The Cyclical Dilemma: Health & Social Justice

A year ago I was lucky enough to study with Professor Doug Band about all issues public-policy related. The time we spent reading and learning about the public health care system was surely one of the most intriguing units, as we read the writings of Paul Farmer and had the opportunity to personally engage in a discussion with him as he visited our class.

Below are some thoughts I began to develop last year…

In Farmer’s Pathologies of Power, Farmer asserts that poor health is a result of structural violence, asking the question of whether the true target of social justice ought to be changing the structural economic and violent conditions, rather than health conditions.

Farmer calls for a sort of moral renewal, where the rich will cease to blame the poor for their conditions and will feel a newfound obligation to assisting the poor. In the article “Why Must the Poor Be Sick?” author Jeffrey Sachs constantly reaffirms Farmer’s humanity as he discusses Farmer’s book Pathologies of Power. Perhaps the most provocative of Farmer’s assertions that Sach’s calls upon is that “the poor are not the victims of their sins but of their circumstances.”(Sachs) Farmer believes that if the well-off can stop seeing the poor as lesser people and begin to truly be compassionate toward the poor, that the better off will then give their money to supporting the poor in their struggles. This marks a critical change in thought in regards to rich people’s views of social justice. The problem is not a lack of money, as many would argue, but rather a lack of compassion.

But transforming health care may not be the solution, in fact, to transforming poor societies. Farmer himself says the poor are not in their given conditions because of misbehavior but because of “the structural fabric of their societies.” (Sachs) If this is the case, one must wonder what the purpose is indeed of providing better health care if the structural systems will ensure the poor continue to be sick.  In Farmer’s “Challenging Orthodoxies: The road ahead for health and human rights,” he says the global human rights community needs to add the right to health care as a fundamental social right. Couldn’t one argue, however, that by achieving civil justice the structural fabric that holds the poor back will be effectively changed, allowing them to leave the conditions that keep them sick. Farmer makes a valid point that without the access to health care the poor can never hope to gain any advantage from the civil rights the global community now fights for.

The problem then appears to be a cyclical one. Which must be ended first- civil injustice, or health injustice? Hopefully the choice is not either/or but rather as both issues are targeted, they will slowly be fixed together. Farmer makes clear, however, that good health is an imperative to anyone’s challenge of leaving poverty. What’s more, it is far more affordable than anyone can admit, and with only a small amount of money in terms of the world’s economy, close to eight millions lives could be saved in just one year.

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1 comment
  1. OK – lots of issues here. Can you offer a citation for saving 8 million lives each year? Through what means/action? But backing up some, you raise important and not easily answerable questions, though lots of data points can inform a road to understanding the tradeoffs better. Some points, all under the heading of A Step at a Time:

    1) Farmer’s certainly right in pointing out that the problem is structural – though violence is a scary (and he would assert) necessarily harsh word. In a world/country where me-ism has taken such strong root, Tea Party is a euphemism for Scaredsh*tless Whites Only, and progressive change is nearly impossible in our frozen bicameral apparatus, aiming to modify our health care system is more doable than rebuilding the whole economic structure. Modifying our health care system, difficult as it is (and Obamacare didn’t come near in what it should do, though it has positive elements), is more within reasonable sight than the structural violence that Farmer calls for. Witness the Occupy Wall Street, Occupy DC, and their Israeli doppelganger movements last year (the last notable for involving some 10% of the WHOLE population). As passionate and rightsounding and HUGE as they were, well, one year later, uh, so what.

    DONTGETMEWRONG. We get nowhere without the BIG DREAMS and the BIGGER DREAMERS. We got nothin without them. Exhibits A: USA, B: Abolition, C: STATE OF ISRAEL. But taking short steps forward when we can’t figure out the great leaps (no Mao sarcasm intended) is not failure. (Old saw: Greatest enemy of the good is the best.)

    2) Structural violence may indeed be called for, but we don’t know whatthehellkind of violence we need to do. The fragility of the European mildly socialistic economies, the hardtojustify inequities between social securities (not talking Social Security here) of American public sector and private sector employees, and the maddening sense of entitlement of so many in this country (“it exists, therefore I should have it”) have muddied the clarity of the “right” way to structure society. It does indeed seem that “health care” should be a basic civil right in a humane society. But defining that is a bear. And we run from bears. Do all people have a right to their own biological children? Do I have to pay for her abortion (which I define as murder)? Do you have the right to chemo that could prolong your life expectancy from 6 months to one year? We have reason to run from bears – we don’t know how to tame them.

    3) We live in a democracy. Horrible messy inefficient awful way to run a place. Also, best we’ve figured thus far. The issues to untangle are incredibly complex: national/international economics, incomplete/conflicting indices of social welfare, manipulative/misleading political machinery, medical/psychosocial measures of health and wellness. Most of us understand all of these at a largely superficial level. If we want our democracy to sort through these effectively, the objectives before us are daunting.

    NOT trying to be a naysayer, nor to be a stumbling block. AM saying that while we need Farmer to light the destination, we need those like Daniel Patrick Moynihan and Mike Bloomberg (even Nelson Rockefeller! The man tried, but he was wrong…) who are willing to slog through the muddy trenches TRYING STUFF along the way to see what works.

    Public policy has got to be one of the most interesting of the social sciences: it touches EVERY single aspect of living.

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