Pathologies of Power: Health, Human Rights, and the New War on the Poor (Volume 4) (California Series in Public Anthropology)

This is a philosophy, a way of life, ethical living. If you don't give any of your money to charity, move on.

Paul Farmer's "Pathologies of Power" will probably give you a headache, undoubtedly cause sleep disturbance, and very likely turn your stomach. In short, it will make you sick. But if you are well enough to read this and rich enough to consider purchasing the book, you are better off than the "disposable millions" whose lives he illuminates and honors in this indictment of global public health as-we-know-it. In this passionate and well-researched treatise, a world-class physician takes his own disciplines of medicine and anthropology to task for failing to ask the right questions. Then, noting that the U.S. pharmaceutical industry is the most profitable industry in the most affluent country in the world, he blows through its defense of those extraordinary profits like a gust of fresh air. A similarly searing deconstruction of health policymakers' rationale for "cost-effectiveness" and their elite argot of oppression reveals a blame-the-victim mentality that plagues the world and explains why, in the midst of unprecedented wealth, over 40 million Americans are without health insurance of any kind. And that is just the beginning.While Farmer's hospital in Haiti, Zanmi Lasante, is not the only hospital to successfully combat the forces of poverty and disease in that country (Hôpital Albert Schweitzer in the Artibonite Valley predates Farmer's project by nearly three decades), his twenty-year presence in Central Haiti has resulted in a deep understanding of how structural violence on a global scale is a leading cause of disease and death among the world's poor, wherever they may live. Drawing on case-study examples from Haiti, South America, Cuba, Siberia, and the United States, he deftly illustrates why tuberculosis deaths, which he describes as 95 percent curable with inexpensive medication developed many years ago, "occur almost exclusively among the poor, whether they reside in the inner cities of the United Stated or in the poor counties of the Southern Hemisphere." Addressing the growing trend of multi-drug resistant strains of TB, Farmer discusses "tuberculosis as punishment" in the world's prison populations and delivers a wake-up call to those who might consider themselves immune from this, and other, infectious diseases.In his critique of the commodification of healthcare, Farmer speaks of "orphan drugs" drugs that are simply not developed because they are needed by people who cannot pay for them, the sale of organs by those without resources to those with money, and the equally revolting multi-million dollar compensation packages of pharmaceutical company CEOs and managed care executives. In the midst of this catalog of inequity, he wonders why medical ethics courses in American schools of medicine focus so narrowly on the "quandaries of the fortunate" like whether or not to refuse a particular technology or whether or not to leave a loved one in a prolonged coma when millions are condemned to death or disease before they learn to walk. Even the World Health Organization (WHO) does not escape his critical analysis: "... the language of social injustice is increasingly absent from public health parlance," he notes.Farmer is one of those remarkable doctors working in remote places who, somehow, finds the energy to look up from his daily workload and ponder the underlying causes of the suffering he treats. Furthermore, he writes about it in the brisk and engaging prose of an investigative reporter and brings provocative interdisciplinary voices of others---Gustavo Gutiérrez, Paolo Freire, Cornel West, Amartya Sen, Jon Sobrino, Nancy Scheper-Hughes, to name a few---to bear on his march toward social justice. His ideas are radical, in part, because they are simple and based on an equitable distribution of health, regardless of wealth. Bringing the observe, judge, act methodology of liberation theology to bear on global public health, Farmer advocates a "preferential option" for the poor, a redefinition of medicine as a healing profession (as opposed to medicine-as-commerce), and a new understanding of healthcare as a basic human right, for all.Toward the end of a chapter entitled "Listening for Prophetic Voices," Farmer distills his argument into a call to action: "We thus find ourselves at a crossroads: healthcare can be considered a commodity to be sold, or it can be considered a basic social right. It cannot comfortably be considered both of these at the same time. This, I believe, is the great drama of medicine at the start of this century. And this is the choice before all people of faith and good will in theses dangerous times."Pathologies of Power is a lucid and alarming statement from a fearless physician. It speaks truth to power and it speaks for the destitute sick. Take two aspirin, lie down, and read the book. In spite of its consciousness-raising side effects, this may be the beginning of a cure for what ails the world.

This is another excellent book from Farmer, critiquing health disparities as related to globalization. Or at least that's my perspective.Farmer draws on his extensive knowledge and fieldwork in Haiti in all the books I've read by him, so this one is no exception. That said, the book is still unique and not a repeat/rehash of prior work as is so very common.I wish I could get more people to read books like this, which very logically point out that social Darwinism is bs, and power rules the world. This is a great critique and discussion of globalization, health, and human rights.I wish we could convince our current administration to put this on their list of required readings...

I like everything about this book. It should be mandatory for every Medical student, History, Sociology, Psychology, Snd Political Science student. Structural violence is a new important phrase that I learned meaning if a country denies people with pre-existing medical conditions that as a form of violence because it leads to death by structure of politics. Also if the poor cannot afford medical care which is a human right that is a form of structural violence.

In Pathologies of Power Dr. Farmer has provided critical evidence of health care as it is effected by social and global inequalities. He discusses cases regarding AIDS and the Haitian Boat Refugees, structural violence in Haiti and Mexico, multi-drug resistant TB in Russia, community based health projects in Chiapas, amongst other reflections on relevant cases and history. The book makes a forceful argument for the need to integrate health and human rights to improve the livelihoods of marginalized people. Professor Farmer recommends the following to complement present efforts to achieve the new health and human rights agenda: make health and healing the symbolic core of the agenda, make provision of services central to the agenda, establish new research agendas, achieve independence from powerful governments and bureaucracies, assume a broader educational mandate, and secure more resources for health and human rights. Furthermore, Dr. Farmer has provided evidence showing that the implementation of the said recommendations saved lives, improved healthcare outcomes, and positively impacted the lives of the sick and marginalized.

I have known of Paul Farmer for years, principally through footnotes in his fellow Bostonian Noam Chomsky's books (whom Farmer thanks in his acknowledgements to this book) and in a variety of other books and articles over the years, and I thought it was about time that I became better acquainted with his writings and managed to get my hands on a copy of his 2004 book "Pathologies of Power".Farmer's basic aim in this book is to argue for a working definition of Human Rights that includes those social justice: in general those social and economic rights which articles 22-27 of the UN Declarations of Human Rights (1948) describe. His particular expertise is in the medical sphere and it is that aspect that the book primarily, but far from solely, focuses on. The first part of the book is based around his experiences with the Non-Governmental Organisation "Partnerships in Health" (which he co-founded in 1987) in Haiti, Cuba, Mexico (Chiapas) and Russia. Haiti is where Partnerships in Health started its first Clinic in an area of Central Highlands where a World Bank funded Dam had submerged the best farming land driving the peasants onto higher, far less fertile land, where they struggle to live off the land, and their community fragments with individuals losing hope and not infrequently ending up in the slums of Port-au-Prince. In Cuba Farmer compares the treatment of HIV+ Haitian refugees at the US base in Guantanamo Bay (after the coup of 1991) and the Cuban's own record with their own HIV+ nationals at Santiago de las Vegas. The former is described as an "Oasis to Haitians" in the New York Times, the latter is generally pilloried in the press and subjected to criticism by Human Rights Groups. The reality Farmer unearths is a brutal, inhuman "quarantine" facility at Guantanamo, and a decent, caring open facility at Santiago de las Vegas. Reality is, not for the first time, the exact opposite of what the mainstream media would have us believe.In Chiapas the focus is on the lives of the indigenous population and their Zapatista uprising which began in 1994. This was an effort by the poor marginalised Indians of the province in southern Mexico to free themselves of the "structural violence" and oppression of the Mexican state which by then had been a de facto one party state for decades. In Russia Farmer visits prisons, including those where prisoners with Tuberculosis are isolated, with completely inadequate treatment, looking to set up a partnership with the Russian Department of Justice in order to provide the best and most effective care for those who are being left to die in Russia's massive prison system (second in size per capita to that of the United States).In the second part of the book entitled "One Physician's Perspective on Human Rights" Farmer reflects on the experiences he describes in the first part, including a definition of what he terms "structural violence" (in short, a form of violence where some social structure or social institution harms people by preventing them from meeting their basic needs) and an exploration of the ideas of Liberation Theology with its preference for looking out for the poor and impoverished. It's perhaps best to quote Paul Farmer at length to get the best idea of where he is coming from:"In short, this "one physician's perspective on human rights" may be summed up as follows: just as the poor are more likely to fall sick and then be denied access to care, so too are they more likely to be the victims of human rights abuses, no matter how these are defined. By including social and economic rights in the struggle for human rights, we help to protect those most likely to suffer the insults of structural violence. It is my belief that the liberation theologians, in advocating preferential treatment for the poor, offer those concerned with human rights a moral compass for future action. A preferential option for the poor, and all perspectives rooted in it, also offers a way out of the impasse in which many of us caregivers now find ourselves: selling our wares and services only to those who can afford them, rather than making sure that they reach those who need them most. Allowing "market forces" to sculpt the outlines of modern medicine will mean that these unwelcome trends will continue until we are forced to conclude that even the practice of medicine can constitute a human rights abuse." (p138)Subsequent to the publication of this book Farmer came a special envoy under ex-president Clinton (whom he criticises in relation to the his administration's policy towards Haiti and Haitians in the first part of the book) for Haiti. Hopefully his close proximity to established power, which I'm certain he's done for quite pragmatic reasons and laudable aims wont blunt Farmers deservedly caustic critique of the way in which the world's poor are treated, either medically or in more general terms. It certainly is difficult to believe that the author of this excellent book, finely written and offering a deep analysis and profound critique of the concept of Human Rights, as well as making a strong case for their definition to include Social and Economic Rights, would act other than for the poor.

Excellent and thought-provoking. The concept of 'pragmatic solidarity' is so simple! Poverty is the key cause of poor health and early death. NHS should learn the lessons. We cannot just stand up for the poor and dispossessed we must stand alongside them and act together. The evidence from Haiti & Cuba that 'Partners in Health' have gathered (in the course of practical action) is damning of traditional models of healthcare. This should be compulsory reading for all trainee doctors, medical students and Government Ministers.

Gift

A classic book that looks at causes behind the causes of disease. Well worth reading (other than the longest series of acknowledgments I have ever seen in a book) and particularly important for physicians to understand why diseases occur beyond the proximate causes.

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