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Mendeley | Further Information

{"title"=>"Structural violence and clinical medicine", "type"=>"generic", "authors"=>[{"first_name"=>"Paul E.", "last_name"=>"Farmer", "scopus_author_id"=>"7101715964"}, {"first_name"=>"Bruce", "last_name"=>"Nizeye", "scopus_author_id"=>"35187581200"}, {"first_name"=>"Sara", "last_name"=>"Stulac", "scopus_author_id"=>"25222130900"}, {"first_name"=>"Salmaan", "last_name"=>"Keshavjee", "scopus_author_id"=>"15033108000"}], "year"=>2006, "source"=>"PLoS Medicine", "identifiers"=>{"sgr"=>"33750877279", "doi"=>"10.1371/journal.pmed.0030449", "pui"=>"44721800", "pmid"=>"17076568", "scopus"=>"2-s2.0-33750877279", "issn"=>"15491277", "isbn"=>"15491277"}, "id"=>"421275cf-acf8-39d3-93f3-1bc21ab5c57c", "abstract"=>"Structural violence refers to the social structures that put people in harm's way. Farmer and colleagues describe the impact of social violence upon people living with HIV in the US and Rwanda.", "link"=>"http://www.mendeley.com/research/structural-violence-clinical-medicine-26", "reader_count"=>498, "reader_count_by_academic_status"=>{"Unspecified"=>8, "Professor > Associate Professor"=>19, "Librarian"=>1, "Researcher"=>48, "Student > Doctoral Student"=>40, "Student > Ph. D. Student"=>62, "Student > Postgraduate"=>33, "Student > Master"=>145, "Other"=>26, "Student > Bachelor"=>95, "Lecturer"=>7, "Lecturer > Senior Lecturer"=>6, "Professor"=>8}, "reader_count_by_user_role"=>{"Unspecified"=>8, "Professor > Associate Professor"=>19, "Librarian"=>1, "Researcher"=>48, "Student > Doctoral Student"=>40, "Student > Ph. D. Student"=>62, "Student > Postgraduate"=>33, "Student > Master"=>145, "Other"=>26, "Student > Bachelor"=>95, "Lecturer"=>7, "Lecturer > Senior Lecturer"=>6, "Professor"=>8}, "reader_count_by_subject_area"=>{"Unspecified"=>18, "Agricultural and Biological Sciences"=>25, "Arts and Humanities"=>14, "Philosophy"=>3, "Business, Management and Accounting"=>6, "Veterinary Science and Veterinary Medicine"=>3, "Chemistry"=>1, "Computer Science"=>1, "Earth and Planetary Sciences"=>2, "Economics, Econometrics and Finance"=>1, "Engineering"=>5, "Environmental Science"=>6, "Nursing and Health Professions"=>37, "Biochemistry, Genetics and Molecular Biology"=>8, "Medicine and Dentistry"=>172, "Design"=>1, "Neuroscience"=>2, "Sports and Recreations"=>2, "Psychology"=>13, "Social Sciences"=>176, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>172}, "Social Sciences"=>{"Social Sciences"=>176}, "Sports and Recreations"=>{"Sports and Recreations"=>2}, "Psychology"=>{"Psychology"=>13}, "Unspecified"=>{"Unspecified"=>18}, "Environmental Science"=>{"Environmental Science"=>6}, "Arts and Humanities"=>{"Arts and Humanities"=>14}, "Design"=>{"Design"=>1}, "Engineering"=>{"Engineering"=>5}, "Chemistry"=>{"Chemistry"=>1}, "Neuroscience"=>{"Neuroscience"=>2}, "Earth and Planetary Sciences"=>{"Earth and Planetary Sciences"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>25}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>6}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>37}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>8}, "Philosophy"=>{"Philosophy"=>3}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>3}}, "reader_count_by_country"=>{"Ecuador"=>1, "United States"=>14, "United Kingdom"=>6, "Sierra Leone"=>1, "India"=>1, "Russia"=>1, "Greece"=>1, "Canada"=>3, "Bangladesh"=>1, "Netherlands"=>1, "Brazil"=>1, "Australia"=>1, "Ethiopia"=>1}, "group_count"=>12}

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Journal Comments | Further Information

• {"type"=>"COMMENT", "annotationUri"=>"info:doi/10.1371/annotation/24ab11f5-b9fc-4f33-9a44-a13b9e8c08fa", "title"=>"Free infant formula for HIV-exposed infants", "body"=>"Author: Ted Greiner\nPosition: Senior Nutritionist\nInstitution: PATH\nE-mail: tgreiner@path.org\nAdditional Authors: Christophe Grundmann, Katherine Krasovec, Christian Pitter, and Catherine Wilfert\nSubmitted Date: December 18, 2006\nPublished Date: December 19, 2006\nThis comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.\n\nWe wholeheartedly agree with Paul Farmer and colleagues (1) that it is vitally important to examine social, as well as molecular, causes of disease. Unless we carefully consider the full range of factors that underlie a given problem, we may produce “solutions” with unintended and deleterious consequences. In this light we express our concern about the infant feeding approach advocated in their article to reduce mother-to-child transmission of HIV in Rwanda.\n\nWhile exclusive replacement feeding reduces the risk of transmission between HIV-positive mothers and their infants, it does not adequately address the specters of infection and undernutrition that accompany avoidance of breastfeeding. We are convinced—by data from regions that are similar to Rwanda and even from African countries with higher standards of living—that replacement feeding from birth is a dangerous and inappropriate approach for HIV-affected families in countries like Rwanda.\n\nIn addition, avoiding breastfeeding from birth can be exceedingly risky, particularly in the same regions where the risk of mother-to-child transmission of HIV is highest. While Partners in Health (PIH) offers high-quality health care support and financial assistance to reduce the risks associated with breastfeeding avoidance in two districts in Rwanda, it is impossible to eliminate those risks. Researchers have found that children in Ghana, Peru, and India who are not breastfed between the ages of 6 weeks and 6 months have a ten-fold higher risk of death (2). A multi-country analysis by the World Health Organization showed that infants who were born to mothers with little education and were not breastfed had a five-fold increased risk of death from 6 to 11 months of age. Since about 5% of breastfed Rwandan babies already die in the first 6 months of life and another 3.5% from 6 to12 months (3), it is essential that PIH substantiate the mortality, nutrition, and morbidity outcomes resulting from their approach before promoting it more widely.\n\nGiven that breastfeeding avoidance increases the risk of death from other causes, even as it decreases the risk of HIV transmission, is there a net gain? The concept of “HIV-free survival” combines the likelihood of surviving with the likelihood of not becoming HIV-infected, allowing a more comprehensive assessment of the risks and benefits of infant feeding. In Botswana (4) and the Ivory Coast (5), rates of HIV-free survival were no better among formula-fed infants than among infants breastfed for 3 to 6 months. At this year’s WHO Consultation on HIV and Infant Feeding in Geneva, reports showed high death rates in ongoing trials in Kenya, Uganda and Malawi associated with breastfeeding cessation at 3-6 months. These results were despite earlier assumptions that breastfeeding cessation at this age might be safe, while avoiding most of the HIV transmission associated with prolonged breastfeeding (6). Since these carefully controlled studies represent best-case scenarios for replacement feeding, most actual program settings will favor breastfeeding (actually, disfavor replacement feeding).\n\nThe risk of mother-to-child HIV transmission in the first six months in a country like Rwanda, where 81% of women are still exclusively breastfeeding at 4-6 months (3), is relatively low—probably approximately 0.3% per month (7). It may be even lower in districts like those in which PIH works, where eligible HIV-positive mothers begin receiving highly active antiretroviral therapy during pregnancy, because the majority of postnatal HIV transmission is from mothers with low CD4+ cell counts (8).\n\nScientific evidence amply demonstrates the significant risks that accompany replacement feeding and the safety and effectiveness of exclusive breastfeeding for the first 6 months, and continued breastfeeding thereafter as appropriate and safe. Around the world, researchers, programmers and policy makers are becoming increasingly convinced that the infant feeding counseling component of prevention of mother-to-child transmission of HIV programs must focus on optimizing HIV-free survival rates, not simply on HIV transmission. Accomplishing this means taking full account of all factors, both social and molecular, that are at work in a particular context, and tailoring responses to meet them.\n_________________\n\n1 Structural Violence and Clinical Medicine, PLoS Medicine, Nov 2006\n2 Bahl R, et al. Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bull WHO. 2005;83:418-26.\n3 Data from DHS surveys 2000 and 2006. IMR of 86 (2005)\n4 Thior I, et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA;296:794-805.\n5 Leroy V. Presentation at WHO Consultation on HIV and Infant Feeding, Geneva, 25 October 2006.\n6 Piwoz EG, Ross JS. Use of population-specific infant mortality rates to inform policy decisions regarding HIV and infant feeding. J Nutr. 2005;135:1113-9.\n7 Iliff PJ, et al, ZVITAMBO study group. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19:699-708.\n8 Coutsoudis A, et al. Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis. 2004;189(12):2154-66.\n\n_________________\n\nTed Greiner, PhD*\nChristophe Grundmann, PhD**\nKatherine Krasovec, ScD*\nChristian Pitter, MD**\nCatherine Wilfert, MD**\n\n*PATH\n**Elizabeth Glaser Pediatric AIDS Foundation", "isRemoved"=>false, "created"=>"2009-03-31T00:03:50Z", "lastModified"=>"2009-03-31T00:03:50Z", "creator"=>{"userId"=>"172479"}, "highlightedText"=>"", "competingInterestStatement"=>{"creatorWasPrompted"=>true, "hasCompetingInterests"=>false}, "parentArticle"=>{"doi"=>"info:doi/10.1371/journal.pmed.0030449", "state"=>"published", "journals"=>{"PLoSMedicine"=>{"journalKey"=>"PLoSMedicine", "eIssn"=>"1549-1676", "title"=>"PLOS Medicine"}}}, "replyTreeSize"=>0, "mostRecentActivity"=>"2009-03-31T00:03:50Z", "replies"=>[]}

Nature

Reddit | Further Information

• {"domain"=>"self.badhistory", "banned_by"=>nil, "media_embed"=>{}, "subreddit"=>"badhistory", "selftext_html"=>"<!-- SC_OFF --><div class=\"md\"><p>The many-headed Hydra is back, this time in the form of <a href=\"https://www.youtube.com/watch?v=JEYh5WACqEk\">a video homage</a> to <em>Guns, Germs, and Steel</em> courtesy of CGPGrey and Audible. At the end of the video CGPGrey calls <em>GG&S</em> “the history book to rule all history books”. He cites Diamond’s work extensively and, with the aid of fun graphics, tries to explain the apparent one-way transfer of infectious disease after contact. </p>\n\n<p>The ideas presented in the video are not new, they were outlined in <em>GG&S</em> almost twenty years ago, and Diamond borrowed extensively from Alfred Crosby’s 1986 <em>Ecological Imperialism</em> for his central thesis. Along with other scholars here and in <a href=\"/r/AskHistorians\">/r/AskHistorians</a>, I’ve previously written several posts arguing against the many aspects of <em>GG&S</em>. In this community alone I <a href=\"https://np.reddit.com/r/badhistory/comments/2cfhon/guns_germs_and_steel_chapter_11_lethal_gift_of/\">discussed the issues with one chapter, Lethal Gift of Livestock</a>, presented a long counter to the notion of a virgin soil population with <a href=\"https://np.reddit.com/r/badhistory/comments/2bqvto/slavery_smallpox_and_virgins_the_us_southeast_as/\">a case study of the US Southeast after contact</a>, and wrote a nine part series called <a href=\"https://np.reddit.com/r/AskHistorians/wiki/profiles/anthropology_nerd#wiki_from_.2Fr.2Fbadhistory.2C_the_myths_of_conquest_series\">The Myths of Conquest</a> where I extensively borrowed from Restall’s wonderful book <a href=\"https://books.google.com/books?id=4bgwAvQYZxQC&dq=seven+myths+of+the+spanish+conquest&source=gbs_navlinks_s\"><em>Seven Myths of the Spanish Conquest</em></a> in an effort to detail multiple issues with a simplistic view of Native American history after contact. You can read the <a href=\"/r/AskHistorians\">/r/AskHistorians</a> FAQ on <a href=\"https://np.reddit.com/r/AskHistorians/wiki/historians_views#wiki_historians.27_views_of_jared_diamond.27s_.22guns.2C_germs.2C_and_steel.22\">Jared Diamond’s <em>Guns, Germs, and Steel</em> here</a> for further information. Also, this October a group of archaeologists, biological anthropologists, historians, and ethnohistorians published what will be the key text in the infectious disease debate for the immediate future. If you don’t believe me, a nerd who likes to discuss history on reddit, I hope you will check out the book. To quote the introduction to <a href=\"https://books.google.com/books/about/Beyond_Germs.html?id=yUw-rgEACAAJ&hl=en\"><em>Beyond Germs: Native Depopulation in North America</em></a></p>\n\n<blockquote>\n<p>We may never know the full extent of Native depopulation… but what is certain is that a generation of scholars has significantly overemphasized disease as the cause of depopulation, downplaying the active role of Europeans in inciting wars, destroying livelihoods, and erasing identities. This scholarly misreading has given support to a variety of popular writers who have misled and are currently misleading the public.</p>\n</blockquote>\n\n<p>If <em>GG&S</em> is the history book to rule them all then, like Tolkien’s One Ring, <em>GG&S</em> is an attractive but fundamentally corruptive influence. Here I’ll briefly explain several of the issues while focusing on one key assumption of the video: universal, catastrophic, irrecoverable demographic decline due to infectious disease transfer from the Old World to the New.</p>\n\n<p><strong>>90% Mortality Due to Disease</strong></p>\n\n<p>I addressed aspects of the > 90% mortality due to disease in <a href=\"https://np.reddit.com/r/badhistory/comments/2u4d53/myths_of_conquest_part_seven_death_by_disease/\">this post, Death by Disease Alone</a>, which I quote briefly. The 90-95% figure that dominates the popular discourse has its foundation in the study of mortality in conquest-period Mexico. Several terrible epidemics struck the population of greater Mexico (estimated at ~22 million at contact) in quick succession. Roughly 8 million died in the 1520 smallpox epidemic, followed closely by the 1545 and 1576 cocoliztli epidemics where ~12-15 million and ~2 million perished, respectively (<a href=\"https://books.google.com/books?id=GutvPQAACAAJ&dq=a+history+of+greater+mexico&hl=en&sa=X&ved=0ahUKEwj9-Pj8tK_JAhXHbiYKHRRuAoIQ6AEIJTAB\">Acuna-Soto et al., 2002</a>). After these epidemics and other demographic insults, the population in Mexico hit its nadir (lowest point) by 1600 before slowly beginning to recover.\nThough the data from Mexico represents a great work of historic demography, the mortality figures from one specific place and time have been uncritically applied across the New World.</p>\n\n<p>Two key factors are commonly omitted when transferring the 90-95% mortality seen in Mexico to the greater Americas: (1) the 90-95% figure represents all excess mortality after contact (including the impact of warfare, famine, slavery, etc. with disease totals), and (2) disease mortality in Mexico was highest in densely populated urban centers where epidemics spread by rapidly among a population directly exposed to large numbers of Spanish colonists. Very few locations in the Americas mimic these ecological conditions, making the application of demographic patterns witnessed in one specific location inappropriate for generalization to the entire New World. In a far different location, lowland Amazonia, most groups showed an ~80% mortality rate from all sources of excess mortality (not just disease) in the years immediately following contact, with ~75% of indigenous societies becoming extinct (<a href=\"http://www.nature.com/articles/srep04541?message-global=remove&WT.ec_id=SREP-631-20140408\">Hamilton et al., 2014</a>). However, examining bioarchaeological, historical, and ethnohistorical accounts show a variety of demographic responses to contact, including relative stasis and an absence of early catastrophic disease spread.</p>\n\n<p>Bioarchaeological evidence, like Hutchinson’s detailed analysis of Tatham Mounds, a burial site along the route taken by de Soto through Florida, show no evidence of mass graves indicative of early epidemics. Even at sites along the route of a major <em>entrada</em>, where at least one individual displays evidence of skeletal trauma from steel weapons, the burial practices reflect the gradual and orderly placement of individuals, just as before, and not mass graves associated with catastrophic disease mortality. There is likewise no evidence of disease introduction into New Mexico until a century after Coronado’s <em>entrada</em>. </p>\n\n<blockquote>\n<p>The silence of records from the sixteenth-century Spanish exploring expeditions to New Mexico on the subject of disease and the apparent absence of large-scale reduction in the number of settlements during that time combine to reinforce the idea that the Pueblo population did not suffer epidemics of European diseases until the 1636-41 period. (Barrett 2002, quoted in Jones 2015)</p>\n</blockquote>\n\n<p>There is no evidence of early catastrophic decline among the Huron-Petun between 1475 and 1633, and despite centuries of continued contact in the U.S. Southeast the first smallpox epidemic finally occurred at the close of the seventeenth century. Hamalainen suggests the Comanches did not face significant disease mortality until after 1840, and mission records in California indicate measles and smallpox arrived quite late, 1806 and 1833, nearly fifty years after the start of the missions.</p>\n\n<p>Could early catastrophic epidemics have taken place during this early period? Absolutely. But to argue for universal cataclysmic epidemic disease mortality spreading ahead of European explorers is to argue from an absence of evidence. In fact, as scholars dive deeper into the history of the protohistoric, the hypothesis becomes untenable. </p>\n\n<p><strong>”A Passive Biological Weaponry”</strong></p>\n\n<p>The quote above, taken from the video, encapsulates the key issue with overemphasizing the importance of infectious disease when discussing the repercussions of contact: placing blame on disease alone (1) divorces disease mortality from the larger host and ecological setting, (2) contextualizes the narrative of contact in terms of eventual Native American defeat, and (3) obscures the centuries of structural violence in the form of warfare, massacres, enslavement, forced labor, territorial restriction and displacement, and resource deprivation poured out over generations.</p>\n\n<p>In the Myths of Conquest series I quoted Wilcox’s <a href=\"https://books.google.com/books?id=wX0QAgAAQBAJ&dq=wilcox+archaeology+of+the+Pueblo+revolt&source=gbs_navlinks_s\"><em>The Pueblo Revolt and the Mythology of Conquest: An Indigenous Archaeology of Contact</em></a>, and here I will do so again</p>\n\n<blockquote>\n<p>One consequence of dominance of “disease and acculturation models” of the postcontact period has been a lack of scholarly attention paid to the subjects of conflict, violence, and resistance between colonists and Native peoples through extended periods of time.</p>\n</blockquote>\n\n<p>European expansion into the New World was not easy, fast, or benign. A century after initial contact more than two million peopled lived east of the Mississippi River. Less than five hundred were European. By 1820 the descendants of European colonists finally gained hegemony east of the Mississippi River. In those two hundred plus years between initial contact and 1820 a pattern of structural violence defined the relationships between European colonists and Native American nations. </p>\n\n<p>Structural violence behaviors are “structural because they are defined within the context of existing political, economic, and social structures, and they are a record of violence because the outcomes cause death and debilitation” (<a href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030449\">Farmer et al., 2006</a>). In the Americas this pattern of behavior includes forced population displacement, engaging in the widespread collection and exportation of Native American slaves, inciting wars to fuel the Indian slave trade, intentional resource destruction to decrease Native American resistance, massacres and display violence against both combatants and non-combatants, a variety of forced labor practices ranging from modification of mit’a tribute systems to mission and <em>encomiendas</em> work quotas, and centuries of identity erasure that served to deny Native American heritage and, on paper, fuel the perception of a terminally declining Indian presence in the New World. </p>\n\n<p>This structural violence could not extinguish the vitality of Native American communities who resisted and accommodated, waged war and forged peace, negotiated and re-negotiated and re-negotiated their positions with more than half a dozen European nations and their colonial offspring over the course of 500 years. Powerful confederacies, like the Creek and Cherokee, rose from the destruction wrought by the slave trade and used their influence to sway the history of the continent. In 1791 the short-lived Northwestern Confederacy nearly annihilated the United States Army on the banks of the Maumee River. Other nations, like the Osage, displaced from their homeland remade themselves in the interior of the continent where they dominated the horse and firearm trade, claiming vast swathes of the Plains as their own. Some, like the Kussoe, refused to engage in English slaving raids and were ruthlessly attacked, surviving members fleeing inland to join new confederacies. Still others, like the Seminole, never formally surrendered and continue to defy claims to a completed conquest.</p>\n\n<p><strong>The Terminal Narrative</strong></p>\n\n<p>The Terminal Narrative permeates nearly every popular, and even many scholarly, discussions of Native American history. Per the narrative, Columbus’s arrival on San Salvador functions as an event horizon, the beginning of the end after which Native American history could only flow on one inevitable and completely destructive course. Those seeking a blameless, passive cause for this decline place the focus on introduced infectious organisms. Disease becomes a “morally neutral biohistorical force” (Jones, 2015) or as Grey states, a “passive biological weaponry”. Introduced infectious diseases did increase mortality, and made demographic recovery challenging. However, in the Myths of Conquest series I argued against the terminal narrative, urging instead a focus on the active agents and the thousands of “what ifs” hidden under the creeping determinism that assumes Native American decline and near extinction.</p>\n\n<p>Europeans did not need a “passive biological weapon”, they were quite satisfied to actively wield their own literal weapons as they attempted to enforce their will on the inhabitants of a New World. Native Americans weren’t so desolate that they simply gave up and allowed conquest to occur. Vibrant communities controlled their own destiny, rolled back the Spanish frontier in North American through violent revolts, conducted feats of diplomacy to pit colonial powers against each other, and in acts both large and small actively negotiated their way into a global trade network. </p>\n\n<p>There is no easy narrative of Native American history after contact. It was a hard fought struggle for both sides, one that we are, in many ways, still fighting five centuries later. A myopic fascination disease obscures five centuries of our shared history on these continents. There are shelves of books, and reams of articles, with evidence against the myth of death by disease alone. <em>Guns, Germs, and Steel</em> is not the history book to rule all history books. It may be a place to start, but if it is your one precious source please consider further reading.</p>\n\n<p>Further posts on the inaccuracies of Grey to come. Stay tuned.</p>\n\n<p><strong>Suggestions for Historically Accurate Further Reading</strong></p>\n\n<p>Cameron, Kelton, and Swedlund, eds. <em>Beyond Germs: Native Depopulation in North America</em></p>\n\n<p>Calloway <em>One Vast Winter Count: The Native American West before Lewis and Clark</em></p>\n\n<p>Gallay <em>The Indian Slave Trade: The Rise of the English Empire in the American South, 1670-1717</em></p>\n\n<p>Kelton <em>Epidemics and Enslavement: Biological Catastrophe in the Native Southeast, 1492-1715</em></p>\n\n<p>Restall <em>Seven Myths of the Spanish Conquest</em></p>\n</div><!-- SC_ON -->", "selftext"=>"The many-headed Hydra is back, this time in the form of [a video homage](https://www.youtube.com/watch?v=JEYh5WACqEk) to *Guns, Germs, and Steel* courtesy of CGPGrey and Audible. At the end of the video CGPGrey calls *GG&S* “the history book to rule all history books”. He cites Diamond’s work extensively and, with the aid of fun graphics, tries to explain the apparent one-way transfer of infectious disease after contact. \n\nThe ideas presented in the video are not new, they were outlined in *GG&S* almost twenty years ago, and Diamond borrowed extensively from Alfred Crosby’s 1986 *Ecological Imperialism* for his central thesis. Along with other scholars here and in /r/AskHistorians, I’ve previously written several posts arguing against the many aspects of *GG&S*. In this community alone I [discussed the issues with one chapter, Lethal Gift of Livestock](https://np.reddit.com/r/badhistory/comments/2cfhon/guns_germs_and_steel_chapter_11_lethal_gift_of/), presented a long counter to the notion of a virgin soil population with [a case study of the US Southeast after contact](https://np.reddit.com/r/badhistory/comments/2bqvto/slavery_smallpox_and_virgins_the_us_southeast_as/), and wrote a nine part series called [The Myths of Conquest](https://np.reddit.com/r/AskHistorians/wiki/profiles/anthropology_nerd#wiki_from_.2Fr.2Fbadhistory.2C_the_myths_of_conquest_series) where I extensively borrowed from Restall’s wonderful book [*Seven Myths of the Spanish Conquest*](https://books.google.com/books?id=4bgwAvQYZxQC&dq=seven+myths+of+the+spanish+conquest&source=gbs_navlinks_s) in an effort to detail multiple issues with a simplistic view of Native American history after contact. You can read the /r/AskHistorians FAQ on [Jared Diamond’s *Guns, Germs, and Steel* here](https://np.reddit.com/r/AskHistorians/wiki/historians_views#wiki_historians.27_views_of_jared_diamond.27s_.22guns.2C_germs.2C_and_steel.22) for further information. Also, this October a group of archaeologists, biological anthropologists, historians, and ethnohistorians published what will be the key text in the infectious disease debate for the immediate future. If you don’t believe me, a nerd who likes to discuss history on reddit, I hope you will check out the book. To quote the introduction to [*Beyond Germs: Native Depopulation in North America*](https://books.google.com/books/about/Beyond_Germs.html?id=yUw-rgEACAAJ&hl=en)\n\n> We may never know the full extent of Native depopulation… but what is certain is that a generation of scholars has significantly overemphasized disease as the cause of depopulation, downplaying the active role of Europeans in inciting wars, destroying livelihoods, and erasing identities. This scholarly misreading has given support to a variety of popular writers who have misled and are currently misleading the public.\n\nIf *GG&S* is the history book to rule them all then, like Tolkien’s One Ring, *GG&S* is an attractive but fundamentally corruptive influence. Here I’ll briefly explain several of the issues while focusing on one key assumption of the video: universal, catastrophic, irrecoverable demographic decline due to infectious disease transfer from the Old World to the New.\n\n**>90% Mortality Due to Disease**\n\nI addressed aspects of the > 90% mortality due to disease in [this post, Death by Disease Alone](https://np.reddit.com/r/badhistory/comments/2u4d53/myths_of_conquest_part_seven_death_by_disease/), which I quote briefly. The 90-95% figure that dominates the popular discourse has its foundation in the study of mortality in conquest-period Mexico. Several terrible epidemics struck the population of greater Mexico (estimated at ~22 million at contact) in quick succession. Roughly 8 million died in the 1520 smallpox epidemic, followed closely by the 1545 and 1576 cocoliztli epidemics where ~12-15 million and ~2 million perished, respectively ([Acuna-Soto et al., 2002](https://books.google.com/books?id=GutvPQAACAAJ&dq=a+history+of+greater+mexico&hl=en&sa=X&ved=0ahUKEwj9-Pj8tK_JAhXHbiYKHRRuAoIQ6AEIJTAB)). After these epidemics and other demographic insults, the population in Mexico hit its nadir (lowest point) by 1600 before slowly beginning to recover.\nThough the data from Mexico represents a great work of historic demography, the mortality figures from one specific place and time have been uncritically applied across the New World.\n\nTwo key factors are commonly omitted when transferring the 90-95% mortality seen in Mexico to the greater Americas: (1) the 90-95% figure represents all excess mortality after contact (including the impact of warfare, famine, slavery, etc. with disease totals), and (2) disease mortality in Mexico was highest in densely populated urban centers where epidemics spread by rapidly among a population directly exposed to large numbers of Spanish colonists. Very few locations in the Americas mimic these ecological conditions, making the application of demographic patterns witnessed in one specific location inappropriate for generalization to the entire New World. In a far different location, lowland Amazonia, most groups showed an ~80% mortality rate from all sources of excess mortality (not just disease) in the years immediately following contact, with ~75% of indigenous societies becoming extinct ([Hamilton et al., 2014](http://www.nature.com/articles/srep04541?message-global=remove&WT.ec_id=SREP-631-20140408)). However, examining bioarchaeological, historical, and ethnohistorical accounts show a variety of demographic responses to contact, including relative stasis and an absence of early catastrophic disease spread.\n\nBioarchaeological evidence, like Hutchinson’s detailed analysis of Tatham Mounds, a burial site along the route taken by de Soto through Florida, show no evidence of mass graves indicative of early epidemics. Even at sites along the route of a major *entrada*, where at least one individual displays evidence of skeletal trauma from steel weapons, the burial practices reflect the gradual and orderly placement of individuals, just as before, and not mass graves associated with catastrophic disease mortality. There is likewise no evidence of disease introduction into New Mexico until a century after Coronado’s *entrada*. \n\n> The silence of records from the sixteenth-century Spanish exploring expeditions to New Mexico on the subject of disease and the apparent absence of large-scale reduction in the number of settlements during that time combine to reinforce the idea that the Pueblo population did not suffer epidemics of European diseases until the 1636-41 period. (Barrett 2002, quoted in Jones 2015)\n\nThere is no evidence of early catastrophic decline among the Huron-Petun between 1475 and 1633, and despite centuries of continued contact in the U.S. Southeast the first smallpox epidemic finally occurred at the close of the seventeenth century. Hamalainen suggests the Comanches did not face significant disease mortality until after 1840, and mission records in California indicate measles and smallpox arrived quite late, 1806 and 1833, nearly fifty years after the start of the missions.\n\nCould early catastrophic epidemics have taken place during this early period? Absolutely. But to argue for universal cataclysmic epidemic disease mortality spreading ahead of European explorers is to argue from an absence of evidence. In fact, as scholars dive deeper into the history of the protohistoric, the hypothesis becomes untenable. \n\n**”A Passive Biological Weaponry”**\n\nThe quote above, taken from the video, encapsulates the key issue with overemphasizing the importance of infectious disease when discussing the repercussions of contact: placing blame on disease alone (1) divorces disease mortality from the larger host and ecological setting, (2) contextualizes the narrative of contact in terms of eventual Native American defeat, and (3) obscures the centuries of structural violence in the form of warfare, massacres, enslavement, forced labor, territorial restriction and displacement, and resource deprivation poured out over generations.\n\nIn the Myths of Conquest series I quoted Wilcox’s [*The Pueblo Revolt and the Mythology of Conquest: An Indigenous Archaeology of Contact*](https://books.google.com/books?id=wX0QAgAAQBAJ&dq=wilcox+archaeology+of+the+Pueblo+revolt&source=gbs_navlinks_s), and here I will do so again\n\n> One consequence of dominance of “disease and acculturation models” of the postcontact period has been a lack of scholarly attention paid to the subjects of conflict, violence, and resistance between colonists and Native peoples through extended periods of time.\n\nEuropean expansion into the New World was not easy, fast, or benign. A century after initial contact more than two million peopled lived east of the Mississippi River. Less than five hundred were European. By 1820 the descendants of European colonists finally gained hegemony east of the Mississippi River. In those two hundred plus years between initial contact and 1820 a pattern of structural violence defined the relationships between European colonists and Native American nations. \n\nStructural violence behaviors are “structural because they are defined within the context of existing political, economic, and social structures, and they are a record of violence because the outcomes cause death and debilitation” ([Farmer et al., 2006](http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030449)). In the Americas this pattern of behavior includes forced population displacement, engaging in the widespread collection and exportation of Native American slaves, inciting wars to fuel the Indian slave trade, intentional resource destruction to decrease Native American resistance, massacres and display violence against both combatants and non-combatants, a variety of forced labor practices ranging from modification of mit’a tribute systems to mission and *encomiendas* work quotas, and centuries of identity erasure that served to deny Native American heritage and, on paper, fuel the perception of a terminally declining Indian presence in the New World. \n\nThis structural violence could not extinguish the vitality of Native American communities who resisted and accommodated, waged war and forged peace, negotiated and re-negotiated and re-negotiated their positions with more than half a dozen European nations and their colonial offspring over the course of 500 years. Powerful confederacies, like the Creek and Cherokee, rose from the destruction wrought by the slave trade and used their influence to sway the history of the continent. In 1791 the short-lived Northwestern Confederacy nearly annihilated the United States Army on the banks of the Maumee River. Other nations, like the Osage, displaced from their homeland remade themselves in the interior of the continent where they dominated the horse and firearm trade, claiming vast swathes of the Plains as their own. Some, like the Kussoe, refused to engage in English slaving raids and were ruthlessly attacked, surviving members fleeing inland to join new confederacies. Still others, like the Seminole, never formally surrendered and continue to defy claims to a completed conquest.\n\n**The Terminal Narrative**\n\nThe Terminal Narrative permeates nearly every popular, and even many scholarly, discussions of Native American history. Per the narrative, Columbus’s arrival on San Salvador functions as an event horizon, the beginning of the end after which Native American history could only flow on one inevitable and completely destructive course. Those seeking a blameless, passive cause for this decline place the focus on introduced infectious organisms. Disease becomes a “morally neutral biohistorical force” (Jones, 2015) or as Grey states, a “passive biological weaponry”. Introduced infectious diseases did increase mortality, and made demographic recovery challenging. However, in the Myths of Conquest series I argued against the terminal narrative, urging instead a focus on the active agents and the thousands of “what ifs” hidden under the creeping determinism that assumes Native American decline and near extinction.\n\nEuropeans did not need a “passive biological weapon”, they were quite satisfied to actively wield their own literal weapons as they attempted to enforce their will on the inhabitants of a New World. Native Americans weren’t so desolate that they simply gave up and allowed conquest to occur. Vibrant communities controlled their own destiny, rolled back the Spanish frontier in North American through violent revolts, conducted feats of diplomacy to pit colonial powers against each other, and in acts both large and small actively negotiated their way into a global trade network. \n\nThere is no easy narrative of Native American history after contact. It was a hard fought struggle for both sides, one that we are, in many ways, still fighting five centuries later. A myopic fascination disease obscures five centuries of our shared history on these continents. There are shelves of books, and reams of articles, with evidence against the myth of death by disease alone. *Guns, Germs, and Steel* is not the history book to rule all history books. It may be a place to start, but if it is your one precious source please consider further reading.\n\nFurther posts on the inaccuracies of Grey to come. Stay tuned.\n\n**Suggestions for Historically Accurate Further Reading**\n\nCameron, Kelton, and Swedlund, eds. *Beyond Germs: Native Depopulation in North America*\n\nCalloway *One Vast Winter Count: The Native American West before Lewis and Clark*\n\nGallay *The Indian Slave Trade: The Rise of the English Empire in the American South, 1670-1717*\n\nKelton *Epidemics and Enslavement: Biological Catastrophe in the Native Southeast, 1492-1715*\n\nRestall *Seven Myths of the Spanish Conquest*", "likes"=>nil, "suggested_sort"=>nil, "user_reports"=>[], "secure_media"=>nil, "link_flair_text"=>"Media Review", "id"=>"3uj3mo", "from_kind"=>nil, "gilded"=>1, "archived"=>false, "clicked"=>false, "report_reasons"=>nil, "author"=>"anthropology_nerd", "media"=>nil, "score"=>324, "approved_by"=>nil, "over_18"=>false, "hidden"=>false, "num_comments"=>213, "thumbnail"=>"", "subreddit_id"=>"t5_2wo26", "hide_score"=>false, "edited"=>false, "link_flair_css_class"=>"mediareview", "author_flair_css_class"=>"", "downs"=>0, "secure_media_embed"=>{}, "saved"=>false, "removal_reason"=>nil, "stickied"=>false, "from"=>nil, "is_self"=>true, "from_id"=>nil, "permalink"=>"/r/badhistory/comments/3uj3mo/inaccuracies_of_grey_90_mortality_from_a_passive/?ref=search_posts", "locked"=>false, "name"=>"t3_3uj3mo", "created"=>1448701475.0, "url"=>"https://www.reddit.com:80/r/badhistory/comments/3uj3mo/inaccuracies_of_grey_90_mortality_from_a_passive/", "author_flair_text"=>"Guns, Germs, and Generalizations", "quarantine"=>false, "title"=>"Inaccuracies of Grey: >90% Mortality from “A Passive Biological Weaponry”", "created_utc"=>1448672675.0, "distinguished"=>nil, "mod_reports"=>[], "visited"=>false, "num_reports"=>nil, "ups"=>324}

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• {"id"=>"205151912893480960", "text"=>"@gRAPHix90 yeah! the article it's from is here: http://t.co/qDtgWqUm it's a short and good read!", "created_at"=>"2012-05-23T04:23:22Z", "user"=>"anu_khosla", "user_name"=>"Anu Khosla", "user_profile_image"=>"http://a0.twimg.com/profile_images/887448463/24711_1313089581385_1055010112_30837906_5311137_n_normal.jpg"}
• {"id"=>"290681295808380930", "text"=>"A favourite: great read on the concept of structural violence in health. http://t.co/FFwyv5At | #globalhealth #globaldev #sdoh #publichealth", "created_at"=>"2013-01-14T04:46:36Z", "user"=>"AndrewBresnahan", "user_name"=>"AndrewBresnahan", "user_profile_image"=>"http://a0.twimg.com/profile_images/1788718928/Andrew_portrait_Jan_2011_normal.png"}
• {"id"=>"290814280452939776", "text"=>"RT @AndrewBresnahan A favourite: great read on the concept of structural violence in health. http://t.co/jDN9aI9u #sdoh #publichealth", "created_at"=>"2013-01-14T13:35:02Z", "user"=>"Monika_Dutt", "user_name"=>"Monika Dutt", "user_profile_image"=>"http://a0.twimg.com/profile_images/2267472357/sbtwe6njos34z0fbyszs_normal.jpeg"}
• {"id"=>"290824527905185792", "text"=>"RT @Monika_Dutt: RT @AndrewBresnahan A favourite: great read on the concept of structural violence in health. http://t.co/jDN9aI9u #sdoh #publichealth", "created_at"=>"2013-01-14T14:15:45Z", "user"=>"CACHC_ACCSC", "user_name"=>"Canada's CHCs", "user_profile_image"=>"http://a0.twimg.com/profile_images/1846009958/CACHC_logo_hi_res_Twitter_normal.jpg"}
• {"id"=>"377792886349111296", "text"=>"Farmer et al: Structural Violence and #Clinical #Medicine http://t.co/BkBwcCztxV #anhtropology #inequality #health", "created_at"=>"2013-09-11T13:56:57Z", "user"=>"das_zehzar", "user_name"=>"cesar padilla", "user_profile_image"=>"http://a0.twimg.com/profile_images/3754551377/cd1a3e1c1ad83affaf7608bdce28c32f_normal.jpeg"}
• {"id"=>"399510493187936256", "text"=>"#PLOSMedicine: Structural Violence and Clinical Medicine - good reminders, #sundayreading in #globalhealth http://t.co/vfIMZwoAID", "created_at"=>"2013-11-10T12:14:58Z", "user"=>"thetrblmkr", "user_name"=>"Jules Sh...", "user_profile_image"=>"http://pbs.twimg.com/profile_images/695505071/philadelphia-airport_normal.jpg"}
• {"id"=>"455007065434767361", "text"=>"Structural Violence and Clinciical medicine. Brilliant paper. #Anthropology #Culture #Publichealth\nhttp://t.co/YSkbTnq6w8", "created_at"=>"2014-04-12T15:38:32Z", "user"=>"zambezi40", "user_name"=>"Dorcas Gwata", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3430208350/8e36af6df1491b58637f0251c2f17467_normal.jpeg"}
• {"id"=>"455013441670238208", "text"=>"RT @zambezi40: Structural Violence and Clinciical medicine. Brilliant paper. #Anthropology #Culture #Publichealth\nhttp://t.co/YSkbTnq6w8", "created_at"=>"2014-04-12T16:03:52Z", "user"=>"AnthroCentrist", "user_name"=>"AnthroCentrist", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3008297419/cc7d12513976e370cafc2735fe657020_normal.jpeg"}
• {"id"=>"482916370234241024", "text"=>"Great @PLOSMedicine article on Structural Violence & Clinical Medicine, focused on equity in healthcare: http://t.co/A4QsTw2iCg @pih (1/3)…", "created_at"=>"2014-06-28T16:00:09Z", "user"=>"nwin", "user_name"=>"Niall Winters", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1079398230/madmen_icon_normal.jpg"}
• {"id"=>"483782192321941504", "text"=>"To the really cool person who asked about structural violence. I recommend this http://t.co/DuDq93erSk #billc36", "created_at"=>"2014-07-01T01:20:37Z", "user"=>"PaceSociety", "user_name"=>" PACE Society", "user_profile_image"=>"http://pbs.twimg.com/profile_images/455744108594597888/U08woo-8_normal.png"}
• {"id"=>"508271321047113728", "text"=>"One of many interesting reading materials from #understandingviolence MOOC. @debhoury @pamelascully\nhttp://t.co/wMfvS64YG0", "created_at"=>"2014-09-06T15:11:40Z", "user"=>"Alex__Calvo", "user_name"=>"Alex Calvo", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1646089774/Alex_Calvo_normal.JPG"}
• {"id"=>"508283930706202626", "text"=>"RT @Alex__Calvo: One of many interesting reading materials from #understandingviolence MOOC. @debhoury @pamelascully\nhttp://t.co/wMfvS64YG0", "created_at"=>"2014-09-06T16:01:47Z", "user"=>"debhoury", "user_name"=>"Debra Houry", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000196084595/b122a2c6e43fa08359e5bdb41f93b887_normal.jpeg"}
• {"id"=>"508653274619068416", "text"=>"RT @nwin: Great @PLOSMedicine article on Structural Violence & Clinical Medicine, focused on equity in healthcare: http://t.co/A4QsTw2iCg @…", "created_at"=>"2014-09-07T16:29:25Z", "user"=>"SocialSaint2327", "user_name"=>"Crystal Monique", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3371793863/dcc268f35bb8ab75d6117ff6e406ebeb_normal.png"}
• {"id"=>"595209662150135808", "text"=>"Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. http://t.co/nRAYTw0doR", "created_at"=>"2015-05-04T12:53:36Z", "user"=>"trishgreenhalgh", "user_name"=>"Trisha Greenhalgh", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1749978296/TRISH_2010_cropped_normal.jpg"}
• {"id"=>"595209761920016384", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:54:00Z", "user"=>"SJaneBernal", "user_name"=>"Jane Bernal", "user_profile_image"=>"http://pbs.twimg.com/profile_images/433314948827971584/o2nZtX8m_normal.jpeg"}
• {"id"=>"595209801539420160", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:54:09Z", "user"=>"Dr24hours", "user_name"=>"Dr24hours", "user_profile_image"=>"http://pbs.twimg.com/profile_images/378800000847533451/9ee5e4a9b35c83124fd614c71e681c15_normal.png"}
• {"id"=>"595210208827318272", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:55:46Z", "user"=>"Talking2YourDoc", "user_name"=>"Zackary Berger, MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/3758829224/8e2c6b9cd45aa0affb398213e19a9ed1_normal.jpeg"}
• {"id"=>"595210208835698688", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:55:46Z", "user"=>"ZackBergerMDPhD", "user_name"=>"Zackary Berger, MD", "user_profile_image"=>"http://pbs.twimg.com/profile_images/512427327062421504/uENqxdeC_normal.jpeg"}
• {"id"=>"595210385063542785", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:56:28Z", "user"=>"davidecarroll", "user_name"=>"david carroll", "user_profile_image"=>"http://pbs.twimg.com/profile_images/552996780321677312/yPIyCnll_normal.jpeg"}
• {"id"=>"595210652676820992", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:57:32Z", "user"=>"prof_goldberg", "user_name"=>"Daniel Goldberg", "user_profile_image"=>"http://pbs.twimg.com/profile_images/458799744832131073/N-iT0T2u_normal.jpeg"}
• {"id"=>"595210953739915264", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T12:58:44Z", "user"=>"luybenans", "user_name"=>"Ans Luyben", "user_profile_image"=>"http://pbs.twimg.com/profile_images/557553800454471681/NZOiSxLT_normal.jpeg"}
• {"id"=>"595211832517754880", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T13:02:14Z", "user"=>"bearagonm", "user_name"=>"bea aragon", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2549786315/2j12ovc6bwqy15wfpupw_normal.png"}
• {"id"=>"595213864825913344", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T13:10:18Z", "user"=>"stormpetrel", "user_name"=>"Patricia Rosewell", "user_profile_image"=>"http://pbs.twimg.com/profile_images/1609805294/Photo-0142_normal.jpg"}
• {"id"=>"595214563378888704", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T13:13:05Z", "user"=>"markomanka", "user_name"=>"Marco Manca", "user_profile_image"=>"http://pbs.twimg.com/profile_images/444463185911746560/b3S6VcbP_normal.jpeg"}
• {"id"=>"595245618244624384", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T15:16:29Z", "user"=>"SnehaAbraham04", "user_name"=>"Sneha Abraham", "user_profile_image"=>"http://pbs.twimg.com/profile_images/585131262500708352/cKXEiahM_normal.jpg"}
• {"id"=>"595277155644395520", "text"=>"RT @trishgreenhalgh: Structural violence: now more than ever. Exclusive focus on molecular-level phenomena => we overlook social causes. …", "created_at"=>"2015-05-04T17:21:48Z", "user"=>"PeterLucassen", "user_name"=>"Peter Lucassen", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2068885143/peter_normal.jpg"}
• {"id"=>"619532389761597440", "text"=>"When ignorance is bliss: Structural violence is perpetuated through analytic omission.\"http://t.co/qzmnpvWhOf", "created_at"=>"2015-07-10T15:43:26Z", "user"=>"Am3nhot3p", "user_name"=>"Akhenaton Tankwanchi", "user_profile_image"=>"http://pbs.twimg.com/profile_images/264455038/Dec_2003_normal.jpg"}
• {"id"=>"621737679139536896", "text"=>"End StructuralViolence\nhttps://t.co/dEDdC0uqX6\n#VisionZero #ActOnClimate\n#JobsJusticeClimate\nhttp://t.co/56OLZkhKpW\n https://t.co/u8vPIeRppk", "created_at"=>"2015-07-16T17:46:28Z", "user"=>"gecko39", "user_name"=>"fj", "user_profile_image"=>"http://pbs.twimg.com/profile_images/712292682/BikeRailExtremeColorPlainCompressedMore_normal.JPG"}
• {"id"=>"627323558419525632", "text"=>"Clinical medicine also has a role in contributing to reduce the toll on structural violence. \nhttp://t.co/7i3uZc4LW6", "created_at"=>"2015-08-01T03:42:46Z", "user"=>"meyrembagdas", "user_name"=>"Meyrem Bagdas", "user_profile_image"=>"http://abs.twimg.com/sticky/default_profile_images/default_profile_1_normal.png"}
• {"id"=>"632456932423540736", "text"=>"@anniecoops @Jennywren1410 Two good reads here; http://t.co/SYGH4gAdF5 and http://t.co/ouIQVJdHKu :)", "created_at"=>"2015-08-15T07:40:57Z", "user"=>"sarasiobhan", "user_name"=>"Sara", "user_profile_image"=>"http://pbs.twimg.com/profile_images/503079343325978624/HTl5nRgt_normal.jpeg"}
• {"id"=>"742975188686503936", "text"=>"Wonder if Aquinas has read any Paul Farmer. Good introduction to his work here - https://t.co/1LKGjJqVcl https://t.co/sdC4B9bZot", "created_at"=>"2016-06-15T07:01:03Z", "user"=>"AnnaStarling", "user_name"=>"Anna Starling", "user_profile_image"=>"http://pbs.twimg.com/profile_images/607972785349120002/zxbv0Dii_normal.jpg"}
• {"id"=>"742979366330732545", "text"=>"RT @AnnaStarling: Wonder if Aquinas has read any Paul Farmer. Good introduction to his work here - https://t.co/1LKGjJqVcl https://t.co/sdC…", "created_at"=>"2016-06-15T07:17:39Z", "user"=>"thoughtspaceuk", "user_name"=>"Thought Space", "user_profile_image"=>"http://pbs.twimg.com/profile_images/739732769006333952/wD81u-cP_normal.jpg"}
• {"id"=>"743000240215719936", "text"=>"RT @AnnaStarling: Wonder if Aquinas has read any Paul Farmer. Good introduction to his work here - https://t.co/1LKGjJqVcl https://t.co/sdC…", "created_at"=>"2016-06-15T08:40:36Z", "user"=>"EdwardDaviesTHF", "user_name"=>"Edward Davies", "user_profile_image"=>"http://pbs.twimg.com/profile_images/573151085629603840/JeZbteVt_normal.png"}
• {"id"=>"760807182187237376", "text"=>"Structural violence - racism, gender inequality, war determine who falls ill and who has access to health care https://t.co/ckikZLKiYR", "created_at"=>"2016-08-03T11:59:02Z", "user"=>"brandon_ferlito", "user_name"=>"Brandon Ferlito", "user_profile_image"=>"http://pbs.twimg.com/profile_images/760707267922624512/k8NtKB6F_normal.jpg"}
• {"id"=>"774269429739819013", "text"=>"Brilliant take on structural violence: https://t.co/jfktFCYC4E", "created_at"=>"2016-09-09T15:33:11Z", "user"=>"AnnaArt4me", "user_name"=>"Anna Szenfeld", "user_profile_image"=>"http://pbs.twimg.com/profile_images/519192778626969600/4b17v278_normal.jpeg"}
• {"id"=>"777598340741619713", "text"=>"A conversation with a friend today reminded me about this excellent Paul Farmer article @PIH https://t.co/1LKGjJqVcl", "created_at"=>"2016-09-18T20:01:06Z", "user"=>"AnnaStarling", "user_name"=>"Anna Starling", "user_profile_image"=>"http://pbs.twimg.com/profile_images/607972785349120002/zxbv0Dii_normal.jpg"}
• {"id"=>"794891940802215936", "text"=>"@PIH \"Many med and public health interventions will fail if unable to understd the social determinants of disease\" https://t.co/dQOC97Wz1i", "created_at"=>"2016-11-05T13:19:41Z", "user"=>"PHR_Students", "user_name"=>"PHR Students", "user_profile_image"=>"http://pbs.twimg.com/profile_images/2949124522/094c87549844a277e3e95805b86f0cd8_normal.png"}

Wikipedia | Further Information

• {"title"=>"Social medicine", "url"=>"http://en.wikipedia.org/wiki/Social_medicine", "timestamp"=>"2019-02-14T11:11:33Z"}
• {"title"=>"Health in Haiti", "url"=>"http://en.wikipedia.org/wiki/Health_in_Haiti", "timestamp"=>"2019-01-26T00:19:28Z"}
• {"title"=>"Social determinants of health in poverty", "url"=>"http://en.wikipedia.org/wiki/Social_determinants_of_health_in_poverty", "timestamp"=>"2019-03-03T16:38:15Z"}
• {"title"=>"Structural violence", "url"=>"http://en.wikipedia.org/wiki/Structural_violence", "timestamp"=>"2018-12-25T08:35:17Z"}
• {"title"=>"Social determinants of health", "url"=>"http://en.wikipedia.org/wiki/Social_determinants_of_health", "timestamp"=>"2019-03-16T09:31:15Z"}
• {"title"=>"Global Health Initiatives", "url"=>"http://en.wikipedia.org/wiki/Global_Health_Initiatives", "timestamp"=>"2019-01-25T19:43:23Z"}
• {"title"=>"Public health", "url"=>"http://en.wikipedia.org/wiki/Public_health", "timestamp"=>"2019-02-26T01:53:53Z"}
• {"title"=>"Structural violence in Haiti", "url"=>"http://en.wikipedia.org/wiki/Structural_violence_in_Haiti", "timestamp"=>"2019-02-19T22:52:58Z"}
• {"title"=>"Infant mortality", "url"=>"http://en.wikipedia.org/wiki/Infant_mortality", "timestamp"=>"2019-03-09T16:35:47Z"}
• {"title"=>"Education in Haiti", "url"=>"http://en.wikipedia.org/wiki/Education_in_Haiti", "timestamp"=>"2019-01-11T00:28:16Z"}
• {"title"=>"Các yếu tố xã hội quyết định sức khỏe trong nghèo đói", "url"=>"http://vi.wikipedia.org/wiki/Các_yếu_tố_xã_hội_quyết_định_sức_khỏe_trong_nghèo_đói", "timestamp"=>"2019-01-27T23:17:03Z"}

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Figshare

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PMC Usage Stats | Further Information

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Relative Metric

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F1000Prime