Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology, 4)
by Paul Farmer
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Book Summary Information
Author: Paul FarmerForeword: Paul Farmer
Foreword: Amartya Sen
Edition: Paperback
Published: 2004-11-22
ISBN: 0520243269
Number of pages: 438
Publisher: University of California Press
Book Reviews of Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology, 4)
Book Review: Admire Paul Farmer, but not necessarily his book; read Kidder instead
Summary: 3 Stars
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.
Summary of Pathologies of Power: Health, Human Rights, and the New War on the Poor (California Series in Public Anthropology, 4)
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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