STRUCTURAL VIOLENCE AND PAKISTAN’S ONGOING INFECTIOUS DISEASES SAGA

Abstract

The concept that structural violence perpe-tuates disease is not new1. It is especially true for infectious diseases as evidenced by the overlapp-ing footprint of poverty and diseases like tuber-culosis, HIV/AIDS and malaria on the global map2. Structural violence describes social arran-gements that expose peopleand nations to harm1. Poverty, lack of education, fragile health care, inequality, elitism, gender bias and political insta-bility are just few of the problems that resource limited countries have faced. In the backdrop of these issues, the heavy burden of infectious diseases in these countries should not come as a surprise.

The social determinants lie beyond the control of the patients or theat risk populations. Clinicians as well as public health practitioners are acutely aware of the vulnerability of certain sections of society to infectious disease. We need to analyse the social arrangements using a bio-social approach2 in order to develop viable interventions for controlling this situation. These interventions need to incorporate both clinical and social facets as described by Farmer1. Distal interventions which encompass clinical aspects and include diagnostic and therapeutic modali-ties as well asproximal ones which incorporate programs for improvements of social circum-stance for prevention of disease are required. If the ongoing saga of infectious diseases in Pakistan is to be stemmed, holistic action is needed at all levels utilizing both distal and proximal interventions.