Pathologies of Power: Rethinking Health and Human Rights in the Global Era

Paul Farmer introduced the second week of the January Series with a talk entitled “Pathologies of Power: Rethinking Health and Human Rights in the Global Era“. Farmer works with Partners In Health seeking “to provide a preferential option for the poor in health care”. His primary work has been in Haiti and many of his examples were drawn from the successful community health programmes his team has initiated there, but also peppered with anecdotes from extensive travelling exploring the multi-faceted issues of healthcare.

Building from principles found in the Universal Declaration of Human Rights, Farmer’s talk was often cluttered and unfocussed, but contained compelling insights from a passionate campaigner.

The main gist of the talk was that cost-benefit analyses of treatment options for diseases such as TB and HIV/AIDS are often short-sighted. While cost-benefit analysis is a useful tool, too often the results of studies are peppered with conventional wisdom (which he argued can often be wrong, using three statements from the WHO and two from The Lancet as examples) and fail to analyse the costs of not taking action. When exploring the latter, he drew out the example of a community in Kenya where an entire generation has been wiped out by HIV/AIDS, but didn’t quite complete making his point which I presume was that the social cost of an entire generation of parentless children having to recreate society for themselves could be immense.

Farmer’s anecdotes about the ways his organisation has sought ways to make use of the particular details of the communities they work with was inspiring. In rural Haiti they found themselves working with a community with no money and 80% unemployment. That unemployment had led to many social problems, but it also meant there was a large population they could pick from to train community health workers, meaning that everyone in a treatment programme can be assisted and supervised by one of their neighbours. This in turn freed up the organisation’s workers to negotiate considerable discounts with pharmaceutical firms. In one case, the cost reduction negotiated was 95% which, as he noted, raises serious questions about the initial pricing.

In the realm of human rights, healthcare and a number of related issues, public scrutiny remains vital. As Farmer pointed out, HIV/AIDS is one area which has risen to government attention of late largely as a result of public pressure. With his example of medical profession received wisdom that could be effectively debunked by an inquisitive public Farmer reminded me of the importance of detailed scrutiny from that public and the need for still further tools to enable that. Programmes to open up consultation documents for simpler dissection within the blogging community (and, I’d hope, overspilling beyond that) are a good start, as are discussions such as this one at Personal Democracy Forum, but engaging public discourse in issues that matter is always going to be a task that requires the very best of our imaginations.

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