Structural Violence: How Societal Factors Affect Health

Income, race and geographic location are often weaponized against communities, preventing them from accessing and achieving health and wellness.

A routine doctor’s appointment may be rare for those living in poverty, causing them to not seek treatment for incipient medical issues. #PACOM. CC BY-NC-ND 2.0.

Income, geographical location, climate and access to resources all affect people’s health in various ways. Indeed, it is rare to get malaria, a mosquito-borne disease in the Arctic. It is also comparatively easier for a wealthy person who has access to top-notch treatments to recover from cancer than a disadvantaged person who cannot afford a routine doctor’s appointment. These societal factors have a proven link to health outcomes, and they are usually not controlled by individuals. To fully foster public health, it is necessary to eliminate those societal factors that precipitate health concerns.

There are both biological and societal factors that affect health. Biologically, genetics can affect one’s health, as the causal relationship between genetics and diseases such as cystic fibrosis have been demonstrated through medical research. However, biological factors are not the only thing that affects health; societal factors do as well. The World Health Organization (WHO) defines social determinants of health as: 

The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

Sometimes, the system itself is rigged against a substantial part of the population from attaining complete physical, social and emotional well-being. That is called structural violence. These arrangements are ‘structural’ because they are “embedded in the political and economic organization” of society, and they are ‘violent’ because they harm people, whether physically or not. 

Lowndes County, Alabama, where the low-income Black population suffers disproportionately from hookworm infections due to structural violence. jimmywayne. CC BY-NC-ND 2.0.

One example of these biosocial determinants and structural violence in play can be found in rural Alabama, where hookworm, a disease thought to be eradicated years ago, is making a resurgence in Lowndes County. That county is 72% Black and has a poverty rate of 21.9%, almost double the national average of 11.4% in 2020. Low-income Blacks in the county are more prone to hookworm because they live next to pools of raw sewage, the perfect breeding ground for the worms. 

Structural violence is also at play here, as the Black population live near the pools of raw sewage because they cannot afford proper sewage systems. The local and state government, in turn, perpetuates this problem by turning a blind eye on the issue and not providing any assistance to the residents. Through no fault of their own, Blacks in Lowndes County have a heightened risk for hookworm due to the circumstance in which society makes them live.

Cultural practices can also precipitate or hinder disease. West African countries that already had fragile healthcare systems were particularly affected by the 2014 Ebola outbreak because of cultural practices regarding funerals. In those cultures, funerals involve washing the dead body by hand before burial and paying respect to the dead through physical contact, both of which are exceptionally high-risk activities with regards to the spread of Ebola, since the virus is still present in the corpse. Controlling the Ebola outbreak must address these cultural issues.

Finally, around the world, food deserts are scattered around urban centers, usually located in areas of poverty. Food deserts are areas with a dearth of supermarkets and other sources of healthy foods, forcing people living there to travel further for quality foods or to settle for cheaper unhealthy foods. Since many food deserts are in areas of poverty, the people living in those areas usually have no choice but to buy cheap  foods with subpar qualities. The unhealthy diet of many in those areas lead to higher rates of obesity and cardiovascular disease.

Structural violence affects food deserts, as the economic disincentives for healthy food sources to serve low-income areas show that society does not provide adequate support to them. In northern Ireland, food deserts are especially pronounced since 32% of households do not have a car. Some food deserts are the result of years of neglect of marginalized communities. Failure of the UK government to provide adequate public transportation in northern Ireland demonstrates that neglect.

Simply treating disease without regard for the underlying causes of it will not eliminate the issue. To eliminate hookworm, proper sanitation services must be implemented. Containing Ebola means educating local communities about safe methods to bury the dead in a way that does not denigrate their culture. To eliminate obesity, focus should be on providing access to healthy foods instead of just telling people to change their diet. It is important to treat diseases as complex issues instead of having a singular focus on the cure. Removing societal barriers to good health is instrumental in ensuring the physical, social and emotional health for all.

To Get Involved

The organization Partners in Health serves to improve healthcare in developing countries through patient-provider partnerships. Partners in Health works to create sustainable healthcare systems that serve all, emphasizing healthcare as a human right.

Often, the best way to remove the societal factors that affect health negatively is by advocacy. Writing to your elected officials is a good way to draw attention to those issues, which may spur them to act on your recommendations. To find your representative in Congress, click here.

Bryan Fok

Bryan is currently a History and Global Affairs major at the University of Notre Dame. He aims to apply the notion of Integral Human Development as a framework for analyzing global issues. He enjoys hiking and visiting national parks.

Environmental Racism is Poisoning Black Communities in the US

Black Americans are 79% more likely than White Americans to live in areas where industrial pollution poses a health threat. The environmental injustice that members of the community face is rooted in centuries of systemic racism and segregation. 

In 2016, Flint, Michigan, was declared to be in a state of emergency by its mayor, Michigan’s governor, and then-President Barack Obama. These state of emergency declarations brought national attention to a crisis that citizens of Flint, a majority-Black community, had been dealing with for two years at that point: undrinkable water. In 2014, the city switched its drinking water supply from Detroit’s system to the Flint River in an attempt to cut costs. The Flint River runs through the center of town and has historically been used as an unofficial disposal site for refuse from local factories and mills. The river’s pollution, combined with inadequate water treatment and testing, led to discolored, bad-smelling water being pumped into Flint homes. Water from the Flint River caused rashes and hair loss, and it also potentially contributed to an outbreak of Legionnaires’ disease that killed 10 people. Later studies showed that the contaminated water had also led to increased cases of elevated blood lead levels in Flint’s children, a condition which can create a range of developmental problems. Flint is still dealing with lead in its water supply because of corroded pipes. The Michigan Civil Rights Commission concluded that the government’s poor response to the Flint water crisis was a result of implicit bias and systemic racism. 

Flint is not the only city to fall victim to environmental injustice, the phenomenon of certain communities, such as communities of color and poor communities, being disproportionately subjected to environmental risk. Environmental injustice is believed to be rooted in systemic racism, and is sometimes referred to as environmental racism. While White people generally breathe 17% less air pollution than they are responsible for generating, Black people breathe 56% more than they cause. In 19 states, Black Americans are at least 79% more likely than White Americans to live in areas where industrial pollution is a health threat. 

St. James Parish, Louisiana, is riddled with factories, chemical plants and refineries. Residents in the area have some of the highest cancer rates in the country, and the region has been nicknamed “Cancer Alley.” Environmentalists say that the area’s fossil fuel industry is the reason for the community’s dismal health. Residents of Grays Ferry, a neighborhood in South Philadelphia, also face disproportionate rates of cancer, which experts attribute to the community’s proximity to a massive refinery. Like Flint, St. James Parish and Grays Ferry are majority-Black communities. 

Factories, refineries and other forms of polluting infrastructure have historically been built in low-income communities of color. Many of these communities were created through segregation and redlining, the refusal of the Federal Housing Administration to issue mortgages in Black neighborhoods. Housing policies under the New Deal were geared toward providing housing to middle-class White families, pushing people of color into urban housing projects. The Federal Housing Administration subsidized the production of subdivisions for White families, requiring that none of the homes be sold to people of color. White neighborhoods received more community investment and better infrastructure, while communities of color suffered from poverty and poor amenities. Companies began exploiting this segregation by buying out Black residents in order to use the land for industrial purposes. After all, people in low-income communities often lacked the means necessary to hire legal representation that could fight back against major corporations. 

The systemic racism that led to segregation and the creation of many low-income communities of color in some ways still perseveres, as these communities are taken advantage of by companies at the expense of residents’ health. Black people have historically been left out of the environmentalist movement, with White people making up 80% of the staff of environmental nonprofits. More recently, Black communities have begun advocating for environmental justice. Activists hope to combine the National Environmental Policy Act, which requires federal agencies to consider the environmental impact of proposed projects and infrastructure, with Title VI of the 1964 Civil Rights Act, which prohibits federally funded entities from discriminating on the basis of race, to create a policy that would dismantle environmental injustice. Environmental policy changes are considered by many to be badly needed, and until they occur, companies will continue to prosper at the expense of Black communities.

Rachel Lynch

Rachel is a student at Sarah Lawrence College in Bronxville, NY currently taking a semester off. She plans to study Writing and Child Development. Rachel loves to travel and is inspired by the places she’s been and everywhere she wants to go. She hopes to educate people on social justice issues and the history and culture of travel destinations through her writing.

10 Places to Honor Black History and Culture

Through artwork, literature, music and history, these institutions amplify Black voices and address race relations in America.  

George Floyd protests in Charlotte, North Carolina. Clay Banks. Unsplash.

Amid global protests against racial injustice, a growing number of people are educating themselves on systemic racism and white privilege.

1. Martin Luther King Jr. National Historical Park - Atlanta, Georgia

Martin Luther King Jr. locating civil rights protests. Thomas Hawk. CC BY-NC 2.0

Located in one of Atlanta’s historic districts, the Martin Luther King Jr. National Historical Park honors the activist who strove for racial equality. The site includes a museum chronicling the American civil rights movement, as well as Dr. King’s childhood home, garden and gravesite. With 185 varieties of roses, the “I Have a Dream” World Peace Rose Garden promotes peace between diverse world communities. Each year, students from the greater Atlanta area write poems that express the ideals of MLK, such as using civil disobedience to reach seemingly impossible goals. These “Inspirational Messages of Peace” are exhibited among the flowers and are read by thousands of visitors each year. Directly across the street is the final resting place of Dr. King and Coretta Scott King, his wife, surrounded by a reflection pool. 

Until his assassination in 1968, King preached at Ebenezer Baptist Church, known as “America’s Freedom Church.” The church has continued to serve the Atlanta community since his death, vowing to “feed the poor, liberate the oppressed, welcome the stranger, clothe the naked and visit those who are sick or imprisoned.” While sitting in the pews, visitors hear prerecorded sermons and speeches from Martin Luther King Jr. Most recently, the funeral of Rayshard Brooks, a Black man fatally shot by police, was held at the church, with hundreds of prominent pastors, elected officials and activists in attendance. 

2. National Museum of African American History and Culture - Washington, D.C.

A student at the NMAAHC uses an interactive learning tool. U.S. Department of Education. CC BY 2.0

The National Museum of African American History and Culture (NMAAHC) is the only museum devoted exclusively to African American life, history and culture. In the words of Lonnie Bunch III, founding director of the NMAAHC, “The African American experience is the lens through which we understand what it is to be an American.” From slavery to the civil rights movement, the museum aims to preserve and document Black experiences in America. With the launch of the Many Lenses initiative, students will gain a greater understanding of African American history by studying museum artifacts and discussing cultural perspectives alongside scholars, curators and community educators. Through the Talking About Race program, the museum provides tools and guidance to empower people of color and inspire conversations about racial injustice. 

3. Black Writers Museum - Philadelphia, Pennsylvania

Langston Hughes, a famous writer featured at the BWM, signs autographs. Washington Area Spark. CC BY-NC 2.0

Built in 1803, the historic Vernon House includes the Black Writers Museum (BWM), the first museum in the country to exhibit classic and contemporary Black literature. The BWM celebrates Black authors, like Langston Hughes and Zora Neale Hurston, who documented the resilience and resistance of African Americans throughout history. Supreme D. Dow, founder and executive director of the Black Writers Museum, noted, “There was a time in American history when Black people were denied the human right to read or write. But, because of the innate drive to satisfy the unquenchable thirst for self determination, our ancestors taught themselves how to read and write in righteous defiance of the law, and in the face of fatal repercussions.” Through books, newspapers, journals and magazines, the museum honors the Black narrators of history. The BWM also strives to inspire future African American authors with community activities like poetry readings, cultural arts festivals and book signings. 

4. Tubman Museum - Macon, Georgia

Artwork depicting Harriet Tubman on the Underground Railroad. UGArdener. CC BY-NC 2.0

Named after Harriet Tubman, the “Black Moses” who led hundreds of slaves to freedom, the Tubman Museum has become a key educational and cultural center for the entire American Southeast. Through artwork and artifacts, the main exhibits recount the struggles and triumphs of Tubman, a former slave, abolitionist and spy. The “From the Minds of African Americans” Gallery displays inventions from Black inventors, scientists and entrepreneurs, such as Madam C.J. Walker and George Washington Carver. The Tubman Museum also actively contributes to the Macon, Georgia, community. The Arts & History Outreach program takes Black history beyond museum walls. Local African American artists and teachers bring museum resources into the classroom, promoting hands-on learning. Due to COVID-19, the museum recently launched a distance learning program to provide people at home with a deeper understanding of the African American experience. 

5. Museum of the African Diaspora - San Francisco, California

Contemporary art by Kehinde Wiley exhibited at the MoAD. Garret Ziegler. CC BY-NC-ND 2.0

The Museum of the African Diaspora (MoAD), a contemporary art museum, celebrates Black culture from the perspective of African diaspora. Focused exclusively on African migration throughout history, the museum presents artwork, photography and artifacts related to the themes of origin, movement, adaptation and transformation. Currently, MoAD is featuring various exhibitions from emerging artists that explore ancestral memory and Black visibility. As active members of the San Francisco community, museum curators offer various programs like public film screenings, artist talks and musical performances. In response to worldwide protests, the museum created a guide with resources to support Black Americans, as well as a video series that promotes community resilience. Monetta White, MoAD’s executive director, announced, “Now more than ever, we affirm that Museums are Not Neutral. As humanitarian educators and forums for conversation, museums are a space to confront some of the most uncomfortable conversations in human history.”

6. National Museum of African American Music - Nashville, Tennessee

Jimi Hendrix, a featured musician at the NMAAM. Clausule. Public Domain.

Scheduled to open its doors for the first time on Sept. 5, the National Museum of African American Music (NMAAM) will be the first museum in the world to showcase African American influence on various genres of music, such as classical, country, jazz and hip-hop. NMAAM will integrate history and interactive technology to share music through the lens of Black Americans. “African American music has long been a reflection of American culture. Additionally, African American musicians often used their art as a ‘safe’ way to express the way they felt about the turbulent times our country faced,” said Kim Johnson, director of programs at the museum. NMAAM will also support the Nashville community through various outreach programs. From Nothing to Something explores the music that early African Americans created using tools like spoons, banjos, cigar box guitars and washtub basins. Children receive their own instruments, learning how simple resources influenced future music genres. Another program, Music Legends and Heroes, promotes leadership, teamwork and creativity in young adults. Students work together to produce a musical showcase in honor of Black musicians. In 2015, student guitarists paid tribute to Jimi Hendrix, the rock icon. “This opportunity gave them a real-life connection to an artist they had only seen in their textbooks or online,” said Hope Hall, librarian at the Nashville School of the Arts.

7. The Legacy Museum: From Enslavement to Mass Incarceration - Montgomery, Alabama

Exterior of the Legacy Museum. Sonia Kapadia. CC BY-SA 4.0

The Legacy Museum is located in a former slave auction warehouse, where thousands of Black people were trafficked during the domestic slave trade. The museum employs unique technology to portray the enslavement of African Americans, the evolution of racial terror lynchings, legalized racial segregation and racial hierarchy in America. Visitors encounter replicas of slave pens and hear first-person accounts of enslaved people, along with looking at photographs and videos from the Jim Crow laws, which segregated Black Americans until 1965. The Legacy Museum also explores contemporary issues of inequality, like mass incarceration and police violence. As part of the Equal Justice Initiative (EJI), the museum is committed to ending mass incarceration and excessive punishment in the United States, with proceeds going toward marginalized communities. “Our hope is that by telling the history of the African American experience in this country, we expose the narratives that have allowed us to tolerate suffering and injustice among people of color,” says Sia Sanneh, member of EJI. 

8. African American Military History Museum - Hattiesburg, Mississippi 

Circa 1942, the Tuskegee Airmen pose in front of their aircraft. Signaleer. Public Domain.

The African American Military History Museum educates the public about African American contributions to the United States’ military. During World War II, the building functioned as a segregated club for African American soldiers. Transformed in 2009, the museum now commemorates the courage and patriotism of Black soldiers, who have served in every American conflict since the Revolutionary War. Artifacts, photographs and medals tell the story of how African Americans overcame racial boundaries to serve their country. For instance, the World War II exhibit features the Tuskegee Airmen, the first African American soldiers to successfully enter the Army Air Corps. 

9. National Voting Rights Museum and Institute - Selma, Alabama 

The 1965 march from Selma to Montgomery for the right to vote. Abernathy Family. Public Domain.

In the historic district of Selma, Alabama, the National Voting Rights Museum and Institute honors the movement to end voter discrimination. With memorabilia and documentation, the museum illustrates the struggle of Black Americans to obtain voting rights. In 1965, nearly 600 civil rights marchers crossed the Edmund Pettus Bridge, hoping to reach Montgomery. However, the day became known as “Bloody Sunday” as local law enforcement attacked peaceful protesters with clubs and tear gas. While the Voting Rights Act of 1965 outlawed voting practices that disenfranchised African Americans, many believe voter suppression still exists through strict photo ID laws for voters, a failure to provide bilingual ballots, and ex-felon disenfranchisement laws. By educating the public, the museum hopes to forever dismantle the barriers of voting in the United States. 

10. National Underground Railroad Freedom Center - Cincinnati, Ohio

On the banks of the Ohio River, a statue depicts a mother and her child escaping slavery. Living-Learning Programs. CC BY-NC-ND 2.0

Near the Ohio River, where thousands of slaves traveled in search of freedom, the National Underground Railroad Freedom Center reveals the ongoing struggle for autonomy. From the historical vantage point of the Underground Railroad, the museum promotes the modern abolition of slavery. Due to widespread human trafficking, nearly 40 million people are currently enslaved around the world. As stated on the museum’s website, “Despite the triumphant prose of our American history books, slavery didn’t fully end 150 years ago. Today and throughout time, people around the world have struggled for their freedom. Yet, as forms of slavery evolve, so do the imaginations of those fighting for freedom.” Through artifacts, photographs and first-person accounts, the museum introduces the men and women who have resisted slavery. “Invisible: Slavery Today” is the world's first permanent exhibition on the subjects of modern-day slavery and human trafficking, challenging and inspiring visitors to promote freedom today. 

Shannon Moran

is a Journalism major at the University of Georgia, minoring in English and Spanish. As a fluent Spanish speaker, she is passionate about languages, cultural immersion, and human rights activism. She has visited seven countries and thirty states and hopes to continue traveling the world in pursuit of compelling stories.