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Book
Review
Adair K. Fincher Pathologies of Power: Health, Human Rights, and the New War on the Poor. By Paul Farmer. Berkeley and Los Angeles, California/London: University of California Press, November 2004, 438 pages, $18.95 for paperback. Paul Farmer—anthropologist, physician and subject of Pulitzer Prize winner Tracy Kidder's 2003 Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World—is one of the world's morally invested few. Farmer's Pathologies of Power: Health, Human Rights, and the New War on the Poor (2004) neatly brings together his three prior important works—his doctoral dissertation, published by the University of California, entitled AIDS and Accusation: Haiti and the Geography of Blame (Comparative Studies of Health Systems and Medical Care) (1993); the 1994 work The Uses of Haiti"; and "Infections and Inequalities: The Modern Plagues (2001). AIDS and Accusation: Haiti and the Geography of Blame primarily focuses on the causes and effects of the AIDS epidemic on the Haitian poor—and the subsequent U.S. and Haitian blame associated with it—through an intimate historical and cultural portrayal of the pandemic. In "The Uses of Haiti," Farmer traces American policy toward Haiti in the years after the 1991 coup that ousted President Jean-Bertrand Aristide, drawing connections between the administrations of U.S. Presidents George H.W. Bush and Bill Clinton and the plight of the very poor in Haiti, as well as those who struggled to leave. In Infections and Inequalities: The Modern Plagues, Farmer, using data from Haiti, the U.S. and Peru, argues that the cause of tuberculosis and AIDS is not only the sickness itself, but also social inequality. Finally, Farmer ties all these works together to create Pathologies of Power, producing an intelligent, important and insightful piece of work. Through an intimate portrayal of those affected by poverty, Farmer weaves a desperate tale of health-based despair. He draws from his personal experiences as a physician in Haiti, Chiapas (Mexico), Russia and Cuba—and as a founder of Partners In Health (PIH), an international health care organization—to familiarize and connect the reader to the health-based suffering of the poverty-stricken in these regions. Pathologies of Power is filled with reader-to-victim introductions in which Farmer identifies each victim by name, story, the context and history of his or her society, the medical issue or ailment that he or she is afflicted with, and finally, how the individual's story ties into the greater aims of the book. He relies heavily on the Dependency Theory, which holds that industrialized countries are maintaining (and benefiting from) underdevelopment in developing countries through various economic policies. The poorest individuals of the world's poorest countries are the hardest hit by the economic actions of industrialized countries. Farmer argues that these individuals will be the most likely to die from treatable or curable diseases not found, or rarely found, in the industrialized world. He believes that this fact alone should be sufficient criteria to allow these individuals preferential treatment in obtaining medication. Farmer's main argument is simply that "equity is the central challenge for the future of medicine and public health." He supports this argument with a repetitive, and at times overly analytical, foray through the struggle of the sick and destitute for social and economic rights, namely the right to public health and access to medical care. He also looks at inequality as a source of violence, and entrapment as a result of structural violence. "Structural violence" is a term coined by Farmer to mean a "broad rubric that includes a host of offensives against human dignity: extreme and relative poverty, social inequalities ranging from racism to gender inequality, and the more spectacular forms of violence that are unquestionably human rights abuses, some of them punishment for efforts to escape structural violence" (pg. 8). Farmer uses cases studies, such as HIV-positive Haitian prisoners in the U.S. base in Guantánamo Bay, Cuba; Russian prisoners who contract tuberculosis due to poor ventilation systems and extreme overcrowding in the prisons; and the Chiapas poor who must side with the Zapatistas in order to demand equality from the state or be forced off their land, to highlight and illustrate his point. In the final chapter of Pathologies of Power, Farmer lays out the changes he thinks would best benefit both health and human rights. These include, but are not limited to, a more pragmatic approach to human rights, a separation of human rights from governments and bureaucrats, and an acknowledgement of social and economic rights. All this is needed in order to prioritize human rights endeavors in a world where human rights trump state sovereignty, he argues. Readers familiar with the subject of global human rights may find Farmer to be repetitive, particularly in the final chapters, as he approaches his main arguments and thesis from various viewpoints. He joins other human rights advocates in the fight for change through recognition of social and economic rights, and may have become, for those well versed in human rights, "just another voice." However, his saving grace is his close focus on health, drawing on his vast background in the area to set him apart from other human rights advocates. For the reader who is unfamiliar with the subject of global human rights, Pathologies of Power is an enlightening look at the subject, its place in the world today and where it could possibly stand in the future. The reader will feel his or her heartstrings tug when reading of the hardships endured by HIV-positive Haitians in Guantánamo or the inmates who have contracted tuberculosis in Russia. The attentive reader will also walk away from Pathologies of Power far more knowledgeable about the health challenges faced by the poor. While Pathologies of Power touches on a depressing topic commonly ignored, it is an enlightening look into the subject of global health, what the very poor must endure and what individuals from industrialized nations disregard. Farmer's tactic of creating a human connection to the victims through telling their stories draws the reader in and hits the very nerve he hopes to touch. By doing this, Farmer "turns on" the ability to care for the welfare of the destitute in other countries as if they were neighbors, which would be his first step toward improving global human rights and, in particular, the right to health. Adair K. Fincher B.S., University of Oklahoma, International and Area Studies, 2004 M.S., New York University, Global Affairs, 2008 PERSPECTIVES ON GLOBAL ISSUES Back to Table of Contents |