Archive for February, 2007

Thursday February 15, 2007

February 15, 2007 - 1:56 am 1 Comment

Pathologies of Power: Health and Human Rights

Joyce Meng


In Pathologies of Power, Paul Farmer argues against the widespread assumption that the poor are responsible for their own destitution. Rather, he claims that the competitive market-driven economy, championed by rich western countries, has unleashed divisive political and economic forces that have inflicted and perpetuated structural violence among the most vulnerable of the world. In light of extreme suffering manifested in hunger, violent conflict, AIDS, tuberculosis, and other infectious diseases, Farmer reveals a plethora of disconcerting profiles and facts, gravely exposing that “the most basic right – the right to survive – is trampled in an age of great affluence”, a seeming contradiction in this epoch of globalization and scientific advancement

 Through his work in Haiti, Farmer relates the suffering of the patients he treats to the greater international socioeconomic framework, in which the United States is implicated for burdening Haiti with an unsustainable level of indebtedness and possible “unmerited manipulation”. Although his PIH clinic is staffed to receive about 35,000 visits each year, an estimated 160,000 patients will travel long distances to seek free treatment, plagued by malaria, polio, and other diseases, often highly treatable. Fearful of an impending health disaster, Farmer criticizes US humanitarian aid policy in failing to provide critical access to health (ex: Bush administration veto of IDB loans designated to Haiti) as well as US foreign policy in entrenching dictatorships and hiding intelligence, as in the case of the FRAPH victims. In his analysis of the conflict in Chiapas and the lasting scars of a competition-based market economy in Cuba, Guatemala, Uganda, and Russia, among other countries, Farmer questions, “Do we North Americans eat well because the poor in the third world do not eat all? Are we North Americans powerful, because we help keep the poor in the third world weak?”

In light of raging inequalities, Farmer advocates a social justice approach to addressing disease and suffering. Drawing upon themes in liberation theology, Farmer contends that progress for the poor is not likely to ensure from development approaches based upon a “liberal” view of poverty, in which the poor are assumed to be responsible for rejecting the “technological fruits of modernity”. Rather, Farmer questions the fundamental legitimacy of the current ideologies of developmentalism and reformism, in which policymaker impatience and a commodification of a one-size-fits-all health transition model has continually led to widening inequalities among countries and within countries. Hence, to better address local contexts in light of increasing global interdependence, Farmer suggests a mode of analyzing health systems that must be both historically deep and geographically broad. For example, Haiti’s health system must be understood in context to the historical legacy of slavery imposed by our ancestors to guarantee a steady commodity flow, and that the fate of the poor in Haiti is never divorced from the actions of the powerful in Washington.

            Linking the deplorable inequities with human rights violations, Farmer laments that lawyers and international activists have often too narrowly focused on civil and political rights to the detriment of social and economic rights. He writes, “The right to vote has not protected the poor from dying premature deaths, caused as often as not by readily treatable pathogens.” Despite Article 26 of the UN Declaration of Human Rights, Farmer exposes that the little progress has been made, although significant ground has been achieved in civil or political rights. For example, in crammed Russian detention centers, hundreds of thousands of Russian detainees await due process, many falling ill with tuberculosis and sent to more than fifty TB colonies. Since treatment is often ineffective as a result of an unsatisfactory regime of first-line drugs, various observers, including international human rights organizations, confound “untreatable” with “expensive to treat”, even though treatment based on the standard of care available in the western world would have cured the great majority of cases. Regrettably, in the rhetoric of human rights, the length of pre-trial detention outweighs discussion on the dismal exposure to disease and the daily struggle for food, drugs, lab supplies, heat, and electricity. For Farmer, this trade-off is unacceptable, as expressed in this angry yet hopefully book.