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Pathologies of Power: Health, Human
Rights, and the New War on the Poor. By Paul Farmer. Berkeley, Cal.:
University of California Press, 2003. Pp. 402. $27.50, cloth.
Paul Farmer writes of the truths that are repeatedly silenced,
lest they make it difficult for the privileged few to sleep at night. His
readers will come to know the unsettling truth of the Haitian girl whose most
viable hope of rescuing her impoverished family from their daily struggle for
survival was a soldier who ultimately only gave her the AIDS that killed her;
the reality of daughters dying of tuberculosis contracted from fathers who
returned home sick from the airborne pathogen after being detained for months
to a year in a crowded Russian prison while awaiting trial for charges of
stealing bread; voices from the community of Chiapas, Mexico, raised in public
outcry about the lack of access to health care that has befallen their
community and left so many to die from neglect rather than from a paucity of
existing remedies. The final bitter irony of these truths is that each of these
illnesses are treatable, each of these premature deaths preventable, but the
medicines that would relieve the pain were simply out of reach.
Some would have you believe that those who die prematurely of
treatable diseases and other needless suffering were simply victims of chance:
born in an unfortunate station in society (in the wrong spot/color/gender) that
did not afford them the “luxury” of “modern” medicine. Such
is the mistaken view of those who locate the problem with the victim. In
Pathologies of Power Paul Farmer argues that the problem lies not with
the victims, but with the fact that our world—and the landscape of life
chances with it—is calibrated to the workings of a competition-driven
market economy that has “lost its soul,” as Nancy Scheper-Hughes put
it (if it ever had a soul in the first place). Farmer asserts that our
competition-driven market economy artificially alters life chances by
unleashing political and economic forces that inflict and perpetuate structural
violence by distorting susceptibility to extreme suffering such as hunger,
torture, rape, AIDS, tuberculosis, and other infectious and parasitic diseases.
Instead of allowing individual destinies to run their course free from
interference, these political and economic forces predetermine “who will
suffer abuse and who will be shielded from harm.” In this way, the range
of opportunities is so closed and human agency so constrained for the
disfavoured. Being born in Haiti is more likely than not tantamount to a
sentence of death by torture, AIDS, or starvation, and being detained in a
Russian prison is tantamount to a sentence of death by tuberculosis. Farmer
solemnly attests that “the most basic right—the right to
survive—is trampled in an age of great affluence” in which increasing
globalization and scientific advancement make solutions to the problems of
survival more and more feasible.
This tragically ironic state of affairs, Farmer asserts, demands
resolution and is the most urgent problem of our time. While acknowledging the
contributions of the legal profession to human rights, Farmer laments that
lawyers too narrowly focus on obtaining civil and political rights to the
detriment of social and economic rights. “The right to vote, for example,
has not protected the poor from dying premature deaths, caused as often as not
by readily treatable pathogens.” Indeed, Farmer asserts that the role of
the medical and public health community is to complement legal contributions to
the human rights struggle by advancing a research and action agenda that will
promote social and economic rights by working towards an equitable distribution
of the fruits of scientific advancement, that is, equal access to the medical
breakthroughs that render many pathogens treatable. If medicine and public
health fail to heed this call, Farmer warns, they will be complicit in the
creating and perpetuating the horrors that result from the pathologies of
power.
Farmer proceeds to unveil his blueprint for action by documenting
how structural violence resulting from our competition-driven market economy
impacts individuals in Haiti, Cuba, Guatemala, Chiapas, Guantanamo Bay, Uganda,
Russia, Boston, and other locales. Having painted a picture of our current
reality, Farmer moves on to indict guilty parties and assess current approaches
to mitigating the damages. Farmer points out obscene inequalities: the Haitian
worker who makes seven cents a day toiling on coffee plantations and arises
each morning to the familiar “fight for food and wood and water,”
versus “the CEO of one managed-care company received a salary of $370,604
and stock options worth more than $15 million.” He decries the avarice of
pharmaceutical companies who do not make needed medicines available to the
destitute sick because there is no profit to be made from such customers.
Indeed, Farmer chides the entire health care profession/industry/community for
allowing profit motives to compromise more fundamental goals, such as honoring
the premise that health care is a basic human right by providing access to
medical technologies to all. At times, Farmer seems to scrape the surface of
deeply embedded structural problems, giving the reader only a hint of the
policy quandary and lapse of social engineering that begs for remedial
attention. Although Farmer falls short of his goal of conducting a deep and
systematic interrogation of the socially constructed structural processes that
inflict and perpetuate structural violence, he does achieve a good overview of
the problem by identifying likely culprits and insightfully critiquing several
relevant mechanisms.
Ultimately, after a tour of the pathologies that characterize our
current hierarchy of power, and the hypocrisy and lies that serve to uphold and
legitimize it, the reader is left with an overwhelming sense of the injustice
that demands to be addressed. If we agree that the right to survival—and
derivatively, the right to health—is one of the most fundamental of human
rights, then why are tens of millions dying each year because market forces do
not allow them to have access to adequate health care, food, or safety? Are
they not considered human? Whose interests are served by this state of affairs?
And when will we conjure up the requisite commitment to resolve this
astronomical atrocity and sin against humanity?
—Michaele Turnage
Copyright © 2004 by the President
and Fellows of Harvard College
Harvard Human Rights Journal / Vol. 17,
Spring 2004 |
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