scholarly journals “Ashamed, Silent and Stuck in a System”—Applying a Structural Violence Lens to Midwives’ Stories on Social Disadvantage in Pregnancy

2020 ◽  
Vol 17 (24) ◽  
pp. 9355
Author(s):  
Eva Neely ◽  
Briony Raven ◽  
Lesley Dixon ◽  
Carol Bartle ◽  
Carmen Timu-Parata
Keyword(s):  
Access To Health Care ◽  
Structural Violence ◽  
Current System ◽  
Social Disadvantage ◽  
Individual Responsibility ◽  
Human Needs ◽  
Aotearoa New Zealand ◽  
Access To Health ◽  
Vulnerability To Poverty ◽  
The Impact

Historical and enduring maternal health inequities and injustices continue to grow in Aotearoa New Zealand, despite attempts to address the problem. Pregnancy increases vulnerability to poverty through a variety of mechanisms. This project qualitatively analysed an open survey response from midwives about their experiences of providing maternity care to women living with social disadvantage. We used a structural violence lens to examine the effects of social disadvantage on pregnant women. The analysis of midwives’ narratives exposed three mechanisms by which women were exposed to structural violence, these included structural disempowerment, inequitable risk and the neoliberal system. Women were structurally disempowered through reduced access to agency, lack of opportunities and inadequate meeting of basic human needs. Disadvantage exacerbated risks inequitably by increasing barriers to care, exacerbating the impact of adverse life circumstances and causing chronic stress. Lastly, the neoliberal system emphasised individual responsibility that perpetuated inequities. Despite the stated aim of equitable access to health care for all in policy documents, the current system and social structure continues to perpetuate systemic disadvantage.

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

scholarly journals Racism in European Health Care: Structural Violence and Beyond

2020 ◽  
Vol 30 (11) ◽  
pp. 1662-1673 ◽  
Author(s):  
Sarah Hamed ◽  
Suruchi Thapar-Björkert ◽  
Hannah Bradby ◽  
Beth Maina Ahlberg
Keyword(s):  
Health Care ◽  
Social Structure ◽  
Social Organization ◽  
Access To Health Care ◽  
Structural Violence ◽  
Theoretical Research ◽  
Subtle Racism ◽  
Access To Health ◽  
European Health ◽  
Unequal Access

Research shows how racism can negatively affect access to health care and treatment. However, limited theoretical research exists on conceptualizing racism in health care. In this article, we use structural violence as a theoretical tool to understand how racism as an institutionalized social structure is enacted in subtle ways and how the “violence” built into forms of social organization is rendered invisible through repetition and routinization. We draw on interviews with health care users from three European countries, namely, Sweden, Germany, and Portugal to demonstrate how two interrelated processes of unequal access to resources and inequalities in power can lead to the silencing of suffering and erosion of dignity, respectively. The strength of this article lies in illuminating the mechanisms of subtle racism that damages individuals and leads to loss of trust in health care. It is imperative to address these issues to ensure a responsive and equal health care for all users.

scholarly journals Cardiovascular Disease Prevention and Implications of Coronavirus Disease 2019: An Evolving Case Study in the Crescent City

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Alexander C. Razavi ◽  
Tanika N. Kelly ◽  
Jiang He ◽  
Camilo Fernandez ◽  
Paul K. Whelton ◽  
...  
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Access To Health Care ◽  
Cardiovascular Health ◽  
Case Fatality ◽  
Noncommunicable Diseases ◽  
Lifestyle Behaviors ◽  
Public Health Perspective ◽  
Access To Health ◽  
The Impact

Abstract Medicine and public health have traditionally separated the prevention and treatment of communicable and noncommunicable diseases. The coronavirus disease 2019 ( COVID ‐19) pandemic has challenged this paradigm, particularly in the setting of cardiovascular disease ( CVD ). Overall, individuals with underlying CVD who acquire severe acute respiratory syndrome coronavirus 2 experience up to a 10‐fold higher case‐fatality rate compared with the general population. Although the impact of the pandemic on cardiovascular health continues to evolve, few have defined this association from a frontline, public health perspective of populations disproportionately affected by CVD and COVID ‐19. Louisiana is ranked within the bottom 5 states for cardiovascular health, and it is home to several parishes that have experienced among the highest COVID ‐19 case‐fatality rates nationally. Herein, we review CVD prevention and implications of COVID ‐19 in New Orleans, LA, a city holding a sobering yet resilient history with previous public health disasters. In particular, we discuss potential pandemic‐driven changes in access to health care, preventive pharmacotherapy, and lifestyle behaviors, all of which may adversely affect CVD prevention and management, while amplifying racial disparities. Through this process, we highlight proposed recommendations for how CVD prevention efforts can be improved in the midst of the current COVID ‐19 pandemic and future public health crises.

Poverty, Welfare Reform and the "Culture of Wealth"

2007 ◽  
Vol 29 (4) ◽  
pp. 43-45 ◽  
Author(s):  
Merrill Singer
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Partner Violence ◽  
Access To Health Care ◽  
Structural Violence ◽  
Well Being ◽  
Legal Rights ◽  
True Nature ◽  
Care Access ◽  
Access To Health

An important shift has occurred in anthropology over the last 30 years. A notable expression of this change is seen in the contemporary anthropology of poverty. As dramatically contrasted with the anthropology of poverty of an earlier era, when the notion of a "culture of poverty" had currency within the discipline, current thinking has been significantly influenced by a structural approach that seeks to understand poverty and its health consequences in terms of what has been called "structural violence." Structural violence was introduced into the lexicon of anthropology to label relations of inequality that are so grave in their effect that they can be seen as a form of sanctioned violence (like the structuring of access to health care in terms of possession of health insurance or the exclusion from quality housing, or even any housing, on the basis of ethnicity and social class). Unlike street violence or intimate partner violence, both forms of physical harm that are criminalized, structural violence is legal and hence unpunished. Indeed, perpetrators, if they are corporate heads, may be rewarded with stock options and other perks that boost their salaries to obscene levels relative to the prevailing wage system in society generally. Structural violence has been publicly denied its true nature as a direct assault on the health and well-being of the poor and other marginalized populations because access to health care, access to housing, and access to food are not legal rights.

Global Health, Vulnerable Populations, and Law

2013 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Solomon R. Benatar
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Universal Access ◽  
Human Condition ◽  
Right To Health Care ◽  
Legal Provisions ◽  
Access To Health ◽  
Access To Medical Care ◽  
The Impact ◽  
Emergency Health Services

The most common response to the challenge of protecting health through law is to focus on protecting the rights of vulnerable individuals and to enhance their access to health care. Each one of us is vulnerable or potentially vulnerable because of the fragile, existential nature of the human condition. Catastrophic and unexpected events could instantaneously transform us from a state of total independence and potential vulnerability to one of extreme vulnerability and complete dependence. Some legal provisions have the potential to provide a modicum of protection when we find ourselves in those situations (for example, through legislation, effective emergency health services can be created to reduce the impact of our potential vulnerability). There are also legal provisions that contribute to beneficial social circumstances; for example, legislation enabling universal access to medical care, and operationalizing respect for the individual’s right to health care, as advocated for by other authors in this issue.

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