Peace is a complex word with definitions that vary depending on its two different aspects – negative and positive. Positive peace is, arguably, the most important and harder of the two to achieve. Positive peace, as defined by John Galtung, is not only the absence of physical war, but also the presence of “desirable states of mind and society, such as harmony, justice, equity, and so on.” (Barash & Webel, 2002). Positive peace is not achievable without the elimination of structural violence and the systems, laws, and beliefs that perpetuate it. Structural violence are acts of violence that do not harm the individual’s self but their livelihoods, future generations, their positioning in society, and directly effects how society views them – regardless of whether the views are correct. An example of acts of structural violence would be healthcare in the United States. The United States is the only highly advanced nation that can afford universal healthcare several times over but refuses to instate it. This is because in the U.S., healthcare is framed as a negative right. Negative rights are characterized as rights that should be obtained by one’s own discernment; it allows people the freedom of inaction from others. In this mindset, no one, specifically the government, should help those without healthcare obtain it.
Universal healthcare could eliminate this indirect violence. Universal healthcare is accomplished when everyone has guaranteed means to easily access curative, preventable, and palliative health care and health care systems regardless of creed, race, religion, sexuality, etc. Universal healthcare is when the allocation of healthcare services is distributed not equally but equitably across the nation to provide ample opportunity for those who could not otherwise afford it. Without universal healthcare this indirect violence can then manifest in the structures such as the historical context and laws and the institutions and ideologies/beliefs that surround healthcare and its relating systems that function to create, allow, and maintain indirect violence. This will allow it to continue to grow, and, with this growth, an increase in presence of violence can be expected because “…violence is present when human beings are being influenced so that their actual somatic and mental realizations are below their potential realizations.” (Curle, 1975).
First and foremost, the most important thing to establish is that healthcare is a human right because, as Paul Farmer says, “Global health equity depends on something as precious as health being recognized as a human right.”. The 1966 International Covenant on Economic, Social, and Cultural Rights (ICESCR) emanates the idea of health as a commodity that should be afforded to all regardless of socioeconomic status, race, etc. Based on the United States Constitution, as people living in America, we are guaranteed the right to life, liberty, and the pursuit of happiness. It is not far off base to argue that healthcare is encompassed in these rights. The denial of these rights contributes to disparities we instated by way of race, gender, socioeconomic status, etc.
They need to be addressed before we can move toward universal healthcare. There are many issues that need to be settled for it to be instated. For universal healthcare to be achievable, it must be affordable, have broad availability even within rural communities, medical staff must be well-trained and motivated, and addressing the social determinants of health, such as education, is essential. Governmental aid and reallocation of funds for programs to address disparities, adequate training for medical personnel, etc. are the means in which these requirements can be met. After this, the burden falls on the government for dissemination of these rights to the population. It is the government’s job to write universal healthcare into the constitution and then further provide the tools to communities across the nation to ensure full adherence to the new law.
The history of universal healthcare is long and seemingly produces the same results each time – promises of change or compromise and then nothing. The first idea of universal healthcare began in Germany in 1882 as “compulsory sickness insurance.” Compulsory sickness insurance was a way to take the financial burden off families should a member fall ill and not be able to earn a wage. Compulsory sickness insurance started in Germany but quickly expanded throughout European countries by 1912 (“History”, 2018).
The primary reason European nations were establishing this form of insurance was to stabilize its constituent’s income and protect them from the burden of lost wages due to unavoidable sickness. It was a way to prevent the government from shelling out money to cover the population’s medical expenses. During this time, the U.S. government rejected compulsory sickness insurance and left it up to the states to choose how they wanted to handle healthcare. The states ultimately decided to leave all issues of healthcare up to private, big business corporations. During the Progressive Era, a time in the early 20th century branded by social activism and political reform, President Theodore Roosevelt made plans to reform the healthcare system because he actively believed that a nation cannot be considered strong if so many of its members are sick and poor, but, with a powerless working class that did not support broader social insurance, sickness funds, or benefit programs, Roosevelt’s plans did not come to fruition and was put on hold by his successor.
Lederach’s idea of the justice gap is applicable to these events. The justice gap is defined as “a gap between the expectations for peace and what is delivered” that is caused by increased space for participation in politics while maintaining a smothered and silence viewpoint. Lederach claims that “we have no adequately developed a peace-building framework that reduces direct violence and produces social and economic justice.” (Lederach, n.d.). Sickness funds were a way to deflect from the bigger issue. When it comes down to it, cheap and effective labor will always outweigh the health of workers in the eyes of people who are driven by profit. Additionally, the lack of labor unions contributed to the historical context of universal healthcare. Vladeck states that one of the primary reasons for the long, repetitive history surrounding universal healthcare is that “there [was] no self-identified working class—no labor party, no national health insurance.” Without people identifying themselves as the working party or needing to work to be able to live, there is no group advocating and fighting for it and therefore there will not be a recognized need for national, universal health insurance coverage.
The development of universal healthcare in the United States began, in a written format within the legal system, as the American Association of Labor Legislation (AALL) Bill of 1915. This bill aimed to reform capitalism as a campaign for health insurance by including services of physicians, nurses, and hospitals, sick pay, maternal benefits, and death benefits to pay for funeral expenses. These costs were eventually shared between workers, employers, and the state. This bill caused discourse across many groups. Three groups in particular with great standing that publicly spoke on this bill were the American Medical Association (AMA), the American Federation of Labor (AFL), and private insurance companies. The AMA adamantly supported the AALL Bill of 1915 because they found that prominent physicians were compassionate toward their patients struggles and wanted to do everything within their authority to support and actively fortify the bill’s standing. However, the AFL condemned the bill. They believed the bill overstepped its boundaries. They thought that if the government doled out insurance, it would overthrow the then current labor unions role in fighting to gain social benefits. Similarly, private insurance companies opposed the bill. It would cause them to lose money because government aid, in terms of healthcare, would weaken the stranglehold big insurance corporations hold over people’s lives.
The institutions of healthcare – insurance companies – are big contributors to indirect violence. Insurance companies like Blue Cross Blue Shield are the main contributors of health insurance, and they are severely lacking in competition. Weisbart states that “We will not solve our health care crisis as long as private insurance plays a dominant role” (Virtual Mentor, 2012). The lack of competition allows them to charge whatever they want for their services because what they offer cannot be found elsewhere. Without healthcare, our health cannot be monitored to ensure we are in good physical and mental standing. Without healthcare, we get ill and cannot afford treatment to fix it, the illness causes us to lose money due to not being able to work, and not being able to work further prevents us from affording the care we need. This level of negligence is the reason many people are being left undiagnosed of life-threatening conditions, untreated for their conditions due to the high costs of medicine and are even unaware their life is in danger because they cannot afford the copay for a checkup by their physician. We have the means to insure everyone, but we allow greediness to overcome compassion. These institutions emerge, as being by Thelen, when individuals have consistent interactions with each other, and every interaction afterward follow the same trend (Verbeek & Peters, 2019). The behavioral processes become embedded in these relationships as roles form and rules are learned and set. This learned behavior contribute directly to the stigma surrounding those who cannot afford healthcare and those who benefit from government assistance.
Stigma also is one of many manifestations of structural violence presented without universal healthcare. Stigma is a set of negative and often unfair beliefs that a society or group of people have about something or someone. Stigma can be enhanced through intersectionality. This is the idea that discrimination or marginalization is amplified when a person has more than one stigmatized identity such as being a poor, black, gay man rather than just being a black man. The instatement of universal healthcare would erase the stigma surrounding being poor. It would allow society to stop punishing people who cannot afford healthcare by creating access to healthcare even when money is scarce. This punishment comes from the garnishment of wages from missed workdays due to the inability to afford a doctor’s appointment, being forced to work despite illness because people would not have the means to afford a certain standard of living without their full paycheck, etc.
While seemingly indirect, these human rights violations stem directly from the laws or lack of laws in relation to healthcare. These are no accidents and they’re not random. These violations are “symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm.” (Farmer & Sen, 2003), and the PIH model would aid in removing these barriers for the people directly affected by these pathologies of power. The PIH Model is followed when the clinical and community barriers to care removed as diagnosis and treatment declared a public good and made available free of charge to patients living in poverty (Farmer, Nizeye, Stulac, Keshaviee, 2006). These symptoms are designed to disproportionately affect those who are less well-off and additionally those that live in rural areas. Rural areas, in Alabama specifically, have higher chances of accessible hospitals closing or not having resources or specialists available to them because of lack of funding. This forces them to drive upwards of an hour to another facility to seek treatment or forgo treatment entirely because they do not have the means for transportation.
By making these resources free or instating universal healthcare, we are one step closer to achieving negative peace. This would be an example of a proximal intervention because instead of waiting to treat and illness we dismantle the barriers in place and prevent the illness from ever occurring by offering people the chance to receive timely checkups and free medical aid. However, despite the installation of universal healthcare benefitting most of the public, it would be met with harsh opposition by many right-wing conservatives, especially in the south.
There are many reasons right-wing conservatives who oppose universal healthcare. The main reason, simply put, is money. In reality, money should not be our primary concern. A nation’s wealth is measured by gross domestic product (GDP). By measures of GDP, the United States is the wealthiest in the world, and we spend the most money per person on health care. Yet, we have the worst health outcomes of all the advanced nations, and many people in our population are uninsured and unable to see a doctor. In 2018, 17.8% of the GDP was spent on healthcare. In Norway, a nation with universal healthcare, they spend around 9.3% of their GDP on healthcare while maintaining substantially better rates of obesity and overall life expectancy than the United States (“Norway,2019). We spend so much money on healthcare and reap none of the benefits.
This is because in the U.S., the high amounts spent on healthcare are used to pay health personnel and administration, pharmaceuticals, and so on. A health-peace initiative through a peace building mechanism would be helpful. A health-peace initiative is any initiative that is intended to improve the health of a population and simultaneously heightens that population’s level of peace and security, and the peace building mechanism consists of heighten that population’s level of peace and security, and the peace building mechanism consists of conflict management, solidarity, strengthening the social fabric, dissent, and restricting the destructiveness of war (MacQueen, 2000). Conflict management, solidarity, strengthening the social fabric, and restricting the destructiveness of war will play a large part in creating a system conducive enough to eliminate the indirect violence put in place by our current method of healthcare attainment.
In many other countries, various methods have worked when doling out free healthcare. Countries across the nation have opted to consolidate fragmented finances, use bulk purchasing to negotiate lower costs, and even have adopted responsible, non-profit driven strategies (Virtual Mentor, 2012). As the wealthiest country in the nation, all of these methods are attainable and would be well within our limits, but many economists believe that a single-tax payer system is the best method for a country of our standing. Under a single-payer system – a system where a single public agency organizes health care financing, but the delivery of care remains largely in private hands – doctors would be able to lower the costs to see patients which would cut government spending on healthcare a significant amount (“How Much Would Single Payer Cost? – PNHP,” 2017). It is important to dive directly into this solution rather than letting the system try to take baby steps into a single-payer system. This cannot be done through a series of micro steps because it would allow for a misstep to happen in terms of doling out the appropriate rights. For example, the social security act began as a series of micro steps, and it allowed the system to pick and choose who received what rights and omitted some of the most important rights such as survivor benefits, federal disability benefits, etc. Vladeck even mentions that “…in the 67 years the Social Security Act has been in existence, it has been amended 40 times, and most years the program has had some incremental improvement.” (Vladeck, 2003).
Peace, in itself, is a complex word that many have come to understand means that ultimately everything and everyone is at peace – from individuals to the laws set in place. We all have a duty to understand the important relationship between peace and indirect or structural violence. Peace, in a positive aspect, is not achievable without the abolition of structural violence. America will never reach this point as long as injustices such as the denial of healthcare as a human right is upheld. We have the resources to insure everyone, but we allow greed, corruption, and arrogance to prevent men, women, and children from doing something as simple as getting a yearly checkup. About 1 in 10 Americans cannot afford healthcare, and because of this many are dying from diseases they did not even know they had. Universal healthcare can eliminate this structural harm and allow people to begin reaching their actual somatic and mental realizations.
References
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