Challenging orthodoxies: The road ahead for health and human rights

Health and Human Rights

Volumn 10, Issue 1, 2008, Pages 5-18

  Farmer, Paul ^a,b,c  

^a HARVARD MEDICAL SCHOOL   (United States)

^b Women's Hospital

^c NONE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

COMMUNITY HEALTH WORKER; HEALTH CARE; HEALTH POLICY; HUMAN RIGHTS; LOW INCOME POPULATION; MARGINALIZATION; PUBLIC HEALTH; STRATEGIC APPROACH;

CATERING SERVICE; ETHICS; HEALTH; HEALTH CARE DISPARITY; HEALTH DISPARITY; HUMAN; HUMAN RIGHTS; MEDICAL SOCIOLOGY; POLITICS; POVERTY; PROCEDURES; PUBLIC HEALTH SERVICE;

FOOD SUPPLY; GLOBAL HEALTH; HEALTH STATUS DISPARITIES; HEALTHCARE DISPARITIES; HUMAN RIGHTS; HUMANS; POLITICS; POVERTY; PUBLIC HEALTH ADMINISTRATION; SOCIOLOGY, MEDICAL;

EID: 57049111610     PISSN: 10790969     EISSN: None     Source Type: Journal    
DOI: 10.2307/20460084     Document Type: Article

References (33)

1. The present article is based in part on the keynote address delivered at the 134th Annual Meeting of the American Public Health Association, Boston, MA, November 5, 2006. The earlier American Journal of Public Health article referred to is: P. Farmer, "Pathologies of Power: Rethinking Health and Human Rights," American Journal of Public Health 89 (1999): pp. 1486-1496.
2. See also a booklength exploration of the topic: P. Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley, CA: University of California Press, 2nd ed., 2005).
3. H. Englund (ed), A Democracy of Chameleons: Politics and Culture in the New Malawi (Blantyre, Malawi: Christian Literature Association in Malawi, 2002): p. 12.
4. A. Sen, Development as Freedom (New York: Knopf, 1999).
5. C. A. Odinkalu, "Why More Africans Don't Use Human Rights Language," Human Rights Dialogue 2/1 (New York: Carnegie Council on Ethics and International Affairs, Winter 2000). Available at: http://www.cceia.org/resources/publications/dialogue/2_01/articles/ 602.html.
6. J.Y. Kim and P. Farmer, "AIDS in 2006 - Moving Toward One World, One Hope?", New England Journal of Medicine 355 (2006): pp. 645-647.
7. P. Farmer, F. Léandre, J. S. Mukherjee, M. S. Claude, P. Nevil, M. C. Smith Fawzi, et al., "Community-based Approaches to HIV Treatment in Resource-poor Settings," Lancet 358 (2001): pp. 404-409.
8. P. Farmer and J. Kim, "Surgery and Global Health: A View from Beyond the OR," World Journal of Surgery 32/4 (2008): pp. 533-536
9. L. Ivers, E. Garfein, J. Augustin, M. Raymonville, A. Yang, D. Sugarbaker, and P. Farmer, "Increasing Access to Surgical Services for the Poor in Rural Haiti: Surgery as a Public Good for Public Health," World Journal of Surgery 32/4 (2008): pp. 537-542.
10. C. Menéndez, C. Romagosa, M. R. Ismail, C. Carrilho, F. Saute, N. Osman, et al., "An Autopsy Study of Maternal Mortality in Mozambique: The Contribution of Infectious Diseases," PLoS Medicine 5/2 (2008): p. e44. doi:10.1371/journal.pmed.0050044
11. S. Lucas, "Maternal Death, Autopsy Studies and Lessons from Pathology," PLoS Medicine 5/2 (2008): p. e48. doi: 10.1371/ journal.pmed.0050048.
12. R. Jean-Louis, "Diagnostic de l'état de Santé en Haïti," Forum Libre (Santé, Médicine et Democratie en Haïti) 1 (1989): pp. 11-20.
13. World Health Organization, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA (Geneva: World Health Organization, 2004). Available at: http://www.who.int/ reproductive-health/publications/maternal_mortality_2000/index.html.
14. Physicians for Human Rights, Deadly Delays: Maternal Mortality in Peru. A Rights-Based Approach to Safe Motherhood (2007). Available at: http://physiciansforhumanrights.org/library/report-2007-11-28.html.
15. Tarek Meguid, the obstetrician who led me through Malawi's largest maternity hospital, wrote that "one does not claim to be in possession of the magic bullet that will solve the problems of health care delivery in rural Africa. On the contrary, I do not believe in bullets, magic or not." T. Meguid, The Challenge of the Periphery (Capetown, South Africa: HARPS Publishers, 2001): p. 5. Since my first visit to this hospital, Scottish philanthropist Sir Tom Hunter has spearheaded an effort to rebuild Malawi's largest obstetrics hospital.
16. In a comprehensive recent report, PHR summarizes the findings of several studies on the African brain drain: "The vast majority of students in Africa attending health training institutions attend public schools, where tuition is paid for primarily or exclusively by the government. When physicians, nurses, and pharmacists trained in these institutions leave the country, a significant public investment leaves with them. It has been estimated that developing countries spend about $500 million annually on training health professionals who migrate to developed countries. In South Africa, where training a physician costs about $61,000-$97,000 and training a nurse costs about $42,000, the overall loss to that country for all health professionals practicing abroad may top $1 billion." Physicians for Human Rights, An Action Plan to Prevent Brain Drain: Building Equitable Health Systems in Africa (Boston, MA: Physicians for Human Rights, 2004). Available at: http://physiciansforhumanrights.org/library/report-2004-july.html.
17. G. Raviola, M. Machoki, E. Mwaikambo, and M. J. D. Good, "HIV, Disease Plague, Demoralization and 'Burnout': Resident Experience of the Medical Profession in Nairobi, Kenya," Culture, Medicine and Psychiatry 26 (2002): pp. 55-86.
18. Centers for Disease Control and Prevention, "Emergence of Mycobacterium Tuberculosis with Extensive Resistance to Second-line Drugs - Worldwide, 2000-2004," (MMWR) Morbidity and Mortality Weekly Report 55 (2006): pp. 301-305
19. Harvard Medical School, Open Society Institute, The Global Impact of Drug-Resistant Tuberculosis (Boston, MA: Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, 1999).
20. P. E. Farmer, B. Nizeye, S. Stulac, and S. Keshavjee, "Structural Violence and Clinical Medicine," PLoS Medicine 3 (2006): p. e449
21. S. Shin, J. Furin, J. Bayona, K. Mate, J. Y. Kim, and P. E. Farmer, "Community-based Treatment of Multidrug-resistant Tuberculosis in Lima, Peru: Seven Years of Experience," Social Science & Medicine 59 (2004): pp. 1529-1539
22. H. L. Behforouz, P. E. Farmer, and J. S. Mukherjee, "From Directly Observed Therapy to Accompagnateurs: Enhancing AIDS Treatment Outcomes in Haiti and in Boston," Clinical Infectious Diseases 38 (2004): pp. S429-S436.
23. One recent review addresses, perhaps sympathetically but certainly out of need, the question of whether or not community health workers are cost-effective. D. G. Walker and S. Jan, "How Do We Determine Whether Community Health Workers Are Cost-effective? Some Core Methodological Issues, Journal of Community Health 30 (2005): pp. 221-229.
24. D. A. Walton, P. E. Farmer, W. Lambert, F. Léandre, S. P. Koenig, and J. S. Mukherjee, "Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons from Rural Haiti," Journal of Public Health Policy 25 (2004): pp. 137-158.
25. P. Freire, Pedagogy of the Oppressed (New York: Continuum Books, 1993).
26. N. Krieger, "Epidemiology and the Web of Causation: Has Anyone Seen the Spider?" Social Science and Medicine 39/7 (1994): pp. 887-903.
27. For more information on Global Health Delivery, a joint project of Harvard Medical School's Department of Social Medicine and Harvard Business School's Institute for Strategy and Competitiveness, see: http://www.hbs.edu/rhc/global_health.html.
28. The National Economic and Social Rights Initiative (http://www.nesri.org) "promotes a human rights vision for the United States that ensures dignity and access to the basic resources needed for human development and civic participation. Towards this end, NESRI works with organizers, policy advocates and legal organizations to incorporate a human rights perspective into their work and build human rights advocacy models tailored for the U.S."
29. A recent article in Amnesty International's newsletter details the commitment of its new executive director, Larry Cox, to advancing social and economic rights alongside the organization's longstanding activism in the realm of political rights. L. Jamison, "A Commitment to Change," Amnesty International 32 (2006); pp. 10-12.
30. C. Anderson. Eyes Off the Prize: The United Nations and the African American Struggle for Human Rights, 1944-1955 (New York: Cambridge University Press, 2003).
31. "Human-rights" organizations have in fact often undermined the rights movement in Haiti - and this is true whether one considers civil rights or social and economic rights. This sordid tale is only now coming to light: see, for example, the in-depth consideration offered by Peter Hallward (P. Hallward, Damming the Flood: Haiti, Aristide, and the Politics of Containment [London: Verso Press, 2008])
32. also the account by human-rights lawyer Randall Robinson (R. Robinson, An Unbroken Agony: Haiti, from Revolution to the Kidnapping of a President [Philadelphia: Basic Civitas Books, 2007]). For ongoing coverage of the mechanisms by which the governments of the United States, France, and Canada joined forces with the anti-democratic - and thus anti-rights - elite in Haiti to unseat elected governments in Haiti, see http://www.ijdh.org, which has sought to document the fate of the democracy and rights movements in Haiti in recent years.
33. N. Klein. The Shock Doctrine: The Rise of Disaster Capitalism (New York: Metropolitan Books, 2007); all quotations are taken from pp. 118-119.