Cover image for Infections and inequalities : the modern plagues
Infections and inequalities : the modern plagues
Farmer, Paul, 1959-
Personal Author:
Publication Information:
Berkeley : University of California Press, [1999]

Physical Description:
xiv, 375 pages ; 24 cm
Format :


Call Number
Material Type
Home Location
Item Holds
RA418.5.P6 F37 1999 Adult Non-Fiction Non-Fiction Area

On Order



Paul Farmer has battled AIDS in rural Haiti and deadly strains of drug-resistant tuberculosis in the slums of Peru. A physician-anthropologist with more than fifteen years in the field, Farmer writes from the front lines of the war against these modern plagues and shows why, even more than those of history, they target the poor. This "peculiarly modern inequality" that permeates AIDS, TB, malaria, and typhoid in the modern world, and that feeds emerging (or re-emerging) infectious diseases such as Ebola and cholera, is laid bare in Farmer's harrowing stories of sickness and suffering.

Challenging the accepted methodologies of epidemiology and international health, he points out that most current explanatory strategies, from "cost-effectiveness" to patient "noncompliance," inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Yet this moving account is far from a hopeless inventory of insoluble problems. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians determined to treat those in need. Infections and Inequalities weds meticulous scholarship with a passion for solutions--remedies for the plagues of the poor and the social maladies that have sustained them.

Author Notes

PAUL FARMER directs the Program in Infectious Disease and Social Change at the Harvard Medical School and divides his clinical time between Boston's Brigham and Women's Hospital and the Clinique Bon Sauveur in central Haiti. He is the author of AIDS and Accusation (California, 1992), which was awarded the Wellcome Medal, and The Uses of Haiti (1994), and editor of Women, Poverty and AIDS (1996), which won the Eileen Basker Prize.

Reviews 3

Booklist Review

As both clinician and anthropologist, Farmer has had considerable field experience in Haiti and Peru. The major infection in those countries is multidrug-resistant tuberculosis, whose prevalence, he maintains, is the result of a threefold "structural violence" wrought by gender inequality, racism, and poverty. "The better the therapy," Farmer asserts, "the more injustice meted out to those not treated." Bolstered by thorough knowledge of the countries in which he practiced, relevant and cogent case histories, and a caring but disciplined attitude, Farmer powerfully argues for substantial changes in epidemiological theory and practice. He discusses in detail medical and governmental policies that regard many inhabitants of poorer countries as "throwaway people," incapable of understanding or sticking to treatment programs. He finds the main underlying problem to be trying to eradicate a social disease without social action. Farmer raises thought-provoking and necessary questions, and he provides answers that, if often unsettling, are pertinent and capable of being put to use by individuals and governments truly interested in solving, not sidestepping, life-threatening situations. --William Beatty

Library Journal Review

Farmer is a physician-anthropologist who directs the Program in Infectious Disease and Social Change at Harvard Medical School. He also has clinical practices in Boston and in Haiti, where he has done extensive fieldwork with Haiti's rural poor. Aiming to explain why infectious diseases such as AIDS and tuberculosis target the poor, he fills his new work with harrowing public-health case studies of the pathogenic effects of poverty and other grim social conditions. Farmer provides a well-referenced analysis of everything from cell-mediated immunity to healthcare access issues. The studies outlined show that extreme poverty, filth, and malnutrition are associated with infectious disease and what attitudes and behaviors contribute to the lack of understanding about disease. Arguing that the predictors of patient compliance are fundamentally "economic not cognitive or cultural," he builds a powerful and persuasive argument for a proactive multinational program to defuse the "infectious disease time-bomb." Highly recommended for all medical school library collections and any collection concerned with public-health issues.ÄRebecca Cress-Ingebo, Wright State Univ Libs., Dayton, OH (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Choice Review

Physician and anthropologist Farmer opens with a chapter that is essentially autobiographical, detailing his clinical work in rural Haiti and the US and his experiences in Peru. The balance of his book employs case descriptions and a political-economic perspective to critique the prevalent view of "emerging" infectious diseases like AIDS and multiple-drug-resistant tuberculosis. Farmer argues that this view fails to acknowledge the salience of political and economic powerlessness and falsely labels poor people as responsible for their diseases through "noncompliance" and unscientific practices. Farmer illustrates how the health care system places poor persons at extreme risk and denies necessary help with poignant life histories of individual patients, which put human faces to commonly recited statistics about lack of access, denial of services, and poor quality. Although the author's political-economic analysis of health care is clearly written and thought-provoking, what ultimately makes this book an important addition to the critical analysis of health systems is its detailed history of poor people's efforts, often protracted and valiant--and too often frustrated--to obtain the medical services they need. General readers; undergraduates and up. L. A. Crandall; University of Miami School of Medicine

Table of Contents

Acknowledgmentsp. xi
Introductionp. 1
1. The Vitality of Practice: On Personal Trajectoriesp. 18
2. Rethinking "Emerging Infectious Diseases"p. 37
3. Invisible Women: Class, Gender, and HIVp. 59
4. The Exotic and the Mundane: Human Immunodeficiency Virus in the Caribbeanp. 94
5. Culture, Poverty, and HIV Transmission: The Case of Rural Haitip. 127
Miracles and Misery: An Ethnographic Interludep. 150
6. Sending Sickness: Sorcery, Politics, and Changing Concepts of AIDS in Rural Haitip. 158
7. The Consumption of the Poor: Tuberculosis in the Late Twentieth Centuryp. 184
8. Optimism and Pessimism in Tuberculosis Control: Lessons from Rural Haitip. 211
9. Immodest Claims of Causality: Social Scientists and the "New" Tuberculosisp. 228
10. The Persistent Plagues: Biological Expressions of Social Inequalitiesp. 262
Notesp. 283
Referencesp. 319
Indexp. 369