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Pathologies of Power

In Pathologies of Power: Health, Human Rights, and the New War on the Poor, Farmer puts together his experiences as a general practitioner and as an anthropologist in the developing world to bring about substantiation and investigation of poverty. He particularly focuses on health while identifying the effects of Tuberculosis, HIVAIDS and other illnesses in some regions while treating patients abused by members of military authoritarianisms and those who experienced starvation. This points to deep social and health problems. As Farmer quickly reveals, military harassments on civilians and HIVAIDS are by the same token socially determined issues (Farmer, 2005).

Farmer embarks on providing evidence that it is the construction of society and not the deficiency of resources that keep any actual social transformations from happening for the poor and those at risk within the society.   This phenomenon is what he terms structural violence. This relates to poverty, inequity as well as more conspicuous physical aggression. The statement means that this type of suppression is not apparent; rather, it is the lack of determination for whatever rich nation or individual to create real change in the livings of the poor. The resultant situation leaves the poor at the mercy of multiple diseases that could be prevented, the factors from lack of appropriate shelter, and undernourishment (Farmer, 2005).

To lay emphasis on this point, Farmer draws on some personal experiences he encountered while doing his research. He explores on the AIDS pandemic in Haiti, then the political aggression in Chiapas, and finally the drug-repellent tuberculosis as a kind of penalty within the Russian prisons. This part of the text presents a clear picture of how the underprivileged are treated. It clearly demonstrates the meaning of structural violence (Farmer, 2005).

Discuss what stance the author took on primary care and public health in the book

The authors’ stance regarding to public health is that every individual should have the right to access to good healthcare. He observes that the right to health is the least contended social right as many activists fight for the right to vote or freedom of speech. These social activists have failed to advocate for good health, and yet the deprived withstand the worst of both preventable poor health and violations against human rights (Milles, 2004). Health advocacy has botched miserably. In some way, public health has to be connected to a return to social integrity. With lack of access to primary health care treatment, diseases such as pneumonia or Tuberculosis are more deadly than AIDS. Poverty exposes the community to risks, as it prevents them from accessing efficient treatment. Those people who do not pay for healthcare services are denied access to treatment, and this action is legitimate in the free market system. Therefore, in such situations, health care is accessible to the rich and powerful, while the poor and weak continue to suffer. This issue is quite confusing as one wonders if health care is an object for business or it is a basic social right that should be accessed by all regardless of the economic status (Schuftan, 2003).

Consequently, justice remains the main challenge for the expectations of public health. The author even speaks of the ‘pathogenic role of inequity’ and hence of a ‘right to equity’.

Farmer uses a case study of Chiapas and Haiti to describe the plight of the poor within the community who are exploited by the wealthy individuals and the government as well. He elaborates how the poor have been subjected to landlessness as their lands are taken by the government for development of infrastructure or other projects belonging to the government or private companies. Consequently, these poor people are displaced leading to their cultural and economic productions being interrupted. They are moved to unproductive lands, and as a result, hunger, undernourishment and social problems generate numerous predicaments of poverty (Farmer, 2005). 

Since poor health and fatality are directly related to political and economic systems far beyond the power of victims, Farmer terms this an instance of structural violence, which he says, is embedded both in national and worldwide political and economic occurrences. Farmer presents a successful revelation of how these socio-economic systems generate conditions that cause health problems to thrive, and aggravate the torment of the poor in the community. A clear example is the case of Haiti where the martial law and United States foreign policy assist each other for their own reasons, and join forces to add to the aggravation of diseases and malnourishment amongst the underprivileged. In other words, the lop-sidedness of power produces many kinds of hushed violence. Inequalities of power bar the poor from gaining access to the opportunities they require to send away poverty. Therefore, disallowing this chance to the poor only serves the interests of those in power. A change of attitude is required in spirits and minds of the powerful. Governing systems and not just people ought to be transformed if the human race is to transform (Milles, 2004).

Why do you think primary health care and public health care interconnected and why is it essential to have a PHC system, which encompasses public health?

Primary health care and public health care are interconnected in that without sound ethical practices have to be practiced at the primary level in order to ensure effective healthcare. Slacked ethical practices are improper. However, in the absence of a social integrity factor, medical ethics risk turning into even another approach for managing inequity. Usual medical ethics touches on the morals of an entity; it is to a certain extent separate from the concrete social reality. Socio-economic rights are the main concerns of what should come to be the new medical moral code. Ethics that dispense justice are required in the field of healthcare. Preventive measures should be taken in consideration by physicians in order to prevent the spread of unnecessary diseases. This could be done by providing the poor with adequate basic needs such as sufficient food to prevent malnutrition, shelter and clothing to prevent diseases such as pneumonia, and basic healthcare services. In addition, these people should be taught how to manage their health by observing high hygiene. This way, the poor will be able to achieve the primary healthcare. Hence, it is essential to have primary health care that encompasses public health (Schuftan, 2003).

Do you agree with the authors view, if so why if not please state your reasons?

I agree with most of the author’s views concerning how the poor are treated and how the governments need to change in order to prevent or suppress efficiently the occurrence of such diseases as pneumonia and tuberculosis among the poor. However, I find his complaints about the human rights arguments that they have been overly lawful and hypothetical, not agreeable as this might have been required to bring human rights to the level they are now. Farmer asserts that the present human rights discussion is every so often removed from reality but this is no more the case especially with the emergence of organizations such as United Nations International Children’s Emergency Fund and International Rescue Committee.  Such organizations are now deeply participating in fighting the violations against human rights as well as ensuring the health of the malnourished. Several humanitarian organizations are providing food, healthcare services and even refuge to the poor and those affected by cases of violence in various parts of the world. Therefore, the claim that human rights activists only fight for the freedom of speech and right to vote is no longer applicable as Farmer claims. This might have been the case, yes, but it has now changed. These humanitarian organizations must be recognized for the work they are doing (Farmer, 2005).  

What did you find most compelling aspect in the book and why and how does it relate to primary health care?

The most compelling aspect of the book is the ethical argument that the author draws all through the textbook, that health care is a basic human right. This case is with a distinct account in intercontinental politics and liberty mysticism. Farmer repeatedly pleads with the Universal Declaration of Human Rights to argue in support of healthcare as a human right arguing that many are suffering and even others are dying due to lack of health care services, which ought to be accessible to them. This is related to primary health care in that, giving these people the right to health care will improve their live by reducing cases of serious illnesses and death. Health practitioners, through their ethical principles, will be able to provide treatments to the poor without charging them, thus health services will be available to all (Milles, 2004).

Further, Farmer criticizes the intentions of the market ideas to health care, and the final consequence that this approach has had on the wellbeing of those living in poverty. Farmer points out that the general health and living without misery is an ethical main concern above any other concern for market financial side. In addition, he criticizes the power inequities in the society, which he regards as prevalent within the healthcare system, and which has overridden the moral values of the general practitioners. He indicates that this power inequality in effect, results in a lack of support on the part of the impoverished and ailing from physicians. These physician, he states, maintain a general ambivalence towards the misery of the poor in the underdeveloped regions (Farmer, 2005).

From a standpoint critical to free market economy, this book offers both perceptivities and issues.  Farmer evidently shows that the level of poverty in the underdeveloped nations is very reliant on the development of international capitalist economy and the partnership of local tyrants with the motives of capital accretion over the populace. Further, dictatorial governments, such as the junta in Haiti, were mostly the making of both United States foreign policy and a lengthy majestic record connected to the enlargement of the worldwide capitalism (Milles, 2004).


To sum up, Farmer uncovers significant proof of international inequity, and the misuse of the poor.  In addition, he makes clear some essential moral controversies concerning medical care in the global capitalistic organization. This is an influential book, which centers on the health issues of the underdeveloped nations as well as on the political roots of global inequity and social prejudice. His investigation of political orientations and its demoralizing effects is above reproach. Hardly any person in the first world countries would like to take notice of the fact that they, given that they reside in a democratic state, are directly accountable for the cruelty and death of countless individuals in third world nations. Regrettably, most of Farmer’s views are true. Farmer intelligently interchanges his studies with references and short verse forms composed by the browbeaten, or their supporters. These are voices rarely got word of in the public press of the developed world, but they are importance to listen to.  Of importance is that, discussion on human rights ought to start with the right to health care.

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