In the chapter “Rethinking Health and Human RIghts” in “Pathologies of Power” by Paul Farmer, Farmer states that reconceptualizing healthcare as a human right is a paradigm shift. It’s not completely realistic and not completely idealistic. Despite the Declaration of Human Rights, many governments still ignore the rights outlined in those documents. Farmer advocates for the participation of citizens and is highly skeptical of large organizations such as the government or private foundations.
Farmer also discusses how we rely too much on government and how government is sometimes (or usually) the source of structural violence. This aspect of the chapter relates to how governments violate human rights through genocide… too many times the actions of other government spill structural violence into other countries. For example, the Vietnam War spilled over into the neighboring countries of Cambodia and Laos. Economic conditions worsened and eventually the guerilla forces known as the Khmer Rouge were able to evacuate the capital city by lying that Americans were going to bomb the city and thereafter inflict genocide that claimed 2 million.
Although not absent, “genocide” seems to be rare nowadays. On the other hand, you could say that there is a present-day “genocide” in which the health of the people are being violated. Many times governments fail to provide for the people and even catalyze conditions that lead to health disparities.
Learn more about Paul Farmer and health as a human right: http://www.npr.org/2008/12/21/98460202/health-is-a-human-right
Recently, Nicolas Sarkozy proposed a bill to the French Parliament that would’ve made it a crime to deny the Armenian genocide. It was struck down by France’s Constitutional Council. However, the illegality of denying genocide isn’t anything novel. People have been imprisoned or fined for denying the genocide. A few individuals deny genocide probably won’t have a huge impact… and in my opinion, 13-month imprisonment seems a bit harsh for a statement that constitutes freedom of speech. However, it is another story when governments deny genocide.
A prominent example is the Armenian genocide denial. Generally, the Republic of Turkey claims that the government did not exterminate Armenian people because Muslim Turks also died in addition to Armenians. They claim that numbers of deaths have been exaggerated and that massacres were committed on both sides. This brings up the issue of the terminology of “genocide”. For example, a genocide defined by the Genocide Convention is a crime with the intent to destroy a protected group. As in the case of the death of Native Americans during European colonization, some could argue that the deaths were not intentional but in fact due to accepted laws of war at the time. Whether or not a historical occurrence is declared a “genocide” has major repercussions.
Learn more about the Armenian genocide denial: http://www.anca.org/genocide/denial.php
“The Absolutely True Diary of a Part-Time Indian” is a poignant tale by Sherman Alexie about a young boy, Junior, who struggles to find a sense of belonging between an Indian community and a white community. The novel deals with the interconnected issues of poverty, identity, racism, and health disparities. The poverty-ridden Spokane reservation is juxtaposed against the hopeful white community as the protagonist attempts to rise above stigmas and stereotypes associated with Native Americans only receive backlash from the people who lives at his reservation. Born with water in his brain, Junior is often the target of bullies.
Even though it’s a young adult novel, I felt the book definitely deserves a read, no matter what age group you’re in.
One of the most prominent issues that Alexie vividly illustrates in the novel I wasn’t initially aware about is the problem and prevalence of alcoholism in the Native American community. (Spoilers) The protagonist’s father is an alcoholic. His grandmother gets hit by drunk driver. His dad’s best friend gets shot in the face by a drunk friend who later hangs himself. His sister dies in a fire while she is drunk. Even though it was just a children’s novel, the issues that Alexie address are very real and require much attention.
Apparently 75% of all Native American deaths are related to alcohol which is highly unfortunate due to the fact that alcoholism is preventable. Alcoholism is linked with the cultural and economic situations of Native Americans; while some people attribute alcoholism to genetics, perhaps socioeconomic factors such as racism, poverty, and cultural isolation make alcohol seem attractive.
Learn more about alcoholism in the Native American community:
“All I Eat is ARVs” by Andreas Kalofons discusses the implications of antiretroviral treatment that exacerbated hunger leading to intense competition for limited resources. It demonstrates how a health treatment can result in suffering and dehumanizing effects. Therefore, political and economic concerns are sidelined by targeting a biological condition. ARVs also affect the issue of food aid. Rather than attempting to create political change, people simply seek accomodation within the status quo.
In “Strerilizing Vaccines or the Politics of the Womb: Retrospective Study of a Rumor in Cameroon” by Pamela Feldman-Savelsberg, the author explores how people in Cameroon propagated a rumor that created hysteria by deeming anti-tetanus vaccinations to be sterilizing vaccinations implemented by the government. It demonstrates how history (“historically deep” analysis according to Paul Farmer) contributes to mistrust of the government. Her article also discusses the role of women, especially because infertility contributes to female impoverishment by decreased interest from husbands.
Both articles refer to elements of public health that are supposed to help the people but instead creates detriment in the society. The idea of compulsory sterilization is reminiscent of the policies implemented during the Nazi regime in which 400,000 were sterilized by force during the 1940s. However, even in the 21st century where eugenics doesn’t seem to be to a pressing, people are wary of the government’s intentions when it comes to anything involving public health. In this article, NPR discusses how vaccine mistrust is prevalent in Africa:
The first chapter entitled “Can the Mosquito Speak?” in Mitchell’s book Rule of Experts highlights the fact that the destructive consequences of malaria was responsible for more deaths than warfare and the German invasion of northern Egypt in 1942. Yet, there are rarely any accounts of the malaria epidemic. Mitchell argues that this is because mosquitos are a non-human agent of death and are therefore omitted from the history of Egyptian development. Even though he acknowledges that humans and non-human agencies are interconnected, Mitchell’s reading encourages social scientists to look beyond simply human agencies and consider non-human agents as variables.
Mitchell’s article makes a great point; while we focus on casualties of war and genocide that are inflicted directly by humans, non-human agents such as vectors of diseases are rarely given any attention. These non-human agents are propagated by conditions created by humans but because the causality is not as apparent, human suffering is often ignored. One of the non-human agents that also catalyzes suffering is the environment. For example, when we think of the Rwandan genocide we think of violence but rarely do we consider the environmental landscape that creates the backdrop for the Rwandan genocide. Factors like soil erosion, overgrazing, land scarcity, population pressures, and wetland destruction, have all contributed to the destruction created by the Rwandan genocide.
Learn more about environmental impact on Rwanda: Environmental causes and impacts of the genocide in Rwanda … (http://www.ajol.info/index.php/ajcr/article/viewFile/63313/51197.)
In Kristin D. Phillip’s article, “Hunger, Healing, and Citizenship in Central Tanzania” the author discusses how low socioeconomic status was manipulated so that politicians can gain power by distributing food aid. Therefore, under the guise of attempting to feed the have-nots and cure famine relief, Tanzanian leaders are able to amass support. The people of Tanzania support the government because they have no one else to go to.
The article reminded me of the Cambodian genocide. After gaining independence, the newly established democratic republic government had not been doing so well which was one of the factors that allowed the Khmer Rouge communist forces to come into power and eventually commit mass genocide. When the city was evacuated, people were promised a better future and a new improved society. Instead, 2 million perished under the rule of the Khmer Rouge. Additionally, the US government supported the Khmer Rouge with aid after their regime ended because the US was fighting against the Vietnamese at the time.
These events demonstrate how many underlying political and economic forces are in play when government promises better living conditions for their citizens (i.e. by providing welfare/food aid.) When developed countries assist a poorer country, there always seems to be a hidden agenda. In a recent article about US and North Korean relationships, the US was cautious about its food aid deal for political reasons; I’m not saying we should ignore the complex relationship between countries but this article implies that politics seem to dominate over a general concern for public health.
Learn more about the US’s food aid deal with North Korea: http://security.blogs.cnn.com/2012/03/01/u-s-cautiously-optimistic-after-food-aid-deal-with-north-korea/
The founding of medical ethics can be partly be attributed to the actions of Nazi doctors during the Holocaust. These “doctors” violated the sacred contract between physician and patient. While these heinous crimes are on the extreme end of the spectrum, are doctors living up to the expectations of medical ethics today? But first, what is forefront of bioethics today? In a chapter entitled “New Malaise” in Paul Farmer’s “Pathologies of Power,” Farmer argues that no, today’s bioethics is catered towards the privileged (ethical dilemmas include genetic testing, doctor-patient relationships, life-prolonging techniques, etc.) instead of considering a large percentage of the world’s population who are living in poverty, unable to access the healthcare necessary to sustain their livelihoods. Global healthcare equity should be at the forefront of bioethics and when we say healthcare for everybody, it should be for everybody as opposed to just the privileged.
However, even if health professionals and governments adopt this mindset, I still do not believe that we will ever come close to achieving global health equity. Who is obligated to pay for a global healthcare system and how do we not allow socioeconomic status to determine who gets better healthcare? Will the affluent really be willing to sacrifice the privilege of a high socioeconomic status in order to provide healthcare for the destitute? I don’t think so. Despite the intricacies of implementing a global healthcare system, health professionals and policymakers should, however, strive for global health equity as much as possible.
Read about complications for bioethics created by the Nazi era: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1484488/