Friday, March 15, 2013

Health Inequalities: Structural Violence and Invisibility

On December 14, 2012, a young man named Adam Lanza forced his way into Sandy Hook Elementary School in Newtown, Connecticut. The results of his actions amounted to one of the saddest, most violent tragedies committed in the United States in the modern era. At a speech during a local prayer vigil on December 16, 2012, President Barack Obama stated, “We gather here in memory of twenty beautiful children and six remarkable adults. They lost their lives in a school that could have been any school in a quiet town full of good and decent people that could be any town in America.”

Yet, twenty-eight people died on that winter day in Connecticut. Adam Lanza and his mother were not included in President Obama’s count.

Who gets sick? Why are people sick? How do people get better? The anthropology of health inequalities identifies the body as the center of health and illness within the political, economic, and social webs of power in society. The scope of inquiry is holistic and multi-faceted. As Heggenhougen (2000:1171) asserts, “the gaze of medical anthropologists must also be critically inclusive and set on a whole range of social, political and economic, as well as on cultural facts.” This inclusivity is the challenge of medical anthropology, as we are called to expose the invisibility of health experiences and health outcomes. Our principle tool in this endeavor is ethnography.

The philosophy guiding ethnography is that our participation in daily life will expose issues, tensions, and violences that are hidden. Sherry Ortner (1995:173) states that ethnography “…has always meant the attempt to understand another life world using the self- as much of it as possible- as the instrument of knowing.” It is through ethnography that we can identify and map the context of structural violence and bring to light the social and bodily suffering around us.

I entered the realm of gender-based violence by volunteering at a local domestic violence shelter. As I delved into the academic world of gender-based violence while situated in the advocacy and activist world, it soon became clear to me that the anthropology of gender-based violence was an undertheorized and understudied terrain. And within this terrain, there was an uneven distribution of research within the issue of gender-based violence. For example, great (and necessary) attention has been paid to the lives of victims of domestic violence around the world (McClusky 2001; Counts, Brown, and Campbell 1992; 1999). Further, anthropologists such as Sally Engle Merry (2006; 2009) have studied the global policy processes related to gender-based violence. However, very little scholarship focused on the lives and work of domestic violence advocates.

Domestic violence advocates are people who act and speak on behalf of another person. Domestic violence advocates do not speak for people or victims of domestic violence, they speak on their behalf when a situation does not allow victims to be visible to society. Advocacy includes acting on behalf of victims of domestic violence to seek financial resources, housing options, legal information, emotional support, health services, childcare subsidies, and any other need the people in shelter identify. In the literature, the voices of domestic violence shelter advocates are frequently rendered silent by binary oppositions of “good victims” and “bad advocates.” It is likely easier in practice and theoretically to establish a population or an individual as a causal agent of another’s poor health outcomes. However, this approach forgives structures rather than people struggling to survive within systems of inequality, thereby acting a mechanism for reproducing structural violence.

The hopefulness of ethnography is that the process of observing and participating in the lives of research participants can deconstruct seemingly normal dualities and expose the invisible spaces present within them. This is why anthropology possesses so much power. It was through ethnography that I witnessed the suffering of domestic violence advocates. Their social suffering was manifested in the struggles they endured in their own relationships and their isolation from the world outside the domestic violence shelter. Their bodily suffering included mental health issues such as depression and difficulty sleeping. They also experienced persistent physical exhaustion from working double shifts, overnight shifts, and working in constant crisis. Their suffering on a daily basis was difficult to watch and difficult to experience in my own life. It is my continuing challenge to illuminate these invisible sufferings and integrate them into a greater understanding of the interconnectedness of human health.

Erve Chambers (2010:374) has eloquently asserted, “Anthropology fails when we stop listening. It fails when we stop observing.” Within these failures are the consequences of invisibility. In the case of Adam Lanza, the public has come to learn that he suffered from Asperger’s Syndrome, diagnostically recognized as a form of autism, and Sensory Integration Disorder. Numerous investigations have indicated that both Adam Lanza and his mother struggled to obtain assistance for his mental health diagnoses. We can only imagine their very real social and bodily suffering as they sought the help he needed.

Whose health matters? When anthropology makes visible the structural violence of health inequalities, it quickly becomes apparent that every single person’s health matters. You may not be a victim of domestic violence, but I feel certain that your life has been affected by gender-based violence. Perhaps it was a classmate, or an aunt with a story that no one talks about. Or maybe the day that you broke your arm the nurse was distracted, after recently completing a forensic rape exam with a seven-year old girl. In this way, the radiating effect of the health of one domestic violence advocate affects the health of hundreds of victims of gender-based violence and the health of one Sexual Assault Nurse Examiner affects hundreds of hospital patients.

And the health of one young man named Adam Lanza in Connecticut affects the lives of millions.

Jennifer R. Wies is an applied medical anthropologist dedicated to teaching and practicing anthropology. She is an assistant professor of anthropology at Eastern Kentucky University in the Department of Anthropology, Sociology, and Social Work. Her research focuses on structures of violence as experienced and expressed by local populations in the United States. This has included her work with victims of gender-based violence, families affected by incarceration, people with HIV/AIDS, and first-generation college women. Her edited volume, Anthropology at the Front Lines of Gender-Based Violence (with Hillary J. Haldane, Vanderbilt University Press, 2011) presents global ethnographies of local-level advocacy and activism in the gender-based violence movement. Her recent work theorizes the intersection between feminist ethnography and feminist activism and traces the legacies of women anthropologists in applied anthropology.


Chambers, Erve. 2010. “In Both Possibilities: Anthropology on the Margins.” Human Organization 68 (4): 374–379. Counts, Dorothy, Judith Brown, and Jacquelyn Campbell, eds. 1992. Sanctions and Sanctuary: Cultural Perspectives on the Beating of Wives. Boulder CO: Westview Press.

Counts, Dorothy, Judith K Brown, and Jacquelyn Campbell, eds. 1999. To Have and To Hit: Cultural Perspectives on Wife Beating. Urbana IL: University of Illinois Press.

Heggenhougen, H. Kristian. 2000. “More Than Just ‘Interesting!’: Anthropology, Health and Human Rights.” Social Science & Medicine 50 (9): 1171–1175.

McClusky, Laura J. 2001. “Here, Our Culture Is Hard:” Stories of Domestic Violence From a Mayan Community in Belize. Austin: University of Texas Press.

Merry, Sally Engle. 2006. Human Rights and Gender Violence: Translating International Law into Local Justice. Chicago Series in Law & Society. Chicago: University of Chicago Press.

——— 2009. Gender Violence: A Cultural Perspective. Malden, MA: Wiley-Blackwell.

Ortner, Sherry. 1995. “Resistance and the Problem of Ethnographic Refusal.” Comparative Studies in Society and History 37 (1): 173–193.

No comments: