{
  "abstract": "Background Health inequalities in England are deeply rooted in systemic social, economic, and political factors. Despite decades of research and policy interventions, health inequalities have not narrowed—and in some cases, have widened. Some have attributed this to a failure to address the root causes of inequality, focusing instead on downstream interventions that target individual behaviours rather than structural determinants. We aimed to explore how stakeholders and community members understood and explained the persistence of health inequalities in their communities. Drawing on their perspectives, it introduces the Cycle of Structural Violence, a novel theoretical model that explains how structural, slow, and symbolic violence interact to sustain these inequities.Methods This research draws on two separate qualitative studies conducted in six towns across England (Middlesbrough, South Tyneside, Hartlepool, Blackpool, Torbay, and Hastings) all of which experience significant health inequalities. Data from these studies have been pooled to provide a broader understanding of the structural determinants of health disparities. In-depth interviews were conducted with stakeholders and community members, and thematic analysis was used to identify key patterns in participants’ narratives.Results The analysis revealed that structural violence—embodied in policies such as those surrounding deindustrialisation, austerity, and economic exclusion—creates the foundation for health disparities. Slow violence manifests in the gradual but cumulative harm caused by these policies, making the long-term effects of systemic injustice less visible to the public. Symbolic violence reinforces these inequities by framing health inequalities as a product of individual failings, rather than products of broader societal structures, and in doing so justifies further structural violence. The Cycle of Structural Violence illustrates how these forms of violence work together to perpetuate health inequalities in deprived communities.Conclusion The Cycle of Structural Violence offers a comprehensive theoretical approach for understanding health inequalities as manifestations of systemic social injustice. Breaking this cycle requires interventions that focus on addressing the root causes of health inequalities—such as economic inequality, social exclusion, and ineffective government policies. This study highlights the need for systemic change to tackle the persistent inequalities that continue to shape health outcomes across the country.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Timothy Price"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK"
      ],
      "name": "Victoria McGowan"
    }
  ],
  "title": "P98 The cycle of structural violence: a novel theoretical framework to understand health inequalities",
  "uid": "a17a6ba8-3e28-543e-b0ba-39fec666e8a0"
}