Health Care and Structural Violence

Just peace theory recognizes that there is more than one kind of violence. There is subjective violence that individual persons commit and there is structural violence, the violence that political, economic, social, cultural, and religion systems commit against individuals. America commits structural violence against more than 40 million of her citizens who do not have health insurance.

Violence is injustice. It is an unjust use of power, a force or array of forces that cause injury. The subjective violence of a personal attack, of war, terrorism, or torture is easy to see and to condemn. Structural violence is less visible, more subtle and therefore harder to critique and change. The structural violence of the health-care system in the United States violates distributive justice. It is a corruption of commutative justice because contractual relationships are forced.

When health insurance is linked to employment, employees are forced to work jobs they despise. They must too often travel farther, work harder and longer for less pay and less satisfaction in order to keep the job because they cannot afford to lose health coverage. This is not liberty. Such is especially the case when a spouse or a child has a serious medical problem that requires continual treatment.

Moreover, this system of health care is burdensome to businesses that have to include the cost of health care in compensation packages in order to attract and keep good people. For people whose employers do not offer health insurance, for part-time or temporary workers, for self-employed people, buying individual health insurance is not an affordable option. So, they go without primary health care that could prevent more serious illnesses in the future.

Now that the nation is facing this problem and is taking steps to address it, some members of Congress are worried about how to pay for it. I do not recall such worried, furrowed brows over deficit spending and the national debt when the George W. Bush administration took this nation to war in Iraq and Afghanistan. I do not recall an interest in going slowly and taking our time to "get it right" before going to war.

Spending billions of dollars a month in these wars while cutting taxes on the rich took this nation into deep debt and our members of Congress, for the most part, voiced no concern about the price. We rushed headlong into the subjective violence of war and did not count the cost. Now we have the opportunity to end the structural violence of an unjust, unsustainable, immoral health-care system and suddenly we are worried about whether the nation can pay for it. We are worried about moving too fast.

Good health-care legislation is a matter of political will, and where there is a will there is a way. President Obama is right to give Congress a deadline and to push for a change in our health-care system. Violence, subjective and structural, is expensive. We all pay the check every day. The questions are: Who pays? Who benefits? What is the currency of exchange?

Dr. Valerie Elverton Dixon is an independent scholar who publishes lectures and essays at She received her Ph.D. in religion and society from Temple University and taught Christian ethics at United Theological Seminary and Andover Newton Theological School.

To learn more about health-care reform, click here to visit Sojourners' Health-Care Resources Web page.

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