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"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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Most Helpful Customer Reviews
13 of 13 people found the following review helpful
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". 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 their 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]
2 of 2 people found the following review helpful
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?
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?
Most Helpful Customer Reviews on Amazon.com (beta)
Amazon.com:
15 reviews
21 of 22 people found the following review helpful
Health and survival as human rights
30 May 2007
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?
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?
17 of 20 people found the following review helpful
Toward a "real" medical ethics
10 Nov 2006
Format:Paperback
It's a big world, but we Americans seem to reside in a small one, at least those of us fortunate enough to be insured and able to afford the health care we need. Many fellow US citizens cannot afford to be sick or ill at all, yet their needs may be tended only once they are so ill that emergency room care is required, but maybe not even then. Then there are the desperately poor of other nations and whole regions of the world that have virtually no care at all. This book is about those folks and medicine as it is currently practiced and dispensed here and abroad. Author Doctor Paul Farmer shows that modern medical practice violates the very ethos that spawned the impulse to heal in the first place.
This book has a lot of structural problems that, while off-putting, are easily ignored by the enormous contribution Farmer makes to our understanding of a set of topics that most of us have not thought about at all. This is an important and inspired book, one that is clear and easy to read, although marred by redundancy that a good editor might have helped eliminate. The thesis topic is that the desperately poor deserve more attention, not less as they now are accorded, because they are more vulnerable by definition. Farmer successfully questions the allocation of our resources toward corporate profits rather than treating the poor of the world.
Farmer's case studies based on his experience of working in Boston, Hattie, and the Russian Republic amply illustrate that our health care priorities are backward and unjust at best, pernicious and self defeating at worst. Every medical ethics course in the US ought to require this along with, or in place of, their existing textbooks that grind over the hoary issues of abortion and euthanasia, and a lot of other topics that are luxuries of a rich society that all but ignores those in greatest need.
This book has a lot of structural problems that, while off-putting, are easily ignored by the enormous contribution Farmer makes to our understanding of a set of topics that most of us have not thought about at all. This is an important and inspired book, one that is clear and easy to read, although marred by redundancy that a good editor might have helped eliminate. The thesis topic is that the desperately poor deserve more attention, not less as they now are accorded, because they are more vulnerable by definition. Farmer successfully questions the allocation of our resources toward corporate profits rather than treating the poor of the world.
Farmer's case studies based on his experience of working in Boston, Hattie, and the Russian Republic amply illustrate that our health care priorities are backward and unjust at best, pernicious and self defeating at worst. Every medical ethics course in the US ought to require this along with, or in place of, their existing textbooks that grind over the hoary issues of abortion and euthanasia, and a lot of other topics that are luxuries of a rich society that all but ignores those in greatest need.
10 of 11 people found the following review helpful
Incendiary essays by public health's foremost messenger
24 Jan 2010
Format:Paperback
This book is a collection of several essays that Dr. Farmer wrote while he was on-site in several of the areas where Partners in Health (an org he co-founded, which provides healthcare for the poor, regardless of ability to pay, including case management of complex diseases such as HIV and multidrug resistant TB) operate. From Haiti to Chiapas to the TB colonies in Russia's prisons to Boston's slums, Farmer--ever the anthropologist--is able to see beyond the symptoms he treats and points to a common cause for the poverty, disease, and suffering that he and his colleagues try to alleviate: structural violence. Hence, what one reviewer (who gave an unfavorable review) commented: that what he wrote is repetitive. I think that was the point Farmer was trying to make: these problems all have the same cause.
The book is divided into two parts: in the first part, he describes the situation; in the second part, he provides analysis. Structural violence is the thread that is woven through all of these essays. The overall effect, as you can guess, is unpleasant. After finishing this book, I had the same feeling in my stomach I got when I saw a motorist deliberately run over a slow-moving critter crossing the road late one night. It is a feeling of anger and revulsion, which Farmer--ever the physician--seeks to treat with the very last chapter (Rethinking health and human rights).
I admit his prose sometimes ventures out into the realm of the abstract (he is an academic after all), but concrete stories about people being beaten by soldiers and left for dead make his message loud and clear. He is angry about what he sees and he wants us to be angry too, and rightly so. Why, he asks, in the age of medical advancements and human rights, do we continue to see people dying 'stupid deaths' from preventable causes? It is an important question to ask, given that the fields of medicine and human rights generally think they don't have anything to do with each other. This book should be required reading for anyone who is studying medicine, be it clinical or public health. It should also be required reading for anyone who thinks about studying international human rights law. Finally, concerned citizens of 'donor countries' would be interested to read this book too, if only to urge our lawmakers to make sure that our tax money is not being used to fund dictatorships and dirty proxy wars.
The book is divided into two parts: in the first part, he describes the situation; in the second part, he provides analysis. Structural violence is the thread that is woven through all of these essays. The overall effect, as you can guess, is unpleasant. After finishing this book, I had the same feeling in my stomach I got when I saw a motorist deliberately run over a slow-moving critter crossing the road late one night. It is a feeling of anger and revulsion, which Farmer--ever the physician--seeks to treat with the very last chapter (Rethinking health and human rights).
I admit his prose sometimes ventures out into the realm of the abstract (he is an academic after all), but concrete stories about people being beaten by soldiers and left for dead make his message loud and clear. He is angry about what he sees and he wants us to be angry too, and rightly so. Why, he asks, in the age of medical advancements and human rights, do we continue to see people dying 'stupid deaths' from preventable causes? It is an important question to ask, given that the fields of medicine and human rights generally think they don't have anything to do with each other. This book should be required reading for anyone who is studying medicine, be it clinical or public health. It should also be required reading for anyone who thinks about studying international human rights law. Finally, concerned citizens of 'donor countries' would be interested to read this book too, if only to urge our lawmakers to make sure that our tax money is not being used to fund dictatorships and dirty proxy wars.
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