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The cost of inaction in the face of inequality is violence, Dr. Paul Farmer told an overflow audience as he delivered the 2005 Gustuv Pollak lecture at the Kennedy School Tuesday night. Farmer, a physician and medical anthropologist committed to serving the destitute sick, co-founded the organization Partners in Health (PIH) in Haiti in 1987, which now has projects in Russia, the Americas, and Africa.
“There is all of this ideological freight,” Farmer said, “and also the freight of history, pushing up against the reading of social facts in places like the ones in which I work, the dangerous and difficult or post-conflict places.” In assessing the risks of the work that PIH does — both the risk of lending legitimacy to bad governments and the risk of danger to himself and his coworkers — Farmer explained that good governance is not a criterion for their engagement. Need is the principal criterion.
“Our mission is making a preferential option for the poor,” Farmer said. “It sounds grand, or maybe to some people even silly, but it is a very good way of staying focused in the middle of turmoil. One of the big problems with using the quality of governance as a criterion for service is that, of course, some of the places with the worst governments have the greatest need, and there’s a direct correlation there.”
The work of PIH and Farmer involves delivering the most basic health care as well as combating the most challenging epidemiological problems of our times: HIV/AIDS and drug resistant tuberculosis. Along with these, Farmer and PIH combat the social forces that contribute to lack of access to the benefits of modern medicine. Farmer invited the audience of public policy educators and students to engage with him in recognizing a shared stake in the problems of the poor.
“If people with policy experience and training…take a problem that has been considered a private problem — AIDS has been considered a private problem — and think of it as a public problem they can make the response to it a public good. That happened with tuberculosis and that’s because it’s airborne,” he said. “If we could move more of these problems into the realm of public good and deal with them collectively rather than piecemeal, I think that would be a huge step forward for these major epidemics.”
Farmer told his audience that he found it tremendously inspiring that they came to hear ideas such as his discussed at the Kennedy School because it meant that they must already be considering the cost of doing nothing.
“If we continue to make grave errors in the management of problems like the ones we discussed tonight, whether they be mass violence or mass dyings due to epidemic disease, there is a cost, and the cost is violence…that’s the cost that we’re all going to pay if we don’t think about some of these problems,” he concluded.
Photos: Martha Stewart