Farmer and colleagues argue that the poor, through their experience of social inequality, discrimination, and limited choice endure a structural violence that concretely manifests on a local level (Farmer, 1999; Farmer et al., 1996). Central to the concept of structural violence is an evaluation of how disease is linked to social inequality, class, and ethnicity. Dressler's (1993) research, for example, demonstrates that skin color is significantly associated with hypertension mediated socially through experiences of racism and not genetically. Singer argues that the high rates of drug use among urban minorities reflects an attempt to alleviate the depression and low self-esteem engendered by the frustration of enduring perpetual racism and poverty (Baer et al., 1997; Singer, 1994).
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