STRUCTURAL VIOLENCE

Tuream WestGlobalization and Human Rights

WHAT IS STRUCTURAL VIOLENCE

Structural violence influences the nature and distribution of extreme suffering. Farmer observes that political and economic forces have structured risk for AIDS, tuberculosis, and most other infectious diseases. Social forces at work there have also structured risk for most forms of extreme suffering from hunger to torture and rape (Sen 2003:xiv).

Farmer argues, “Human rights violations are not accidents, they are not random in distribution or effect. Right violations are, rather symptoms of deeper pathologies of power and are linked closely to the social conditions that so often determine who will suffer abuse and who will be shielded from harm” (Sen 2003:xiv).

FACES OF STRUCTURAL VIOLENCE HIV/AIDS is the leading cause of death in Malawi

(Checchi et al. 2011:375). In Malawi HIV/AIDS, malaria, and other priority communicable diseases, including TB are linked to poverty. Globally the burdens of communicable diseases are found in poor countries. Deprivation associated with poverty, including malnutrition and overcrowding, increases the risks of infection and disease (Kemp et al. 2007:580).

The battle for economic survival while battling diseases is unjust (Sen 2003: xv). Pathologies of power damage all concerned but kill the poor. International inequalities in health care are unjust and is unequally distributed (Boylan 2004:205).

MALARIA In Africa there are 200 million cases of Malaria per year and 1 to 2 million deaths. Most deaths take place in the age group younger than 5 years (White 2011:221).

Malaria is still a major cause of death in sub-Saharan Africa (i.e., Malawi). 90 child autopsies have been completed with the cause of death confirmed as malaria in 64 cases (71.1%) (White 2011:220).

MALARIA

Malaria in Malawi, which most of the world does not know exist, still battles a disease that most of the world got rid of in the mid-20th century.

When the Global Malaria Eradication Plan was launched in the 1950s, it was thought that the situation in Africa was too complex to tackle and so the continent was bypassed (White 2011:221).

POVERTY

Poverty in Malawi is prevalent and a person who earns 0.25 U.S. dollars per person per day lives in poverty (Kemp et al. 2007:581). In order to be deemed non-poor in Malawi your income would be 1.23 US dollars. The cost of food decreases their daily earnings between 30-58%. (Kemp et al. 2007:582).

When a woman or when the poor are sick, the opportunity costs are greater than their household income. Patient and household costs of TB diagnosis are relatively high even where services are provided free of charge (Kemp et al. 2007:580).

CONSEQUENCES Consequence of structural violence is inequalities

of power that prevent the sharing of different opportunities. Vulnerable lives are dominated by decisions made by others (Sen 2003: xvi). The world’s economic and social systems are unjust because it contains them (Boylan 2004:205).

In Malawi some people believe that everyone is infected with the virus. (McCreary el at. 2013:288).

Among adults aged 15-59, HIV/AIDS mortality was 7/20 (35%). Forty three percent of children under the age of five died from infectious diseases (i.e., HIV/AIDS, malaria, and TB); and forty five percent of people over the age of five; nearly forty nine percent of the total population (Checchi et al. 2011:377).

COST OF TREATMENT Average cost of treatment for TB is 13 US dollars

(i.e., 18 days of income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129% of total monthly income or 184% after food expenses. For the poor this cost rose to 248% of monthly income or 574% after food (Kemp et al. 2007:580).

Testing for malaria is less than 1 US Dollars (White 2011:220).

The word “insurance is unknown among the poor (Farmer 2003:253). The poor are powerless and deprived of essential human needs (Sen 2003:xiii).

BASIC RIGHTS Rights to health and food are basic rights as they

are necessary for the enjoyment of other rights. Basic rights have three kinds of corresponding duty:

1. Deprivation duties not to deprive others of the substance of their basic rights,

2. Protection duties to protect others against deprivation

3. Aid duties to aid those who have been deprived(Boylan 2004:205).

Basic human rights should include access to health care, education and other social services. Far too many human rights abuses are committed in the name of protecting and promoting some variant of market ideology (Farmer 2003:5-6).

MORAL RIGHTS A moral right provides

the rational basis for a justified demand. That the actual enjoyment of a substance be and socially guaranteed against standard threats (Boylan 2004:205).

Boylan states “The substance of a right is what the right is a right to”(Boylan 2004:205).

HUMAN RIGHTS The United Nations Commission for Human Rights

has emphasized that discrimination on the basis of HIV and AIDS status (actual or presumed is prohibiting by existing human rights standards (Kohi et al. 2006:404-405).

According to the Universal Declaration of Human Rights published in 1948, human rights are universal and guaranteed by international standards that legally protect individuals and groups, focus on the dignity of human beings, and cannot be waived or taken away (Kohi et al. 2006:404-405).

This link show how corruption hinders Human Rights.

VIOLATIONS OF HUMAN RIGHTS In Malawi people living with HIV and AIDS human

rights are being violated in a variety of ways, including denial of access to adequate or no health/care services, and denial of home care, termination or refusal of employment, and denial of the right to earn an income, produce food or obtain loans (Kohi et al. 2006:404-405).

Specific violations related to human rights, compared with the Universal Declaration of Human Rights, a person living with HIV and AIDS is often abused, rejected and negated. HIV and AIDS stigma and discrimination are recognized as barriers to the provision of adequate health care, adequate psychological and social support, and medical treatments (Kohi et al. 2006:404-405).

VIOLATIONS OF UDHR States are obligated to respect, protect, and fulfill

these human rights. (Kohi et al. 2006:404-405) Article 1 All human beings are born free and

equal in dignity and rights…(e.g., basic rights) Article 5 No one shall be subjected to inhuman or

degrading treatment…(e.g., discrimination) Article 21.2 Everyone has the right to equal

access to public service in his country… (e.g., social serv.)

Article 23.1 Everyone has the right to work… (e.g., income)

Article 25.1 Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family… (e.g., healthcare).

OBLIGATED TO ACT

The Global Fund’s mandate to direct resources to support the fight against HIV, TB, and malaria is grounded in the human rights commitment. It supports governments in their obligation under the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Universal Declaration of Human Rights (UDHR) to realize the right to the attainable standard of health (Davis 2014:137).

The right to the highest attainable standard of health is premised on availability, accessibility, acceptability, and quality of health services provided by the State, and all four elements of the right to health can be addressed through the combination of funding and technical support provided through the Global Fund and its technical partnerships(Davis 2014:137).

MOVE TOWARDS ACTION

“The people most vulnerable to disease often don’t have access to health programs due to lack of information, discrimination, and fear of arrest. To reach the most vulnerable people…greater engagement is needed by partners in civil society including community and faith based groups that meet people where they are” according to Mark Dybul, Executive Director of Global Fund (Davis 2014:138).

Poor countries lack knowledge and understanding about HIV and AIDS (McCreary el at. 2013:287). Farmer argue that anyone who wishes to be considered humane has sufficient cause to consider what it means to be sick and poor in the era of globalization and scientific advancement (Farmer 2003:6).

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Kluwer Academic Publishers. 2004. eBook. Checchi, Francesco; Nyasulu, Peter; Chandramohan, Daniel; Roberts, Bayard. Rates and

Causes of Death in Chiradzulu District: Malawi. 2008. A key informant study Tropical Medicine & International Health. Mar 2011, Vol. 16 Issue 3, p375-378

Davis, Sara L.M. Health and Human Rights Journal. Human Rights and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. June 2014 Number 1 Volume 16 pp 134-147 http://www.hhrjournal.org/

Farmer, P. 2003. Pathologies of power: Health, human rights, and the new war on the poor . Berkeley: University of California Press.

Kemp, Julia R.; Mann, Gillian; Simwaka, Bertha Nhlema; Salaniponi, Felix M. L.; Squire, Stephen Bertel. Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe. Bulletin of the World Health Organization. Aug 2007, Vol. 85 Issue 8, p580-588. Database: Consumer Health Complete – EBSCOhost

Kohi, Thecla W.; Makoae, Lucy; Chirwa, Maureen; Holzemer, William L.; Phetlhu, Deliwe René; Uys, Leana; Naidoo, Joanne; Dlamini, Priscilla S.; Greeff, Minrie. HIV and AIDS Stigma Violates Human Rights in Five African Countries. Nursing Ethics. Jul 2006, Vol. 13 Issue 4, p404-415. Database: Consumer Health Complete - EBSCOhost

McCreary, Linda L.; Kaponda, Chrissie P. N.; Davis, Kristina; Kalengamaliro, Mary; Norr, Kathleen F.; Empowering Peer Group Leaders for HIV Prevention in Malawi. Journal of Nursing Scholarship, 2013 Sep; 45 (3): 288-97

White, Valerie A. Malaria in Malawi: Inside a Research Autopsy Study of Pediatric Cerebral Malaria. Archives of Pathology & Laboratory Medicine. Feb 2011, Vol. 135 Issue 2, p220-226.

Universal Declaration of Human Rights. http://www.un.org/en/documents/udhr/ Accessed December 10, 2014.