Infections and Inequalities: The Modern Plagues
by Paul Farmer
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Book Summary Information
Author: Paul FarmerEdition: Paperback
Published: 2001-02-23
ISBN: 0520229134
Number of pages: 419
Publisher: University of California Press
Book Reviews of Infections and Inequalities: The Modern Plagues
Book Review: Where are the Virchows of global public health?
Summary: 5 Stars
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.
Summary of Infections and Inequalities: The Modern Plagues
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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