Comment tammy nov 21 6:09 am


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In reading the Health Disparity and Structural Violence study, it made sense to me and rang true in what I encounter.  Fear and violence are the words that continued to jump out.  Health is a fundamental human right and yet the disparities remain.  This points out how violence is entrenched in people’s everyday lives as disparity, mainly health disparity, even going as far as “who will live, and who will die”.  The structural violence framework covered 3 areas:

1.     Cost

2.     Language, discrimination, and immigration status

3.     Cultural disconnect

People without health insurance will often wait to go to the doctor’s office or don’t go at all.  Their problems go untreated and undiagnosed which then it becomes more acute and ironically more expensive.  People put their children first, providing the bread, milk, eggs, roof over their heads first.  Illness may kill them, however, not today.  Today they need to worry about requirements for human survival.  The fear of disease itself is not the fear but it’s the cost of disease bringing stress and “debilitating fear”.  This is not felt by those that can afford insurance.

Those that speak another language, mainly Spanish, felt like they were discriminated against, starting from the receptionist, this being implied disapproval.  Many Hispanic people felt like they were a burden or felt ashamed because they did not speak English.  “You’re in America now, speak English”.  How many times have you heard someone say that.  The fear of feeling stupid, less than, keeps them from asking questions.  It keeps them from even going to the doctor in the first place.  Fear of being illegal is ever present.  Illegal implies bad.  Deportation is an ever-present fear.  Living in this fear is described as debilitating fear.

There is a cultural disconnect on the part of the provider.  When patients utilize traditional remedies, they may not want to share this with the health care provider.  Medicines interact with herbs, this can be dangerous.  Ethnocentrism creates a stigma for those who have a world view.  Something the person sees as value may be perceived as wrong, silly, or irrational.  Voodoo medicine.  This approach under appreciates diverse cultures (Page-Reeves et al., 2013).

People every day are being framed by fear, that fear that wakes you up in the wee hours of the morning.  This makes me sad because it is so true.  I had a patient that had planned a home delivery but it didn’t work out for her so she ended up with us.  She wanted to save her placenta for encapsulating, the physician wanted it sent to pathology.  In the end, she got to take it home with her because of her cultural beliefs and wishes.  In another study that explored promotion of healthy choices and cost effective accessibility.  It concluded that nurses need a new vision of the future of global health and present economic situations (Jadelhack, 2012, p. 68).  We are the agents of change.



Jadelhack, R. (2012, June 1, 2012). Health promotion in nursing and cost-effectiveness. Journal of Cultural Diversity,19, 65-68. Retrieved from

Page-Reeves, J., Niforatos, J., Mishra, S., Regino, L., Gingrich, A., & Bulten, J. (2013, Summer 2013). Health disparity and structural violence:  how fear undermines health among immigrants at risk for diabetes. Journal of Health Disparities Research and Practice, 6, 30-48. Retrieved from




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