Introduction
From the class reading, Paul Farmer stresses that structural violence, or large-scale social factors, which disproportionately harm unequally positioned persons, significantly influence the recent outbreaks of new illnesses. Farmer frequently uses this idea in his research because he understands how poverty, racism, and sexism play a role in the disproportionate distribution of disease (Famer, 2009).
Large-scale social forces’ and ‘unequally positioned individuals’
In Chapter 8, Farmer expands on his concept of diseases ‘social origins,’ characterizing them as the previously mentioned ‘structural violence’ and ‘inequally positioned individuals. He then discusses how current epidemiological methodologies fail to reflect disease’s “social roots.” He demonstrates how new diseases disproportionately affect the poor and weak due to causes such as poverty, violence, and civic instability (Farmer, 2009). He highlights how the Syrian civil conflict has displaced millions of people and increased the incidence of diseases such as cholera and malaria. In Chapter 9, he discusses how “dominant analytic paradigms may conceal the basic basis of sickness origin.” He explains that the complex web of social, economic, and environmental factors that have contributed to the emergence of new diseases makes traditional epidemiological approaches to disease control, such as surveillance and contact tracing, ineffective. He claims that the previously mentioned “structural violence” and “unequally positioned persons” necessitate a more comprehensive solution. Farmer, for example, believes that “social determinants of health” should take precedence over “individual risk factors.” Recognizing that “social and economic problems, such as poverty and unequal access to healthcare, are the root causes of poor health outcomes” and trying to alleviate them is part of this (Ch.9). According to Farmer, this form of “critical epistemology” is required to resist the “structural violence” that contributes to the spread of infectious illnesses.
Structural violence
According to Farmer, knowledge of history and political economy is essential for comprehending the present AIDS and tuberculosis epidemics in Haiti and the rest of the postcolonial globe. Based on more than a decade of fieldwork in rural Haiti, this essay follows in the footsteps of scholars like Sidney Mintz, who have linked the interpretive endeavor of contemporary anthropology to a historical comprehension of the broad social and economic structures within which illness is situated (Ch.4). These diseases, which disproportionately affect Haiti’s young adults, can be traced back to the colonial legacy of slavery and prejudice that accompanied European expansion into the New World. Understanding how poverty and social inequality are materialized as an unequal risk for infection and, among those already infected, for unfavorable outcomes, including mortality, requires a syncretic and appropriately biosocial anthropology of this and other plagues. Part of the interpretive task is to link such an anthropology to epidemiology and to an understanding of differential access to the new diagnostic and therapeutic tools now available to the fortunate few, given the different modes of transmission, pathophysiology’s, and treatments for these two diseases (Farmer, 2004).
According to Farmer’s paper, “the illnesses that affect the poor have been moulded by the environment in which they live” (Farmer, 1996). He posits that the unequal distribution of these diseases may be attributed largely to the fact that those in poverty are more susceptible since they have less money to spend on health care and are more likely to reside in unsanitary conditions. For instance, Farmer mentions how most Haitians are impoverished, without proper shelter, food, or medical care (Ch.8). A “vulnerable population” which lacks access to basic utilities is at a higher risk of infection than others.
Farmer elaborates on the notion of social determinants of health in Chapter 2, stating that these forces are to blame for the unequal distribution of illnesses, with certain groups being more susceptible to infections than others. He claims that “without understanding the social causes that have caused the disparities, it is difficult to explain the unequal distribution of infectious illnesses” (Farmer,1996). That is to say, contrary to popular belief; Farmer argues that social forces like poverty, inequality, and prejudice are the true causes of the disproportionate illness burden in some populations. He also points out that those with fewer resources are less likely to receive the same quality medical attention as those with more, contributing to the unequal distribution of illnesses (Ch.4). Farmer notes in Chapter 4 structural violence and other large-scale social dynamics can be directly responsible for the spread of illness. Poverty, inequality, and discrimination are all connected to as systemic violence, he argues (Farmer, P., & Farmer, C. F. (2001). Infections and inequalities: The modern plagues. Univ of California Press.). He claims structural violence is to blame for the uneven prevalence of sickness since people with fewer means have less access to adequate medical care.
Farmer shows how some groups are disproportionately affected by the disease because of societal circumstances. He claims that “structural inequities ranging from poverty, racism, and gender-based discrimination” make “particular groups more prone to specific illnesses” (Farmer et al., 1996). He contends that these social dynamics produce a more susceptible population to infection than more affluent groups.
Lastly, Farmer provides an “epistemology of emergence” study, which is a critical look at how social influences might mask aspects of illness genesis that are otherwise obvious. Specifically, he claims that “[a] critical epistemology has to investigate what characteristics of illness onset are concealed by prevailing analytic frameworks” (Ch.2)). He claims that the prevalence of such frameworks might cause illnesses to be disproportionally distributed by hiding important details about disease genesis. He talks about how poverty, conflict and civil unrest are significant causes of the birth of new diseases, and how these diseases disproportionately impact the poor and underprivileged. He cites the example of how the civil conflict in Syria has led to the relocation of millions of people and a spike in the frequency of infectious diseases such as cholera and malaria (Ch.9).
Paul Farmer concludes in his book Infections and Inequalities: The Modern Plagues that structural violence, or widespread societal pressures, disproportionately impacts those already disadvantaged. Farmer shows how poverty, inequality, and prejudice increase the risk of infection among the disadvantaged group he examines in his examination of the social determinants of health. In addition, Farmer shows how the unequal distribution of illnesses is caused by how dominant analytic frameworks hide particular elements of disease genesis (Farmer P., & Farmer, C. 2001).
Structural Injustices
Dr Paul Farmer writes that the COVID-19 outbreak has exposed long-standing societal disparities in his book Infections & Inequalities: The Modern Plagues. Certain populations are more at risk for contracting the virus than others because of health, housing, and food disparities. He also asserts that the virus has exacerbated inequalities in diagnosis, treatment, and immunization distribution.
Farmer contends that structural violence is pain induced by large-scale social causes that establish and perpetuate uneven power dynamics amongst individuals in precarious social positions. He contends that structural violence is a key contributor to human distress and should be addressed to lessen global suffering. In order to successfully counter systemic violence, he believes, one must first comprehend how it functions.
Paul Farmer argues that structural violence, or widespread societal pressures, disproportionately affects those in less advantageous social positions and is thus a major factor in the present outbreaks of new illnesses. Farmer shows how poverty, inequality, and prejudice put people at greater risk of disease than those with more resources by analyzing the relationship between these factors and the social determinants of health. The social determinants of health and their implications for public health receive further clarification from the works of other theorists, such as Farmer (2009). The first step toward a more fair and just society is to acknowledge the role of structural violence in the unequal distribution of illnesses.
Dominant analytical frameworks
The prevalent views on illness development are frequently founded on prejudices and racism. Therefore, Paul Farmer’s comment that a “critical epistemology needs to investigate what characteristics of disease emergence are disguised by mainstream analytic frameworks” critiques these ideas. Examples of this “geography of blame,” which Farmer defines as “the inclination to assign human disasters to the shortcomings of people and social groupings, rather than to structural factors,” may be found in his book, Pathologies of Power (Farmer et al., 2006).
A prime illustration of this is the blame on Haitian citizens for the country’s HIV/AIDS crisis. According to the Farmer, Haiti was first blamed as “the genesis of the virus rather than a region where it had spread”. The widespread notion that Haiti is a “backward” and “primitive” culture contributed to the view that the spread of HIV/AIDS was the result of individual “moral failure” rather than systemic problems like poverty and political unrest (Ch.9). Because of this, the prevailing interpretive framework of the HIV/AIDS pandemic blamed Haitians for the country’s plight rather than addressing the structural causes that contributed to the disease’s rapid spread.
Another instance of this “geography of blame” is Farmer’s argument against the commonly held belief that low-income persons are less likely to follow their tuberculosis (TB) treatment regimens (Ch.8). The poor are assumed to be “irrational, indolent, and indifferent to medical advice,” as Farmer points out (Farmer et al. 1996). Farmer, however, thinks that this simplifies the situation and that there is more to it. He says that “economic and social restraints are more commonly the result of TB treatment regimen completion issues than patient indifference”.
Criticism
Farmer’s criticisms of the prevalent analytical frameworks for disease formation are just the beginning of what might be learned from other required readings and sources. For instance, “structural issues such as poverty, inequality, and racism impact health outcomes more than individual decisions,” as stated by Farmer in their work “The Social Determinants of Health: A World Perspective”. Because “social and economic situations significantly impact the capacity to comply with TB treatment,” she says this is especially crucial when it comes to TB treatment (Farmer, P. & Farmer, C.,2001). Infections and inequalities: The modern plagues. Univ of California Press. As a result, Farmer argues that measures targeting TB’s broader structural causes are necessary for the therapy to be effective (Farmer, 2004). As a result, the prevalent analytical framework of tuberculosis therapy blames the impoverished for their suffering rather than addressing the underlying structural concerns.
The conventional views on illness emergence are frequently founded on prejudices and racism; therefore, Paul Farmer’s comment that a “critical epistemology has to investigate what characteristics of disease emergence are disguised by dominant analytic frameworks” is a critique of these ideas. He uses the HIV/AIDS pandemic in Haiti and the belief that impoverished people are not cooperative with TB treatment as instances of this “geography of blame” in his book. Farmer argues that society’s most vulnerable individuals should not be unduly punished for disease outbreaks by challenging the prevailing analytical frameworks that have been used to date (Farmer, P., & Farmer, C. 2001).
Paul Farmer’s contention in his book “Pathologies of Power: Health, Human Rights, and the New War on the Poor” is that the formation of infectious illnesses is intricately linked to massive social forces and dominating ideologies that tend to obfuscate the true reasons for disease origination (Ch. 4). He argues that a critical epistemology is necessary to investigate the uneven power relations in the interdependent communities hit by pandemics.
Systemic Violence
In Chapter 2 of his book, Farmer explains his position on systemic violence. He emphasizes that the unequal allocation of a society’s wealth and power, which he calls “structural violence,” is a crucial factor in the spread of infectious illnesses. He contends that strong nations’ political and economic actions contribute to a hospitable environment for the spread of infectious illnesses by limiting people’s access to basic health care, sanitation, and nourishment (Farmer et al., 2006). He also emphasizes how prevalent analytical frameworks tend to hide issues like poverty, racism, and social injustice as root drivers of new disease outbreaks.
Farmer delves more into the Link between institutional violence and the spread of illness in Chapter 4. He points out that the effects of structural inequality, such as increased susceptibility to infectious illnesses, are typically exacerbated among marginalized communities. He gives the example of how the spread of cholera and other infectious illnesses has been facilitated by the absence of health care and sanitation in rural regions of Haiti (Farmer, 2004). Malnutrition, linked to poverty and inequality, makes people more susceptible to infectious illnesses.
Farmer’s book continues its investigation of the impact of societal dynamics on the spread of infectious illnesses in Chapter 8. He argues that globalization has promoted the spread of infectious illnesses because of the greater mobility of people, products, and ideas. Noting that the strategies of international organizations typically put economic development ahead of public health, he stresses their involvement in the spread of infectious illnesses (Farmer et al., 2006). In the last chapter, Farmer analyzes how climate change has contributed to the spread of infectious illnesses worldwide. Climate change, he says, can alter both ecosystems and migration patterns, raising the potential for the establishment of new diseases. Certain people are already more susceptible to infectious illnesses due to climate change. He points out that this predicament might be exacerbated by the unequal distribution of resources and power across states.
Paul Farmer presents a persuasive case that structural violence contributes significantly to global misery and must be addressed to minimize the quantity of suffering that happens. “On Pain and Systemic Violence: A Perspective from Below,” the study is titled. Farmer uses evidence from his studies and information from other sources to demonstrate how structural violence produces and perpetuates unequal power relations between people in unequally positioned positions, as well as how it has caused suffering in many parts of the world. His work emphasizes the need to comprehend systemic violence and create solutions to it to reduce suffering and advance the cause of justice (Farmer, 2001). In sum, Paul Farmer’s research emphasizes recognizing the widespread societal influences that help spread new infectious illnesses. He asserts that a critical epistemology is essential for investigating the power imbalance in networks of people and for revealing the characteristics of illness onset hidden by the preeminent analytic frameworks.
References
Farmer, P. (1996). Social inequalities and emerging infectious diseases. Emerging Infectious Diseases, 2(4), 259–269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2639930/
Farmer, P. (2009). Infections and Inequalities : The Modern Plagues. Univ. Of California Press.
Farmer, P. (2004). An Anthropology of Structural Violence. Current Anthropology, 45(3), 305–325. https://doi.org/10.1086/382250
Farmer, P., & Farmer, C. F. P. (2001). Infections and inequalities: The modern plagues. Univ of California Press.
Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS medicine, 3(10), e449.
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