Paul Farmer on the Power of the Community

Paul Farmer speaks June 5, 2009 at the Heifer Village Dedication Ceremony in Little Rock, Ark. Image by Bryan Clifton

Interview by Austin Bailey, World Ark Associate Editor

Paul Farmer, a founder of Partners in Health and renowned doctor to the world’s poor, is a leader in global health, specifically in the battle against infectious disease. On a June 5 visit to Heifer Village, the new education center on Heifer’s Little Rock campus, Farmer talked about the importance of building “communities of concern” that will take up the cause of ending poverty and disease.

Farmer spoke of the need for nonprofits to form partnerships in the struggle to overcome disease and poverty. Speaking about Heifer International and his organization, Partners in Health, he said, “We must be from the same family tree,” because the organizations share similar visions of ending hunger, poverty and disease. But how can individuals make a difference? By “passing on the gift of what we’ve learned,” Farmer suggested.

Farmer’s work with the poor and sick in Haiti is chronicled in the book “Mountains Beyond Mountains” by Tracy Kidder. Farmer has also written several books, the most recent “Pathologies of Power: Health, Human Rights and the New War on the Poor.” He is also vice chair of the Department of Global Health and Social Medicine at Harvard Medical School. Farmer sat down with us to answer a few questions about his visions for global health.

Q. What is your best argument for people in the West to care about global health?

A. Over the years we’ve developed so many approaches to persuade people to care about these things. There are some I really don’t use very much, like bio-security, the concept that these epidemics could be coming to you. It’s the enlightened self-interest argument. It’s good, but it’s not really what I find most persuasive.

What I find most persuasive is to say, “Look, these are important problems. It will enrich your life to serve other people and try to make the world a place more like the kind of world we want to pass on to the next generation.” That’s what I say to Americans, Canadians, Europeans. This is the right thing to do; we can do it; we need better strategies; we have the resources. It will make the whole planet better.

When the tsunami hit and 45 percent of American households donated, they didn’t do it because they were worried about their own security or self-interest. They did it because they’re generous people. We should draw on that.

Q: What can Heifer and other nongovernmental organizations do to be more effective in combating poverty and disease?

A: Heifer would not be a good example of doing something wrong, but it’s true, with many NGOs there’s a lot that’s not being done right.

Let me take some examples from my own work in places I know best, for example Haiti. In Haiti there are literally thousands of NGOs and church groups, and you know, we’re not adding up to the sum of our parts, much less greater than the sum of our parts. Why is that? It’s a failure to coordinate, a lack of commitment to a shared vision of breaking the cycle of poverty and disease.

I look at another experience in Rwanda where there are also many NGOs, many church groups and community organizations that are brought more carefully and more successfully into the process of creating a shared vision of development.

There are also the NGOs who have too much overhead. After awhile you end up having contractors and NGOs who are really concerned more with their own survival than with the effectiveness of an intervention to break the cycle of poverty. That’s concerning to me.

Q. Can you talk about foreign policy and how it affects work on the ground?

A: I started off as probably Heifer did, working in a community, then two, then three. I was really focused on the struggles of poor people in certain areas, which led me to Haiti, Peru, Boston, Russia, all over the place. I’m glad I do that. How you can be sure implementation is actually happening is by having that on-the-ground, pragmatic experience. We don’t want to give that up. But to create an environment in which good works can flourish, you need good policy.

An example is the “do not treat” policy climates for certain problems that are regarded to be too expensive to treat. I’m a doctor. Should I say, “Sorry, you can’t treat cancer in the Third World, you can’t treat AIDS”? That is a bad policy environment for equity, and equity is important.

Changing a policy does not make implementation happen, but it allows it to happen. We need to push policymakers in Washington, Geneva, Tokyo, wherever, to make sure we can deliver.

Q. Do you think the recent media blitz about the swine flu helped or hindered people’s overall understanding of global health?

A: There’s very interesting piece in last week’s New Yorker about parrot fever. That’s what they called it back in 1929 when there was an outbreak. It’s actually called psittacosis. It started in Baltimore, and it’s a disease of birds. Humans can get it.

It created hysteria and got a lot of national attention. They created a lab that was not a good lab, it didn’t have infection control, etcetera. It was one of those hysterical responses. But it led to the creation of the National Institutes of Health.

With swine flu, maybe it doesn’t go pandemic now, but it reminds us we need a strong public health system in place that can protect the huge number of people living on our crowded planet.

Q. Do you think the new administration is making global health enough of a priority?

A: I’m a doctor who works in global health, so you know what I’m going to say. Of course we should do more. We still have half a million women dying in childbirth every year. We need more resources just like a lot of other neglected public goods do. Education, universal primary education, is another example. I look back at the previous administration, and I see that one area that administration made very substantial investments in was some of the programs they did with AIDS and malaria. I think that’s great. Can we build on that and have a stronger global health program? I think we can. Will the administration move in that direction? I think we will.

Q. You talk about creating “communities of concern.” What does that mean?

A: Food sovereignty, food security, creating a world without extreme poverty. Those are the concerns of Heifer International. How are you going to do that without having something beyond donors? Donors are critical, but supporters are there through thick and thin. If you’re going to finish a project like this [Heifer Village] in the middle of a financial crisis, you need a community of concern. You need a group who regards it as their responsibility to make sure these projects go forward.

That’s been something we’ve been talking about over the last couple of years at Partners in Health. We’re not just building donor lists, we’re creating communities of concern.

Q. What’s one thing about global health that people don’t know that you wish they did?

A: I think the thing I’d really like people to know is that investments in global health are not some sort of black hole where all the resources disappear. You’re saving lives, and the needs are infinite. I want them to understand that the recipe for leaving extreme poverty behind needs to include health. That’s actually true in United States, also. I read this week that 60 percent of bankruptcies in the United States are related to health problems. The need is infinite.

Jaman Matthews, World Ark Associate Editor, contributed to this article.