Poverty

1. Select two major concepts from the article by Farmer et al (2006), Explain how they are linked to poverty and health:

Here I would select Structural Violence and AIDS to say something about how they are linked to poverty and health.

First, I will present the relationship between poverty and health.
Human poverty is a complex set of deprivations in many dimensions. It has several clusters of meanings: income-poverty, material lack or want, capability deprivation and so on. And it’s disadvantages: Lack of info, Lack of Education, Institutions and Access, Poverty of Time, Seasonal Dimensions, Place of the poor, Insecurities, Physical Illbeing, Material Poverties, Social Relations, Ascribed and Legal Inferiority, Lack of Political clout. There is a complicated web between them, each one potentially having an impact on all of the others, and vice versa.
Poverty creates ill- health because it forces people to live in environments that make them sick, without decent shelter, clean water or adequate sanitation. Poverty creates hunger, which in turn leaves people vulnerable to disease. Poverty denies people access to reliable health services and affordable medicines, and causes children to miss out on routine vaccinations. Poverty creates illiteracy, leaving people poorly informed about health risks and forced into dangerous jobs that harm their health.
Poverty and health interact in many ways. Poverty can cause disease, and disease can also cause poverty. They usually go together, that’s why we should follow the issue of poverty when we do public health research.
Structural Violence, poverty, health:
What is Structural Violence? Different from what the article mentioned, the explain in Wikipedia seems more at large: a term which was first used in the 1960s and which has commonly been ascribed to Johan Galtung, denotes a form of violence which corresponds with the systematic ways in which a given social structure or social institution kills people slowly by preventing them from meeting their basic needs. Institutionalized elitism, ethnocentrism, classism, racism, sexism, adultism, nationalism, heterosexism and ageism are just some examples of structural violence. Life spans are reduced when people are socially dominated, politically oppressed, or economically exploited.
Drawing from Bronfenbrenner, we suggest that structural violence is nested within three systems, the socio-political (the macrosystem), the socio-environmental (the mesosystem) and the psychological (the microsystem). The mechanisms by which structural violence operates are found in the state and its institutions. Social institutions including the law and educational facilities sanction and enforce conditions that place people at high risk for negative consequences such as economic (unemployment), psychological (suicide, mental illness), behavioral (crime), and physical (illness).
As Gandhi saw, "the deadliest form of violence is poverty." The truth of Gandhi's generalization has been confirmed repeatedly by empirical research showing how death rates increase when poverty rates increase, in both cross-cultural and longitudinal studies. In fact, the difference in death rates suffered by poor nations, compared with wealthy ones, has been shown to be far greater than the death rates caused by all forms of violent behavior put together, including homicide, suicide and warfare. What is it that refer to the increased death rates that the poor suffer------ Structural violence.
In fact, Structural Violence is a concept of sociology and of course a wide concept, we can see from above that how it cause poverty and disease, then there is also a strong relationship between poverty and disease as I mentioned at beginning. Actually, Structural Violence is nested with poverty and health.

AIDS, poverty, health:
I think it is needless to say more about the relationship between health and AIDS, here I will concentrate on poverty and AIDS.
AIDS which has often been described as a “disease of poverty” is never an isolated problem –always part of a wider problem in a society.
Poverty to AIDS: The fact that most people living with HIV in the region today are poor simply reflects the fact that the epidemic has now spread throughout the generalized population in a region that has a high proportion of poor people. Here are some example: Household studies in Thailand, India and Sri Lanka suggest AIDS is disproportionately affecting the poor in Asia; Evidence from Bangladesh, Nepal, Indonesia and Vietnam shows the least educated are at greater risk; The least educated are less likely to use contraception and to be aware of dangers of AIDS; The poorest are more likely to turn to sex work, and less able to insist that their clients use condoms.
AIDS to poverty: AIDS kills people in the prime of their working and parenting lives, with a devastating effect on the lives and livelihoods of affected households. Incomes shrink when employed household members become sick or die, and resources are further depleted by medical and funeral-related costs. The impact on poor households is clearly disproportionate, with many struggling to meet demands for treatment and care. Moreover, even if drugs are free, poor families may have insufficient resources to meet basic nutrition needs or the costs of travel to health clinics for care. In addition, AIDS increases TB, which mainly affects poor.


2. Describe also what value this articles point of view brings to discussion on poverty and health:

Since structural interventions might arguably have a greater impact on disease control than do conventional clinical interventions, we would do well to pay heed to them. And distal and proximal interventions are complementary, not competing. The poor are the natural constituents of public health, and physicians, as Virchow argued, are the natural attorneys of the poor. In this struggle, equity in healthcare is our responsibility. Only when we link our efforts to those of others committed to initiating virtuous social cycles can we expect a future in which medicine attains its noblest goals.

References:
1.Susan James, PhD,Structural violence: the invisible violence in our communities
2.Water shortage as a form of structural violence written by James Gilligan, MD , School of Arts and Science, New York University, New York, NY
3. http://en.wikipedia.org/wiki/Structural_violence
4. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040314
5. http://www.line.dk/reading/blankertz6.html
6. Farmer, P., Nizeye, B., Stulac, S. & Keshavjee, S. 2006. Structural Violence and Clinical Medicine. (pdf) PLoS Medicine, Vol. 3(10)
7. Dying for change. Poor people's experience of health and ill-health. (pdf) WHO & The World Bank. Complete report