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Structural Violence, Exclusion and Inclusion in Venezuela

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Portland State University PDXScholar Dissertations and Theses Dissertations and Theses 2009 Red de Salud -- Network of health : structural violence, exclusion and inclusion in Venezuela Steven John Bates Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the Latin American Languages and Societies Commons, and the Peace and Conflict Studies Commons Let us know how access to this document benefits ou.y Recommended Citation Bates, Steven John, "Red de Salud -- Network of health : structural violence, exclusion and inclusion in Venezuela" (2009). Dissertations and Theses. Paper 3795. https://doi.org/10.15760/etd.5679 This Thesis is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. THESIS APPROVAL The abstract and thesis of Steven John Bates for the Master of Science in Conflict Resolution were presented October 7, 2009, and accepted by the thesis committee and the program. COMMITTEE APPROVALS: DEPARTMENT APPROVAL: Conflict Resolution Program ~ ABSTRACT An abstract of the thesis of Steven John Bates for the Master of Science in Conflict Resolution presented October 7, 2009. Title: Red de Salud - Network of Health: Structural Violence, Exclusion and Inclusion in Venezuela This thesis is a study of the socio-economic changes in the Bolivarian Republic of Venezuela since the new government came into office in 1999. The research hypothesis for this thesis is that the changes and parallel socioeconomic structures being implemented in Venezuela since 1999 have decreased structural violence, and have provided more inclusion for previously excluded people. As the methodology used is qualitative, utilizing textual analysis to conduct a case study, academic journals from the fields of conflict resolution, sociology, political science, public health, cultural studies and economics were relied upon for the most part. This study of structural violence and exclusion has necessitated the contextualization of the ., situation, and as such, neoliberalism as a major influence has been discussed to aid in understanding and drawing conclusions. The results indicate that the changes and parallel socioeconomic structures being implemented in Venezuela since 1999 have decreased structural violence, and have provided more inclusion for previously excluded people. '· ,,. 2 '- RED DE SALUD - NETWORK OF HEALTH:' STRUCTURAL VIOLENCE, EXCLUSION AND INCLUSION IN VENEZUELA by STEVEN JOHN BATES \\ A thesis submitted in partial fulfillment of the requirements for the degree of . MASTER OF SCIENCE in CONFLICT RESOLUTION Portland State University 2009 This thesis is dedicated to the people of the Bolivarian Republic of Venezuela. May they continue their healthful and peaceful revolution. A sincere thank you for showing us a better world is possible .. This thesis is also dedicated to my wife Joan E Bates. Without her patience, intelligence, and encouragement this thesis may never have been written. Thank you Joan E for being here. Table of Contents List of Figures v Introduction 1 Chapters: 1. Literature Review 3 2. Methodology 6 3. What is Exclusion? 16 Exclusion as Structural Violence 17 The Hidden Character of Structural Violence 22 4. Health as Complete Well-being - Alma-Ata 29 5. The Neoliberal Agenda and the Shift Initiated in the 1980s 32 ,.. Venezuela, the IMF, and the Caracazo 47 6. The Exclusion from Healthful Well-being in Venezuela 63 7. Constitutional Mandate for Health and Inclusion in Venezuela 69 8. Social Restructuring in Venezuela 81 Lockouts, Strikes, and Coup - Interruption of Reforms 87 ii 9. Third Party Intervention in Venezuela 92 Anti-Statist Liberals and Anti-Statist Neoliberalism 104 10. Parallel Structures - Mission Barrio Adentro 108 Mission Barrio Adentro and Alma-Ata 119 11. Inclusion of Previously Excluded Persons in Venezuela 130 Physicians and Medical Care 131 Medical Care for Children 132 Food Security 134 Clean Drinking Water and Sanitation 135 Education 137 Women 141 Income and Employment 145 Agrarian Reform 151 12. The Reversal of Orientation 155 The Reversal of Value 159 The Reversal of Subject and Object 163 iii 13. Conclusion 167 Suggestions for Further Research 172 Works Cited 174 Appendix 182 iv List of Figures 1. Percentage distribution of labor income 51 2. Rural to urban population distribution in Venezuela 63 3. Venezuela's Human Development Index 85 4. Social spending as a percentage of Gross Domestic Product 86 5. Percentage of individuals in extreme poverty 86 6. Infant mortality rate 1999-2001 87 7. Mortality from diahrrea, pneumonia, meningitis, malnutrition in children under 5 years old, per 100,000 1996-2005 90 8. Cases and deaths from diahrrea in children 1 to 4 years of age, 1996-2005 90 9. Cases and deaths from pneumonia in boys and girls under 1 year of age, 1996-2005 91 10. Two-circle Venn diagram 110 11. Three-circle Venn diagram 113 12. Networks typologies 114 v 13. Child, infant, neonatal, post neonatal mortality 1998-2005 132 14. Reduction of infant mortality 1980-2007 133 15. Reduction of under 5 years old mortality 1980-2007 133 16. Access to clean water and sanitation 1998-2007 136 17. Access to clean water and sanitation 1981-2007 137 18. Enrollment of women in secondary education 1981-2006 140 19. Enrollment of men in secondary education 1981-2006 141 20. Poverty and extreme poverty 1981-2007 146 21. Percentage of population receiving old age, disability, and survivor benefits 1998-2008 147 22. Per capita social expenditures 1990-2006 148 23. Public expenditures not including PDVSA, 2000-2006 149 24. Direct fund contributions from PDVSA to social programs 2003-2008 149 25. Employment figures 1998-2008 150 26. Venezuelan flag change in 2006 159 vi Introduction There have been dramatic socio-economic changes in Venezuela since the new government came into office in 1999. Tensions have been very high within Venezuela, and as Venezuela is an international actor, international tensions have repeatedly flared since 1999 as well. Difficulties due to distance and language have made understanding what has been happening in Venezuela challenging. This thesis aims to add to the literature with the goal of helping to clarify the situation to assist in further analysis and understanding. As this is a study of change in social structure since 1999, there was a necessity of discussing what the situation was prior to 1999, what contributed to the changes that have taken place, and what those subsequent changes have been. This implies, and demands, detailed discussion of not only the socio-economic and historical context, but also the international influencers ofthe changes. Due to historical, distance, and language barriers, as well as the necessity of documenting statistical facts available in the literature, the methodology chosen is particularly well suited to this thesis. This thesis is a journey from the present, to a time in the not too distant past, and back again to the present. It is also a journey from where we are, to places many have never been, in hopes that it will bring us back home to where we are: here and now, in the world with others. This is not just a collection of statistical facts, although many will be found here. It is hoped that the references to statistics, populations, and classes will not obscure the fact that it is individual people whose 1 lives have been affected. It is not a journey in uncharted waters (although it may be for some). Some insight may be essential to stay the course, as there are many reversals in orientation that may confound us, but there are hopefully enough signposts or buoys along the way so that insight and numbers are never removed from the current that carries us along our way. 2 Chapter One Literature Review There was a wide array of literature to be drawn from for this thesis. The seminal work of Johan Galtung (1969) was essential in establishing a foundation from which to clarify the characteristics of structural violence as inequalities in distribution of food, medical care, education, life expectancy, income, and other factors. Stressing that violence is committed when resources are withheld that could provide basic needs, only adds to Galtung's position that such exclusion is fundamentally social injustice. Opotow (2001), as well as Winter and Leighton (2001), drew from and built upon Galtung's seminal works to further clarify structural violence and exclusion. The long career of epidemiologist Milton Terris (1975) clarified and expanded the meaning of health as not just physical and mental well-being, but that health includes and requires social well-being also. His later work provided an essential historical perspective, as he pinpointed in time (1980s during the Reagan era) and place (the U.S.) for a major shift in the value of healthful well-being. Dr. Terris was adamantly anti-neoliberal, and his concern for the people in developing nations, including specifically Venezuela, helped immensely in drawing a timeline, and also in clarifying the source of concern. In 1978, the International Conference on Primary Health Care in Alma-Ata, Kazakhstan, promulgated the Declaration of Alma-Ata, which is of particular 3 importance as that document called for a worldwide social and economic reorientation to provide health for all. That document essentially spans the entire period covered in this thesis, connecting the past and the present, and its importance cannot be overstated. The Pan American Health Organization [PAHO] (2006) report, regarding Mission Barrio Adentro in Venezuela, historically ties the development ofthat mission, and the socioeconomic reforms that began in Venezuela in 1999, directly to the 1978 Declaration of Alma-Ata. That Mission, founded upon the values explicit in the Declaration of Alma-Ata, has been implemented in Venezuela, changing the fundamental social structure of Venezuelan society for many millions of people in that country.
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