Monday, 21 April 2014

Structural Violence and Contemporary Indigenous Health

Although colonisation is often seen as a part of our history, as a relic of the past, it is a force that has created and sustained structures within our society that cause harm to peoples’ bodies, minds and spirits. In this post, Tarapuhi briefly looks at the relationship between colonisation and contemporary indigenous health.

These opinions are my opinions and do not necessarily represent the views of any groups or individuals mentioned in this post.

Tihei Mauri Ora 1990 Robyn Kahukiwa

There are a great number of peoples across the globe who are understood as indigenous, aboriginal or native groups; each with their own unique and distinct identities, histories, biology, struggles, geographical and environmental surroundings, languages, rituals, clothing, gender relations, successes, failures, traditions, relationships with nature, relationships with the state, morals, and values. Indigenous people's and cultures are complex, modern, traditional, changing, and living.

There are, of course, distinct groups within indigenous populations in each nation, and the people within these groups also live extremely varied lives. For example, Māori represent more than 70 distinct tribes that make up the tangata whenua, the indigenous peoples, of Aotearoa/New Zealand. Many Māori do not identify with a tribe, some reject being called Māori and identify themselves in reference to their iwi (tribal) identity, or just as New Zealanders. There are those who live in rural areas, in the cities, or in between. Māori live their lives according to infinite combinations of Māori and Pākehā (non-Māori) worlds.

There are also many long standing, rich, and innovative relationships of solidarity between indigenous groups. These often manifest as a sense of spiritual and moral support, and a common experience of 'indigeneity'. 
Māori Women In Solidarity With Idle No More by Robyn Kahukiwa
The only common thread distinguishing these groups as a distinct category is their indigeneity which makes the trends pertaining to indigenous health and well-being even more alarming. Bio-medical discourse paints a dismal representation of indigenous health across all nations. Specifically indigenous peoples suffer from drastically poorer health and avoidable death rates, and have a 4-20 year difference in average life expectancy, than all other ethnicities in their respective national population (Fong et al. 2003:136), (Anderson et al. 2007: 177). Furthermore, it is estimated that 70% of chronic disease experienced by indigenous individuals is avoidable (Ring and Brown 2003: 404). Indigenous peoples incur higher incidences of most diseases including diabetes, mental disorders, cancer, and in developed countries, much higher experiences of diseases like tuberculosis and rheumatic fever (Durie 2003: 10). Reflecting this, in Aotearoa Māori have the poorest overall health status- a claim succinctly represented by an 8-9 year lower life expectancy than non-Māori (Harris et al. 2006: 1429). 

Colonisation

Although I am wary of making generalisations that may further reproduce reductive ideas about these groups, these generalisations help to highlight the perniciousness of colonisation as a force on the body, the mind, and the spirit.

To understand indigeneity, we must also understand colonisation. Colonisation refers to the historically informed, continued, purposeful, and evolving permittance of the “(mis)appropriation and transfer of power and resources from indigenous peoples to the newcomers…enabled by layer upon layer of new systems“ which “construct who will benefit and be privileged” (Reid and Robson 2000: 5). 

This allocation of power is informed by the de-humanization of indigenous peoples which appears on a spectrum that ranges from genocide to neglect, and from paternalism to romanticism (Reid and Robson 2000: 4). Historically, racism has been a feature of colonisation that has fuelled tactics and policies that cause the disenfranchisement, forced assimilation, cultural degradation, and genocide of indigenous peoples and their culture, as well a 'cultural amnesia' or erasure of these histories (Czyzewski 2011: 2). 

Structural Violence 

Structural violence is a theory that is useful to bring to light the harm caused by colonisation. It refers to the reproduction of social and economic inequality by complex, layered structures in society, such as the media, policy makers, the education system, city councils and hospitals, and highlights the violence caused by this process (Farmer et al. 2006). Colonisation is by definition a form of structural violence.

Paul Farmer, one of the most notable writers on structural violence states: "neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress”  (Farmer et al. 2006).

This violence it is not restricted to that which causes physical suffering during “event assaults,” such as rape, torture or battery, but it also refers to what Farmer calls “sustained and insidious suffering” such as the harm and “pain born of deep poverty”, sexism, racism and other inequalities (1996: 261). Thus, violence exists in less explicit examples of inequality where it is not necessarily the “pain of hunger or the humiliation of rags, but the impossible choices you face”, the choice of which child gets to use the mosquito net, and which child must risk the chance of malaria (Kristof 2007: 443). Therefore, violence which affects people’s bodies, minds, identities, spirits and personalities. 

Robyn Kahukiwa's evocative painting at the beginning of this post acknowledges the historical and contemporary violence caused by colonisation, especially referring to the impact patriarchal structures have had in subjugating Māori.

Because structural inequality is historically informed, it often has become so entrenched into society that it is impossible to assign culpability or responsibility for the resulting violence. Within the context of colonisation especially, inequality is so entrenched that it has become invisible and normalised, and consequently may not provoke outrage or dismay from the general population (Reid and Robson 2000:3), (Farmer et al. 2006). Accordingly, in westernised nations, indigenous health disparities are often treated as a result of individual choice, or as a resistance to assimilating into ‘mainstream’ cultural ideals. For example, health disparities experienced by Māori are explained as “any mix of inferior genes, intellect, education, aptitude, ability, effort or luck” (Robson and Harris 2007: 5). 



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These ideas rest upon the facade that we live in a meritocracy in which hard work and skill always create income, health and goodness-that 'all New Zealanders are born with the same opportunities'. This sets up the perception that those on the bottom rung of the social ladder may not be deserving, ‘normal’, willing to be helped or help themselves.

Therefore, drawing attention away from social and structural ethnic/racial inequalities, such as evidence showing that health inequalities are experienced by Māori across all economic brackets and therefore cannot be understood merely in reference to economic inequality or lifestyle. For example, He Ritenga Whakaaro: Māori Experiences of Health Services reports that Māori experience higher disability and morbidity rates and yet have less access to health, rehabilitation and disability services than non-Māori. Reid and Robson also state that Māori “receive lower levels of health services and poorer quality of service” than other ethnicities in our national population (2000: 5). Harris and colleagues have shown in their study, that there is a strong relationship between experiences of racism and poor health, including overall lower physical functioning, poorer mental health, tobacco use and cardiovascular disease. This study also highlights that Māori are almost ten times more likely to experience multiple types of racism in New Zealand than European/Others (Harris et al. 2006). 

Agency

Structural violence works through layered structures which "conspire to constrain individual agency" (Farmer et al. 2006). The general understanding of agency points to a person or group’s ability to understand the structures around them and essentially their “capacity to affect things” (Ortner 2006: 137). Colonisation constrains agency  as it “shapes what we know, how we understand the world and relate to it, the level of access we have to societal resources and opportunities, as well as our ability to navigate our way through the system”  (Reid and Robson 2000: 6). 



The ability to influence and understand structural influences on one's self is particularly influenced by  symbolic violence. Bourdieu’s concept of symbolic violence refers to the mechanisms that cause the victims of structural violence to internalise discrimination and thus see their place on the social hierarchy as deserved and as the ‘natural way of things’ (Bourgois and Schonberg 2009: 17). 



By acknowledging how indigenous peoples agency, and choices are constrained by colonisation, calls for self-determination and the proliferation of indigenous agency become even more relevant.

Importantly, the psyche is never fully dominated by hegemonies and thus never fully without agency, and although indigenous agency is constrained by structural violence it is not completely dissolved by it (Ortner 2006: 6). Furthermore, the impact of expressions of agency and “resistance is less than we make it out to be…the degree to which agency is constrained is correlated inversely, if not always neatly, with the ability to resist marginalisation and other forms of oppression” (Farmer 2004: 4).

Stories of resistance and expressions of agency are often swept under the rug, so as to not make visible the relationship between who succeeds and who does not. Indigenous expressions of agency are visible in the continuos efforts to reclaim, reimagine, and reinvigorate indigenous knowledge, rights, identity, and culture by indigenous academicspoliticiansactivists, and everyday people. This is occurring in various arenas, including through social networking, fashionpetitionsbusinessmusic, sports...and the list goes on.



References

Anderson, I., Crengle, S., Kamaka, M. L., Chen, T. -H., Palafox, N., & Jackson-Pulver, L. 2007 Indigenous health 1: Indigenous health in Australia, New Zealand, and the pacific. The Lancet 367: 1775-1785.
Bourgois, Philippe, & Jeffrey Schonberg 2009 “Righteous Dopefiend”. California: University of California Press.
Czyzewski, K. 2011 Colonialism as a broader social determinant of health. The International Indigenous Policy Journal 2(1): 5.
Durie, M. H. 2003 The health of Indigenous peoples: depends on genetics, politics, and socioeconomic factors. BMJ: British Medical Journal 326 (7388): 510.
Farmer, P. 2004 An anthropology of structural violence 1. Current Anthropology 45(3):305-325.
Farmer, P., Nizeye, B., Stulac, S., & Keshavjee, S. 2006 Structural violence and clinical medicine. PLoS Medicine 3(10): 449.
Farmer, Paul 1996 On Suffering and Structural Violence: A View from Below. Daedalus (125)1: 261-283.
Fong, M., Braun, K. L. & Tsark, J. U. 2003 Improving native Hawaiian health through community-based participatory research. Californian Journal of Health Promotion 1(1):136-148.
Harris, R., Tobias, M., Jeffreys, M., Waldegrave, K., Karlsen, S. & Nazroo, J. 2006 Racism and health: The relationship between experience of racial discrimination and health in New Zealand. Social Science & Medicine 63 (6):1428-1441.
Kristof, Nicholas D. 2007 Wretched of the Earth. New York Review of Books, May 31: 1-10.
Reid, P. & Robson, B. 2000 1 Understanding Health Inequalities. Hauora: Māori. Te Rōpū Rangahau Hauora a Eru Pōmare: 3-10.
Ring, I. & Brown, N. 2003 The health status of indigenous peoples and others: The gap is narrowing in the United States, Canada, and New Zealand, but a lot more is needed. BMJ: British Medical Journal 327 (7412): 404.
Robson B, Harris R. (eds). 2007 Hauora: Màori Standards of Health IV. A study of the years 2000–2005. Wellington: Te Ròpù Rangahau Hauora a Eru Pòmare.









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