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Abstract
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The killing of Eric Garner in 2014 at the hands of the New York Police Department and the footage that circulated of his death after he was put in a chokehold elevated the phrase "I can't breathe" to a protest chant for those in the fight against structural racism worldwide. Its repetition by George Floyd in Minneapolis, MN, USA, in 2020 and by others in anti-racism protests amid the COVID-19 pandemic has deepened the salience of these words. While much public health research has shown that racism is a fundamental determinant of health outcomes and disparities, racist policy and practice have also been integral to the historical formation of the medical academy in the USA.
The term structural violence has its origins in peace studies in the 1960s as a way of understanding the iniquities of imperialism that persisted in the post-colonial world. As Paul Farmer and colleagues have described, structural violence explains how the organisation of society "puts 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)." While no single concept can capture the complexity or full dynamics of racism, the brief historical examples we discuss here show that structural violence is helpful for understanding how the histories of violence, neglect, and oppression that crisscross law enforcement, politics, medical care, and public health are inextricably linked and manifested in the present.
Like the history of US policing, the history of medicine and health care in the USA is marked by racial injustice and myriad forms of violence: unequal access to health care, the segregation of medical facilities, and the exclusion of African Americans from medical education are some of the most obvious examples. These, together with inequalities in housing, employment opportunities, wealth, and social service provision, produce disproportionate health disparities by race. The health community needs to confront these painful histories of structural violence to develop more effective anti-racist and benevolent public health responses to entrenched health inequalities...
Language: en |