One Physician's Perspective on
excerpted from the book
Pathologies of Power
Health, Human Rights, and the
New War on the Poor
by Paul Farmer
University of California Press,
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.
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.
INSIGHTS FROM LIBERATION THEOLOGY
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
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
"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
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
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."
"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
"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."
Index of Website