Product Description: Paul Farmer has battled AIDS in rural Haiti and deadly strains of drug-resistant tuberculosis in the slums of Peru. A physician-anthropologist with more than fifteen years in the field, Farmer writes from the front lines of the war against these modern plagues and shows why, even more than those of history, they target the poor. This "peculiarly modern inequality" that permeates AIDS, TB, malaria, and typhoid in the modern world, and that feeds emerging (or re-emerging) infectious diseases such as Ebola and cholera, is laid bare in Farmer's harrowing stories of sickness and suffering. Challenging the accepted methodologies of epidemiology and international health, he points out that most current explanatory strategies, from "cost-effectiveness" to patient "noncompliance," inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Yet this moving account is far from a hopeless inventory of insoluble problems. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians determined to treat those in need. Infections and Inequalities weds meticulous scholarship with a passion for solutions--remedies for the plagues of the poor and the social maladies that have sustained them.
Where are the Virchows of global public health? The context of epidemics is important. What happens to the poor people who have drug resistant tuberculosis? Market mechanisms do not serve the interest of global health equity. The cost-efectiveness argument is weak. Poverty limits freedom of choice. AIDS education falls short. Arguments about limited resources should not prevail. There is a global web of unequal relationships. Structural violence and cultural difference have been conflated in AIDS studies.
Anthropology and medicine have blind spots. Virchow understood medicine had biologic and social underpinnings. There is not enough high-tech medicine to go around. Inequality itself is a pathogenic force. The author's interpretation of modern plagues has been shaped by work in Haiti and Peru. As scientific and medical communities tried to make sense of AIDS, the author was drawn into the discipline of the sociology of knowledge. World systems theory, one of the newer anthropological theories, could posit that Paul Farmer of Harvard and Haiti is a conduit for resources.
In many instances of disease emergence, social topography is more important than geographic topography. The differential political economy of risk is described. The major risk factor for AIDS is poverty. Personal agency has been exaggerated. From typhoid to tuberculosis to AIDS, blaming the victim is a theme in the literature. Being sick results from structural violence, not from bad personal choices. The author lived in a village in rural Haiti when both AIDS and political violence arrived. Haitian cases of AIDS defied the risk-grouping descriptions prevalent in the 1980's. The Haitian epidemic of AIDS originated in the United States.
Recent circumstances in Haiti include deepening poverty, gender inequality, instability. The author and other physicians and health workers have learned that a belief in sorcery among Haitians does not preclude adherence to a biomedical regimen. Furthermore, high cure rates for tuberculosis, (often a twin affliction of AIDS), are possible in settings of extreme poverty. Juxtaposing treatment with prevention are false debates.
The author has traced the march of inequality as it affects health care in a myriad of ways. Endnotes and an extensive bibliography follow the text of this excellent work. Everyone should buy it, everyone should read it.
Buy it. Read it. An enlightening and insightful book that passionately sets a higher standard for those involved in medicine or any type of humanitarian work. He is passionate about what he says, but careful not to make assumptions that have not been well documented and researched. The book challenged my thinking when it comes to health care, poverty, and our social duty to take action against injustices in the world.
Infections & Inequalities by Paul Farmer Too long . Written with sientific dicipline & detail and burdened by too much specialized medical terminology for the popular reader . The idealism is admerable and the conclusion are justified but it speaks to the medical profession more than to the general public . A slow diffucult book to read . Sombody else should write the same book for the popular reader and for leaders in public policy .
careless errors, mediocre conclusion By claiming "social reform," Farmer contradicts his stance as an American citizen: Haiti has no money to support its own citizens, that's why the US and others are doing Haiti's job. But, the US has to care for its own citizens as well therefore has to first work on its own AIDS patients within its boundary. If the US does that as its social reform, Haiti instantly dries up.
Irritating mistakes somehow got through inspection: PAligre Dam? PEligre? (P. 174) PuertO Plata? PueltA? (P. 119)
Medical-anthropological approach to HIV & TB illuminates roles of inequality and poverty in spread of disease Farmer, a physician-anthropologist and activist, examines both the way that poverty and inequality result in the spread of HIV and TB today and the flawed justifications for inequitable access to treatment. His ethnographic analysis provides a powerful complement to standard epidemiological work, and this treatise on the danger as well as the immorality of inequity in medical care is largely convincing.
Farmer illustrates several broad themes effectively with case studies from Haiti and Peru. One is the idea that most studies overemphasize individual agency, failing to recognize serious "structural" factors, such as the pressure that extreme poverty exerts on people to engage in unhealthy behaviors and the problems introduced by economic inequality. (One example of the latter is that in unequal countries like Peru, second-line TB drugs are available because of demand by the rich, so doctors also prescribe them to the poor who can only afford them intermittently, which generates drug-resistant strains of the disease.) Another theme is that people in rich nations tend to place heavy weight on "strange" cultural beliefs and customs in explaining high disease prevalence, whereas actual epidemiological research tends to show that these factors carry little weight relative to poverty-related factors. While he uses AIDS in Haiti to illustrate this tendency, it applies perfectly to popular Western conceptions of AIDS in Africa: the popular media tend to emphasize cultural practices such as wife inheritance and a strong sex drive, whereas epidemiological research fails to support a major role for these.
A third theme, which Farmer often trumpets but not as convincingly, is that many of the trade-offs voiced by policymakers are ultimately false. One example is the question of whether to treat tuberculosis with drugs or prevent it (e.g., by investing in economic development). He then uses the success of his clinic in Haiti as an example of both treating and preventing TB. The ultimate argument is that the wealthy have no right to withhold their wealth from the poor. However, he gives us no clear sense of how the resources to generalize this to the world at large should be marshaled. While the trade-off may be philosophically false, the practical application is unclear.
But even without a plan of action, Farmer illuminates key problems in the analysis of infectious disease spread and makes a convincing plea to share the wealth (and the technology).
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