One of the better definitions of Structural Violence as is given by the famed Dr. Paul Farmer, “Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way.” This, as has been discussed, in central to epidemiology in the regards for the strong divide between the haves (those with access to modern medical and scientific advancements) and the have-nots (those who lack this access) when it comes to who is at most at risk for the morbidity and mortality of infectious diseases. The simple fact is, the lower your income and access to these advancements are, the higher risk you are to contract, get sick, and die from infectious diseases.
Reading the book The Spirit Catches You and You Fall Down, by Anne Fadiman shows a clear picture of this in some of her chapters. The Hmong, a mountainous people who have lived at high elevations for much of their history in China, and later Laos, had not dealt with illness like Malaria, which are much more common in the lower, hotter regions of where they resided. During, and even more so towards and follow the end of the Vietnam War, the Hmong were placed into small, compact refugee settlements, since much of their previous land had be destroyed in the war. With an inablity to return to their homes, and forced to live in these squalor settlements or immigrate to someplace new and strange, diseases and illnesses that the Hmong had little to no previous experience with ran rampant. Between the close quarters, lack of any treatment (traditional or otherwise), and inability to find ways to prevent the illnesses, many suffered and died.
Back to Dr. Farmer, who was interviewed frequently during the Ebola crisis, and is a well-respected individual in the Public Health community. In his interview with Democracy Now!, Farmer said, “Pathogens don’t have borders… or don’t respect them.” This is part of a larger argument he was making, which amounts to the simple truth that if we want to optimally and fully protect our self (American) we need to look after and ensure treatment for the poorest of the world. Ebola wasn’t a new illness during this most recent outbreak. In fact, it was discovered in 1976 in Africa, and outbreaks have occurred quite sporadically in Africa before and since (CDC, About Ebola). The recent one gained such attention for much the same reason anything does in American media, it did or could affect us at home. The fear of an infection coming stateside drove its attention, not the fact it was killing by the hundreds. The spread of this illness, as said by Farmer in his interview, could’ve been lessened or stopped altogether if there were cohesive, effective public health initiatives in place to prevent it. But because the people affected were mostly poor, and thus lacking something as simple as effective prevention protocol (personal protective gear like gloves, masks, clean syringes, etc) which are so common-sense in America that I was required to wear gloves when applying band-aids to kids the summer I worked as an on-site Health Office for a YMCA camp. Overall, Dr. Farmers idea that the best way to protect ourselves is to protect everyone, especially the poor whom experience extreme structural barriers to health care, is accurate. Pathogens don’t care about borders, race, sex, or income. This is especially true in our current time, where global travel is as quick and easy as it is. A cross ocean trip that took months now takes only a sizeable portion of a single day. If we continue to do nothing until another outbreak hits, it is only a matter of time before we move to slow and it becomes a pandemic. To protect ourselves, we must protect everyone. It isn’t just the smart thing to do, it’s the human thing to do.
“About Ebola Virus Disease.” Centers for Disease Control and Prevention. 2016. Accessed August 05, 2016. http://www.cdc.gov/vhf/ebola/about.html.