By Amienata Fatajo
In this paper, I further expand on the implications of communication-based structural violence. Communication is defined as the imparting or exchanging of information or news. Regarding structural violence, communication-based structural violence emphasizes the idea that barriers to communication can cause harm to an individual through a combination of institutions. Through the University of North Carolina at Chapel Hill Southern History Oral Project, “Stories to Save Lives,” I use the firsthand accounts of Jacqui Laquiatus, Jim Kellenberger, and Marie-Flynn Vargo to illustrate the importance of dual communication between healthcare providers and patients to guarantee that everyone gets the best outcome. Their stories weave together to present something that reflects healthcare: patients do not get all of the information that they need to make informed decisions about their condition, and that can harm them in the long run. This can be defined as structural violence in how different forces within the healthcare field can work together to harm low-income people of color.
To properly understand the implication of what communication-based structural violence looks like, we need to understand what effective communication is. This looks like is by ensuring there are accurate diagnoses and a clear plan for treatment. When there is clear and direct communication between healthcare providers and patients, it results in ethical care that addresses the patient’s needs. Health communication is the overall term to describe the conversations between provider and patient.
A great example that can illustrate the importance of healthcare communication is the game of telephone. In the telephone game, one person gives a message, and as it is received by multiple people, it gets distorted to where what was originally stated is incomprehensible. This can be applied in a real life setting in via the perspective of Jacqui Laquiatus, a Chilean nurse who works in a maternal health unit, and was interviewed as part a part of the Stories to Save Lives Project. In her interview, she reflects on her interactions with a patient to which she was giving birth but did not speak English, an obvious barrier of communication. She details how there were gaps in communication, and as a result, the providers had to act as they had seen fit. One of the unintended consequences of no communication is that it leaves no room for what the patient would want. This is important because the language barrier creates a clear disconnect between provider and patient, and it means that the patient cannot have her wishes communicated. Some questions that can be considered regarding her care such as: what is her medical history? And how a play a role in the decisions she would make regarding her care. These questions are important to consider when looking at what disparities the patient could be subjected to, because of unknown medical history.
Lack of information can contribute to long-term healthcare outcomes because it can increase the number of inequities already present in the healthcare system. As stated in the article titled “ The Health Disparity of Access”, “ The lack of health/care information access jeopardizes care access and quality, putting people at-risk for worse health outcomes, eventual higher costs, and greater burden of disease compared with people who enjoy health information access.” In other words, not having the information puts the patient at risk for as stated previously, worse health outcomes, greater costs associated with treatment, and progression of the disease. The longer it takes for the patient to seek out help with their ailment, the further it progresses, and can even lead to the development of a chronic illness. To understand how costly a chronic illness can be, “90% of the US $3.8 trillion in annual healthcare expenditures are for people with chronic and mental health conditions.” (CDC) These factors combined create the system in which I am arguing that structural violence persists in, and it all starts with communication.
Health communication’s primary aim is to make medical information more accessible to patients and to encourage complex discussions between patients and providers. An absence of these objectives, however, can cause a deliberate form of structural violence in which the patient’s words fall on deaf ears, and can leave them at a higher risk of developing chronic illnesses. This lack of information ends up being harmful on the side of the patient, as positive healthcare outcomes increase as the patient knows more information.
Through the perspective of Marie Flynn-Vargo, we understand the impact lack of communication has on women’s health. Vargo reflects on her upbringing, and how when she had questions about her body, it was regarded as a taboo subject. Stigmas related to women’s health are a barrier to communication because it results in women downplaying their symptoms until it becomes debilitating. As a result, it makes it harder for women to speak up about the issues regarding them, and when they do, their condition has developed in severity. This is further reflected in the work titled “Women’s Reproductive Health: The Silent Emergency” talks about how when women’s health is stigmatized, government funding isn’t allocated to ease the problem. This source was important in understanding how structural violence becomes ingrained once there are certain attitudes towards women’s health, that it is not important.
The last perspective highlighted within my interviews was via Jim Kellenberger, an engineer who offhandedly remarks about how there were sterilizations performed at Dorthea Dix without the consent of the person it was being done on The sterilizations were the result of white supremacist ideals in an effort to rule out “undesirable traits” . The sterilizations most of the time were performed without the consent of the patient, and most of them never knew until they had gone to other physicians. The sterilizations represent how when there is a lack of communication, and the provider performs a procedure without the consent of the patient, it leads to distrust. This distrust can even be inherited, to different generations even though the eugenics movement formally stopped in 1979. This is exemplified in the work, “Interventions to Address Reproductive Health Disparities among African-American Women in a Small Urban Community: The Communicative Construction of a ‘Field of Health Action.”, as the historical reason for medical mistrust within the black community was because the fact that the legacy felt very recent.nt.
Improving communication skills can help more people receive adequate care. In terms of communication, both sides can improve. For example, patients need to communicate their needs and expectations so that the provider can understand their general perspective regarding treatment. At the same time, providers can explain the treatment terms in simple language, and offer outside sources to make the information more accessible. To conclude, we examined some of the factors that impact effective communication such as medical mistrust; and how that manifests in outcomes for patients- i.e. higher burdens of cost and disease. In addition, we examined how stigmas relating to women’s conditions impair their ability to seek treatment.
“Effective Communication in Health Care.” Effective Communication in Health Care, https://publichealth.tulane.edu/blog/communication-in-healthcare/.
“Health and Economic Costs of Chronic Diseases.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 27 Apr. 2022, https://www.cdc.gov/chronicdisease/about/costs/index.htm.
Matsaganis, Matthew D., and Annis G. Golden. “Interventions to Address Reproductive Health Disparities among African-American Women in a Small Urban Community: The Communicative Construction of a ‘Field of Health Action.’” Journal of Applied Communication Research, vol. 43, no. 2, 2015, pp. 163–184., https://doi.org/10.1080/00909882.2015.1019546.
Jacobson, Jodi L. Women’s Reproductive Health: The Silent Emergency. Worldwatch Institute, 1991.
Kellenburger, Jim. Interview with Caroline Efird. Friday, January 4, 2019 (Y-0020). Southern Oral History Program Collection (#20), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Laquiatus, Jacqui. Interview with Isabell Moore. August 2nd, 2019. (Y-00108) Southern Oral History Program Collection (#108), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Vargo, Marie-Flynn. Interview with Nicholas Allen. 10/24/2018. (Y-0133) Southern Oral History Program Collection (#20), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.