One Physician's Perspective on Human Rights

excerpted from the book

Pathologies of Power

Health, Human Rights, and the New War on the Poor

by Paul Farmer

University of California Press, 2005, paperback


Article 25
Universal Declaration of Human Rights

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.


Article 27
Universal Declaration of Human Rights

Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.

Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.



For decades now, proponents of liberation theology have argued that people of faith must make a "preferential option for the poor." As discussed by Brazil's Leonardo Boff, a leading contributor to the movement, "the Church's option is a preferential option for the poor, against their poverty." The poor, Boff adds, "are those who suffer injustice. Their poverty is produced by mechanisms of impoverishment and exploitation. Their poverty is therefore an evil and an injustice."

Peruvian theologian Gustavo Gutiérrez

"Latin American misery and injustice go too deep to be responsive to palliatives. Hence we speak of social revolution, not reform; of liberation, not development; of socialism, not modernization of the prevailing system. "Realists" call these statements romantic and utopian. And they should, for the reality of these statements is of a kind quite unfamiliar to them."

Liberation theology, in contrast to officialdom, argues that genuine change will be most often rooted in small communities of poor people, and it advances a simple methodology - observe, judge, act. Throughout Latin America, such base-community movements have worked to take stock of their situations and devise strategies for change. The approach is straightforward. Although it has been termed "simplistic" by technocrats and experts, this methodology has proven useful for promoting health in settings as diverse as Brazil, Guatemala, El Salvador, rural Mexico and urban Peru. Insights from liberation theology have proven useful in rural Haiti too ...

Liberation theologians are among the few who have dared to underline, from the left, the deficiencies of the liberal human rights movement. The most glaring of these deficiencies emerges from intimate acquaintance with the suffering of the poor in countries that are signatory to all modern human rights agreements. When children living in poverty die of measles, gastroenteritis, and malnutrition, and yet no party is judged guilty of a human rights violation, liberation theology finds fault with the entire notion of human rights as defined within liberal democracies. Thus, even before judgment is rendered, the "observe" part of the formula reveals atrocious conditions as atrocious.

The Zapatistas, who refer often to early death from treatable illnesses, explain it this way in an early communiqué:

"Some ask why we decided to begin now, if we were prepared before. The answer is that before this we tried other peaceful and legal roads to change, but without success. During these last ten years more than 150,000 of our indigenous brothers and sisters have died from curable diseases. The federal, state, and municipal governments' economic and social plans do not even consider any real solution to our problems, and consist of giving us handouts at election times. But these crumbs of charity solve our problems for no more than a moment, and then, death returns to our houses. That is why we think no, no more, enough of this dying useless deaths, it would be better to fight for change. If we die now, we will not die with shame, but with the dignity of our ancestors. Another 150,000 of us are ready to die if that is what is needed to waken our people from their deceit-induced stupor."

Janet Poppendieck links a rise in "kindness" to a decline in justice:

"The resurgence of charity is at once a symptom and a cause of our society's failure to face up to and deal with the erosion of equality. It is a symptom in that it stems, in part at least, from an abandonment of our hopes for the elimination of poverty; it signifies a retreat from the goals as well as the means that characterized the Great Society. It is symptomatic of a pervasive despair about actually solving problems that has turned us toward ways of managing them: damage control, rather than prevention. More significantly, and more controversially, the proliferation of charity contributes to our society's failure to grapple in meaningful ways with poverty."

Leonardo and Clodovis Boff argue:

""Reformism" seeks to improve the situation of the poor, but always within existing social relationships and the basic structuring of society, which rules out greater participation by all and diminution in the privileges enjoyed by the ruling classes. Reformism can lead to great feats of development in the poorer nations, but this development is nearly always at the expense of the oppressed poor and very rarely in their favor. For example, in 1964 the Brazilian economy ranked 46th in the world; in 1984 it ranked 8th. The last twenty years have seen undeniable technological and industrial progress, but at the same time there has been a considerable worsening of social conditions for the poor, with exploitation, destitution, and hunger on a scale previously unknown in Brazilian history. This has been the price paid by the poor for this type of elitist, exploitative, and exciusivist f t development."

Howard Waitzkin, The Second Sickness

"As of 1999, more than 43 million people in the United States f \ did not hold any form of public or private health insurance, while health-care expenditures totaled more than one trillion dollars annually, equivalent to about 14 percent of the gross domestic product. Many people with insurance coverage still experienced major barriers to access, due to co-payments or other deductible provisions. Most strikingly, every proposal for a national health program in the United States, intended to address the problems of inadequate access and high costs, failed. As the United States enters the new millennium, it remains the only economically developed country without a national health program that ensures universal access to care .... The structures of oppression and the social origins of illness... have emerged as even greater problems as corporate penetration of health care has increased."

Attributed to Dr. Martin Luther King Jr.

"Of all the forms of inequality, injustice in health is the most shocking and the most inhumane."

Of every 100,000 U.S. citizens, 690 are incarcerated, the majority for nonviolent offenses; the rate for Russians, in turn, is 676 per 100,000. For the sake of comparison, note that in many European countries the rate ranges from 60 to 130 per 100,000.

The Tuskegee Syphilis Study was conducted in Alabama by the U.S. Public Health Service from 1932 to 1972. The researchers recorded the natural history of syphilis in an attempt to learn more about the disease by following six hundred men, of whom about four hundred had syphilis, throughout their lifetimes. All were African American, many were sharecroppers, and most lived in poverty. Despite the 1947 discovery of a cure for the disease-to this day, syphilis is treated with penicillin-subjects were never offered that very inexpensive drug, even though they had joined the study assuming that they would be treated. Nor were they informed of the study's real purpose.

Tuskegee ended in 1972 amid public outrage when the Atlanta Constitution and the New York Times ran front-page stories on the study. In a critical reassessment of Tuskegee, historian Allan Brandt notes, "The entire study had been predicated on nontreatment. Provision of effective medication would have violated the rationale of the experiment-to study the natural course of the disease until death."' It took the U.S. government decades to acknowledge its wrongdoing; President Clinton's public apology came in 1997.

As Marcia Angell has argued:

"Research in the Third World looks relatively attractive as it becomes better funded and regulations at home become more restrictive. Despite the existence of codes requiring that human subjects receive at least the same protection abroad as at home, they are still honored partly in the breach. The fact remains that many studies are done in the Third World that simply could not be done in the countries sponsoring the work. Clinical trials have become a big business, with many of the same imperatives. To survive, it is necessary to get the work done as quickly as possible, with a minimum of obstacles. When these considerations prevail, it seems as if we have not come very far from Tuskegee after all."

Rosalyn Higgins

"No one doubts that there exists a norm prohibiting torture. No state denies the existence of such a norm; and, indeed, it is widely recognized as a customary rule of international law by national courts. But it is equally clear from, for example, the reports of Amnesty International, that the great majority of states systematically engage in torture. If one takes the view that noncompliance is relevant to the retention of normative quality, are we to conclude that there is not really any prohibition of torture under customary international law?"

The Zapatista rebellion was launched on the day the North American Free Trade Agreement was signed, and the initial statement of the rebellion's leaders put their demands in terms of social and economic rights:

"We have been denied the most elemental education so that others can use us as cannon fodder and pillage the wealth of our country. They don't care that we have nothing, absolutely nothing, not even a roof over our heads, no land, no work, no health care, no food, and no education. Nor are we able freely and democratically to elect our political representatives, nor is there independence from foreigners, nor is there peace or justice for ourselves and our children."

Pathologies of Power

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