Structural violence
Not to be confused with Structural abuse
Structural violence is a term commonly ascribed to
Johan Galtung, which he introduced in the article “Vi-
olence, Peace, and Peace Research” (1969).[1] It refers to
a form of violence wherein some social structure or social
institution may harm people by preventing them from
meeting their basic needs. Institutionalized adultism,
ageism, classism, elitism, ethnocentrism, nationalism,
racism, and sexism are some examples of structural vi-
olence as proposed by Galtung. According to Galtung,
rather than conveying a physical image, structural vio-
lence is an “avoidable impairment of fundamental hu-
man needs”.[2] As it is avoidable, structural violence is a
high cause of premature death and unnecessary disability.
Because structural violence affects people differently in
various social structures, it is very closely linked to so-
cial injustice.[3] Structural violence and direct violence
are said to be highly interdependent, including family
violence, gender violence, hate crimes, racial violence,
terrorism, and war.
In his book Violence: Reflections on a National Epi-
demic, James Gilligan defines structural violence as “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.” Gilligan largely describes these
“excess deaths” as “non-natural” and attributes them to
the stress, shame, discrimination, and denigration that re-
sults from lower status. He draws on Sennett and Cobb,
who examine the “contest for dignity” in a context of dra-
matic inequality.
1 Cultural violence
“Cultural violence” refers to aspects of a culture that can Scheper-Hughes.
be used to justify or legitimize direct or structural vio- Theorists argue that structural violence is embedded in
lence, and may be exemplified by religion and ideology, the current world system; this form of violence, which is
language and art, empirical science and formal science.[4] centered on apparently inequitable social arrangements,
Cultural violence makes direct and structural violence
look or feel “right”, or at least not wrong, according to
Galtung.[5] The study of cultural violence highlights the
ways the act of direct violence and the fact of struc-
tural violence are legitimized and thus made acceptable
in society. One mechanism of cultural violence is to
change the “moral color” of an act from “red/wrong” to
“green/right”, or at least to “yellow/acceptable”.[6]
2 International scope
See also: Structural violence in Haiti
Petra Kelly wrote in her first book, Fighting for Hope
(1984):
A third of the 2 Billion people in the
developing countries are starving or suffer-
ing from malnutrition. Twenty-five per cent
of their children die before their fifth birth-
day […] Less than 10 per cent of the 15
million children who died this year had been
vaccinated against the six most common and
dangerous children’s diseases. Vaccination
costs £3 per child. But not doing so costs us
five million lives a year. These are classic ex-
amples of structural violence.
The violence in structural violence is attributed to the
specific organizations of society that injure or harm indi-
viduals or masses of individuals. In explaining his point
of view on how structural violence affects the health of
subaltern or marginalized people, medical anthropologist
Paul Farmer writes:
Their sickness is a result of structural vio-
lence: neither culture nor pure individual will
is at fault; rather, historically given (and often
economically driven) processes and forces con-
spire to constrain individual agency. Structural
violence is visited upon all those whose social
status denies them access to the fruits of scien-
tific and social progress.
This perspective has been continually discussed by Paul
Farmer, as well as by Philippe Bourgois and Nancy
is not inevitable. Ending the global problem of structural
violence will require actions that may seem unfeasible in
the short term. To some, this indicates that it may be eas-
ier to devote resources to minimizing the harmful impacts
of structural violence. Others, such as futurist Wendell
Bell, see a need for long-term vision to guide projects for
social justice. Many structural violences, such as racism
and sexism, have become such a common occurrence in
1
2 3 SEE ALSO
society that they appear almost invisible. Despite this
fact, sexism and racism have been the focus of intense
cultural and political resistance for many decades. Signif-
icant reform has been accomplished, though the project
remains incomplete.
2.1 Access to health care
Structural violence affects the availability of health care
in the sense that physicians often need to pay attention
to broad social forces (racism, gender inequality, clas-
sism, etc.) to determine who falls ill and who will be
given access to care. It is more likely for structural vi-
olence to occur in areas where biosocial methods are ne-
glected in a country’s health care system. Since struc-
turally violent situations are viewed primarily as biologi-
cal consequences, it neglects environmentally stimulated
problems, such as negative social behaviours or inequal-
ity prominence. If biosocial understandings are forsaken
when considering communicable diseases such as HIV,
for example, prevention methods and treatment prac-
tices become inadequate and unsustainable for popula-
tions. However, the challenge is obvious: many coun-
tries cannot afford to stop the harmful cycle of structural
violence.[3] Paul Farmer argues that the major flaw in
the dominant model of medical care is that medical ser-
vices are sold as a commodity, remaining only available
to those who can afford them.[3] The concept of struc-
tural violence is used to show how medical profession-
als are not trained to understand the social forces behind
disease, nor are they trained to deal with or alter them.
Medical professionals have to ignore the social determi-
nants that alter access to care, and as a result, medical in-
terventions are significantly less effective in low-income
countries.[3] Structural violence is an issue not only in de-
veloping countries, but also in North America. For ex-
ample, it has had a significant impact on diagnosis and
treatment of AIDS in the United States. A 1990 study by
Moore et al. found that blacks had a significantly lesser
chance of receiving treatment than whites.[3] Structural
violence is the result of policy and social structures, and
change can only be a product of altering the processes
that encourage structural violence in the first place. Paul
Farmer claims that “structural interventions” are one pos-
sible solution.
Countries such as Haiti and Rwanda have implemented
these interventions with positive outcomes. Examples
include prohibiting the commodification of the citizen
needs, such as health care, ensuring equitable access
to effective therapies, and developing social safety nets.
These initiatives increase citizen’s social and economic
rights, thus decreasing structural violence. However, for
these structural interventions to be successful, medical
professionals need to be capable of executing such tasks.
Unfortunately, many of these professionals are not trained
to perform structural interventions.[3] Mireover, medical
professionals continue to operate under conventional clin-
ical intervention because physicians can rightly note that
structural interventions are not their job. Therefore, the
onus falls more on political and other experts to imple-
ment such structural changes. As noted, structural forces
account for most if not all epidemic diseases (e.g., HIV).
Medical professionals still continue to operate under the
downstream phenomenon, with a focus is on individual
lifestyle factors rather than general socio-economic, cul-
tural, and environmental conditions. This paradigm ob-
scures the structural impediments to changes because it
tends to avoid the root causes that should be focused on.
One response is to incorporate medical professionals and
to acknowledge that such active structural interventions
are necessary to address real public health issues.[3]
The lessons that have been learned from successful ex-
amples of structural interventions in these countries are
fundamental. Although health disparities resulting from
social inequalities are possible to reduce, as long as health
care is exchanged as a commodity, those without the
power to purchase it will have less access to it. Biosocial
research should be the main focus. Sociology can bet-
ter explain the origin and spread of infectious diseases,
such as HIV or AIDS. Research shows that the risk of
HIV is highly affected by one’s behavior and habits.[3]
Although some structural interventions can decrease pre-
mature morbidity and mortality, the social and historical
determinants of the structural violence cannot be omit-
ted. Although the interventions have enormous influence
on economical and political aspects of international bod-
ies, more interventions are needed to improve access.[3]
Structural violence also exists in the area of mental health,
where systems are designed to ignore the lived experi-
ences of people with mental illnesses when making de-
cisions about services and funding without consulting
with the ill, including those who are illiterate, cannot ac-
cess computers, do not speak the dominant language, are
homeless, are too unwell to fill out long formal surveys,
or are in locked psychiatric and forensic wards. Online-
only consultation may be inappropriate for people with
a lived experience of mental illness. Structural violence
is also apparent when consumers in developed countries
die from preventable diseases 15–25 years earlier than do
people without a lived experience of mental health.
3 See also
• Aggression
• Discrimination
• Imperialism
• Lawsuit
• Structural abuse
• Symbolic violence
• Violence
 3

4 Footnotes
[1] Galtung, Johan. “Violence, Peace, and Peace Research”
Journal of Peace Research, Vol. 6, No. 3 (1969), pp.
167-191

[2] Johan Galtung, “Kulturelle Gewalt” (1993) Vol. 43 Der

Burger im Staat p. 106 in Ho, Kathleen “Structural Vio-
lence as a Human Rights Violation” (2007). Essex Human
Rights Review Vol. 4 No. 2 September 2007

[3] Farmer, Paul E.; Nizeye Bruce; Stulac Sara; Keshav-

jee Salmaan (October 24, 2006). “Structural Vio-
lence and Clinical Medicine”. PLoS Medicine 3 (10):
1686–1691. doi:10.1371/journal.pmed.0030449. PMC
1621099. PMID 17076568. Retrieved August 2014.

[4] Galtung, Johan. “Cultural Violence,” Journal of Peace

Research, Vol. 27, No. 3 (Aug., 1990), pp. 291-305

[5] Galtung 1990, p. 291

[6] Galtung 1990, p. 292

4.1 References
• Johan Galtung, “Violence, Peace, and Peace Re-
search,” Journal of Peace Research, Vol. 6, No. 3.
(1969), pp. 167–191.

5 External links
• Robert Gilman: “Structural violence. Can we find
genuine peace in a world with inequitable distribu-
tion of wealth among nations?" (1983)

• Kathleen Ho: “Structural Violence as a Human

Rights Violation”, Essex Human Rights Review, Vol.
4 No. 2, September 2007 (ISSN 1756-1957)
4 6 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

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