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Infections and Inequalities: Updated with a New Preface: The Modern Plagues [Paperback]

Paul Farmer
5.0 out of 5 stars  See all reviews (2 customer reviews)
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Book Description

5 Mar 2001
Paul Farmer has battled AIDS in rural Haiti and deadly strains of drug-resistant tuberculosis in the slums of Peru. A physician-anthropologist with more than fifteen years in the field, Farmer writes from the front lines of the war against these modern plagues and shows why, even more than those of history, they target the poor. This 'peculiarly modern inequality' that permeates AIDS, TB, malaria, and typhoid in the modern world, and that feeds emerging (or re-emerging) infectious diseases such as Ebola and cholera, is laid bare in Farmer's harrowing stories of sickness and suffering. Challenging the accepted methodologies of epidemiology and international health, he points out that most current explanatory strategies, from 'cost-effectiveness' to patient 'noncompliance,' inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Yet this moving account is far from a hopeless inventory of insoluble problems. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians determined to treat those in need. "Infections and Inequalities" weds meticulous scholarship with a passion for solutions - remedies for the plagues of the poor and the social maladies that have sustained them.

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Product details

  • Paperback: 422 pages
  • Publisher: University of California Press; Revised edition edition (5 Mar 2001)
  • Language: English
  • ISBN-10: 0520229134
  • ISBN-13: 978-0520229136
  • Product Dimensions: 22.7 x 15.2 x 2.6 cm
  • Average Customer Review: 5.0 out of 5 stars  See all reviews (2 customer reviews)
  • Amazon Bestsellers Rank: 430,365 in Books (See Top 100 in Books)

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"The only things that distinguish Farmer's account from a Dostoevskian novel is a meed of hard, effective science and a depressingly familiar story of the powerfully malignant of racism.... It is hard to think of more compelling examples to underpin his arguments. It makes the book and its message accessible to the general reader and forcefully reminds doctors, nurses, scientists, sociologists, economists and aid workers of their unfinished business.... But the main lessons he draws are for us all. We must do all we can to diminish social inequality." - Hugh Pennington, Times Higher Education Supplement "A strangely uplifting read. Infections and Inequalities is a powerful and rigorously argued critique of economic and health care inequality." - Phil Whitaker, The Guardian (UK) "Bolstered by thorough knowledge of the countries in which he practiced, relevant and cogent case histories, and a caring but disciplined attitude, Farmer powerfully argues for substantial changes in epidemiological theory and practice. He raises thought-provoking and necessary questions, and he provides answers that, if often unsettling, are pertinent and capable of being put to use by individuals and governments truly interested in solving, not sidestepping, life-threatening situations." - William Beatty, Booklist"

About the Author

Paul Farmer directs the Program in Infectious Disease and Social Change at the Harvard Medical School and divides his clinical time between Boston's Brigham and Women's Hospital and the Clinique Bon Sauveur in central Haiti. He is the author of AIDS and Accusation (California, 1992), which was awarded the Wellcome Medal, and The Uses of Haiti (1994), and editor of Women, Poverty and AIDS (1996), which won the Eileen Basker Prize.

Inside This Book (Learn More)
First Sentence
As I prepared this book, an anonymous reviewer of an early draft suggested that, since the book reflects a personal journey, it should make explicit the itinerary taken. Read the first page
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Front Cover | Copyright | Table of Contents | Excerpt | Index
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Most Helpful Customer Reviews
9 of 11 people found the following review helpful
By A Customer
This work focuses on HIV and tuberculosis infection through the lenses of both anthropology and medical practice. Farmer, qualified in both, examines the impact of these infectious diseases particularly in Haiti, but also in the United States and South America. The author particularly examines the relationships between increasing global inequality and infection. Drawing on case studies of his patients, what is particularly interesting is his distinction between "culture" and "structural violence", and he argues that the two have often been conflated. Structural violence is the means by which people are disenfranchised and have extremely limited life choices by virtue of colour, nationality, wealth and gender. Thus there are powerful social forces at work, which determine one's health outcomes. The author demonstrates how both TB and HIV are diseases of poverty, and explanations of their increased emergence in the world - such as culture (voodoo, reliance on herbal remedies), patient non-compliance and so on - are in fact the result of inequality, poverty and inaction on the part of the powerful world.
This work examines the lives and case studies of people who have been so dramatically affected by the HIV and TB pandemics, and whose choices have been so restricted by their poverty and lack of access to medical care. This is an important book that places biomedical science within its social context, and asks important questions not only about the distribution of wealth in the world, but also about the distribution of health care and medical intervention in the treatment of HIV and TB. The dramatic affect of racism and unequal power relations between the genders is underlined. This is important reading for those interested in HIV or TB and its relationships to poverty and development.
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1 of 1 people found the following review helpful
5.0 out of 5 stars Powerful! 30 Aug 2010
Format:Paperback|Verified Purchase
The evidence is damning. The Western world has ignored the poorer nations at its own peril. Farmer argues cogently, but beneath the logic lies an anger, and this compelling book tells the stories of how people are dying from treatable diseases merely because they're poor. Anyone interested in global health should read this book. Anyone interested in the way the world treats its lesser brethren should read this book. Anyone with a conscience should read this book.
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Most Helpful Customer Reviews on (beta) 4.3 out of 5 stars  20 reviews
79 of 83 people found the following review helpful
5.0 out of 5 stars Complex causality: why people are really at risk for disease 8 Jun 2000
By Jonathan Joseph, MD - Published on
Finally Dr. Farmer couples his lucid historical, political and economic analyses of the conditions that put the poor at risk for bad health outcomes, with a plainly indignant calling out of healthcare professionals and healthcare organizations to make honest efforts to understand and remedy conditions which would never be tolerated among the well off in Western nations. In his goundbreaking, earlier books, "AIDS and Accusations," and "The Uses of Haiti," Dr. Farmer matter of factly discusses the global and local structural conditions and misrepresentations which led to the spread of disease and persistent, dismal health conditions in Haiti. In "Infections and Inequality," Dr. Farmer adds moral overtones to incisive, sociopolitical analysis and his characteristic accounts of individuals suffering from disease. The book consequently provides a powerful reflection from a man who has worked in some of the world's poorest regions on what the benefits of medical technology mean for people who have not traditionally had access to them. A powerful, informative read that clearly reflects the years of experience of a physician who has wrestled with the global responsibility of caring for the those who are worst off. An obligatory read for anyone even thinking of working for the impoverished of the world.
33 of 34 people found the following review helpful
5.0 out of 5 stars Shining a Light 2 Jan 2004
By Andrea Ducas - Published on
Dr. Farmer sums up what you can hear in his lectures (he is an amazing speaker), read in journals, and hear in his interviews: The "modern day plagues" result directly from Structural Violence. I read this book for my culture and health class and could not put it down. He writes with an eloquence unheard of in most anthropologists while at the same time with the passion of a deeply concerned physician. Although in some points the book can get repetitive (as case studies overlap) it is a spectacular, enlightening read that I would recommend to anyone, particularly potential (and current) medical anthropologists.
31 of 32 people found the following review helpful
4.0 out of 5 stars Medical-anthropological approach to HIV & TB illuminates roles of inequality and poverty in spread of disease 11 July 2005
By David Evans - Published on
Farmer, a physician-anthropologist and activist, examines both the way that poverty and inequality result in the spread of HIV and TB today and the flawed justifications for inequitable access to treatment. His ethnographic analysis provides a powerful complement to standard epidemiological work, and this treatise on the danger as well as the immorality of inequity in medical care is largely convincing.

Farmer illustrates several broad themes effectively with case studies from Haiti and Peru. One is the idea that most studies overemphasize individual agency, failing to recognize serious "structural" factors, such as the pressure that extreme poverty exerts on people to engage in unhealthy behaviors and the problems introduced by economic inequality. (One example of the latter is that in unequal countries like Peru, second-line TB drugs are available because of demand by the rich, so doctors also prescribe them to the poor who can only afford them intermittently, which generates drug-resistant strains of the disease.) Another theme is that people in rich nations tend to place heavy weight on "strange" cultural beliefs and customs in explaining high disease prevalence, whereas actual epidemiological research tends to show that these factors carry little weight relative to poverty-related factors. While he uses AIDS in Haiti to illustrate this tendency, it applies perfectly to popular Western conceptions of AIDS in Africa: the popular media tend to emphasize cultural practices such as wife inheritance and a strong sex drive, whereas epidemiological research fails to support a major role for these.

A third theme, which Farmer often trumpets but not as convincingly, is that many of the trade-offs voiced by policymakers are ultimately false. One example is the question of whether to treat tuberculosis with drugs or prevent it (e.g., by investing in economic development). He then uses the success of his clinic in Haiti as an example of both treating and preventing TB. The ultimate argument is that the wealthy have no right to withhold their wealth from the poor. However, he gives us no clear sense of how the resources to generalize this to the world at large should be marshaled. While the trade-off may be philosophically false, the practical application is unclear.

But even without a plan of action, Farmer illuminates key problems in the analysis of infectious disease spread and makes a convincing plea to share the wealth (and the technology).
7 of 8 people found the following review helpful
5.0 out of 5 stars Where are the Virchows of global public health? 20 Jun 2008
By Mary E. Sibley - Published on
The context of epidemics is important. What happens to the poor people who have drug resistant tuberculosis? Market mechanisms do not serve the interest of global health equity. The cost-efectiveness argument is weak. Poverty limits freedom of choice. AIDS education falls short. Arguments about limited resources should not prevail. There is a global web of unequal relationships. Structural violence and cultural difference have been conflated in AIDS studies.

Anthropology and medicine have blind spots. Virchow understood medicine had biologic and social underpinnings. There is not enough high-tech medicine to go around. Inequality itself is a pathogenic force. The author's interpretation of modern plagues has been shaped by work in Haiti and Peru. As scientific and medical communities tried to make sense of AIDS, the author was drawn into the discipline of the sociology of knowledge. World systems theory, one of the newer anthropological theories, could posit that Paul Farmer of Harvard and Haiti is a conduit for resources.

In many instances of disease emergence, social topography is more important than geographic topography. The differential political economy of risk is described. The major risk factor for AIDS is poverty. Personal agency has been exaggerated. From typhoid to tuberculosis to AIDS, blaming the victim is a theme in the literature. Being sick results from structural violence, not from bad personal choices. The author lived in a village in rural Haiti when both AIDS and political violence arrived. Haitian cases of AIDS defied the risk-grouping descriptions prevalent in the 1980's. The Haitian epidemic of AIDS originated in the United States.

Recent circumstances in Haiti include deepening poverty, gender inequality, instability. The author and other physicians and health workers have learned that a belief in sorcery among Haitians does not preclude adherence to a biomedical regimen. Furthermore, high cure rates for tuberculosis, (often a twin affliction of AIDS), are possible in settings of extreme poverty. Juxtaposing treatment with prevention are false debates.

The author has traced the march of inequality as it affects health care in a myriad of ways. Endnotes and an extensive bibliography follow the text of this excellent work. Everyone should buy it, everyone should read it.
6 of 7 people found the following review helpful
5.0 out of 5 stars Buy it. Read it. 10 May 2008
By K. B. Dozier - Published on
An enlightening and insightful book that passionately sets a higher standard for those involved in medicine or any type of humanitarian work. He is passionate about what he says, but careful not to make assumptions that have not been well documented and researched. The book challenged my thinking when it comes to health care, poverty, and our social duty to take action against injustices in the world.
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