12 takeaways from Paul Farmer’s Pathologies of Power

Pathologies of Power

Pathologies of Power book cover; picture from The Measles Project. I read the e-book.

I recently finished reading Pathologies of Power: Health, Human Rights, and the New War on the Poor, by Paul Farmer, founder of Partners in Health and a professor at Harvard Medical School.

As a student in the US, I learnt about Paul Farmer through my roommate who was a global health student activist (he now works with Paul Farmer in some capacity, and recently told me about his “highlight of the week” lending 20 dollars to Paul Farmer to pay a cab fare).

Anyway, I was extremely inspired by this man’s unrelenting belief and efforts in promoting health as a human right and social justice generally, and he certainly influenced the decisions I’ve made in my own career.

The publisher describes the book:

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.

You can read the full description on the publisher’s website, and you can find summaries and reviews of the book elsewhere.

What I’ve done is listed 12 takeaways from the book, based on what I found to be relevant to my own work in human rights and women’s rights in Malaysia. I’ve also picked out some quotable quotes.

  1. Suffering and injustice is largely a product of human action, or inaction; it happens due to structural violence. Thus suffering must be analysed considering deep history and broad geography, and interrelated social factors such as gender, ethnicity, and socio-economic status. Structural violence cannot be conflated with cultural differences.
  2. Social inequalities have historically been used to deny the status of fully human to certain groups of humans. The struggle to expand inclusion has often been the struggle for power sharing rather than for social justice. But:

    “Human rights arguments are most powerful if we really believe that all humans are equally valuable.”

  3. Cost effectiveness should not be used as an excuse against providing high standards of care to the poor and marginalised. Such choices may be false choices, whereby one could instead make efforts to reduce the price of medical products and services, and to increase (as opposed to reallocating) the pool of funding for essential goods and services. Adhering to cost effectiveness alone could further widen inequalities. For example, certain treatments may be less cost effective to deliver in poorer countries. To address inequalities, a certain amount of efficiency sometimes must be sacrificed.
  4. Of three approaches to health care (and other rights) – charity, development, and social justice – only social justice is adequate. Although charity is sometimes necessary and helpful, it assumes marginalised people are inherently inferior, rather than subject to structural inequalities, and that there will always be haves and have-nots (in order to have the continued opportunity to express their generosity, the perpetrators must perpetuate inequality as well). Development may lift society in aggregate, but it may not lift the poorest of the poor.
  5. Inequalities are even more significant now, because of vast scientific advancement. Access to healthcare now could be the difference between life and death – whereas before the technology simply did not exist.

    “Everyone has the right … to share in scientific advancement and its benefits” (Article 27, Universal Declaration of Human Rights)

  6. Relying on states to comply with a social justice agenda is naive at best. But at the same time state sovereignty should be respected and NGO services should not alleviate and thus perpetuate weak states, as states are much better placed to guarantee certain rights.
  7. For human rights advocacy to be adequate, it must be accompanied by sound technical solutions.

    “All the prison reform activism will come to naught if the prisoners are given the right to treatment but receive the wrong prescription.”

  8. Physicians have a special accountability in the struggle for health equity (similarly, human rights activists have a special accountability in the struggle for human rights for all).
  9. Human rights standards and laws are not sufficient mechanisms to address inequalities. Human rights language can sometime be too academic and legal, making it hard for people to relate to human rights. More human rights law is not sufficient, especially since existing laws are largely ignored.

    “Laws are made of paper, bayonets are made of steel.” (quoting a Haitian saying)

  10. Not all sufferings are equal. This doesn’t mean that a “lower” suffering is trivial, but the practical risk is that focusing on a “lower” sufferings could drown out “higher” suffering.
  11. The principle of non-discrimination is not useful if the result of this non-discrimination is the individual obtaining a position to oppress others.
  12. Human rights are universal but risks of having rights violated are not; rather risks are concentrated and not random. The poor are more likely to suffer, thus we need to provide preferential treatment for the poor. Human rights is most effective when it protects the most vulnerable.

    “The concept of human rights may at times be brandished as an all-purpose and ‘universal’ tonic, but it was developed to protect the vulnerable. The true value of the human rights movements central documents is revealed only when they serve to protect the rights of those who are most likely to have their rights violated.

Other quotable quotes:

“The branch was called rotten, but wasn’t there snow on it?” (quoting Bertolt Brecht, On Sterility)

“The condition of truth is to allow the suffering to speak.” (quoting Cornell West)

“Sometimes we appear to step on toes of those who have long been at work, when we mean instead to step on their shoulders.”

“Disclosure is often the first step in the struggle against impunity.”

“Accountability should be to the afflicted, not to the privileged.”

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