Poverty

The concept of structural violence and distal and proximal intervention are the two concepts I choose from Farmer's article.


Structural violence are arrangements or structure that are in place that cause harm to the population or that impairs human lives. These structures may be political, economical or social. Structures and institutions are central to this analysis. These structures are either at the domestic level or at the international level. Although John Galtung theory of structural violence was first and foremost related to peace research, his concept of structural violence is widely applicable and has extended to fields such as anthropology, clinical medicine, and sociology (Essex Human Rights Review Vol. 4 No. 2 September 2007) .That is why Farmer can use this concept to explain health and poverty in a society.


Health and poverty can be explained by using structural violence. The fact that unjust and exploitative social, economic and social system structures are in place and facilitate physical or psychological harm is said to impact health and poverty. Health and poverty are markers of structural violence because it focuses on the underlying causes of poverty and health. Those disparities that cause more than 2.7 billion people to leave on less than 2.7 dollars a day why there is a 30 years difference between people living in Africa and those in the rich nations (http://www2.helsekompetanse.no). “Structural violence erases the history and consciousness of the social origins of poverty, sickness, hunger, and premature death, so that they are simply taken for granted and naturalized so that no one is held accountable except, perhaps, the poor themselves” (Scheper-Hughes 2004:14).Considering that in the world, health and poverty are shaped by social, political and economic conditions (Irwin et al. 2006) these factors go a long way to decipher if people have access to health services.

Structural violence gives us that opportunity to be able to understand some basic human contemporary phenomenon. In understanding these we are able to implement solutions to areas that need them
This can be exemplifies by the disparities that accord in HIV care that is why Africa American are said to be more likely to contract HIV and also among patients infected with HIV, blacks are significantly less likely than whites to have received ART same goes in the case of Rwanda and Haiti. (http://model.pih.org).It is therefore required that social causes of ill health should be looked in to.
Since people can be killed or harmed through sociopolitical and economic structures there affect the health and poverty level of societies or communities. This thus leaves certain groups of the community prone to the social injustices of these machineries thus an observation of health disparities or differences in health status between wealthy elites and the poor in stratified societies (Evolution and Prehistory: The Human Challenge 2007).

Wealthy states, corporations are using their power to structure world system which in effect leave them at a competitive advantage thus the existence of structural violence especially when such powers undermine the well being of others as populations of less developed countries continue to languish in poverty and the health state of the populations of these countries continue to deteriorate since there are on the disadvantage. It is thus logical to say that when an agency is constrained to the extent that fundamental human needs cannot be attained, structural violence becomes a structural violation of human rights (Essex Human Rights Review Vol. 4 No. 2 September 2007).

John Galtung asserts that in structural violence there may not be any person who directly harms another person and that violence is built into the structure and shows up as unequal power and consequently as unequal life chances. Thus take the case of inequality in a society, racism, where for example a particular race is at a systematically disadvantage and as such unequal life changes thus it the structures that are in place that perpetrates these constrain and not a person thus making it possible for poverty, ill health to be an issue of concern in these populations. Institutionalized social structure lowers the level of actual fulfillment of one’s fundamental needs, such as healthcare and thus according to Farmer these structures then creates an unequal distribution of power then these distribution of power then systematically disadvantages those who do not hold as much if any power (Farmer, Pathologies of Power 2005).It can be seen that structural violence is embedded in inequality,

                            Only poverty will cause children to play in such dirty and drink such dirty water


Poverty on the other hand actually create conditions where to meets ones fundamental human needs are obstructed thus poverty can be said to create violence that makes it actually impossible to meets basic fundamental needs of some people .Thus it is poverty that makes it possible for 815 million people to be undernourished while 1.1 billion lack access to safe drinking water and 880 million lack asses to basic health care (Pogge 2003,)


The concept of distal and proximal intervention tries to remove some of the basic obstacle at the point of care. These levels of care are given at both the distal and proximal level. All these level of intervention are important. The distal and the proximal intervention go hand in glove and as such complement each other. These two levels of interventions both tackle health crisis and poverty. From my understanding these two sorts of interventions can effectively illustrate the level of health and poverty in a community. When one is at the state of ill health (sick) it is very necessary that distal intervention be carried out because it will increase their chances of surviving and also lessen the risk of whatever disease they may be suffering from, medical personnel’s are trained to carry out this level of intervention then the proximal level which is more or less like a preventive level.

It can be said while both are important but depending on the society in question one can take precedence. Take the case of most Scandinavian countries, individuals or people are more concern with the distal level of intervention, in case of any ill health or sickness they individual know that have to go to the hospital and let the medical personnel carry out diagnoses of their illness and prescribe drugs for them. Proximal level of intervention in these societies can be said to be already established since structures that are in places have already made sure that there are in place facilitating this level of intervention. Most third world countries mostly due of structural violence still have to take both these level of intervention seriously, because most often one without the other will not work effectively. In poor health they population worries about having the possibility of having distal care ,already they are meant with obstacles firstly due of the unavailability of medical practitioners and also the fact that they cannot afford for health care services. In cases where they manage to have these distal intervention they are still face another delimer,how to maintain these state of health such as lack of clean water ,basic sanitation and most especially lack of possibility to effect a change in the being and also how to prevent these deceases from occurring . Thus proximal intervention becomes very important because it requires the available of certain necessities before distal intervention can be effective. Yes one can be provided with anti retro-viral  drugs but if they have no food to eat, lack access to clean drinking water, sanitation is poor it actually becomes difficult to fight the disease.


This is exemplified in the voices of the poor, where it states that poor places keep people poor and also poor places kill if this statement is extrapolated we can as well say that this situation has very much created a situation where it is difficult to provide for proximal intervention, thus these poor places will kill you before you even have the opportunity to have distal intervention. Thus a lack of these basic necessities which is cause by poverty leads to ill health. Therefore it can be suggested that “good health” and “well-being” must be a combination of distal and proximal intervention. It is said poverty and ill-health are inseparable thus in Voices of the Poor” ill-health is perceived both as a cause of increased poverty and as an obstacle to escaping it (Voices of the Poor, a project led by Deepa Narayan, 2000).

Value that Farmer’s articles brings to discussion on poverty and health.

It raises the awareness that poverty and ill-health are inseparable and that due to structures that are in place poverty and health can either be ameliorated or they can deteriorate .It brings to light the issues of denied opportunities and these opportunities are being denied to people who need them by socio economic and political structures. Thus rising both ethical and moral values that basic human rights should not be neglected. He illustrates how structural violence violates people’s basic human right.
By linking structural violence to poverty and health he opens up a discourse .This discourse allows for the re-thinking of the concept of poverty .By illustrating how structural violence create disparities between groups of people he does not just create an awareness but brings to light how structures can be part of the worlds poverty and ill health issues.


Farmer also makes it clear that despite the presence of this violence, problems created can still be solved by using both distal and proximal intervention. He outlines the fact that these distal and proximal interventions can be attainable if we wish. Because he considers that these violence in the first place are avoidable. Thus structural intervention should be made available.
In Farmer's article he clearly point how structural violence have created inequality, gender issues,racism,social injustice etc.These then allows for poverty which then create conditions that allows for human rights to be violated be it at the global level or at the community level.


To conclude Farmers articles allows me to evaluate and to appreciate the fact that although structures may be very much be part of why poverty exist I can understanding at what point individuals should take responsibility .Thus for me it is a mixture of the presents of structures that facilitate poverty and individuals that do not take responsibility .


References
- Essex Human Rights Review Vol. 4 No. 2 September 2007)
-Farmer, Paul, Pathologies of Power (Berkeley: University of California Press, 2005).
-Galtung, John, ‘Cultural Violence’ (1990) 27.3 Journal of Peace Research
-Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, Koller T, Vega J (2006). The Commission on Social Determinants of Health: tackling the social roots of health inequities. PLoS Med
-Poggs, Thomas, ‘Priorities of Global Justice’ in David Held and Anthony McGrew (eds.),
The Global Transformations Reader, (Cambridge: Polity Press, 2003).
- Scheper-Hughes N (2004). Dangerous and endangered youth: social structures and determinants of violence. Annals of the New York Academy of Sciences
- William A. Haviland, Dana Walrath, Harald E. L. Prins, Evolution and Prehistory: The Human Challenge (2007) Wadsworth Publishing

-Voices of the Poor, a project led by Deepa Narayan, World Bank, published 2000.
www.worldbank.org/poverty/voices.)
- Dying for Change .Poor people’s experience of health and ill-health http://siteresources.worldbank.org/INTPAH/Resources/Publications/Dying-for-Change/
- http://www2.helsekompetanse.no
-(http://model.pih.org).