Limited choices then directly affect health outcomes. Individual support is limited by and confined within the choices that are accurately




Disparity can take many shapes, health disparities can be recognized as one of the utmost tangible indicators of disparity, often regulating who will live and who will die—with the poor and immigrants suffering unreasonably. We can appreciate that individual health behavior is limited by structured and institutionalized inequality that confines the power of individuals to make choices. Limited choices then directly affect health outcomes. Individual support is limited by and confined within the choices that are accurately available. In many situations, health-promoting choices are not an option, or they may not embody the most respected strategy for a person in the context of other restricting features—irrespective of whether other choices are healthy or not. The fear for individuals who lack documents or have family members without papers, the fear is more concretely about being discovered. Deportation is an ever-present reality for people living in the shadows because they lack legal immigration status. This threat, especially when combined with the other dimensions of fear, becomes virtually paralyzing for many people in terms of seeking assistance with health problems. Many of those who lack documents do not feel comfortable or safe going to a clinic or to the emergency room. For example, when a physician or nurse has aggressive questioning for patients in regards to their immigration status, they fear INS [Immigration and Naturalization Service] may be looking over their answers (Page-Reeves, J., Niforatos, J., Mishra, S., Regino, L., Gingrich, A., & Bulten, J., 2013).



“With few exceptions, clinicians are not trained to understand such social forces, nor are we trained to alter them. Yet it has long been clear that many medical and public health interventions will fail if we are unable to understand the social determinants of disease. It does not matter what we call it: structural violence remains a high-ranking cause of premature death and disability… The poor are the natural constituents of public health, and physicians, as Virchow argued, are the natural attorneys of the poor. In this struggle, equity in healthcare is our responsibility. Only when we link our efforts to those of others committed to initiating virtuous social cycles can we expect a future in which medicine attains its noblest goals” (Farmer PE, Nizeye B, Stulac S, Keshavjee S, 2006). We must recognize these barriers, educate, reach out and empower our minority groups to improve their health outcomes. These struggles are very real to our underprivileged and indigent populations. It is part of our duty to help break these barriers and promote illness prevention, as well as, health and wellness.



“One key aspect of structural violence is that it is often hard to see.  Even more difficult than identifying structural violence is assigning culpability” (Burtle, A., 2013).  Structural violence many times manifests itself as negative outcomes that may or may not lead to death. These outcomes may just mean a shorter life and/or poor health and lifestyle choices. Some form of structural barriers may include illiteracy preventing a person from taking advantage of government programs for lack of understanding. Another barrier could be for illegal immigrants avoiding care due to fear of deportation. The harm may be hard to recognize, but it’s still there (Burtle, A., 2013).  I do believe that we have social and government structures that are set up poorly. I agree that our lower socioeconomic populations are encapsulated by fear of seeming ignorant, illiterate, and or in danger of repercussions. This is an area in need of intervention, education and change. We must put our resources towards the overhaul of these programs and public health platforms. It is our responsibility as health care workers to ensure we are doing all we can to improve the health and wellness of the communities we serve.






Burtle, A. (2013). Structural Violence inequality and the harm it causes. Retrieved November 21, 2016, from



Farmer PE, Nizeye B, Stulac S, Keshavjee S (2006) Structural Violence and Clinical Medicine. PLoS Med 3(10): e449. doi:10.1371/journal.pmed.0030449

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