Do No Harm: The Clinician's Obligation to Reduce Structural Violence
The attempted repeal of the Affordable Care Act is an example of structural violence that may result in a loss of health insurance coverage for millions of Americans.
Coined to describe a type of indirect violence manifested as unequal power and unequal life changes between specific population subsets, the term “structural violence” can encompass any number of harmful social policies. In particular, denial of healthcare — one such example of structural violence — may ultimately lead to increased morbidity and mortality rates, regardless of the disease state. The role of healthcare professionals in creating and changing policies that prevent these disparities is an area that requires further emphasis, according to a report published in the AMA Journal of Ethics.
Economic inequality, another form of structural violence, often coincides with high rates of homicide or other violent crimes. Violence may be a result of the interplay of personal and family relationships, community, and societal factors. Healthcare professionals may work with patients who have been involved in both direct and indirect violence, making many of these professionals an important part of powering social change.
By understanding the inequalities in society, healthcare workers have first-hand knowledge of the individual components that are involved in structural violence, knowledge that they can use to develop programs that address and potentially prevent future violent acts.
Many have witnessed the push to repeal and replace the Patient Protection and Affordable Care Act, another example of structural violence that may result in a loss of healthcare coverage for millions of Americans. This real-world example of structural violence may lead to increased rates of morbidity and mortality associated with a variety of diseases; however, health advocates may help fight this change. Physicians, healthcare practitioners, and patients have the right and the voice to enact change in how healthcare unfolds, but direct and immediate action must take place.
Online social networks and Web-based video and news sites have improved our ability to observe and react to social injustice and violent acts more than ever before. These new technologies and platforms have made it difficult for anyone to ignore structural and direct violence in the world today. The dictum “do no harm,” while often used in the clinical sense, may also mean “preventing the occurrence of further harm by thinking creatively about how to transform unjust social structures into caring ones.”
Lee BX, Young JL. Clinicians' need for an ecological approach to violence reduction. AMA J Ethics. 2018;20(1):91-98.