Pathologies of Power Review by Emma Adkins


“There is no doubt that the only way to love the poor is to struggle for their liberation.”(Farmer 2003, 145). The full title of this book is Pathologies of Power: Health, Human Rights and the New War on the Poor. Paul Farmer, a highly experienced medical anthropologist is the writer of this ethnography. He is a well-known advocate for promoting equity in healthcare systems.

In this book he discusses a wide array of topics relating mostly to health issues that encompass those in poverty. Often when ethnographies are discussed people tend to think about a description of a particular culture. Take Hugh Brody’s “Other Side of Eden” for example. This was an ethnography highlighting different cultural aspects of the Northern Inuit people. Farmer’s ethnography however, is a little different. Simply put, his book is an ethnography of the poor.

In the beginning he defines the role of structural violence in society. It is a concept which underlines the trickle-down effect of how systems disadvantage individuals. Sen Amartya (2003, xiv), who writes the forward for the book, express his viewpoint on Farmers approach to the discussion of structural violence. “While keeping his eyes firmly on the general picture as he sees it, he goes from one case study to another to explain what, ‘structural violence’ is like (or how disparity of “power” may operate)”.

Through such case studies, Farmer emphasises the importance of giving a voice to those who might not otherwise be heard. A person may be born, struggle to live and then die from an easily preventable cause. Taking a moment to acknowledge the individuals who may have fallen victim to this tragic life pattern is exactly what Farmer strives to do. Though these stories can often be disheartening, I like what Claudio Schuftan (2012) says in his book review of the ethnography. He says, “The case studies may be depressive, but overall, they convey a message of optimism. The book not only searches for, analyzes and explains the social causes of structural violence and extreme suffering, but it also explores and deplores our collective tolerance of the social aberrations and abuses it describes”.

Within the text, Farmer discusses the topics of tuberculosis outbreaks; the rise of HIV; effects of the political, social, and economic determinants on healthcare; the influence of power on social structure; and human right issues involving the justice system. To illustrate these issues Farmer uses examples from both developing and developed nations. I believe that he does this not only to eliminate discrimination, but also to remind the readership that suffering is a reality in all societies. With the wide range of topics being discussed in the ethnography, the question of the unifying theme still remains.

The central concept which farmer is attempting to illuminate can actually be posed as a question. Are the “privileged” able to present a case for the poor and disenfranchised that not only spreads awareness about their reality, but takes further steps towards elucidating the core issues? It is crucial for the reader of this review to keep this question in mind as it will re-appear later on.

I once heard the illustration of a man standing at a river, when he suddenly starts to notice helpless children floating down a river. He of course does his best to save them, but they just keep coming. The man is now forced to make a decision. In order to maximize the amount of children he can save should he continue to struggle in the river or go directly upstream to the source of the problem? The same can be asked about issues of social justice. At what levels can the most people truly be helped; this is question not easily answered. Before diving into the main theme, Farmer discusses his desire to speak as an advocate for the “voiceless”. But he also alludes to the dangers of exposing the already vulnerable to further oppression by those who make it their mission to shield the corruption which fuels their own prosperity.

The discussion of all these issues, brings to light a second question. What type of audience does Farmer intend to target? For any author, the consideration of a target audience is one of the things that greatly impacts the style of writing, because it will elicit a very specific response. In specificity to this ethnography, I wouldn’t say that Pathologies of Power is necessarily written for a student readership. Based upon the rigidity of structure and technical jargon of the text, it seems to be geared more towards fellow doctors, other health care professionals, and anthropologists. On a less formal level, it is possible that he is also targeting those interested in human rights, social justice or humanitarian work.

Aside from readership, there are other characteristics of ethnography to take into account. One that appears in this book comes directly from Marcus and Cushman’s idea of a classic ethnography; “the native point of view.” In this book however, ‘the native point of view,’ takes a different form. This stems from the fact that the book is not a cultural ethnography per say. And so, in presenting much of the information in the book as stories, Farmer allows for the personal experiences of others to be acknowledged. In addition to this, he also features dozens of quotes from individuals (politicians, journalists, victims…etc) who actually experienced the events that he may not have witnessed himself. Perhaps what struck me the most about his method of writing is that despite the rigidity in the text, the tone and personal stories had the power to evoke such emotion. Showing the reader (whether they can identify or not) what it means to truly suffer.

Finally, it can be said that throughout his book, Farmer inspires a way of thinking that I think is absolutely crucial for critical analysis. What do I mean by this? Very simply put, he shows the audience how to read between the lines.

When it comes to controversy’s involving health care, there are many variables to be considered: politics, social determinants, economics, and so on. In a way he is asking people to understand that things are not always as they appear. This can be seen in current medical provisional systems, in which healthcare has been transformed from being a service, to taking the form of a business, with the intent of garnering a profit. In his review, Ben Brucato, discusses the hierarchy of western medicine. “Farmer is sharply critical of the purposes of the market approach to medical care, and the net effect this has had on the health of the world’s poor. Calling upon the ethical argument of economist, Amartya Sen, and of liberation theologists, the authors positions the overall health and the lack of suffering as a moral priority above any concerns for the market economics” (Brucato, 2011).

Recognition that what is often presented to the public by governments, top organisations, and even media, is often a smokescreen, is crucial for society. Sheer violations of human rights occur every single day, and often they are committed by those who possess the power to prevent them. The irony being that many times the offenders pose as advocates against structural violence and crimes against humanity. Sadly, this reality continuously manages to elude the attention of many people today. However, this does not discourage Farmer from trying to shed some light, and raise awareness. This brings us straight back to the central concept, which was previously introduced in the form of a question.

In hindsight, this is an excellent and well written book. Paul Farmer is clearly passionate about the subject for which he speaking and the people for which he has tirelessly worked to help. I recommend the book to anyone willing to expand their perspective about those who occupy a vast majority of Earth’s population, the poor. Statistically speaking, according to the Global Monitoring Report put out by the World bank in 2015, about 10% of the world’s population lives on less than 2 dollars a day (Global, 2015 ). This book illuminates the potential issues that that people at such levels of destitution may face; as poverty and sickness often go hand in hand. But like I stated early, Farmer does not limit his discussions to the lives of those living at this extreme level of poverty. People of all economic backgrounds are the same in that despite their specific reality they each face the daily struggle that accompany the human condition. I would like to revert the attention back to the first quote regarding the liberation of the poor, because it is crucial. Farmer finally states, “This liberation will consist, first and foremost , in the liberation at the most elementary level—that of their simple, physical life, which is what is at stake in the present situation” (Farmer 2003, 145).


Schuftan, Claudio. 2012. “Review of Pathologies of Power: Health, Human Rights and the New War on the Poor, by Paul Farmer, University of California Press” Journal of Health Population and Nutrition. Volume 21(3): page-page. Accessed on March 30, 2017

Brucato, Ben. 2011. “Review of Pathologies of Power: Health, Human Rights and the New War on the Poor, by Paul Farmer, University of California Press, 2003” Accessed on March 30, 2017.



Shellekens, Phillip et al., 2016. “Global Monitoring Report.” World Bank. Accessed on March 30, 2017.


Farmer, Paul. 2003. Pathologies of Power: Health, Human Rights and the New War on Poverty., London: University of California Press