public health
Dr. Paul Farmer “I’m a cheerleader for the market economy as long as it’s not hurting people and as long as you have those safety nets to catch people when they fall.” Credit: Mike Cohea/Brown University

Up close with students, Paul Farmer discusses inequities of economics and disease

It’s a rare treat when a major international figure sits in on a class and participates. Students in Mark Lurie’s “Health and Human Rights” class had that chance when Dr. Paul Farmer paid them a visit.
By David Orenstein  |  October 5, 2010  |  Email to a friend

Paul Farmer is a physician in high demand, with a calling to help the poorest of the world’s poor. But on Monday when public health concentrators in a senior seminar class sought wisdom beyond the pages of one of his books — their assigned text — he made a house call.

Farmer, who is also an anthropologist at Harvard and a major figure in global health equity, spoke to about 30 students in Mark Lurie’s “Health and Human Rights” class.

Rather than delivering prepared remarks, as he did before a much larger audience on the subject of Haiti later in his day at Brown, he dedicated the hour to answering student questions. They ranged from how they, as future global health workers, could better involve the communities they serve, to the role of cost-effectiveness in public health decision making.

Lurie, assistant professor of medical science, acknowledged that he’s not always able to give his students such intimate in-person access to the authors he assigns, much less the famous ones. “It’s a rare treat,” he said.

The doctor makes a house call: Students in Mark Lurie’s “Health and Society” class are reading a book by Paul Farmer. They had a rare treat: The door opened, and in he walked. The doctor makes a house call Students in Mark Lurie’s “Health and Society” class are reading a book by Paul Farmer. They had a rare treat: The door opened, and in he walked. After the session, one of the students readily confessed to being “a big fan” of Farmer, a prolific author who is perhaps best known as a co-founder in Haiti of the now global NGO Partners in Health and the Institute for Health and Social Justice.

Although Farmer is noted for providing groundbreaking AIDS and tuberculosis treatment in Haiti and elsewhere, almost all of his discussions with the students Monday focused on economics. He expressed a simultaneous acceptance and lamentation of market forces as a central influence in the mission of global health causes.

For instance, when a student in the front row asked that question about community involvement, Farmer said the short answer was “jobs,” suggesting that financial empowerment — he teased the students that the “e-word” is overused everywhere and especially at Brown — is essential to any assurance of sustained public health. A critic of unfettered markets, he offered that jobs, like health care and housing, should be considered a right.

But that was only after he had acknowledged, in response to a question about the impact of globalization, that the market will be essential to Haiti’s recovery.

“We are kind of stuck with the world we’ve got,” Farmer said. “Haiti is enmeshed in an economic framework that is centuries in the making. ... Right now we’ve got to get more investment in Haiti — better jobs and greener jobs. That’s not going to mean letting Haiti be out of the international market economy. On the contrary.

“I’m a cheerleader for the market economy as long as it’s not hurting people and as long as you have those safety nets to catch people when they fall, as they invariably do,” he said.

Farmer also fielded a question from Lurie, who asked what condition he would say global health and human rights are in, if those fields were a patient.

Farmer noted that when he wrote some parts of the book the class is reading, Pathologies of Power: Health, Human Rights, and the New War on the Poor, as many as a dozen years ago, things looked terribly bleak. Now, after major initiatives like the President’s Emergency Plan for Aids Relief and The Global Fund to Fight AIDS, Tuberculosis and Malaria, they’ve pulled away from the brink.

“The patient is on life support [and] intubated,” Farmer said, “but things are better than they were 12 years ago.”

Soon it will be up to the students he was addressing — the next generation of public health workers — to get the patient out of bed and breathing easier.

Community health senior Akinyi Shapiro left Farmer’s visit feeling inspired.

“Talking to Paul Farmer face-to-face made the realities of public health issues far more immanent for me,” she said. “He has done much in the field for people who have lost much of their dignity in the past to public health errors [such as] using cost-effectiveness as a measure for ignoring their lives.”