The article "Structural Violence and Clinical Medicine" by Paul E. Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee explores the impact of social determinants of disease on clinical practice and public health. The authors argue that while physicians are aware of the social forces that determine who falls ill and who has access to care, these insights are often not translated into formal frameworks linking social analysis to clinical practice. They emphasize the need for biosocial understandings of medical phenomena, where social analysis is integrated into clinical decision-making. The concept of "structural violence" is introduced to describe social arrangements that harm individuals and populations, embedded in political and economic structures. Structural violence is linked to social injustice and oppression, and it affects the distribution and outcome of diseases like HIV/AIDS. The authors provide examples from the United States and Rwanda to illustrate how structural interventions can address these issues. In the United States, they discuss how race and poverty contribute to disparities in HIV care, and how proximal interventions, such as improving access to transportation and addressing comorbid conditions, can reduce these disparities. In Rwanda, they describe a model where clinical and community barriers to care are removed, and patients receive free treatment and support, including home-based care and access to clean water and infant formula. The authors conclude that structural interventions can significantly improve health outcomes, even in the face of cost-effectiveness analyses and flawed policies. They advocate for a broader understanding of disease distribution and outcome, emphasizing the importance of addressing social inequalities to reduce premature death and disability. They call for medical professionals to collaborate with others trained in proximal interventions to create a "virtuous social cycle" that shifts the burden of pathology away from vulnerable populations.The article "Structural Violence and Clinical Medicine" by Paul E. Farmer, Bruce Nizeye, Sara Stulac, and Salmaan Keshavjee explores the impact of social determinants of disease on clinical practice and public health. The authors argue that while physicians are aware of the social forces that determine who falls ill and who has access to care, these insights are often not translated into formal frameworks linking social analysis to clinical practice. They emphasize the need for biosocial understandings of medical phenomena, where social analysis is integrated into clinical decision-making. The concept of "structural violence" is introduced to describe social arrangements that harm individuals and populations, embedded in political and economic structures. Structural violence is linked to social injustice and oppression, and it affects the distribution and outcome of diseases like HIV/AIDS. The authors provide examples from the United States and Rwanda to illustrate how structural interventions can address these issues. In the United States, they discuss how race and poverty contribute to disparities in HIV care, and how proximal interventions, such as improving access to transportation and addressing comorbid conditions, can reduce these disparities. In Rwanda, they describe a model where clinical and community barriers to care are removed, and patients receive free treatment and support, including home-based care and access to clean water and infant formula. The authors conclude that structural interventions can significantly improve health outcomes, even in the face of cost-effectiveness analyses and flawed policies. They advocate for a broader understanding of disease distribution and outcome, emphasizing the importance of addressing social inequalities to reduce premature death and disability. They call for medical professionals to collaborate with others trained in proximal interventions to create a "virtuous social cycle" that shifts the burden of pathology away from vulnerable populations.