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

Pathologies of Power: Health, Human Rights, and the New War on the Poor: Health, Human Rights and the New War on the Poor (California Series in Public Anthropology) [Kindle Edition]

Paul Farmer , Amartya Sen
5.0 out of 5 stars  See all reviews (3 customer reviews)

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Review

"In his compelling book, Farmer captures the central dilemma of our times - the increasing disparities of health and well-being within and among societies. While all member countries of the United Nations denounce the gross violations of human rights perpetrated by those who torture, murder, or imprison without due process, the insidious violations of human rights due to structural violence involving the denial of economic opportunity, decent housing, or access to health care and education are commonly ignored. Pathologies of Power makes a powerful case that our very humanity is threatened by our collective failure to end these abuses." - Robert S. Lawrence, President of Physicians for Human Rights and Edyth Schoenrich Professor of Preventive Medicine at the Bloomberg School of Public Health, Johns Hopkins University "This is an angry and a hopeful book, and, like everything Dr. Farmer has written, it has both passion and authority. Pathologies of Power is an eloquent plea for a working definition of human rights that would not neglect the most basic rights of all: food, shelter, and health. This plea has special potency because it comes from Dr. Farmer, a person who has proven that the dream of universal and comprehensive human rights is possible, and who has brought food, shelter, health, and hope to some of the poorest people on this earth." - Tracy Kidder, author of Mountains beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer"

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Pathologies of Power uses harrowing stories of life—and death—in extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world’s poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experiences of individual victims to a broader analysis of structural violence. Farmer challenges conventional thinking within human rights circles and exposes the relationships between political and economic injustice, on one hand, and the suffering and illness of the powerless, on the other.

Farmer shows that the same social forces that give rise to epidemic diseases such as HIV and tuberculosis also sculpt risk for human rights violations. He illustrates the ways that racism and gender inequality in the United States are embodied as disease and death. Yet this book is far from a hopeless inventory of abuse. Farmer’s disturbing examples are linked to a guarded optimism that new medical and social technologies will develop in tandem with a more informed sense of social justice. Otherwise, he concludes, we will be guilty of managing social inequality rather than addressing structural violence. Farmer’s urgent plea to think about human rights in the context of global public health and to consider critical issues of quality and access for the world’s poor should be of fundamental concern to a world characterized by the bizarre proximity of surfeit and suffering.

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  • Format: Kindle Edition
  • File Size: 4042 KB
  • Print Length: 438 pages
  • Publisher: University of California Press; First Edition, With a New Preface by the Author edition (25 April 2003)
  • Sold by: Amazon Media EU S.à r.l.
  • Language: English
  • ASIN: B0031M9ZVE
  • Text-to-Speech: Enabled
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  • Average Customer Review: 5.0 out of 5 stars  See all reviews (3 customer reviews)
  • Amazon Bestsellers Rank: #211,509 Paid in Kindle Store (See Top 100 Paid in Kindle Store)
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14 of 14 people found the following review helpful
5.0 out of 5 stars Speaking for the nobodies� 29 Nov 2004
Format:Paperback
There are some books whose message is so pertinent to your daily life that they stay with you for a long time. Farmer's PATHOLOGIES OF POWER will have a profound impression on you. Its substance is highly relevant for current topical debates, whether on Medicare and the forty million uninsured in the US, the Canadian government's ambition to "fix" healthcare or on strategies to fight health pandemics like HIV/AIDS. Farmer submits an emphatic challenge to the medical profession, to political and business leaders, mainstream media and all of us.
Farmer stands emphatically on the side of the destitute, marginalized and usually overlooked. His vivid case studies exemplify the fate of millions of "nobodies" - the silent majority of the world's population who have none or inadequate heath care. Why, he asks, are health care services not made available to all human beings irrespective of race, gender, locale, or the ability to pay? Is it not a fundamental human right? Why do millions in developing countries, in the slums of US cities or prisons in Russia, die prematurely of infectious diseases to which medical research has found successful treatments? Can we morally accept that medical research prioritizes cures for baldness or impotence over medicines that protect from drug-resistant tuberculosis or malaria? And, where has medical ethics come to that condones, or even supports, the "commodification" of medicine? How can cost-effectiveness and the ability to pay apply to essential medical treatment? he queries.
Rooted in his deep belief in human dignity and the fundamental nature of human rights, Farmer also draws strength from liberation theology as he "walks the talk".
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2 of 2 people found the following review helpful
5.0 out of 5 stars Health and survival as human rights 11 May 2009
Format:Paperback
Paul Farmer, perhaps the most famous 'Third World doctor' living today, has written an eloquent and moving plea for a reconsideration of modern approaches toward healthcare in the developing nations in this book, "Pathologies of Power". Based on his personal experiences of care in Haiti, but also his professional visits to Russia, Africa, Central America, Mexico, Cuba and many other places besides, Paul Farmer demonstrates that the problematics of healthcare and those of poverty and inequality are insolubly linked in these nations. Whoever says "heal the sick" must also say "end poverty", for the one is not possible without the other; and whoever says "prevent disease" must also say "destroy socio-economic inequality", for the one is not possible without the other. That is the message of this book.

A large part of the work consists of reflections by Farmer on his experiences in Haiti and elsewhere and on the way in which the current worldwide economic structures engender a genuine and systematic violence against the rights of the poor. Strongly inspired by liberation theology (though not necessarily religious), Farmer eloquently and effectively contrasts the heavy importance attached to individual political and legal rights with the way in which the violations of rights done by structural inequalities and injustices is wholly ignored in the same circles that would complain about the former. Rights issues are the domain of jurists, development issues the domain of (liberal) economists; but the way in which the poor and weak are constantly crushed by the systematic repression that is poverty and inequality, at least as real and at least as much a violation as any torture, that seems to be the domain of nobody at all.
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5.0 out of 5 stars Farmer in Fields of Horror and Hope 18 May 2014
By S Wood TOP 1000 REVIEWER
Format:Paperback|Verified Purchase
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.
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Amazon.com: 4.3 out of 5 stars  39 reviews
107 of 108 people found the following review helpful
5.0 out of 5 stars Take Two Aspirin and Read This Book 10 April 2004
By Patti M. Marxsen - Published on Amazon.com
Format:Hardcover|Verified Purchase
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.
58 of 60 people found the following review helpful
5.0 out of 5 stars Giving a voice to nobodies... 15 Sep 2004
By Friederike Knabe - Published on Amazon.com
Format:Hardcover
There are some books whose message is so pertinent to your daily life that they stay with you for a long time. Farmer's PATHOLOGIES OF POWER will have a profound impression on you. Its substance is highly relevant for current topical debates, whether on Medicare and the forty million uninsured in the US, the Canadian government's ambition to "fix" healthcare or on strategies to fight health pandemics like HIV/AIDS. Farmer submits an emphatic challenge to the medical profession, to political and business leaders, mainstream media and all of us.

Farmer stands emphatically on the side of the destitute, marginalized and usually overlooked. His vivid case studies exemplify the fate of millions of "nobodies" - the silent majority of the world's population who have none or inadequate heath care. Why, he asks, are health care services not made available to all human beings irrespective of race, gender, locale, or the ability to pay? Is it not a fundamental human right? Why do millions in developing countries, in the slums of US cities or prisons in Russia, die prematurely of infectious diseases to which medical research has found successful treatments? Can we morally accept that medical research prioritizes cures for baldness or impotence over medicines that protect from drug-resistant tuberculosis or malaria? And, where has medical ethics come to that condones, or even supports, the "commodification" of medicine? How can cost-effectiveness and the ability to pay apply to essential medical treatment? he queries.

Rooted in his deep belief in human dignity and the fundamental nature of human rights, Farmer also draws strength from liberation theology as he "walks the talk". For more than 20 years, Farmer, anthropologist as well as medical doctor, has dedicated his life to the struggle of the "nobodies" for survival, health and dignity. Working among the poorest and the outcasts, he has lived with the evidence that illness is intimately linked with poverty. From his base in central Haiti, one of the world's poorest regions, he has embarked on an international crusade for social and economic rights and the right to health for all - and "that means every body!" Whether in Haiti, the slums of New York and Boston, in Peru or the prisons in Russia, "structural violence" has been the underlying cause for the desperate spiral of illness and destitution. Farmer uses the concept of "structural violence" broadly to describe social inequalities, lack of economic opportunities, activities of oppressive states: the "misery of extreme poverty". Nobel Prize winning economist Amartya Sen, one of Farmer's mentors, describes it as the destructive forces of "unfreedoms".

Farmer's book is a passionate testament to his many patients and their struggle for rights and dignity. Consequently, it is a damning critique of current health delivery services by governments, international health experts and aid agencies. He analyses the flaws of the charity and development models to healthcare and concludes that "...In a world riven by inequity, medicine could be viewed as social justice work."

While his recounting of individual cases makes at times gloomy reading, his empathy and fervour speak directly to us, his readers. We are drawn emotionally and intellectually into this complex and multifaceted challenge. Drawing on numerous scholars and practitioners, he exemplifies why we should question the underlying fabric of our current approach to human rights, development policy and globalized economy. Human rights work, he argues, has primarily been viewed from a legal perspective with an emphasis on civil and political rights. Instead, he insists, the focus needs to shift so that public health and access to medical care are treated as social and economic rights. These, in turn, have to be understood as critical as civil and political rights, he concludes.

PATHOLOGIES OF POWER is central to the current debates on health, social justice and human rights. It is also an essential tool for anybody involved in any aspect of public health care, medical ethics and sustainable development. Furthermore, it is an extraordinary study resource for everybody interested in the future of human well being. Farmer's own testimony, "bearing witness", and his in-depth analyses are enriched by detailed quotes and ample footnotes from a wide spectrum of analysts and visionaries. [Friederike Knabe, Ottawa Canada]
26 of 27 people found the following review helpful
3.0 out of 5 stars Admire Paul Farmer, but not necessarily his book; read Kidder instead 22 Mar 2008
By Stephen R. Laniel - Published on Amazon.com
Format:Hardcover
Paul Farmer has long been famous, I take it, within the medical community as a brave lifesaver in some of the world's most destitute places. He's lived in Haiti for 20-some years, tending to the poor and sick. He used his success against tuberculosis there as a springboard into Russia, where he's helped prevent the spread of Multidrug-Resistant Tuberculosis (MDRTB) within and beyond the country's prison population. He is, to put it succinctly, a saint.

His fame spread to a much broader audience with the publication of Tracy Kidder's Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer. Mountains Beyond Mountains is a hopeful, awe-inspiring, life-changing book. A couple years after reading it, I picked up Farmer's own Pathologies of Power, expecting great things.

It shouldn't be surprising that Farmer is a true Christian. Reading a lot of economics -- and even a lot of politics inspired by economics -- and then reading Farmer, I'm struck by how arid the former sounds in contrast to the latter. A cold calculus might explain to us why we should treat the poor well. Maybe we can justify redistribution to the poor because their utility from one marginal dollar is higher than that for a wealthy person. Or maybe we should aim to stop MDRTB in prisons because those prisoners will go out into the outside world and infect the nonpoor. Farmer cuts through that: *we should help the poor because they are poor, and it is our obligation as humans to serve the least fortunate*.

Not only that: we should help them because, in most every case, their poverty is a sign that we have failed them. Farmer angrily ticks off case after case, most of them straight from his first-hand experience, where what initially looks like a senseless, random death is seen to be a symptom of a deeper systemic problem. The most haunting of these may be the death of a young Haitian girl named Acephie who contracted HIV from a Haitian soldier. She had sex with him because soldiers are some of the few Haitians with dependable salaries. But what led Acephie into that position of economic dependence to begin with? It didn't help that the Haitian government, with the blessing of Western development agencies, had evicted Acephie's family years before to build a dam; the family had to move to higher, poorer ground because of someone's idea of what was good for them. The road from there leads more or less directly to the AIDS death of a Haitian girl. (James Scott's Seeing Like A State contains a lot more tragedies in this direction.)

Pathologies of Power is filled with stories like that. It is not a hopeful book; it is very, very bitter. This despite Kidder's blurb on the cover to the contrary: Kidder recognized the anger, but saw hopefulness that I didn't.

We won't permanently end the suffering of the poor, says Farmer, until we fix the causes of that suffering. He labels these causes "structural violence." Structural violence is what leads poor Haitians to die of preventable disease ("stupid deaths," to use the Haitians' phrase) because the World Health Organization deems their treatment "cost-ineffective," while pharmaceutical companies get wealthy and we argue over the cost-effectiveness of keeping old Americans alive longer. A world devoted to lifting up the least fortunate would stop the stupid deaths first. Drug companies and governments would help the poor *even if there were no money to be made from them*.

Based purely on its message, I couldn't recommend this book highly enough: everyone should learn to think like a true Christian in the midst of rapacious capitalism. But stylistically it's a chore; Farmer is angry, and is lashing out in all directions. His anger leads him to repeat himself 20 or 30 times throughout the book, and to offer very few actual solutions. Which is surprising: the man himself lives to solve the problems of the destitute.

So I think it's vital to differentiate Farmer The Man from Farmer The Author. That's also why I'd recommend that you go right out and read Mountains Beyond Mountains instead: it teaches the same powerful lessons, only a lot more concisely and inspiringly.
25 of 27 people found the following review helpful
5.0 out of 5 stars St. Paul Farmer 6 Aug 2003
By Peter M Hines - Published on Amazon.com
Format:Hardcover
Dr. Farmer argues that, at the very least, access to health care should be a basic human right, especially if we are to uphold the belief that all human lives are equally valuable. Pathologies of Power is an indictment on the social structures that exist to keep the destitute poor of the world just as they are - destitute, impoverished, and without hope. While the powers-that-be make excuses, Dr. Farmer provides solutions that are, indeed, quite simple. His passion for his struggle to provide health care to the poorest of the poor is matched only by his disdain for the social inequities that perpetuate the structural violence inflicted upon the least fortunate of the world. It is heartening to know that there are a few compassionates, amongst the millions of complacent, that work so tirelessly to effect change that is so desperately needed. Hopefully this book will serve as a wake-up call for the rest of us.
21 of 22 people found the following review helpful
5.0 out of 5 stars Health and survival as human rights 30 May 2007
By M. A. Krul - Published on Amazon.com
Format:Paperback
Paul Farmer, perhaps the most famous 'Third World doctor' living today, has written an eloquent and moving plea for a reconsideration of modern approaches toward healthcare in the developing nations in this book, "Pathologies of Power". Based on his personal experiences of care in Haiti, but also his professional visits to Russia, Africa, Central America, Mexico, Cuba and many other places besides, Paul Farmer demonstrates that the problematics of healthcare and those of poverty and inequality are insolubly linked in these nations. Whoever says "heal the sick" must also say "end poverty", for the one is not possible without the other; and whoever says "prevent disease" must also say "destroy socio-economic inequality", for the one is not possible without the other. That is the message of this book.

A large part of the work consists of reflections by Farmer on his experiences in Haiti and elsewhere and on the way in which the current worldwide economic structures engender a genuine and systematic violence against the rights of the poor. Strongly inspired by liberation theology (though not necessarily religious), Farmer eloquently and effectively contrasts the heavy importance attached to individual political and legal rights with the way in which the violations of rights done by structural inequalities and injustices is wholly ignored in the same circles that would complain about the former. Rights issues are the domain of jurists, development issues the domain of (liberal) economists; but the way in which the poor and weak are constantly crushed by the systematic repression that is poverty and inequality, at least as real and at least as much a violation as any torture, that seems to be the domain of nobody at all. As Paul Farmer clearly shows, even in the lately so blossoming domain of medical and bioethics the issue of socio-economic structures is completely swept under the carpet. As he says, this really is the "elephant in the room".

The same also goes for the oft-invoked importance of efficiency. Callous and counterproductive Western, often American, inspired healthcare policies in the developing nations (among which we must now sadly share Russia as well) generally fail at providing effective treatment against simple preventable disease such as TBC, because those medications that would actually help are considered "not cost-effective". This is in fact just a polite way of saying "we don't care about these people", but then phrased in a manner that will lead to less of an uproar in the newspapers. Farmer however is not fooled so easily, and sees this for what it is - a structural repression of the developing nations by the developed ones, in the name of "efficiency", i.e. efficiency in achieving the aims of the Western states.

This book is a very powerful work, and a strong indictment of the prevailing attitude towards healthcare and development issues and the little attention paid to their interrelation. It also demonstrates convincingly how the current worldwide economic system is bad for everybody's health. And what could be a more important thing than that?
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&quote;
Human rights violations are not accidents; they are not random in distribution or effect. Rights violations are, rather, symptoms of deeper pathologies of power and are linked intimately to the social conditions that so often determine who will suffer abuse and who will be shielded from harm. &quote;
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The central thesis of this book is that human rights abuses are best understood (that is, most accurately and comprehensively grasped) from the point of view of the poor. &quote;
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&quote;
They were both, from the outset, victims of structural violence. The term is apt because such suffering is "structured" by historically given (and often economically driven) processes and forces that conspire-whether through routine, ritual, or, as is more commonly the case, the hard surfaces of life-to constrain agency." &quote;
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