Health, Equity, and Political Economy: A Conversation With Paul Farmer

Fitzhugh Mullan


Health Affairs. 2007;26(4):1062-1068. 

In This Article

Abstract and Introduction

Physician, anthropologist, and pied piper for global health equity, Paul Farmer is one of the world's leading voices for health and development. His mix of applied humanitarianism, scholarship, and charisma have brought focus to the plight of the world's poor and demonstrated that strategic health and socioeconomic interventions can make a difference. In 1987 he cofounded Partners In Health, an international organization that works to provide care in resource-poor settings around the world. In this interview with Health Affairs contributing editor and global workforce expert Fitzhugh Mullan, Farmer talks about the state of global health and the interplay between health, equity, and political economy.

Fitzhugh Mullan: You've been working on global health—really, global health equity— for most of your adult life. A lot has changed since you first went to Haiti as a student in 1983. How are we doing? Has the world made progress in regard to global health?

Paul Farmer: If we look at the possibilities now compared to twenty years ago, I think we are doing better. The world is paying more attention to the diseases of poverty: There is new concern about malaria and tuberculosis [TB], and we are finally reaching poor people with AIDS with lifesaving antiretroviral drugs. But I also think we have to be self-critical. Things looked very up in the 1970s when the smallpox eradication effort proved successful, and there was a lot of optimism about transnational interventions. A lot of people came together from all over the world to try to eradicate smallpox—and it worked.

But if you look at the subsequent two decades, there have been fewer victories to point to: malaria was recrudescent; HIV came along and devastated an entire generation of young adults in some regions; TB remained a problem and has become increasingly resistant to antibiotics; and, of course, other chronic noncommunicable diseases and problems like child mortality persisted or grew. So, I think there was a high point in the 1970s, but by the end of the 1990s there were a lot of dispirited people and underfunded efforts.

Mullan: Dispirited in the sense that people had previously thought that disease eradication on a massive scale was within our grasp, but, in fact, it proved not to be?

Farmer: Exactly. Whether you talk about infant mortality or infectious disease, funding never really was sufficient. And First-World interest in the diseases of the poor—not just the ones I mentioned above, but a lot of tropical diseases—in disease control, in strengthening of health systems—seemed to falter. For a long time there was nothing like the Global Fund to Fight AIDS, TB, and Malaria, which came into being only four years ago; there were few new multilateral programs. There was really no support for treatment efforts that could strengthen health systems in poor countries.

Now, in 2007, there are many new initiatives to fund such efforts. The Gates Foundation, to the surprise of many, declared itself dedicated to finding solutions to the health problems of the world's poor. This was unprecedented. There is a lot about which we can be optimistic and a lot of reasons why we have the chance to make real progress. Now we have to show we can do it.


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