Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 54 social construct was institutionalized with the help of legislation and judicial decisions such as Plessy v. Ferguson (1896) 163 US 537. This judicial decision endorsed segregation by taking judicial notice, “that a negro or black is any person with any black ancestry” and it was acceptable to be separate but equal (Davis, 2002, p. 8). One of the many impacts of segregation in the United States is that there is a legacy of underrepresentation of minority healthcare providers (Welch et al., 2005; Merchant & Omary, 2010). Decisions such as Plessy v. Ferguson (1896) 163 US 537 and Jim Crow laws (U.S. laws that allowed for racial segregation prior to 1965) accentuated racial divides which resulted in the exclusion of minority physicians from medical education which historically has been largely limited to white, male, and upper class individuals (IOMNA, 2002). Throughout the 20 th century, only 12% of North American physicians come from a working class background (Wear, 2003, p. 553). The mean income of the parents of medical students who enrolled in all the Association of American Medical Colleges for year 2000 was $101,319 and the mean education level for fathers was a graduate degree and for mothers a college degree (Wear, 2003, p. 553, citing Association of American Medical Colleges, 2000). This tendency of medical students to come from a family in which both parents are highly educated and have a high socioeconomic background continued between 1992 and 2008 and is most noticeable among white students (Grbic, Garrison, & Jolly, 2010). In 2011 the percentage of minority students matriculated in medical schools (e.g., Asian (20.1%), Hispanic (8.5%), black (6.1%), and Native American, Alaskan, Hawaiian, and other Pacific Islander (0.1%)) continues to be extremely low when compared to white students (57.5%) (Association of American Medical Colleges, 2012, p.27). Beyond the legal and medical ideology, the scientific community has also been instrumental in legitimizing and perpetuating discrimination towards minority groups by promoting theories such as eugenics that were used to wrongly justify the inferiority of minority groups (e.g., African Americans, poor, mentally retarded) (IOMNA, 2002). To this day, many blacks distrust medical institutions and white physicians as a result of a collective memory of oppression that springs from abuses such as the Tuskegee experiments by which black patients were untreated for syphilis decades after there was a cure in order to see the effects of the disease (Bloche, 2001; Welch et al., 2005). Structural violence, in turn, is justified or legitimized by cultural violence to the extent that it becomes ubiquitous and yet, simultaneously, invisible (Farmer et al., 2006; Galtung, 1990). Cultural violence “makes direct and structural violence look, even feel right,