Pathologies of Power

Pathologies of Power is a 2003 book on human rights by American physician, anthropologist, and pioneer of global health, Paul Farmer. Focusing on some of the world’s most vulnerable populations, the book seeks to refine popular notions of what the term “human rights” really means, and what its scholarly pursuits have yet to understand and fix. Farmer draws from decades of experience working in Russia, Peru, and Haiti to advocate for the fundamental rights of those who live at the margins, for reasons ranging from poverty, to racism, to illness. Farmer argues that the struggle of the world’s most disadvantaged people is humanity’s most important struggle overall. The book has helped solidify Farmer’s status as one of the world’s preeminent global health scholars.

Pathologies of Power compiles many essays that cast a wide net over the global epidemic of human suffering. Their topics range from the backbreaking conditions and moral costs of the Russian prison-industrial complex, to the remote communities of Chiapas and Haiti, which lack access to proper hygiene and food systems. Farmer backgrounds his theory in the narratives of actual people to make larger structural arguments about how various forms of suffering can be alleviated. For example, he uses interviews of people with HIV to understand the subjective effects of social and economic injustice. HIV represents a multi-decade, global epidemic that cannot be understood simply as a disease limited to the body. Rather, it is a multi-systemic disease that extends into the social, political, and economic domains.

Farmer outlines some promising technologies in medicine and communications that suggest an upturn in global health over the coming decades. However, he contends that new technologies by themselves will not suffice. He limits technology to the task of “managing” inequality and is doubtful about whether it can reduce structural violence. Because global public health relates so directly to many open questions about human well-being, it is the most urgent field of study when asking why some people are endowed with immense privileges and services, while many of their neighbors are not. The study of public health helps us understand that these groupings are not arbitrary, but rather bound up in the complex history of inequality.



Farmer rebukes the capitalistic agenda of the modern medical industry. The logic of the market compels everyone from pharmaceutical executives to doctors to maximize profits in healthcare delivery. He challenges the notions that the pioneers of many modern medicines are altruistic. In fact, many are willing to manufacture and sell drugs without rigorous testing and through the leveraging of invasive and abusive marketing tactics. Farmer argues that consumers are complicit in this process, because they continue to validate these market logics with their purchasing choices. An alternative, healthier, and more equity-oriented state of mind for the modern individual is that of “pragmatic solidarity.” This view involves an attentiveness to the existence of the marginalized and suffering, an embrace of the fact that we are all bound up in the same global systems, and a drive to hold those systems more accountable to the people they are supposed to serve, rather than the other way around.

Farmer also investigates the meaning of “structural violence,” a term developed by Norwegian sociologist Johan Galtung that refers to the passive harm inflicted on people through unequal systems. In most contemporary situations, the group most vulnerable to structural violence is the poor. Farmer adds that most negative health outcomes today are highly correlated with inequalities between categories such as gender and economic classes. Human rights violations are therefore the effects of oppressive “pathologies of power.” With this term, Farmer suggests a silver lining in the problem of modern inequality: since it consists of certain pathologies, or predictable patterns, it can be studied empirically and is susceptible to focused treatment.

Farmer’s book is both a diagnosis of the structural violence that plagues the modern world and a statement of hope for its study and resolution. Future medical technologies and the affordances of new methods for communicating and creating political organization offer humankind more and more opportunities to stop needless violence and suffering.