Social Violence, Structural Violence, Hate, and the Trauma Surgeon

Violence can be committed against oneself or against another person or group. As trauma surgeons, we are often required to administer urgent surgical interventions on patients who have sustained life-threatening injuries, including from violence. The roots of such violence, nationally and globally, are related to structures of discrimination and alienation, termed “structural violence.” This is embedded in ubiquitous social structures and normalized by stable institutions and regular experience while “normalizing the abnormal.” Surgeons and physicians have a long history of critical analysis of the upstream “causes of the causes” to understand and prevent further harm. Hate can be well adapted to the classic public health model of the spread of “disease,” with hate speech as the vector leading to direct violence. Social medicine views social inequality as the cause of disease, with political action required to protect and improve population health. It acknowledges the need to address and end structural violence, through political solutions. It is our responsibility to create the dignified environments of growth and progress for our patients and to challenge the agents of harm such as hate and discrimination. As Dr. Norman Bethune, the father of social surgery stated, “Charity should be abolished, and replaced by justice”.