Structural violence and institutionalized individuals: A paleopathological perspective on a continuing issue.

Area of Science:

• Paleopathology
• Anthropology
• Public Health

Background:

• Historical and contemporary institutions exhibit structural deficiencies impacting patient care and leading to neglect.
• Fracture trauma, particularly hip fractures, is a significant concern for institutionalized populations.
• Previous studies suggest a link between institutionalization and increased risk of severe injury.

Purpose of the Study:

• To investigate the prevalence of hip fractures in institutionalized individuals using paleopathological analysis.
• To examine the relationship between institutional environments and the incidence of hip fractures.
• To highlight the historical and ongoing nature of structural violence contributing to preventable injuries.

Main Methods:

• Analysis of 600 individuals from the Robert J. Terry Anatomical Collection (born 1822-1877).
• Examination of skeletal remains for evidence of hip fractures.
• Cross-referencing skeletal findings with institutional, death, morgue, and census records.

Main Results:

• 36.3% of studied individuals died in institutions.
• Hip fracture prevalence was significantly higher in institutionalized individuals (4.3%) compared to non-institutionalized (2.3%).
• Many fractures occurred near the time of death and were linked to understaffing and underfunding.

Conclusions:

• Structural violence, including underfunding and understaffing, contributes to preventable hip fractures in institutionalized populations.
• Paleopathological analysis reveals the long-standing nature of these issues.
• Equitable care for institutionalized people should be recognized as a human right, necessitating policy changes.