Ridge Damien T, Broom Alex, Alwan Nisreen A, Chew-Graham Carolyn A, Smyth Nina, Gopal Dipesh, Kingstone Tom, Gaszczyk Patrycia, Begum Samina
School of Social Sciences, University of Westminster, London, United Kingdom.
Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia.
Soc Sci Med. 2025 Feb;366:117603. doi: 10.1016/j.socscimed.2024.117603. Epub 2024 Dec 5.
Structural violence - related to 'isms' like racism, sexism, and ableism - pertains to the ways in which social institutions harm certain groups. Such violence is critical to institutional indifference to the plight of ethnic minority people living with long-term health conditions. With only emergent literature on the lived experiences of ethnic minorities with Long Covid, we sought to investigate experiences around the interplay of illness and structural vulnerabilities. Thirty-one semi-structured interviews with a range of UK-based participants of varying ethnic minorities, ages and socio-economic situations were undertaken online between June 2022 and June 2023. A constant comparison analysis was used to develop three over-arching themes: (1) Long Covid and social recognition; (2) The violence of medical ambivalence; and (3) Pathways to recognition and support. Findings showed that while professional recognition and support were possible, participants generally faced the spectre and deployment of a particular mode of structural violence, namely 'medical ambivalence'. The contours of medical ambivalence in the National Health Service (NHS) as an institution had consequences, including inducing or accentuating suffering via practices of care denial. Despite multiple structurally shaped ordeals (like healthcare, community stigma, and sexism), many participants were nevertheless able to gain recognition for their condition (e.g. online, religious communities). Participants with more resources were in the best position to 'cobble together' their own approaches to care and support, despite structural headwinds.
结构性暴力——与种族主义、性别歧视和能力主义等“主义”相关——涉及社会机构伤害某些群体的方式。这种暴力对于机构对患有长期健康问题的少数民族群体困境的冷漠态度至关重要。鉴于关于患有长期新冠后遗症的少数民族生活经历的文献刚刚出现，我们试图调查疾病与结构性脆弱性相互作用方面的经历。2022年6月至2023年6月期间，我们通过在线方式对英国不同少数民族、年龄和社会经济状况的31名参与者进行了半结构化访谈。采用持续比较分析方法得出了三个总体主题：（1）长期新冠后遗症与社会认可；（2）医疗矛盾心理的暴力；（3）获得认可和支持的途径。研究结果表明，虽然获得专业认可和支持是可能的，但参与者普遍面临一种特定形式的结构性暴力的幽灵和影响，即“医疗矛盾心理”。作为一个机构的国民医疗服务体系（NHS）中医疗矛盾心理的状况产生了一些后果，包括通过拒绝护理的做法加剧痛苦。尽管面临多种由结构造成的折磨（如医疗保健、社区污名和性别歧视），许多参与者仍然能够使自己的病情得到认可（如在网上、宗教团体中）。尽管存在结构性阻力，但资源较多的参与者最有能力“拼凑”出自己的护理和支持方式。
