worker could work towards eliminating these barriers to healthcare accessibility in the United States through community education and policy advocacy. A social worker may implement the methods used to reduce AIDS-related stigma in Haiti by first collecting information about the community they intend to serve through interviewing community members as well as through conducting a literature review (Castro & Farmer, 2005). Next, the social worker may identify specific needs that can be addressed, such as educating individuals who have immigrated on their rights to healthcare, and where they can receive specific services. The social worker may create a psychoeducational group as a method for informing these individuals, and the worker may want to collaborate with individuals within the community who can promote this psychoeducational group within the community (Castro & Farmer, 2005). Lastly, the social worker can contact local legislators and political advocacy groups to work towards creating policies that are inclusive of all genders and individuals who have recently immigrated to the United States in order to create more accessible healthcare.

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  8. In the US a hotly debated issue of contention within politics is the issue of health care and if all people should have equal access to it. While health care is accessible, it is not necessarily affordable to all. Those who can afford to have private insurance are often limited by the constraints of their health care plans, in addition to the premiums and other expenses that may be incurred for health care costs, many of which can be very unaffordable to the average American. Low-income families can qualify for Medicaid and other government funded programs but there are limitations to those services as well, and costs are still incurred for medical visits. One must also be reminded of the many undocumented immigrants in the US who do not qualify for any type of health care coverage, as well as many middle class Americans who cannot afford privatized health care plans and yet do not qualify for government assisted Medicare.

    Structural violence is defined as a type of violence that is indirect and not done by one person directly to another person; instead it is institutional and limits basic human rights and needs. This type of violence according to Ho is built into the structure of a society and manifests itself as unequal power and unequal life chances (Ho, 2007). Structural violence results in an unequal distribution of resources, which has a direct impact on the constraints of a person’s agency (Ho, 2007). Ho provides an excellent example of a societal group in her article that is heavily affected by structural violence within the United States, African American women, who are subject to high HIV/AIDS rates and are more likely to be victims of poverty with little access to health care and treatment in comparison to their white counterparts in the US (Ho, 2007). This is due to structural violence stemming from institutional racism that still runs deep in the US.

    One example of structural violence in the US is the issue of the prison population being completely unbalanced in terms of the number of minorities that are incarcerated in comparison to Caucasians. While African Americans comprise only 12% of the US population they make up two fifths of the prison population, and 8.1% of all black men ages 25-29 are in prison currently (Garland et al., 2008). It is estimated that if this trend of incarcerating young black men at a higher rate than other racial groups that soon one in every three black men will have been incarcerated at some point in their lifetime in comparison to one in every seventeen white males (Garland et al., 2008). The Hispanic population is not left out of this equation either as they have the second highest rates of incarceration next to African Americans.

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  9. These minorities are often prosecuted more severely for their crimes and typically spend more time in prison. Many of these minorities who are incarcerated for long periods of time become institutionalized and accustomed to life in prison and become unaware of how to lead successful lives in mainstream society. Many prisons do not provide successful life training skills to prisoners or offer educational resources for them to better themselves while serving out their sentence, which in a sense directly impacts the recidivism rate as many of their minorities do not know anything other than a life of crime. This also has a direct impact on the families of many of these prisoners as the culture of prison keeps them removed from being able to support their children, wives, parents or other family members which likely continues the cycle of poverty for all involved.

    As a globally informed social worker it is important to advocate for issues like this and to push for reform. Without advocacy nothing will change in terms of structural violence within a society. A globally informed social worker should work with various outreach groups and social service organizations in order to better serve this population and create programs that can provide skills that are necessary for success and decreases the overall effect of institutionalization of the prison population.

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    1. Your perspective into the issues of the prison system was beyond profound. The role of the prison system has strayed immensely from its original purpose when whites heavily populated its cells. It’s disturbing to track the shift of the prison system as a place of rehabilitation and a method to reintroduce offenders back into to society, to a holding cell. Simply based on the racial makeup of the majority within its walls.

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  10. In Lithuania, we have a mandatory basic health and social insurance, that is deducted from our salary every month, or compensated by the state if unemployed or a student; or, you must pay on your own if self employed. This should provide free medical services – primary care, hospital expenses, dental care, etc. Therefore, medical services are available in Lithuania. If not insured, first aid or paid services are available.
    Structural violence, as described in K. Ho‘s article,as structural inequalities, systematically denies people their basic human needs,and violate their human rights. Galtung‘s definition of structural violence includes avoidability criteria, which shows us also unequal life chances and possibilities, injustice. So according to this, In Lithuania, if we talk about structural violence of a human right to get health services, there shouldn‘t be such cases. But of course, vulnerable or marginalised groups do suffer from this violence.
    I woud like to give an example of structural violence in health care system in Lithuania. As mentioned earlier, medical care is provided in Lithuania for all persons. In the health care policy it is said , that medical care is free for children up to the age of 18 years of age, or, in other words , they are insured by the state (http://www.sam.lt/go.php/Pacientu_teises ) . Nevertheless, there are certain diseases, that are very rare, and the treatment of those diseases is extremely expensive; therefore, the state wouldn't compensate the expensive surgeries and medicine (drugs), needed to cure /treat those diseases. So several children have to stay in hospitals for months. Recently there was a story in the news, that Lithuanian patients, that have multiple sclerosis, disease, that damages the brain, are not treated with the most effective medications, that the 19 countries of Europe is treated, but Lithuanian health ministry decided to buy the cheaper medications. And according to statistics of LISS ( Lithuanian Association Of Multiple Sclerosis), only 105 patients need that medication. The need for this is not only based on the suffering and disability of the patients, but also hits the economic side – according to to the survey, in 2006 57% of patients with this disease were working, in 2009 – 47%, and in 2010 – only 35%.
    For a globally informed social worker , in this case, there would be several things : firstly, advocate for patients rights, for human rights to get the available treatment.Motivate and empower people to look for help, maybe try reach organizations that could be able to help – charity funds in Lithuania and abroad, NGO‘s, and other.Also, not to silently wait for something to happen, but to act on the problem solving in any means possible. Secondly, social worker should try to implement changes in the policy levels – gather the information about the patients‘ needs, means to get those needs satisfied. Also, social policy change can be achieved by drawing public attention in the media locally and abroad – international attention often serves as a jump start of at least admiting that the problem exists, and then trying to find solutions to solve it.

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  11. Based on Kathleen Ho (2007), structural violence becomes a structural violation of human rights.
    Structural violence consists of economic, political, and social factors. Reproducing historically established balances of power and they are economically driven processes and forces since the rich use these structures to get richer. It has the causal relationship between power differentials in structures and its effect on individual agency. There are clear indicators that poverty effectively constitutes the violence that creates the disparity between actual and possible abilities to meet fundamental human needs. The social factors: sexism and racism also represent additional instances of structural violence that constrain agency. Violations are paired with images of a different nature: starving children, diseased bodies, and desperate poverty. Alternative conceptions of human rights violations include ones that focus on individuals who are responsible rather than the structures that produce the violations. There are systemic and structural causes that place some populations at a greater risk of human rights violations than others.
    For example in Lithuania, structural violence we can see in mental health. According to Puras, Germanavičius, Povilaitis, Jasilionis (2004), analysis of contextual factors revealed high levels of social pathology (including violence, suicide and other self-destructive behaviour) with stigmatizing approaches by the general population to mentally disturbed persons and other vulnerable groups. The largest proportion of physical and human capital is concentrated in psychiatric institutions, with large numbers of beds, psychiatrists and increasing funding for medications, while other components of care—such as housing, psychosocial and vocational rehabilitation, community-based child mental health services—are not being developed.
    What we can see? That are not correctly divided the money, and people who have mental problems cannot get all medication, psychiatrists or another service, they cannot take care of themselves and defend their rights. On the other hand - this has an impact on the community resulting from indifference, fear, stigma about people who have mental disabilities or disorders.
    The global social worker need be advocate between client, community, health organization and government, reduce the divide between these systems. Educate society about mental illness, create self-help groups in psychiatric institutions and protect these people’s right. It is good dream for me.

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    1. Andželika, you bring up an important point about the conception of structural violence. Structural violence not only consists of economic, political and social factors, but also of racism and sexism. The structural violence is big problem in whole world and this field is a good for social work practice. I agree with you that social worker should advocate between client, community, health organization and government. I am sure that your dream about societies’ education, self-groups is extremely good. I believe that you can make it happen!

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  12. In Lithuania we have mandatory , basic health and social insurance, it’s social security guaranteed by state, for employed, students, schoolchildren, pensioners, mothers with small children, etc.. It’s possible to pay social insurance by yourself. Mostly medical care is free of charge (primary care, hospital, etc.), but not everything. If you need special clinical trials (special blood test, ultrasonography) or something like that, it costs. For example, in neighbor country Latvia, people are paying almost for every medical care, even if they need to visit a specialists, like ENT doctor, neurologists and etc. .
    When I think about structural violence, some maybe sarcastic thoughts comes to my mind: how “improved” mankind, that now we have not a direct violence, but indirect, which called structural violence. It’s more easily can be hidden, than direct violence, but not less painful. According to Kathleen Ho (2007, p.15), we can see a structural violation of human rights, because of structural violence. In this article and A. Castro (2005) article, we can see, how close are poverty and structural violence; the poor people is more vulnerable group. But it can be vice versa, when people became poor because of structural violence. I have one example of structural violence from my experience and would like to share. Friend of my mother has a disease-lupus erythematosus (liet. raudonoji vilkligė) (I haven’t found any statistical data about that disease in Lithuania, but in one informational article was written, that for one million people are born 5 children with this disease every year) which is severe autoimmune disease, incurable and there a high risk of death (http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/lupus.asp). In this case, disease relapsing as a big unhealing bleeding sore (wound) on the leg, which makes woman hard to move, because every move hurts so much, that it’s hard to be consciousness. It means that all most of time she is lying in bed. In hospital, she was stayed there for several times, they only heal her leg for a short time than it’s relapsing again. There are some medicaments to facilitate the symptoms, but not everything she can use, because they have very side effects, which are forbidden to her. The family doctor said, that there are a medicaments, which can be more conducive, but it costs a lot and she can’t afford it, because she can’t work and her income is low. For her situation, there are offset ointment and medical plaster to sore, but provided quantity contravene to her, it means, that it is not enough for such a big sore, but nobody will give more, because it’s not provided. Another thing, that she live in the flat with her adolescent daughter and mother, which is after heart attack and can’t move from the bed at all. It means, that the woman should take care for her sick mother, but how she can help her, if she cannot serve herself? Her daughter is learning at school still, and it’s a big issue for her too to care about the mother and grandmother (she is preparing for final exams now). Family doctor says, that she must go to the hospital day care again, but she can’t do this, because she can’t leave her mother at home alone. She didn’t get any support from medical institution, like care at home, social worker visiting or something like that, because officially she and her mother didn’t have severe disability.

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  13. II. I think, in situation which I described, in my dreams social worker can do several things. First of all, it’s necessary to provide people with such diseases a free of charge medicament, which is very important. As it was written in A. Castro article (2005), the one of biggest problem, why people are suffering from disease, because they can’t buy drugs. Maybe medications will not heal completely, but it can make people alive, came to term with theirs disease. Knowing that there drugs, which can help you from suffering, but they are unavailable to you, can be very painful… Everyone deserves a chance to live qualitative life. Second thing, is to help people in their everyday life, the help can be simple: help to clean the house, to prepare food, to take care of children or relatives, to found information about help or benefits, even to advocate in institutions and so on. It’s not so hard, but ir can be very valuable and beneficial for people, who had such diseases. The third thing can be inspiring to social policy, health system changing, to provide more services for sick people, to speak about diseases, which are not so “popular”, but they are. As a global social workers we can implement a successful experience of others countries into our country, trying to solve problem cooperating with colleagues from other countries. Social worker need to be open and active, do not be afraid of making changes.

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  14. 3. a. Johan Galtung was the first person to talk about structural violence. In his way of describing it, he says structural violence is any harm on a person because of economic or political structures (Winter, & Leighton, 2001).
    b. An example of structural violence in my country is the availability of healthcare. Since there are many people living in poverty it is hard for them to receive proper health are. With prices of insurance increasing constantly it is difficult for people who are living on the poverty line or below to afford such insurance. From 1980s to 1990s there was a 90% increase of the cost of insurance. Because these people are getting proper insurance they tend to go to hospital for medical assistance and sometimes they aren’t even receiving the adequate health care in the emergency rooms (Butterfield, Rocha, & Butterfield, 2010).
    c. My dream for what a globally informed social worker would call an international seminar to learn how other countries deal with health care. At this seminar hopefully the U.S. could learn from other countries how their health care works and maybe they can form a similar plan. In my dream there would be policies made to me it much easier to receive proper health care for anyone. I would like to see social workers working to add more to the Obama Care Act.

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    1. Samantha, I think it's a great idea to call an international seminar to collect positive experience from the other countries , how they are dealing with similar problems, what innovations other apply in medical care. In modern times of media, internet, global comunication, it's an easy way to spread new ideas and to share experience. Besides when in one place meet a lot of professionals of different countries, different work fields, it looks much more serious. It's a great way to be heard of media, of society, of politicians.
      In my country publicity is even more effective, because Lithuania is quite small country. Big international meetings, seminars, conferences being much more faster observed. Besides in Lithuania is popular now to speak about necessity to be modern, to learn from more developed countries, so such international seminar would be meaningful.

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  15. Structural violence is a form of violence that restricts a person from meeting their basic needs; it strips away their human rights resulting in absolute poverty (Ho, 2007). Structural violence is directly linked to social injustice; it is built into social structures and built into stable institutions. A textbook example of structural violence within the United States is Hurricane Katrina. Race is a powerful predictor of many environmental hazards, including the distribution of air pollution, the location of municipal solid waste facilities, the location of abandoned toxic waste sites, toxic fish consumption, and lead poisoning in children (Bullard, 1993). The effects of Katrina were felt mostly by non White Americans and those whose financial standings placed them the poverty line.

    The enormous stigma which attaches to the mentally ill arises out of ignorance, and prejudice, and results in discrimination. There is no known country, society or culture in which people with mental illness are considered to have the same value and to be as acceptable as those who are not. And the Virgin Islands are no exception. Citizens are at risk because of their inability to obtain effective mental health treatment as a direct result of the territory's limited financial resources and lack of service options (Bain, 2008). Most people feel uncomfortable about mental illness, and their behavior reflects this. As a result, there is great stigma associated with mental illness.

    The Sainsbury Centre for Mental Health (2002) states that Black and African Caribbean people are over-represented in mental health services and experience poorer outcomes than their White counterparts. Stereotypical views of Black people, racism, cultural ignorance, and the stigma and anxiety associated with mental illness often combine to undermine the way in which mental health services assess and respond to the needs of Black and African Caribbean communities. When prejudice and the fear of violence influence risk assessments and decisions on treatment, responses are likely to be dominated by a heavy reliance on medication and restriction.

    There are no government facilities that provide inpatient health care to children. According to the Caribbean Exploratory Research Center (2010) the following are challenges faced by the Virgin Islands in relation to adapting an effective health care system:
    •Difficult access to certain services due to cost and time constraints for inter-island travel
    •Staff shortages-psychiatrists, mental health staff at all levels, social workers
    •No cultural competency training program for service providers or mandated services for diverse sub-populations
    •Medicaid not significant source of revenue due to Federal cap on Medicaid Title XIX program

    A globally conscious social worker should be attuned to the rituals and the cultural norms of the people. My dream of what a globally informed social worker would do coincides with the four dimensions of Healey (2008): advocacy, professional exchange, international practice, and international policy development. Advocacy would take the shape of being aware of mental health legislations that promote and protect the human rights of mentally ill and aiming to increase budget allocated to mental health, allowing for a flexible utilization of existing resources within the mental health system. The fostering of cross cultural cooperation can begin with researching methods used in neighboring countries and assisting in the implantation of these new programs (Ahmadi, 2003).

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    1. Yes, I agree with you, that are very big stigma and risk for people who have mental health problems. And need will do so much in this structure.
      Yes, people afraid, don't understand these poeple who have mental problems, because we don't have good education about that.
      But I see very big risk for these people, who have mental illness, because they meet with these problems as exploitation, deception, bullying, discrimination, izoliation and more.
      For exemple, when I had practice in Psichical health centre, people, who have mental illness told, that they meet with discrimination in the State institution, and meet with neighbors, relatives whose wanted to take advantage of their health problems and defraud a property, and they accommodation in boarding homes. Meet with people or people from health instutiont, whose wanted close in psichical clinics, but they were able to live independently, just need a little help. And these people usually are isolate from society like disruptive.
      What I want to say, that here are very important global social workers role like advocate between these sistems (mezo, micro, macro)and to know international practice, where you can share and get new knowledge about the system improvement of real help for people with mental illness.

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  16. Often times when a violent act occurs people instantly look for a party to blame. Violent acts such as rape, and murder carry with them a person who committed the offense, but what happens when the violence is committed by a larger entity that produces structural violations of human rights such as starvation, poverty or disease? Kathleen Ho, suggest that this act of violence is considered to be Structural Violence. Structural violence is defined as the, “Avoidance disparity between the potential ability to fulfill basic needs and their actual fulfillment.”(p.2) Structural violence also refers to the way in which structures harm or disadvantage individuals.
    b) give an example of structural violence in your country (supported by data)
    As previously stated, structural violence occurs when human rights are violated. The United States is seen as a country of prosperity, promise, and freedoms. People are drawn to this magnet by the possibility of overcoming oppression in their perspective countries. Considering that this nation makes basic human needs unattainable at times is contradictory to the way America is perceived globally. Even the very citizens of this nation are suffering from the lack of affordable healthcare, a proper healthy nutrition, and severe poverty.
    It is noted that race, class, and gender (in the American Context) make a difference in the way in which services will be received. According to the Center for Disease Control and Prevention, “Approximately two of every five persons of Hispanic ethnicity and one of five non-Hispanic blacks were classified as uninsured during both 2004 and 2008. Both these groups had significantly higher (p<0.001) uninsured rates (average rates 42.7% and 22.6%, respectively) for 2004 and 2008 compared with Asians/Pacific Islanders and non-Hispanic whites (average rates 16% and 14.1%, respectively). Hispanics accounted for one third of the uninsured population.”( Moonesinghe et. Al, 2011)
    b) present your dream of what a globally-informed social worker could do about that example
    I believe that I have been “Called,” to work with the undocumented immigrant population. As a globally-informed social worker it is imperative that I understand the systemic inequalities, and disparities, that my clients endure on a day to day basis. Healthcare is not provided to undocumented individuals in this country, unless these are women who have become pregnant, and for that matter they are only covered for a period of 9 months and 30 days after delivery. These men, women, and children who migrated to this country for a better chance at life now face the possibility of a shorter life expectancy due to the lack of proper health care. Lynne Healy’s defines International Social Work as, “International professional action and the capacity for international action by the social work profession and its members.” (Healy, 2007) Alice Johnson expands this definition by providing 4 dimensions that support Healy’s definition: Internationally Related Domestic Practice and Advocacy, Professional Exchange, International Practice, and International Policy Development and Advocacy. Each of these dimensions push my practice towards becoming more culturally sensitive, and competent.

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    1. Monica, I'm glad you brought up the dichotomy between how the US is perceived globally and the reality behind health insurance coverage. As a country that is constantly becoming more diverse, it really is essential that we as social workers work towards equal (and hopefully comprehensive) health care for everyone. I also thought it was very interesting that you brought up our undocumented immigrant population. Those who come to this country in search of a better life for themselves and for their families should be able to succeed and prosper. It is impossible to do this without adequate health care. I'm just wondering about what we can do in the short-term. Immigration reform is such a sticking point in American politics and most of the conversation centers only around citizenship. Even if undocumented workers are recognized as citizens, they would still most likely face the same challenges that citizen minorities do. Is there any conversation about improving health care without addressing citizenship? And what might that look like? It is a large problem to tackle and seems almost overwhelming to think about. I applaud your drive and ambition to work with this population and perhaps make some great strides in eliminating this type of structural violence.

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  17. Often times when a violent act occurs people instantly look for a party to blame. Violent acts such as rape, and murder carry with them a person who committed the offense, but what happens when the violence is committed by a larger entity that produces structural violations of human rights such as starvation, poverty or disease? Kathleen Ho, suggest that this act of violence is considered to be Structural Violence. Structural violence is defined as the, “Avoidance disparity between the potential ability to fulfill basic needs and their actual fulfillment.”(p.2) Structural violence also refers to the way in which structures harm or disadvantage individuals.
    b) give an example of structural violence in your country (supported by data)
    As previously stated, structural violence occurs when human rights are violated. The United States is seen as a country of prosperity, promise, and freedoms. People are drawn to this magnet by the possibility of overcoming oppression in their perspective countries. Considering that this nation makes basic human needs unattainable at times is contradictory to the way America is perceived globally. Even the very citizens of this nation are suffering from the lack of affordable healthcare, a proper healthy nutrition, and severe poverty.
    It is noted that race, class, and gender (in the American Context) make a difference in the way in which services will be received. According to the Center for Disease Control and Prevention, “Approximately two of every five persons of Hispanic ethnicity and one of five non-Hispanic blacks were classified as uninsured during both 2004 and 2008. Both these groups had significantly higher (p<0.001) uninsured rates (average rates 42.7% and 22.6%, respectively) for 2004 and 2008 compared with Asians/Pacific Islanders and non-Hispanic whites (average rates 16% and 14.1%, respectively). Hispanics accounted for one third of the uninsured population.”( Moonesinghe et. Al, 2011)
    b) present your dream of what a globally-informed social worker could do about that example
    I believe that I have been “Called,” to work with the undocumented immigrant population. As a globally-informed social worker it is imperative that I understand the systemic inequalities, and disparities, that my clients endure on a day to day basis. Healthcare is not provided to undocumented individuals in this country, unless these are women who have become pregnant, and for that matter they are only covered for a period of 9 months and 30 days after delivery. These men, women, and children who migrated to this country for a better chance at life now face the possibility of a shorter life expectancy due to the lack of proper health care. Lynne Healy’s defines International Social Work as, “International professional action and the capacity for international action by the social work profession and its members.” (Healy, 2007) Alice Johnson expands this definition by providing 4 dimensions that support Healy’s definition: Internationally Related Domestic Practice and Advocacy, Professional Exchange, International Practice, and International Policy Development and Advocacy. Each of these dimensions push my practice towards becoming more culturally sensitive, and competent.

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    1. Monica, I really like the passion you displayed in your answers. And I liked how you opened up to more awareness of the lack of medical insurance made for non-white populations. While this is not an uncommon issue sadly, this is indeed an eyeopener especially with the passage of medical coverage in the United States. And I really like how you talk about what you hope to accomplish as a globally-informed social worker.

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  18. 3. According to Johan Galtung, structural violence is the “avoidable 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” (Ho, 2007). This definition of violence is beginning to be applied to international human rights work by looking at the large scale causes of poverty, sexism, racism, etc. Those with power and money have more opportunity and possibility to grow and thrive than those who do not. And moreover, this first group participates in structures that actively limit the growth and achievement of the second. Structural violence is not defined by identifying one transgressor and one victim but rather a systemic organization of structures that limit a person’s ability to achieve a standard consistent with basic human rights.

    Access to affordable healthcare is an example of structural violence in the United States. According to the National Institutes of Health, access to healthcare depends on “financial, organizational and social or cultural barriers the limit the utilization of services [and therefore]access is measured in terms of utilization dependent on the affordability, physical accessibility and acceptability of service and not merely the adequacy of supply” (Gulliford, M., et al, 2002). The US has advanced technology and well-trained doctors along with private insurance companies that help buffer the costs of treatment but only if you can afford it and access it. Lack of health insurance is disproportionately represented in minority populations and the poor. In 2009, 300 million Americans did not have health insurance (US Census Bureau, 2012). According to the US Department of Health and Human Services Office of Minority Health, Hispanics have the highest uninsured rates of any race in the United States. Hispanics make up 16.7% of the US and have an uninsured rate of 30.7% compared with the 11.7% of uninsured non-Hispanic Whites (Office of Minority Health, 2012). This pattern is repeated in most minorities and has far-reaching consequences for health. Without health insurance, people cannot afford to visit their primary care doctor when they are sick with something like a sinus infection or the flu. They cannot afford to miss work either so they continue to get sicker. Easily curable diseases turn into life threatening problems. Kathleen Ho uses the example of a patient with tuberculosis (Ho, 2007). With advances in medicine, no one in the US should die or go into debt for an easily curable disease (medical bills are a large cause of bankruptcy) (Politifact.com). Additionally, those with chronic conditions may not be able to afford prescriptions that would keep them healthy and those with more serious diseases are not able to afford the same state-of-the-art care that others do. Language barriers and cultural differences also play a role in access to health insurance and therefore health care.

    A globally-informed social worker could attack this problem through advocacy. For example, setting up a community program that informs members about their rights, the steps to take to acquire insurance, and which programs might be right for them. Social workers could advocate for their community by lobbying at the state and local level for insurance reform. President Obama has taken some steps in the right direction by eliminating preexisting conditions as a reason for denial and working toward universal health care. A global social worker would also study countries that have a better track record of insurance coverage and attempt to implement policies adapted to the unique makeup of the United States. Individual communities can only do so much. What is really needed is a dramatic overhaul of the US health system and social workers can be a vital part of that process by making sure the needs of those affected by structural violence do not get lost in the shuffle.

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    1. You noticed, that "language barriers and cultural differences also play a role in access to health insurance" and I'm thinking, that it's interesting, why it's a problem in United States. Lithuania, for example, is very national country, that means, that many of people are not very cosmopolitan. But US is so "united", I think, there so many people from different origin countries, nationalities and so on, why a different languages and cultures are a problem? Of course, it's not easy to communicate with people, who can't speak English, but, for example, in Scotland (United Kingdom), if you are going to visit a doctor, but you don't speak English, you can ask for a translator and they will provide you such a service free of charge. Your answer showed me a broader view about healthcare in US, thank you.

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  19. a) Structural Violence is when a country or any governing system denies people basic human rights due to inequalities embedded within the system. According to Castro and Farmer, structural violence can be demonstrated through classism, sexism, racism, and other “social inequalities that are rooted in historical and economic processes” (2005). Structural violence is both intentional and unintentional. When Kathleen Ho defines structural violence according to Galtung, it is described as an “avoidable impairment of fundamental human needs or, to put it in more general terms, 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” (2007). Galtung also discusses that structural violence, unlike human rights violations, is more indirect as it is not caused by a singular person, but indirectly by a governing body and does not inflict direct harm on the person (2007). Some who commit this might not even be aware of committing violence as these causes are ingrained in the system. Structural violence is both an unequal distribution of power and opportunities because of how the system is set up, as well as the prevention of accessing basic care and rights.
    b) One form of structural violence in my country is the issue of reproductive rights. For nearly a century, women have been advocating for access to birth control, distribution of contraception, and the right to have an abortion. On one hand, women have made many gains in reproductive rights. Laws have been passed to allow women the right to a safe and private abortion, insurance companies are now required to provide free access to birth control. However, while there have been gains the United States government has also passed laws limiting reproductive rights accessibility for women, or banning them altogether. Even though reproductive health is considered a basic human right, the United States has passed laws to either ban or place limits on reproductive rights, from limiting access to contraception and abortions to cutting funding from reproductive clinics so people can’t seek reproductive services (Alzate, 2009). Accessing reproductive care is even worse for minority women due to “the nature of the U.S. health care system, which restricts…access to health care” (Alzate, 2009). What is worse, those in office who placed many of these anti-reproductive rights laws into practice are older white men, who are not capable of getting pregnant. The ability to decide pregnancy is considered a “core value of being a full human being” for women, and having these rights limited or taken away is a violation of that (Alzate, 2009). The limitations or complete ban of reproductive rights is considered structural violence as these movements are rooted in sexism and racism as these bans affect mostly women, denying them the ability to have a say in their lives and putting their socioeconomic status at risk.

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  20. c) A globally-informed social worker needs to be able to advocate and educate clients on the issue reproductive access to encourage community engagement. In order to combat the issue of barriers and restrictions on reproductive accessibility, a globally-informed social worker could do both advocacy for policy change and working with individuals to educate them about their rights while providing them the tools to advocate for more effective and equal accessibility for contraception and abortion accessibility. One of the key components of education is to “foster high level of community participation”, which is rule four of the Ten Commandments of Community Health Education (Torres, 2005). Education is one of the key steps in raising awareness of the situation. In fact, Torres (2005) identifies education as one of the Ten Commandments of Community Health. Community participation is also an important component for a globally-trained social worker to do regarding reproductive rights. Through community participation, individuals can come together no matter how different the cultural ideologies and norms to find compromise in reaching a common goal, and can learn from one another (Torres, 2005). This also allows the community to form their own voice as a global social worker’s best way to educate provide the tools for others to speak for themselves. Finally, through advocacy a globally-trained social worker can also speak out against the legislatures who pass laws limiting or banning thes. By educating community members, both activists and everyday individuals, they both are able to advocate for the end of structural violence in healthcare but also make themselves and others more aware of the socioeconomic and cultural stigmas which influence structural violence in reproductive accessibility.

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  21. Definition:
    Violence, as defined by Galtung (1969), is ‘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’; further, he asserts that the structural violence is built into the structure and shows up as unequal power and consequently as unequal life chance, which is indirect in that ‘there may not be any person who directly harms another person in the structure’. Farmer claims that structural violence is ‘not the result of accident or a force majeure; they are the consequence, direct or indirect, of human agency’. Structural violence originates in this unequal distribution of power among actors and can further trace its origins to human agency (Ho, 2007, p4).

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  22. Example of structural violence in my country:
    Nowadays, it is estimated that there are more than 780,000 HIV/AIDS people living in China (Ministry of Health, China & Jointed United Nation program on HIV/AIDS, WHO, 2011). Chinese government has been putting a lot effort on prevention and treatment for HIV/AIDS people. However, while all the people with HIV/AIDS can accept proper treatment or whether they can afford those treatments still remains a big issue unsolved. There is still another form of violence awaiting them which results from the discrimination and phobia toward people living with HIV/AIDS (PLWHA)—the difficult access to general health care (not specific treatment for HIV/AIDS), especially surgical operations in the medical institutes. It has been reported that PLWHA who want to get treatments for diseases which aren’t related to HIV/AIDS have to conceal the fact that they are living with HIV/AIDS to be able to access to general health care in the public hospitals. Since it is common that if they have been found out with HIV/AIDS, most medical institutes will refuse to treat them or find an excuse to transfer them to other hospital. As listed clearly in the regulation, the public medical institutes shall not refuse or reject general medical requirement of people with HIV/AIDS. However, people with HIV/AIDS are still discriminated against, stereotyped and feared in China, even among the medical staff, which contributes to the difficult or limited access to general medical care. China Alliance of PLWHA (CAP+, 2011) collected 38 specific cases of the evasiveness and refusal of health facilities to give surgical operations on people living with HIV/AIDS and found out that the legitimate rights and interests of people living with HIV and AIDS patients in their equitable access to medical services are being seriously infringed upon, i.e. they generally cannot receive surgical operations needed to treat diseases other than AIDS or receive such service in a timely manner. Such evasiveness and refusal have constructed structural violence.

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  23. The inequalities that exist in terms of disproportionate life chances because of disease or poverty are directly caused by an unequal distribution of resources but the underlying problem is that ‘the power to decide over the distribution of resources is unevenly distributed’ (Ho, 2007, p4). Seemingly the evasiveness and refusal comes from the coldness and ignorance of the medical staff or the institutes, but the root causes are based on the inability of the government to enforce the law against the discrimination, the discrimination and ‘monsterized image’ and the exaggeration of the public media which aggravates the fear of the public toward people living with HIV/AIDS.
    As globally-informed social workers, facing such a complex social problem, firstly, we need to embrace and advocate the idea of social justice and human rights without regard to race, disease or social status. Furthermore, there are some aspects that I consider that I can work for:
    1. Conduct a survey among university students, especially medicine schools, about their attitudes toward people living with HIV/AIDS in order to gather information and see what needs to improve in the medical education in terms of attitudes toward HIV/AIDS. According to the research results, designs an intervention program to help students better understand this disease.
    2. Work in an organization oriented to in eradication of discrimination toward PLWHA. Get together the vulnerable groups who are mistreated or at risk to be mistreated to articulate their right through social media, conferences, and forums. Work on offering legal help, together with other disciplines such as legal experts for PLWHA who have been rejected by the medical institutes.
    3. Work with international organizations like UNAIDS, WHO and the local academic scholars to conduct convincible research on this topic. Facilitate the united effort of the grass root organizations or NGOs to lobby the policy makers to enact strong laws against discrimination, to protect the legal rights of PLWHA and to devote more financial help for the medical institutes to accept and treat PLWHA in terms of their requirement of general health care.

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  24. If we are talking about health care system in Lithuania, it will be good to mention, that in USSR we had have that for everything was paid from country budget (health expenditure was one part of the USSR budget) health insurance model of Semashko. After independence we started to reorganize our health system and try to combine Bismarck and Beveridge systems. We spent a lot of many and other resources trying to apply this innovation. There was spent lot of many renovating hospitals and their equipment, and few years ago, a lot of hospitals where closed, because our ne health system reorganization try's to centralize hospital's and health system. So we spend a lot of money just for that, what we could close renovated hospitals with new equipment.
    According "Health consumer powerhouse" Lithuania health system is second from the bottom in EU. According them availability of adequate treatment is very poor, and quality also is not very good. But in other hand Patients' Rights Act and access to personal data was evaluated very good. Those evaluators, as you can see, noticed that our health system focuses on policy level, but not on client needs. My brother's are doctors, one is surgeon and other therapeutist. We have a lot of discusions about our health system, about theory and policy and about practice. According them, they was learning how to treat dissease's with modern drugs and modern methods, but then they started to work, they realized, that they do not have opportunity to treat in way they was educated, because government does not pay for those moderns drugs or methods, and doctor need to learn again, how to use not so „modern“ways of treatment. And other example, if you have suspicious that your patient suffer from one or another disease and you order medical research, and then answers come's you saw that you was wrong – you will go to talk with the high doctor (hospital director) why you are using funds irresponsibly, and if it repeats, you can loose part of your salary (of course unofficially).
    This health system structural violence is directed to all health system workers and especially to the patients. Of course, that is not statistical data that we could use, but that are arguments of honest people who are working in that field. In these two cases. There are problem that preparing young doctors (theory of study) and reality (practice field) mismatches and other important thing that then hospital try's to save money, they are constraining doctor's who can not give proper treatment to their patients. In this case patients are not insured right to the proper treatment. There are a lot of scandals there patients sue's hospital's and win's, because their right was damaged.
    What could do globally-informed social worker in this case is hard to imagine. I think best way could be to use European Court of Human Rights, and try to change our health system reorganization to other side, where patient is the main objective. Help politician's to prepare amendments using good experience of other countries. For example Estonia, has similar health system budget like our, but they was evaluated much better, they are in top-5 of best EU countries. Is not a secret that our hospital's are managed by hierarchical way of managing, so it is very hard to make a changes if you are only person below of all. So I think, our health system could be better and we need to do reorganization of the partly-reorganized health system.:)

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    1. Hello Bronius, I agree with you that even as a globally-informed social worker, it is difficult for us to change such situation. One of the similarities between China and Lithuania is the medical systems in these countries are both operated in such a hierarchical and conservative way.There are people who want to maintain such status que. However, is it possible for social workers work in a micro level i.e.to support the vulnerable groups, to unite them together to articulate their rights or to work with other disciplines to offer help like legal consultation?

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    2. Of course Yi, it is necessary to use society power organizing changes in our society!

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  25. a. Structural violence is a complex concept that is multifaceted. Kathleen Ho (2007) discusses this concept in-depth and provides an excellent summary of the key features of structural violence. There are two key components to the term structural violence.
    First the word structural refers to who or what is causing the inequalities. Structures can be institutions, organizations, communities, companies or any network or group of individuals who share an interdependent relationship. These structures and the relationships that are inherent in them are influenced by political, social, or economic forces. The key is that these structures are not individuals and the forces in play are indirect or invisible. It is not easy to place any blame or responsibility to any one person within the structure for consequences of the structure.
    Secondly the word violence refers to the infringement or denial of human rights. The denial of human rights should be defined as broadly as possible and include political, economic, social, cultural, and civil rights. From the class readings, The Universal Declaration of Human Rights developed by the United Nations provides a good summary of the rights that are covered in this definition. By denying these rights, the result is mass inequalities to certain groups of people. The affected groups of people are determined by the power dynamics inherent within the structures. The violence is perpetuated based on the uneven distribution of power within the system. The last component of the violence is that the inequalities that are created are avoidable. The effects of the violence serve to limit the potential of the people it affects.
    So to summarize structural violence in one sentence, it can be defined as the structures and institutions in place that create inequalities and an infringement on human rights.

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  26. b. In the United States, one of the most current and relevant examples of structural violence is the inability for gay people to get married. Article 16 of the UN Universal Declaration of Human Rights calls for marriage rights yet same sex marriage is illegal in most states in the U.S. This inequality has real social and economic impacts including tax breaks, survivor benefits, sick leave, child custody, domestic violence protection, and hospital visitation rights. The following website provides a good summary of some of the rights that are denied to the LGBTQ population due to marriage inequality:
    http://www.nolo.com/legal-encyclopedia/marriage-rights-benefits-30190.html
    In addition to the denial of tangible benefits there are also mental health implications from the denial of these rights and benefits. Gay people have difficulty gaining acceptance from many groups and being comfortable with their own identity because they are exposed to these messages of inferiority. This stigma may cause other problems such as depression, substance abuse or anxiety disorders.
    c. There is much that a globally-informed social worker could do to help combat the lack of marriage equality rights for gay people. The first is to become as fully educated about the issues as possible. There have been many people who have asked why gay people want marriage rights in the first place without realizing the benefits that come from marriage in the United States. Also by understanding the lack of gay marriage rights in not just the United States, but also globally will help social workers understand the extent of the problem and increase their capacity for empathy. Also by studying the very few countries that do have gay marriage rights for its citizens, social workers can use those examples to help guide their own practices.
    Another concept that is important to combat these types of structural violence is the idea of positive peace described by Grodofsky (2007). The concept of positive peace states that by eliminating social injustices caused by structural violence, it will promote peace, enhance human development, and ultimately strengthen societies. At the center of positive peace is advocacy and community building, each of which can take many forms. Each of these forms should be informed from a global perspective as people from different countries can exchange ideas and examples of what has worked for them.
    Advocacy and community building efforts may include examples from the Torres (2005) article which discusses demilitarizing Vieques, Puerto Rico or the Castro and Farmer (2005) article which discusses the AIDS-related stigma in Haiti. Examples may include:
    • nonviolent protests
    • directly speaking with lawmakers about gay marriage equality
    • creating educational forums where community members can gather to share stories and discuss the issues of gay marriage
    • distributing informational packets that can fully educate the population about why the denial of gay marriage rights are no different than the denial of many other human rights.

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  29. The United States spends more than twice as much annually per person for health care as other industrialized nations. However, there are major health disparities within the United States because access to health care is a problem for the uninsured (those who lack health care insurance) and the underinsured (those who do not have adequate health insurance). Furthermore, individuals who are poor and members of minority groups generally receive less primary health care and those individuals who lack health insurance also do not have access to quality care. The term structural violence was a term coined by John Galtung and refers to systematic ways in which social structures harm or otherwise disadvantage individuals. It causes much suffering and can lead to conflict, war, and genocide. It is unfortunate because while you can blame war on behavioral violence, structural violence is subtle and often has no one specific person who can be held responsible. The accumulated effects of structural violence on an individual will necessarily mean less helath and shorter life. Those who suffer from structural violence cannot control the conditions that have caused their suffering. For example, when reading about AIDS in Haiti, structural violence “…determines who has access to counseling, diagnostics, and effective therapy for HIV disease. Finally, structural violence determines, in large part, who suffers from Aids-related stigma and discrimination” (Farmer, 2005, pg. 55). For this reason, structural violence often leads to feelings of complete and utter hopelessness.
    There are many examples of structural violence in the United States. Kathleen Ho gives the examples of how after Hurricane Katrina there were many poor African Americans, which disproportionately suffered slow recoveries. This is because after a disaster, minorities and low-income individuals suffer greatly because they receive less information, less government relief, and encounter bias in the search for long-term housing. Furthermore, Hurricane Katrina brought to light how African American, Latino, and Native American communities have a disproportionate share of environmental and health risks. Racial minorities are more likely to be exposed to environmental threats than whites of the same social class. Some of these environmental threats are distribution of air pollution, the location of toxic waste sites, and lead poisoning in children. There is also the issue of less effective educational systems, lower quality housing, and increased morality rates.
    My dream for a globally informed social worker would be to work closely with the government so that they are more aware of these health and environmental issues. Thomas Pogge’s, World Poverty and Human Rights, discusses how structural violence correlates with the power of deciding what resources go where and to who. Therefore, these resources are distributed unevenly, which is why the aftermath of Hurricane Katrina was so devastating and horrible.

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  31. b.) When i started to think about lack of availability of health care in my country, i remembered, when I went to hospital couple of days ago. There were waiting elder people in the queue for doctor's consultation. They started to talk about health care in Lithuania, a lot of them, who grew up in soviet times, said, that in soviet times medical care was free. And now situation is very bad, because not all people have enough money to pay for medical care, drugs, surgery, dental repair. Retired seniors told me, that they have money just for food or for medical drugs. One old woman said, that she needs a lot of expencive drugs every monht, so she must all the time to choose, what is more important: food or drugs. She also said, that she have forgotten the taste of butter, 'cause its to expensive, although she worked hard for over forty years.
    So although generally medical care in Lithuania is free of charge for people, who are working and paying social insurance taxes (students, pensioners are released from state social insurance contribution), but there are quite enough services or procedures, surgerys, medical drugs, which people must pay for. Despite this, in Lithuania a lot of patients give bribe, gratuity for doctors, nurses, hoping to get medical care faster of in better quality. So I think, that this is a great example, how difficult people can live in Lithuania because of powerty, because of structural violence.
    b.) Acording Johan Galtung, which the first started to talk about termin "structural violance", structural violence is ‘that which increases the distance between the
    potential and the actual" human rights to resourses and human rights. As K. Ho (2007) writes, "structural violence exists when there is an avoidable gap between actual and potential abilities to meet human needs". I think Sen's insight in Kathleen's (2007) essey that poverty is consequenses of a structural, systematic denial of basic freedoms is very appropriate. In his case old people loose freedom after forty years of hard working to get old with dignity, to have right to food, medical care, so to have freedom to live. In the WHO's constitution is written, that human's health is "a state of complete physical, mental and social well-being". In lithuanian Konstitution is saying, that people have freedom to life, to health. K. Ho (2007) writes, that denial of one freedom amplifies or multiplies the denial of other freedoms, poor people become more vulnerable to violations. How Hughes (Violence in War and Peace, 2004) noticed, structural violence is unfortunately invisible 'cause it is part of the routine, of everyday life. In time it can become as a norm.
    c.) A globally- informed social worker in this situation could do:
    advocate people,
    educate people to see situation deeper, to help them to understand, that person has a problem to get medical care not just because of him, but because of structural violence, poverty, global processes.
    to empower people to express their minds, needs, right to govermant
    to intermediate betveen people and goverment. To help people to be heard by politiciant.
    To try to solve problem globaly, working together with international, national organizations, agencies.
    And probably what comes in to my mind more- to inititiate interdisciplinary, internationaly konferences, seminars about structrural violance, medical system's situations, peoples poverty.
    At least- to speak out loud about situation in public, media, books- to educate not just people, but goverment, politicians too. In times of media, internet, its quite good opportunity to be heard.

    In reality, when structural violence lays roots down in country's, society's life, it's difficult to eliminate it alone. And just global, bright thinking, collaboration with other countries, which are in better situation, can help.

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  32. a) Various studies show that social inequality and economic deprivation are not the only one of the main reasons for the formation of aggression, some researchers think that the poverty is one of the most difficult forms of structural violence. Structural violence is usually carried out through appropriate policies, people who have power are profitted from others with less political power.

    b) everyone want to show his the best sides and hide minuses. This issue is common not only for people but also for structural derivatives (state, municipality etc.). Structural violence is one of these things, which municipalities seek to hide, so that is why it is very hard to support by data. This kind of problem is known among people and often in rumors form. I found the only one official data which may show the example of structural violence, which I would like to represent. According to my personal experience, there are cases when some social workers of municipality do not inform clients on purpose about the available services, because they have order to save funds of municipality. And if person did not know about all services he could get, he will get only these which he knew about. 2009 state data audit conclusion revealed that there was no clear plan for minimum level of municipal budget funds to provide necessary social services, so there was a risk that local governments provided these services not adequate municipal budget. When a municipality was a lack of financial in other areas it could take resources from social service, because there was not officially planed how much they will spend, so they can cut off resoursers from social services and say that there is no more money.
    c) Our current political system is very influenced on the past events. So I think our the most important tasks are: to go deep into another countries, collect information and disseminate the best practices in our country. At the first we need to promote public awareness, to enable people to solve problems and not to be afraid to fight for their rights.

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  33. About the availability of medical services I've talked to replying the first question, but since I work in the medical institution this subject of me is very interesting and close. I think access to health care services in Lithuania has to be relevant and problematic. Access to health care - state in accordance with recognized health conditions, providing health care services in the economic, communicational and organizational acceptability of the individual and society. This is perhaps the unavailability of medical services can we call structural violence?
    According to Kathleen Ho (2007) violence defined as impairment of human needs or human life. I think that structural violence is the main form of aggression. Structural violence theorists characterize the world system as vastly Unequal, exemplified by a growing disparity between Those who are rich and getting richer and poor Those who are getting poorer and (Kathleen Ho). Various studies have shown that social inequality and economic deprivation is not only one of the main reasons for the formation of aggression - some of the same researchers treat poverty as one of the most difficult forms of structural violence (structural violence is usually carried out through a policy of government have benefited other people with less political power at the expense).
    I think that Lithuania, as in many other countries of the structural violence is "legally" used and ordinary people can not to oppose it in any way. To give an example of structural violence in my country , again I use my work experience and my example will deal with the health care system and personal financial opportunities. Rehabilitation Programme in Lithuania is quite well developed and we have many good, competent rehabilitation hospitals. Availability tend to be secured, but patients often confronted with the problem of access to a rehabilitation hospital. The reason is that every private doctor has a certain number of trips to rehabilitation, but often happens is that the voucher is not goes to to those patients who really need them, but the rich people who have enough money to pay doctors and buy the rest of the rehabilitation hospital. This is especially popular when talking about sanatoriums located in resort towns of Lithuania. So, in this case, the problem is that the money is managed by even the process of entry to the rehabilitation hospital. Lithuania people know about it and often speaks on this subject. At my own work I have sometimes heard as sick children parents talking about that their family doctor did not give them rehabilitation, because in that year the hospital had already exhausted all the trips to sanatoriums. But that time of the child is very important and necessary this rehabilitation...
    The global social worker need be advocate between client, health organization and government. I think that the social worker in this case should raise this issue with the management level and to represent their clients. Namely the social worker may reflect the client / patient needs and explain the problem, seek solutions that would be beneficial to patients. Social worker should try to solve problem globaly, working together with international, national organizations, agencies.

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  34. A)Structural violence
    Gilligan addresses the structural violence that is built into capitalism, including poverty, unemployment, unsafe work, war, pollution, and race and class inequality, “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.”
    http://susanrosenthal.com/articles/the-crime-of-punishment
    Also Structural violence, a term which was first used in the 1960s and which has commonly been ascribed to Johan Galtung, denotes a form of violence which corresponds with the systematic ways in which a given social structure or social institution kills people slowly by preventing them from meeting their basic needs. Institutionalized elitism, ethnocentrism, classism, racism, sexism, adultism, nationalism,heterosexism and ageism are just some examples of structural violence. Life spans are reduced when people are socially dominated, politically oppressed, or economically exploited. 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.

    How “institutional violence” we describe in Lithualia? Institutional (structural) violence is an organization Institucinis smurtas
    Tai dar retai vartojama sàvoka. Institucinis smurtas – an organization
    violence against the person, for the benefit of the institution, but also to the detriment
    individual.http://portalas.emokykla.lt/Documents/Metodiniai%20leidiniai/SPPC/Smurtas%20mokykloje_2.pdf


    B)In Lithuania "institutional violence" concept still rarely used. Maybe because it is hidden violence located within the institution, system, political system, and other. When I think about "structural violence" I think about my experience.
    I know of one situation where a person divorced with his wife, he left with two minor children, and a few years later he had a stroke – then has assumed the responsibility to take care of the man's mother. She went into the ward, the information about opportunity for some kind of assistance granted access, support. There has been said that she just has to go to school - there will free meals for children, for more information or advice it received. After the examination of the situation, analyze the financial situation of the family, I noticed that this family owned and more support options. And only when we have come together in the ward and said that we have to got other support. Only then we have been given support. Of course, the employee's conduct was not particularly pleasant. I think there revealed institutional violence. Finally, in what is the total of the reasons? Maybe in the fact that they receive attachments on their "good" work, because they are "working" due to the number of people needing assistance. And that state indicate what neighborhoods are "productive" work.


    C)I thin our country should listen people, who have a problem. They know their problems the best. And create help process together. Also I think that people should look to other countries, to their experience. And use good examples in our country. Of course we must to create new help system looking to our country, out laws, out cultural view, to our people needs.

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  35. Lithuania health care delivery provides the Republic of Lithuania Law on Health Insurance (1996). Lithuania has two health insurance connection:
    Compulsory;
    Complementary(voluntary);
    Compulsory health insurance are Lithuanian citizens and nationals of other countries and stateless persons permanently residing in the Republic of Lithuania as well as in Lithuania temporarily residing foreign nationals and stateless persons who are legally working in the Republic of Lithuania, as well as their family members.
    The insured, who are covered by state funds (other than persons who are required to pay or for the payment of health insurance premiums): persons receiving the Lithuanian statutory pension of any kind; persons of working age, place of residence registered with the labor exchange as willing and able to work in a certain job; unemployed persons of working age, have the compulsory state social pension insurance for state social insurance old-age pension; The women, who according to the law on maternity leave, as well as the non-working women in their 70 days of pregnancy (after 28 weeks of pregnancy or more) before the birth and 56 days after birth; a parent raising a child under 8 years of age, as well as a parent raising two or more children under the age of majority; persons under 18 years of age; the Lithuanian general education, professional, college and high school students and full-time students; state-supported persons receiving social benefits; persons, according to the laws recognize the disabled; who are ill and dangerous to the public from communicable diseases, which are included in the Ministry of Health of the list; resistance (resistance) - the volunteer soldiers, freedom fights, rehabilitation of political prisoners and persons equated to them, deportees and persons equated to them and those who have suffered in 1991. January 13 th event, or in defense of Lithuania's independence and nationhood; persons who have contributed to the accident at the Chernobyl nuclear power plant emergency; The former ghetto and former minors fascist forced detention of prisoners; state-recognized religious communities of priests, the training of clergy and religious school students performing monastic novitiate formation for the novice; The persons to whom the law has been recognized as the Afghan war's legal status.
    Lithuanian Republic soldiers, foreigners have submitted an application for refugee status by a court or law enforcement authorities detained persons in police custody, sentenced imprisonment and individuals who have made public a dangerous act, which the court granted an order forced to medical instruments, health care paid for by the State budget the Republic of Lithuania (hereinafter - the Government) or its authorized institution. Companies, institutions, and organizations and individuals who are engaged in individual activities, pay 3 percent of wages and salaries, mandatory health insurance contributions, humans who work legally, paid 6% of wages and salaries to compulsory health insurance fund, to get the medicine care services. In the Compulsory Health Insurance Fund paid the following health care services: preventive medical care, health care, medical rehabilitation, social services, and services for personal health care, and personal health expertise. So if you want to get the medicine care services you must to work or paid yourself, or for you paid the state.

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  36. A)Structural violence, a term coined by Johan Galtung and by liberation theologians during the 1960s, 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, according to Galtung, 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 PE, Nizeye B, Stulac S, Keshavjee S (2006). The term of structural violence is one way of describing social arrangements that put individuals and populations in harm's way. The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people (typically, not those responsible for perpetuating such inequalities). With few exceptions, clinicians are not trained to understand such social forces, nor are we trained to alter them. Yet it has long been clear that many medical and public health interventions will fail if we are unable to understand the social determinants of disease.

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  37. B) I work as a social worker in a stationary mental health care institution. Here treat a variety of mental disorders with adults, children and teenagers . Very often I hear when clients or their family members say that they don’t want that someone outside of clinic boundaries to know that client is treating here. Clients and their family members do not want that the school community, co-workers, or even family members or relatives will know that he or she treatment in psychiatry. Customers fear that employers know their employee treated for a psychiatric clinic, exempt him or her from working. Frequently the case when people are afraid to call for help when they went out from residential mental health care institution. Unfortunately, that the stigma in society and in human consciousness disrupts the required service availability.
    C) I’m interesting in social network. Its very important for clients to in order to ensure the continuity of social services in the environment, where they live. I think they need for a help not only for psychiatry (medicine), but they need for help to solve the social issues. Psychiatric patients are vulnerable group of society, often they suffering from abuse, deprivation, do not have money to live on, suffering from addictions, they have a family member who must arrange. So often the clinical diagnosis is hiding a lot of social problems. My dream is that people receive the social services in the environment they live. Sometimes people don’t know about social resources in the town or outside town and afraid that someone of neighborhoods to know about psychiatric diagnose and look strange then. I feel obligated to find the agencies that provide social services (disabled clubs, support charities, disabled day care centers). Importance of cooperation between institutions to share information in order to maintain continuity of service to help people receive the services they need. On a wider social level, presumably some form of public education would be most useful. This could take many forms. Of course, a sympathetic presentation of the mentally ill on television and radio, in newspapers and in the cinema would be useful (see Wahl & Lefkowitz, 1989) (Hayward, Peter Bright, Jennifer A, Journal of Mental Health, 1997). I agree with thing about public education, but it difficult imagine how to educate public, it seems impossible. To educate all public is very hard, but maybe in a small steps, it can be possible, for example in the day centre of psychiatric patients, make presentations or seminars, when human who suffering from stigma can tell about how he or she feels.

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  38. Structure violence is defined as an avoidable social condition of unequal distribution of resources that diminishes a person’s personal agency (Ho, 2007). When a person’s personal agency is diminished by social structures that promote unequal distribution of resources, this becomes a “structural violation of human rights” because basic needs are not being met (Ho, 2006, p. 1). Social structures that promote unequal distribution of resources such as food, shelter and heath care, also creates impoverished conditions that are in fact preventable.
    In our city of Chicago, we see evidence of huge discrepancies between access to healthcare in neighborhoods of higher socio-economic status and more impoverished communities. Racial and ethnic minorities in economically struggling neighborhoods have much higher rates of health issues such as diabetes. For instance, the rate of diabetes on the South Side is 19.3 percent, while the national rate is 10.7 percent and the overall rate in Chicago is around 7 percent (Peek, et al, 2012). When we consider the structural conditions that create such a wide discrepancy, it becomes evident that “economic, political, and social factors” include limited access to health care and healthy foods (Ho, p. 2). Efforts to reduce this structural violence found in these neighborhoods can be seen by the creation of accountable care organizations, which have been authorized under the Affordable Care Act of 2010 (Peek, et al., 2012). These organizations mobilize communities and use evidence-based preventative strategies “that build on community resources” to improve health outcomes (Peek, et al. 2012). Building on the strengths of communities as well as fostering high levels of community participation will help reduce structural violence in these neighborhoods (Torres, 2005, p. 9).

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  41. Talking about availability of health care in Lithuania I would say that our state is trying to provide health care for all citizen’s equally but if it works in reality it is other question. Seven years ago independent expert organization "Health consumer powerhouse" published that Lithuanian health index was the lowest of the 26 participating Europe countries. That fact wasn’t ignored and our government’s efforts are reflected in laws. They started initiate public health care reform. The main goal was to develop the public health care system which ensure public health safety and effectively protect consumers' rights to public health safety and quality approach. At the moment we have three levels of health care in Lithuania: first (personal and public health care services for which recipients don’t pay directly to the health care institutions), second (paid personal and public health services) and the third. The same independent expert organization "Health consumer powerhouse" last year published that Lithuania belong to categories of countries which rapidly climbing up (http://www.bernardinai.lt/straipsnis/-/83364). Situation changed in group of patient’s rights, awareness and access to services. On the other hand there is still lack of some diseases prevention, availability of medicines to consumers, not good compensation for some drug. In my opinion it is naturally that our country is developing after getting independence and the health care system is in the process becoming better.
    I will continue talking about structural violence. No one of us can’t ignore this fact that violence exist. This phenomenon can have a lot of faces. He can touch one person or group of people. It can be visible or not. So we as social workers need to be always open-eyed that timely notice clients who most need help. One of Lithuania’s sociologist Adomas Puras (Valstybe 2012.3(59)) expresses the idea that our feature not only depends on our motivation and efforts but also strong influence has the collective environment in which we grow up and seek own happiness. According this idea to avoid violence there need to be respect for human being. There can’t be one race, one gender or one ethnic group better or have better opportunities then other.
    Shortly I want to present situation which touch me very strong because I also had a experience working in children's foster home. Not long time ago all Lithuania heard about one little girl. She was seven years old and brought to the hospital because her weight was five kilograms. According to Human rights monitoring institute spokeswoman Dovilė Šakalienė that was one of the worst child neglect cases. In this situation there is no what to blame. Every institution deny them fault. It’s really very painful because these children can’t protect or take care by themselves and they don’t have families who do that. We as social workers need extremely take care children like this because they really need support. We are working in really situations so our responsibility is to initiate laws or to talk about this situation loudly. We need to do prevention not let a situation like this happens.

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