Concepts, disciplines and politics: on ‘structural violence’ and the ‘social determinants of health’

It has long been recognised that human health is indelibly shaped by a variety of factors. These include pathogens such as bacteria and viruses, but also broad-ranging social, economic and political forces operating at different spatial scales. In seeking to understand the nature and effects of these forces, two concepts have become particularly influential: the ‘social determinants of health’ and ‘structural violence’. In this paper, we critically examine their origins, tracing their ‘prehistory’ and little-recognised intersections, based on searches of both concepts in PubMed and Google Scholar, and a critical reading of the range of texts our searches produced. This forms the groundwork from which we examine their similarities and differences, and their potentialities and limitations. We demonstrate that both concepts operate largely as black boxes. Their usage has thus become tied to disciplinary and methodological projects, with attendant implications for their wider usage – especially given the respective statuses of the fields of medical anthropology and social epidemiology in public health. We conclude that structural violence and the social determinants of health have both been influential in research and policy, but have struggled to effect the kinds of political change that their moral commitment to social justice promises and that further dialogue between them is required.