Pathologies of Power: Health, Human Rights, and the New War on the Poor
Zaidi, Sarah, Ethics & International Affairs
Paul Farmer (Berkeley: University of California Press, 2003), 419 pp., $27.50 cloth.
In Pathologies of Power: Health, Human Rights, and the New War on the Poor, Paul Farmer documents the linkages between structural violence and human rights violations through the specific lens of the right to health. The book presents a profound critique of existing power relations in the area of international health and suggests that we adopt in response a positive agenda of social and economic rights enforcement.
Farmer challenges the inherent inequalities of the reigning free market ideology, where the U.S. dollar is king, corporate profit takes precedence over human life and dignity, and health care is a commodity priced beyond the reach of millions of people. He describes one example after another of resilient individuals struggling for health against often insurmountable odds. Through these narratives, Farmer discredits the standard excuses of power--that the poor are largely responsible for their own deprivation, and that poverty-reduction strategies within the existing neoliberal economic model of privatization are the best that we can hope for.
Farmer argues that the structural violence embedded in our social acceptance of poverty has to be countered by promoting social and economic rights. The right to health exists in international law. But, as Farmer demonstrates, it has yet to be achieved, especially for entire communities of people facing death from preventable and curable diseases, such as HIV/AIDS or multidrug-resistant tuberculosis. An effective human rights approach must therefore lead to a redistribution of wealth and power as well as a transformation in public attitudes toward poverty and inequality.
Farmer is a rare combination of skilled professional and passionate activist. Part I of the book, "Bearing Witness," draws on his experiences as a physician and anthropologist working with people in conditions of extraordinary (yet all too ordinary) poverty and powerlessness. In each case, he describes how structural violence and power inequalities work in distinct ways to bring the person or community to the edge of an abyss. There is Yolande lean, rotting in Guantanamo for attempting to flee Haiti after the Cedras coup, her health adversely affected by forceful injections of the contraceptive Depo-Provera, unlawfully imprisoned by the richest country on earth in conditions that were "an abomination and a crime" (p. 69). There is Sergei, a tall, thin man with black horn-rim glasses who, like so many other Russians languishing in squalid prisons, suffers from multidrug-resistant tuberculosis (with which he was infected before even coming to trial), a treatable disease rendered untreatable by exorbitant "First World" pricing. In Chiapas, we learn of the indignities suffered by indigenous communities, who lack access to health, education, clean water, and electricity even while their region generates tourism revenue for the government.
In Part II, "One Physician's Perspective on Human Rights" Farmer takes his examples and constructs an analysis of how social and economic rights, coupled with liberation theology's preferential option for the poor, can oppose market forces that commodify health and devalue life. His approach is to incorporate medical expertise into the rights framework in a constructive partnership. He rightly argues: "Casting prison-based tuberculosis epidemics in terms of social and economic rights offers an entree for public health and medicine.... Conversely, failure to consider social and economic rights can prevent the allied health professionals and the social sciences from making their fullest contribution to the struggle for human rights" (p. 216). This is a significant step forward for the U.S. public health and medical community, which has traditionally understood the role of the healer in terms of providing services rather than addressing root causes of violations. …