Paul Farmer (2003).

Paul Farmer (2003). “Rethinking Health and Human Rights” in Pathologies of Power. Berkeley: University of California Press.
In this chapter Paul Farmer is trying to show how the same definition of human rights (HR) is open to contestation and discussion when considering it in a narrow or wide way. He takes the case of Russian prisoners in the attested prisons after the collapse of the USSR in which prisoners (under illegal long pre-trial detentions) are dying of TB in spite of having access to medication. Farmer shows that many social, economic and legal factors are interplaying to produce this sickly situation for the prisoners. Prisoners are first held in overcrowded jails, then in TB colonies, and are receiving old medication that does not do anything to the resistant type of TB they are experiencing. So for Farmer HR should be considered as economic and social rights, prisoners in Russia in TB colonies, having developed multidrug-resistant tuberculosis (MDRTB) are untreatable in such conditions. But many international HR organizations of wealthy donor nations using the logic of cost-effectiveness say they cannot give the right medication (not resistant) because they are too expensive for developing countries. But this argument of cost-effectiveness fails to consider that the majority of the drugs use in the treatment is old and so off-patented. Farmer shows that in poor countries such as Peru or Haiti MDRTB can indeed be cured. He also highlights that public health and access to medical care are social and economic rights. In other words, in order to understand violence inflicted over individuals we need to consider the deep-rooted structural violence that caused it and its relation with HR, according to Farmer, we need to develop a pragmatic solidarity. One problem I see, that Famer is very aware is the divergence between HR discourses and declarations at the international and national levels of jurisdization and the real experiences in which people live and the facts they face on everyday basis. If HR are not seen narrowly, if they are seen as economic and social rights the contradiction between HR discourse and real life is even more pronounced. So inequalities in health are difficult to reconcile because the same state that violates social, economic and civil rights creating wider inequalities is eager to cover these same violations. Many HR organizations are also very tied to economic, social and state powers. So the “pragmatic solidarity” is not only to denounce these violations but also to actually help the sufferers moving beyond the “blaming the victim” discourse. There is a need for moving beyond the analysis to find useful strategies for the poor and in need. Is to move from “who did what to whom, and when?” to “what is to be done?” Farmer suggests that in order to find strategies that would really work they need to put a new agenda of health and human rights, and make health and healing the symbolic core of the agenda. So in a way is to “medicalize the human rights” and Farmer considers this because he saw it can work, for instance with the Russian prisoners when the debate started to be a medical debate and not a legal or prison reform debate, the situation for the prisoners, the need to control the epidemic and to cure the prisoners started to change. And in doing so the sick and abused need to be listened and be part of the solutions. Finally I think one important issue is to re-consider the role of the state. States that legitimate growing inequalities and are urged to do more but are the same time are dispossessed (or portraying they are) of the means to alleviate these inequalities, basically the social and economic rights of the poor. I overall think that this chapter is showing the contradictions that HR organizations and researchers/activists have when trying to help to reduce the social inequalities. They are working within the frame of the state but trying to criticize and resolve some of the damage produced by the same state. So I agree with Farmer that we need to move beyond a narrow consideration of HR to a broader one in which economic and social rights of the poor are included. And a pragmatic strategy is needed if one wants not to reproduce what is not working and to find solutions that work for the people that need them. Sometimes considering "the poor" as a category seems over-simplifying but I do see his approach, with his loing experience in the field, as valuable and worth thinking.