Being responsible for COPD - lung disease as a manifestation of structural violence.

Lung health, the development of lung disease, and how well a person with lung disease is able to live, all depend on a wide range of societal factors. Considering COPD as a manifestation of structural violence, something that continues to be done to people, despite it being largely preventable, makes the causal processes more apparent and the responsibility to interrupt or alleviate these clearer. We developed a taxonomy to describe this, containing five domains. 1)Avoidable lung harms: (i)processes impacting on lung development (ii)processes which disadvantage lung health in particular groups across the life course. 2)Diagnostic Delay: (i)healthcare factors (ii)norms and attitudes that mean that COPD is not diagnosed in a timely way, denying people with COPD effective treatment. 3)Inadequate COPD Care: ways in which the provision of care for people with COPD falls short of what is needed to ensure that they are able to enjoy the best possible health, considered as (i)healthcare resource allocation (ii)norms and attitudes influencing clinical practice. 4)Low status of COPD: ways in which both COPD as a condition and people with COPD are held in less regard and considered less of a priority than other comparable health problems. 5)Lack of Support: factors that make living with COPD more difficult than it should be (i)socioenvironmental factors (ii)factors that promote social isolation. This model has relevance for policymakers, healthcare professionals and the public as an educational resource, to change clinical practices and priorities and to stimulate advocacy and activism with the goal of the elimination of COPD.