A Cycle of Social Violence: a novel theoretical framework for explaining how structural, slow, and symbolic violence interact to produce and maintain health inequalities in England

Health inequalities are a form of violence, produced and sustained by political, economic, and social structures that systematically disadvantage certain communities. Drawing on qualitative data from 194 participants in six English towns, this study develops the Cycle of Social Violence, a novel theoretical framework that conceptualises how structural, slow, and symbolic violence interact to create and perpetuate health inequalities. Participants' narratives illustrate how structural violence, driven by neoliberal economic policies creates the material conditions for poor health. These harms unfold over time as slow violence, extending their impacts and making their effects difficult to trace to specific causes. Symbolic violence then legitimises and obscures these injustices, reinforcing narratives that blame individuals rather than structural forces. The interaction of these three forms of violence produces a self-perpetuating cycle that deepens inequalities and erodes resistance to systemic harm. This study highlights how these dynamics manifest in deindustrialised and economically deprived communities, where declining public services, insecure work, and stigma reinforce poor health outcomes. Breaking the cycle of social violence requires policy interventions that incorporate the lived experience of people in affected communities and that go beyond surface-level regeneration to address the root causes of economic and social deprivation.