Pathologies of Power: Health, Human Rights, and the New War on the Poor.

• Author: Jain, Eisha
• Position: Book Review

Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer Publisher: University of California Press (2003) Price: $27.50

Pathologies of Power (1) opens with Paul Farmer's account of a visit to a refugee camp in the highlands of Guatemala. Farmer uses the setting of the camp as a way of illustrating a larger point about the ideology that ought to guide health care. He contrasts two approaches to health care reform that have played out in the camp. One initiative, developed in Guatemala City, involves a series of refugee rehabilitation workshops on themes such as gender sensitivity. The other proposal, developed by the refugees, involves exhuming mass graves where genocide victims have been buried by the Guatemalan army. The survivors tell Farmer that the dead have been "buried with their eyes open" and cannot know peace until they receive a proper burial. Farmer sees this project as a valuable way for health workers to act based on the voices and interests of the refugees. In contrast, he rejects the workshops as a misguided attempt to change the minds and culture of the refugees, and to advance "an agenda imported from capital cities ... from do-gooder organizations ... from U.S. universities with the 'right' answers to ... every question." (2)

Farmer's account of the Guatemalan camp reveals much about his goals and his analytical framework. As an anthropologist and a physician who operates a clinic in Haiti and also teaches at Harvard Medical School, Farmer has much to say about international approaches to health care. Put simply, his goal is to show that devastating inequities in global health are not inevitable, but rather are created and maintained by economic, social, and political frameworks that trap the poor in a cycle of sickness and poverty. Farmer calls this process structural violence, and challenges the human rights community to recognize its effects on poor communities. In Part I, Farmer examines structural violence in a number of contexts--Haiti, Chiapas, and Russia, and in Part II, he examines different analytic perspectives in the field of health and human rights. Throughout the work, Farmer emphasizes local approaches to health care. He argues that the health of the poor ought to be the ultimate indicator of progress, rather than markers such as gross national product, economic development, or the creation of human rights charters, which often do not translate into better lives for the poor.

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