Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Article Selection and Assessment
3. Results
3.1. Characteristics of the Included Studies
3.2. Conceptualization of Structural Violence and Key Findings across the Reviewed Studies
4. Discussion
4.1. Areas for Further Research
4.2. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Galtung, J. Violence, peace and peace research. J. Peace Res. 1969, 6, 167–191. [Google Scholar] [CrossRef]
- Gilligan, J. Violence: Reflections on a National Epidemic; Vintage Books: New York, NY, USA, 1997; pp. 1–306. [Google Scholar]
- Farmer, P. An anthropology of structural violence. Curr. Anthropol. 2004, 45, 305–326. [Google Scholar] [CrossRef]
- De Maio, F.; Ansell, D. As natural as the air around us. On the origin and development of the concept of structural violence in health research. Int. J. Health Serv. 2018, 48, 749–759. [Google Scholar] [CrossRef]
- Berkman, L.F.; Glymour, M.M.; Kawachi, I. (Eds.) Social Epidemiology; Oxford University Press: Oxford, UK, 2014. [Google Scholar]
- Honjo, K. Social epidemiology: Definition, history and research examples. Environ. Health Prev. Med. 2004, 9, 193–199. [Google Scholar] [CrossRef] [PubMed]
- Von den Knesebeck, O. Concepts of social epidemiology in health services research. BMC Health Serv. Res. 2015, 15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Solar, O.; Irwin, A. A Conceptual Framework for Action on the Social Determinants of Health of Social Determinants of Health Discussion Paper 2 (Policy and Practice); World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
- Farmer, P.E.; Nizeye, B.; Stulac, S.; Keshavjee, S. Structural violence and clinical medicine. PLoS Med. 2006, 3, e449. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Leites, G.T.; Meneghel, S.N.; Hirakata, V.N. Female homicide in rio grande do sul, brazil. Rev. Bras. Epidemiol. 2014, 17, 642–653. [Google Scholar] [CrossRef] [Green Version]
- Basnyat, I. Structural violence in health care: Lived experience of street-based female commercial sex workers in Kathmandu. Qual. Health Res. 2017, 27, 191–203. [Google Scholar] [CrossRef]
- Khan, S.; Lorway, R.; Chevrier, C. Dutiful daughters: HIV/AIDS, moral pragmatics, female citizenship and structural violence among devadasis in Northern Karnataka, India. Glob. Public Health 2017, 13, 1065–1080. [Google Scholar] [CrossRef] [PubMed]
- Muderedzi, J.T.; Eide, A.H.; Braathen, S.H.; Stray-Pedersen, B. Exploring structural violence in the context of disability and poverty in Zimbabwe. Afr. J. Disabil. 2017, 6, a274. [Google Scholar] [CrossRef] [Green Version]
- Teixeira, C.C.; Da Silva, C.D. Indigenous health in Brazil: Reflection of forms of violence. Vibrant Virtual Braz. Anthropol. 2019, 16. [Google Scholar] [CrossRef] [Green Version]
- Joseph, S. Structural Violence and Maternal Healthcare Utilisation in Sub-Saharan Africa: A Bayesian Multilevel Analysis. Ph.D. Thesis, University of Glasgow, Glasgow, UK, 2020. [Google Scholar]
- Roberts, J.H. Structural violence and emotional health: A message from Easington, a former mining community in northern England. Anthropol. Med. 2009, 16, 37–48. [Google Scholar] [CrossRef] [PubMed]
- Johnson, K.; Drew, C.; Auerswald, C. Structural violence and food insecurity in the lives of formerly homeless young adults living in permanent supportive housing. J. Youth Stud. 2020, 23, 1249–1272. [Google Scholar] [CrossRef]
- Page-Reeves, J.; Niforatos, J.; Mishra, S.; Regino, L.; Gingrich, A.; Bulten, R. Health disparity and structural violence: How fear undermines health among immigrants at risk for diabetes. J. Health Dispar. Res. Pract. 2013, 6, 30–47. [Google Scholar] [PubMed]
- Hole, R.D.; Evans, M.; Berg, L.D. Visibility and voice: Aboriginal people experience culturally safe and unsafe health care. Qual. Health Res. 2015, 25, 1662–1674. [Google Scholar] [CrossRef]
- Bowen, E.A. A multilevel ecological model of HIV risk for people who are homeless or unstably housed and who use drugs in the urban United States. Soc. Work Public Health 2016, 31, 264–275. [Google Scholar] [CrossRef]
- Saleem, R.S.; Vaswani, A.; Wheeler, E.; Maroney, M.; Pagan-Ortiz, M.; Brodt, M. The effects of structural violence on the well-being of marginalized communities in the United States. J. Pedagog. Plur. Pract. 2016, 8, 181. [Google Scholar]
- Mead, P. Understanding Appointment Breaking: Dissecting Structural Violence and Barriers to Healthcare Access at a Central Florida Community Health Center. Master’s Thesis, University of South Florida, Tampa, FL, USA, 2017. [Google Scholar]
- Banerjee, A.; Daly, T.; Armstrong, P.; Szebehely, M.; Armstrong, H.; Lafrance, S. Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia. Soc. Sci. Med. 2012, 74, 390–398. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dziban, A. ICRSE Community Report: Structural Violence: Social and Institutional Oppression Experienced by Sex Workers in Europe; International Committee on the Rights of Sex Workers in Europe: Amsterdam, The Netherlands, 2015; pp. 1–15. [Google Scholar]
- Commercio, M.E. Structural violence and horizontal inequalities. Conflict in southern Kyrgyzstan. Politics Groups Identities 2017, 6, 764–784. [Google Scholar] [CrossRef]
- European Commission. A Union of Equality: EU Anti-Racism Action Plan 2020–2025. Communication from the Commission of the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Available online: https://ec.europa.eu/info/sites/default/files/a_union_of_equality_eu_action_plan_against_racism_2020_-2025_en.pdf (accessed on 28 June 2021).
- Isakjee, A.; Davies, T.; Obradovic-Wochnik, J.; Augustova, K. Liberal violence and the racial borders of the European Union. Radic. J. Geogr. 2020, 52, 1751–1773. [Google Scholar] [CrossRef]
- Moher, D.; Liberati, A.; Tetzlaff, J.; Altman, D.G.; Group, T.P. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann. Intern. Med. 2009, 151, 264–269. [Google Scholar] [CrossRef] [Green Version]
- Mendeley Reference Management Software; Version 19.8; Elsevier: The Hague, The Netherlands, 2020.
- Rodríguez-Martínez, P.; Cuenca-Piqueras, C. Interactions between direct and structural violence in sexual harassment against Spanish and Unauthorized migrant women. Arch. Sex Behav. 2019, 48, 577–588. [Google Scholar] [CrossRef]
- Sánchez-Sauco, M.F.; Villalona, S.; Ortega-García, J.A. Sociocultural aspects of drug dependency during early pregnancy and considerations for screening: Case studies of social networks and structural violence. Midwifery 2019, 78, 123–130. [Google Scholar] [CrossRef] [PubMed]
- Larchanché, S. Intangible obstacles: Health implications of stigmatization, structural violence, and fear among undocumented immigrants in France. Soc. Sci. Med. 2012, 74, 858–863. [Google Scholar] [CrossRef] [PubMed]
- Pursch, B.; Tate, A.; Legido-Quigley, H.; Howard, N. Health for all? A qualitative study of NGO support to migrants affected by structural violence in Northern France. Soc. Sci. Med. 2020, 248, 112838. [Google Scholar] [CrossRef]
- Owczarzak, J.; Kasi, A.K.; Mazhnaya, A.; Alpatova, P.; Zub, T.; Filippova, O.; Phillips, S.D. You’re nobody without a piece of paper: Visibility, the state, and access to services among women who use drugs in Ukraine. Soc. Sci. Med. 2021, 269. [Google Scholar] [CrossRef] [PubMed]
- Sarang, A.; Rhodes, T.; Sheon, N.; Page, K. Policing drug users in Russia: Risk fear, and structural violence. Subst. Use Misuse 2010, 45, 813–864. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hamed, S.; Thapar-Björkert, S.; Bradby, H.; Ahlberg, B.M. Racism in european health care: Structural violence and beyond. Qual. Health Res. 2020, 30, 1662–1673. [Google Scholar] [CrossRef] [PubMed]
- Lewis, S.; Russel, A. Young smokers’ narratives: Public health, disadvantage and structural violence. Sociol. Health Illn. 2013, 5, 746–760. [Google Scholar] [CrossRef] [Green Version]
- Bhopal, R.S. Racism and health care in Europe: Reality or mirage? Eur. J. Public Health 2007, 3, 238–241. [Google Scholar] [CrossRef] [Green Version]
- Gil-González, D.; Carrasco-Portiño, M.; Vives-Cases, C.; Agudelo-Suárez, A.A.; Castejón-Bolea, R.; Ronda-Pérez, E. Is health a right for all? An umbrella review of the barriers to health care access faced by migrants. Ethn. Health 2015, 20, 523–541. [Google Scholar] [CrossRef]
- Williams, D.R.; Lawrence, J.A.; Davis, B.A. Racism and heath: Evidence and needed research. Annu. Rev. Public Health 2019, 40, 105–125. [Google Scholar] [CrossRef] [Green Version]
- Belliveau, M. Gendered matters: Undocumented mexican mothers in the current policy context. Affilia 2011, 26, 36–46. [Google Scholar] [CrossRef]
- Public Health Agency of Canada (PHAC). What Determines Health?—Population Health. 2011. Available online: http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php (accessed on 28 June 2021).
- Pierce, C.M. Stress analogs of racism and sexism: Terrorism, torture and disaster. In Mental Health, Racism and Sexism; Willie, C.V., Rieker, P.P., Kramer, B.M., Brown, B.S., Eds.; Routledge: New York, NY, USA, 1995; pp. 277–293. [Google Scholar]
- Sue, D.W. Micro-Aggressions in Everyday Life: Race, Gender and Sexual Orientation; Willey: New York, NY, USA, 2010. [Google Scholar]
- Montesanti, S.R.; Thrurston, W.F. Mapping the role of structural and interpersonal violence in the lives of women: Implications for public health policy. BMC Women’s Health 2015, 15, 100. [Google Scholar] [CrossRef] [Green Version]
- Galtung, J. Peace: Research, Education, Action; Christian Ejlers: Copenhagen, Denmark, 1975. [Google Scholar]
- Ho, K. Structural violence as a human rights violation. Essex. Hum. Rights Rev. 2007, 4, 1–17. [Google Scholar]
- Nelson, E.-U. Policy crackdowns, structural violence and impact on well-being of street cannabis users in a Nigerian City. Int. J. Drug Policy 2018, 54, 114–122. [Google Scholar] [CrossRef]
- Opotow, S. Reconciliation in times of impunity: Challenges for social injustice. Soc. Justice Res. 2001, 14, 149–170. [Google Scholar] [CrossRef]
- Weber, L.; Pickering, S. Structural violence. In Globalization and Borders. Transnational Crime, Crime Control and Security; Palgrave Macmillan: London, UK, 2011. [Google Scholar]
- Winter, Y. Violence and visibility. New Political Sci. 2012, 34, 195–202. [Google Scholar] [CrossRef]
- Hernandez, J.; Galleta, A. The continuum of structural violence: Sustaining exclusion through school closures. Comm. Psych. Glob. Persp. 2015, 2, 21–39. [Google Scholar]
- Neely, E.; Raven, B.; Dixon, L.; Bartle, C.; Timu-Parata, C. Ashamed, silent and stuck in a system—Applying a structural violence lens to midwives stories on social disadvantage in pregnancy. Int. J. Environ. Res. Public Health 2020, 17, 9355. [Google Scholar] [CrossRef]
- Undurraga, T. Neoliberalism in Argentina and Chile: Common antecedents, divergent paths. Rev. Sociol. Política 2015, 23, 11–34. [Google Scholar] [CrossRef] [Green Version]
- Mladenov, T. Neoliberalism, postsocialism, disability. Disabil. Soc. 2015, 30, 445–459. [Google Scholar] [CrossRef] [Green Version]
- Owen, R.; Harris, S.P. No rights without responsibilities: Disability rights and neoliberal feform under new labour. Disabil. Stud. Q. 2012, 32. [Google Scholar] [CrossRef]
- Rotarou, E.S.; Sakellariou, D. Neoliberal reforms in health systems and the construction of long-lasting inequalities in health care: A case study from Chile. Health Policy 2017, 121, 495–503. [Google Scholar] [CrossRef]
- Vaidya, A.A. Shadows of colonialism: Structural violence, development and adivasi rights in Post-Colonial Madhya Pradesh, South Asia. J. South Asian Stud. 2018, 41, 315–330. [Google Scholar] [CrossRef]
- Williams, C.; Maruthappu, M. Healthconomic crises: Public health and neoliberal economic crises. Am. J. Public Health 2013, 103, 7–9. [Google Scholar] [CrossRef] [PubMed]
- Karamessini, M. Sovereign debt crisis: An opportunity to complete the neoliberal project and dismantle the Greek employment model. In A Triumph of Failed Ideas: European Models of Capitalism in the Crisis; Lehndorff, S., Ed.; ETUI Aisbl: Brussels, Belgium, 2012; pp. 155–183. [Google Scholar]
- Stuckler, D.; Reeves, A.; Loopstra, R.; Karanikolos, M.; Mckee, M. Austerity and health: The impact in the UK and Europe. Eur. J. Public Health 2017, 27 (Suppl. 4), 18–21. [Google Scholar] [CrossRef] [PubMed]
- Cervero-Liceras, F.; Mckee, M.; Legido-Quigley, H. The effects of the financial crisis and austerity measures on the Spanish health care system: A qualitative analysis of health professionals’ perceptions in the region of Valencia. Health Policy 2014. [Google Scholar] [CrossRef]
- Legido-Quigley, H.; Karanikolos, M.; Plaza, S.; Freitas, C.; Bernardo, L.; Padilla, B.; McKee, M. Effects of the financial crisis and troika austerity measures on health and health care access in Portugal. Health Policy 2016, 120, 833–839. [Google Scholar] [CrossRef] [Green Version]
- Canelo, M.J.; Gianolla, C.; Santos, F.; Serapioni, M.; Navarro, P.P.; Silva, P.; Peixoto, P.; Lima, T.M.; Neves, V. Crisis, Austerity and Health Inequalities in Southern European Countries; Universidade the Coimbra: Coimbra, Portugal, 2019; pp. 1–223. [Google Scholar]
- Herrick, C.; Bell, K. Concepts, disciplines and politics: On ‘structural violence’and ‘social determinants of health’. Crit. Public Health 2020. [Google Scholar] [CrossRef]
- Frolich, K.; Corin, E.; Potvin, L. A theoretical proposal for the relationship between context and disease. Sociol. Health Illn. 2001, 23, 776–797. [Google Scholar] [CrossRef]
- Armstead, T.L.; Wilkins, N.; Nation, M. Structural and social determinants of inequities in violence risk. A review of indicators. J. Community Psychol. 2021, 7, 1–28. [Google Scholar] [CrossRef] [PubMed]
Author, Year/Country/Reference | Study Objective | Design, Sample, and Method of Analysis | Conceptualization of Structural Violence (SV) | Health-Related Outcome (s) | Findings |
---|---|---|---|---|---|
Sanchéz-Sauco, 2019/Spain/[31] | To contribute to closing the current gap in the literature that holistically examines socio-cultural influences on perinatal drug dependency. | Qualitative study (semi-structured interviews)/thematic analysis Perinatal substance use and/or drug dependency in 10 pregnant women. | Socio-cultural factors | Substance use/drug dependency | The criminalization and stigmatization of addiction, and the risk discourse elucidate the multi-layered social barriers that drug-dependent women experience when seeking rehabilitation services. |
Rodríguez-Martínez and Cuenca-Piqueras, 2019/Spain/[30] | To investigate how sexual harassment in the workplace intersects with other forms of direct and indirect violence towards Spanish and unauthorized migrant women working in sex and domestic work who have suffered direct and indirect violence. | Qualitative study/multi-level intersectional analysis Interviews with 32 Spanish and unauthorized migrant women (Latin American, Eastern European, and African). | Power imbalance and discrimination (related to working as a sex worker and immigrant status) | Intimate partner violence/sexual harassment | Findings were that the interviewed women did not consider verbal abuse as sexual harassment and attributed the abuse to their work. In addition, they perceived sexual harassment to be linked to respect and not to love. The authors indicated that sexual harassment had less devastating consequences for women than did intimate partner violence. |
Larchanché, 2012/France/[32] | To identify obstacles for undocumented immigrants to realize their health care rights. | Qualitative participant observation, critical review of legislative debates and reports related to health care of migrants (n = 5)/ethnographic analysis. | Social stigmatization, precarious living conditions, fear created by restrictive immigrant policies | Health care access | Findings showed that while, legally, undocumented immigrants were entitled to health care rights in France, the consequences of their social stigmatization and of their precarious living conditions, and the climate of fear and suspicion generated by increasingly restrictive immigration policies in practice hindered many from feeling entitled to those rights. |
Pursch et al., 2020/France/[33] | To explore the provision of health services to migrants in Calais and La Linière in northern France; to contribute to the discourse on the effects of SV on non-governmental service providers and migrants in precarious conditions; and to inform service provision policies. | Qualitative (semi-structured interviews)/20 key interviewees—Non-governmental organization (NGO) representatives/thematic analysis. | Immigrant status | Health care access | Structural violence negatively affected migrant well-being through restricted services, intentional chaos, and related disempowerment. The NGOs were required to shift service delivery to adhere to boundaries set by the government, such as limiting distribution points and constantly changing distribution locations to ensure that individuals living on the streets had difficulties to access services. |
Owczarzak et al., 2021/Ukraine/[34] | To explore paperwork as a form of SV through its production of “legitimate” citizens, often through reinforcement of gender stereotypes and moral narratives of deservingness. In addition, the study examined the relationship between the government and NGOs in the provision of services to women who used drugs. | Qualitative study including 78 participants (41 medical and social service providers and 37 women who used drugs)/grounded theory. | Paperwork bureaucracy | Health and social care provision | Documentation requirements were enacted as a form of SV towards already marginalized women through use of coding for marginalized, stigmatized, ill, or disabled identities, and prevented the women from accessing the services and resources they needed. |
Hamed et al., 2020/Sweden, Germany and Portugal/[36] | To study access to health care in several neighbourhoods by interviewing local health care users. | Qualitative study (semi-structured interviews)/11 interviewees (health care users)/thematic analysis. | Discrimination (racism, racial inequalities) | Health care access | Findings were that users felt that medical staff viewed these patients’ narratives as illegitimate, and regarded the patients as unworthy of treatment, which often resulted in a delay in treatment. |
Lewis and Russel, 2013/United Kingdom/[37] | To understand the issues faced by young smokers—and those trying to quit smoking—in a deprived community. | Qualitative study (ethnographic study with participant observation) including 5 members of a youth club located in a disadvantaged neighbourhood. | Neighbourhood deprivation | Smoking /quitting smoking | The study found that young people were somewhat caught between three competing domains (economic and political structures, media structures, and organized crime). These domains together conspired to provide young people with means of consumption from which they were excluded through legitimate structures. |
Sarang et al., 2010/Russia/[35] | To explore accounts of HIV and health risks among injection drug users. | Mixed-method study including a qualitative (semi-structured interviews) and quantitative (descriptive) design and a sample of 209 injection drug users. Qualitative data analysed using thematic analysis. | Drug policing strategies | Drug use/risk of physical violence | The study found that policing practices violated the rights of drug users directly, but also indirectly, through inflicting social suffering. Extrajudicial policing practices introduced fear and terror into the day-to-day lives of drug injectors, and ranged from the mundane (arrest without legal justification or evidence in order to expedite arrest or detainment; and extortion of money or drugs for police gain) to the extreme (physical violence as a means of facilitating confession, and as an act of “moral punishment” without legal cause or rationale, as well as torture and rape). |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Macassa, G.; McGrath, C.; Rashid, M.; Soares, J. Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 6998. https://doi.org/10.3390/ijerph18136998
Macassa G, McGrath C, Rashid M, Soares J. Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(13):6998. https://doi.org/10.3390/ijerph18136998
Chicago/Turabian StyleMacassa, Gloria, Cormac McGrath, Mamunur Rashid, and Joaquim Soares. 2021. "Structural Violence and Health-Related Outcomes in Europe: A Descriptive Systematic Review" International Journal of Environmental Research and Public Health 18, no. 13: 6998. https://doi.org/10.3390/ijerph18136998