Dying for Capitalism

“I want to eradicate poverty” announced Jim Yong Kim, the new World Bank President to The Guardian in an exclusive interview on July 25. “I think that there’s a tremendous passion for that inside the World Bank.”

In March 2012, President Obama nominated anthropologist Kim, MD, a co-founder of the non-profit Partners in Health, to head the World Bank. Several sectors of the international community questioned Dr. Kim’s credentials and argued that the selection process was undemocratic and not based on merit. Kim was widely supported by U.S. liberals as well as prestigious publications like the Financial Times and the New York Times.

Disregarding the international community’s call for transparency, Kim accepted the post and joined President Obama, Secretary of State Hillary Clinton and Treasury Secretary Timothy Geithner in the Rose Garden ceremony. Kim began his new job on July 1, 2012.

Kim’s nomination was strongly endorsed by his friend, Paul Farmer, his Partners in Health co-founder, also a physician-anthropologist. He argued, “Kim’s humility would serve World Bank well” in a Washington Post column on April 11, 2012.

Both Drs. Kim and Farmer say that they are highly influenced by the radical educator Paulo Freire (author of Pedagogy of the Oppressed) in their work. At first glance this seems consistent with Kim’s excellent 2000 “Dying for Growth,” a book that Kim co-edited with several others from the Institute for Health and Social Justice Issues in Cambridge, Massachusetts. We have both used the book in our Medical Anthropology teaching and Hans Baer reviewed the book for the Medical Anthropology Quarterly in its March 2001 issue.

We will argue that Drs. Kim and Farmer misrepresent the fiercely anti-capitalist Paulo Freire and make an astounding public reversal from their tone in Dying for Growth, which implied a strong anti-capitalist stance. In fact, one of Dr. Kim’s chief actions today is to vigorously promote capitalism, albeit a form of capitalism with a human face. In a recent BBC interview Jim Kim said that capitalist “market-based growth is a priority for every single country.” Kim said that this was the best way to create jobs and lift people out of poverty.

In making this critique, we argue for a resuscitation of Paulo Freire, Karl Marx, and the relentless questioning of the Frankfurt school philosopher Theodor Adorno.

As renowned health experts and political appointees whose profiles rise higher and higher on the world stage, Drs. Kim and Farmer’s interpretations of Freire will likely influence millions. As such, they deserve increased critical attention for their work as public and engaged anthropologists.

Astounding Reversal from “Dying for Growth”

“The splinter in your eye is the best magnifying-glass.”

Theodor Adorno

In its various chapters, Dying for Growth explores the linkages between neoliberalism or late capitalism and health problems among the poor in various countries. In the concluding chapter, Millen, Irwin, and Kim advocate a program of “pragmatic solidarity” that calls for a collective effort that aims to counter the adverse effects of neoliberalism upon the health of the poor. While Baer wrote a generally positive review of Dying for Growth, he faulted the editors for failing to provide readers with a vision that will not simply ameliorate the worst effects of global capitalism upon the health of the poor. In his view, this would entail the creation of health for all that entails constructing an alternative global political economy oriented to meeting social needs rather than to profit making.

Perhaps this omission provided Kim with the wiggle room he may have needed when during his nomination process for the World Bank many questioned whether the author of “Dying for Growth,” was, in fact, anti-capitalist. The book had appeared to be, fiercely challenging the growth mantra. However in Farmer’s Washington Post editorial, he responded with a resounding no, arguing that “any reasonable reading of the book indicates that ‘Dying for Growth’ is pro-growth, raising questions about particular policies and patterns of growth that exclude the great majority of people living in poverty. Hence the double entendre in the title” (Farmer and Gershman 2012).

In reality, both Farmer and Kim appear to be  overlooking the increasing number of scholars and activists who are challenging the growth paradigm associated with global capitalism, especially in light of the increasing evidence that the treadmill of production and consumption highly dependent on fossil fuels is not only contributing to increasing social inequality around the world but also depletion of natural resources and environmental degradation, of which the most profound form is climate change.

What is needed is ‘appropriate development’ or economic growth for the poorest people in the world but de-growth of the affluent in both developed and developing societies and achieving a steady-state economy oriented to both social parity and justice, environmental sustainability and a safe climate.

While Farmer himself has for sometime been reluctant to critique capitalism per se but has tended to cite “structural violence” as the source of the problems of many of the world’s poor, in his recent book Haiti After the Earthquake he does acknowledge that “growing inequality, both within countries and between them, is the linchpin of modern servitude” (Farmer 2011:117).

In terms of Farmer’s defense of his colleague, CounterPuncher Patrick Bond has not bought his argument. “I’ve met both Farmer and Gershman, and like everyone else, I immensely respect their traditional role: haranguing powerful institutions to do less harm,” he said, “[but] what they did in the Washington Post was the opposite, offering excuses for the World Bank and its status quo ideology because their friend is about to take over. The contradictions will be spectacular. The scholar who co-edited the great anti-neoliberal book Dying for Growth will be compelled to actively ignore data (from Christian Aid) which suggest 185 million African deaths in the 21st century will be due to climate change, in addition to immediate coal-related health problems” (Bond 2012).

A Model based on Paulo Freire?

Kim and Farmer’s social justice model combines biomedicine, public advocacy, backstage politics, and avowedly “true” charity work as discussed by Freire. The idea of “true generosity” defeating “false charity” is a foundational motif of their physician practices. This concept is referenced often in their public speeches and publications. In their view, Freire’s intellectual insights support a “medicine and social justice” praxis whereby the chief causes of oppression are posited as “structural violence,” “poverty” and “inequality.”

Paulo Freire is indeed a major influence on both Kim and Farmer, they both assert. In a lengthy interview with the Boston Phoenix reported by Tinker Ready, “Kim explain[ed] that he and Farmer share several key influences. One is Paulo Freire’s classic 1968 manifesto Pedagogy of the Oppressed (‘True generosity consists precisely in fighting to destroy the causes which nourish false charity,’ it reads in part). The other is the radical Catholic doctrine known as liberation theology, which preaches that the Church should be in the business of fighting poverty and oppression. So, he says, they work alongside the poor and answer to the poor, not to the WHO or government health ministries,” he told Ready (Ready 1996).

Farmer explains how his Freirean social justice model is a vast improvement over the charity model and development models of health care. He said, “Charity . . . presupposes that there will always be those who have and those who have not. This may or may not be true, but again, there are costs to seeing the problem in this light. In Pedagogy of the Oppressed, Paulo Freire put it this way: ‘In order to have the continued opportunity to express their ‘generosity,’ the oppressors must perpetuate injustice as well. An unjust social order is the permanent fount of this ‘generosity,’ which is nourished by death, despair, and poverty.’ Freire’s conclusion follows naturally enough: ‘True generosity consists precisely in fighting to destroy the causes which nourish false charity.’ Given the 20th century’s marked tendency toward increasing economic inequity in the face of economic growth, there will be plenty of false charity in the future” (Farmer 1995).

In 2011 PIH generated revenues of $88 million. There were more than 15,000 new donors the last fiscal year. Among its corporate and foundation donors are Abbot Laboratories, Aetna Foundation, Inc. American Express, the Bill and Melinda Gates Foundation, General Electric, Co, Goldman, Sachs Co., Google, Home Depot, HSBC Philanthropic Programs, J.P. Morgan Chase & Co., Microsoft, Morgan Stanley, Novartis, Pfizer, UPS, U.S. Bancorp, Wells Fargo and  Weyerhaeuser Family Foundation

(PIH Annual Report 2011).

Seeing the Proof

Over the past two decades Kim and Farmer have demonstrated  that diseases could be treated successfully and economically in some of the poorest, remotest places in the underdeveloped world.

According to Bond, the Director of the Centre for Civil Society at the University of KwaZulu-Natal in South Africa, “[these] breakthroughs required making alliances with grassroots activists, including South Africa’s Treatment Action Campaign, to win an historic fight against Big Pharma and the World Trade Organization’s Intellectual Property rights protections in 2001. The payoff was provision of generic and discounted AIDS medicines to several million poor people at an affordable price, whereas a decade earlier those medicines cost $15,000/patient/year. It was one the greatest recent victories against corporate-facilitated oppression [in recent decades]”

Said Kim, “That was the moving thing for me. Seeing the proof.”

For their indefatigable efforts Kim and Farmer were awarded MacArthur Genius Awards. Farmer busily travels around the world treating patients and raising money for his Partners in Health clinics which total more than 76 clinics in 12 countries serving 2.6 million people per year. PIH employs almost 15,000 in countries including Haiti, Rwanda, Peru and Kazakhstan. Farmer was offered the job to head US AID in 2009, but declined. Since the Haitian earthquake in 2010 Farmer has worked extensively with former President Bill Clinton to help alleviate the suffering of many. He is now UN Special Envoy to Haiti under Clinton.

Environmental Protest Against Kim in Africa 

In July 2012, after just a few weeks in office, Kim drew strong protest from a number of environmental groups for the World Bank’s approval of a $684 million loan for a new Power Transmission Line that will supply electrical power to Kenya from a controversial dam in Ethiopia. The groups, including Human Rights Watch and Survival International, argued that Kim undermined the rights of indigenous peoples and the environment with its loan approval. Other groups included Friends of Lake Turkana, International Rivers and the Bank Information Center.

Anthropologist Bill Derman, an Africanist with more than thirty years of experience on water projects, said that “There is a long history involved in World Bank banking on large dams.  . . .[and] it gives credibility to environmentally disastrous and culturally genocidal projects. . . .At the very least the new head of the bank should have called for a thorough review of the basis for supporting Kenya’s request without examining the horrendous social and environmental so-called research carried out on behalf of the Ethiopian government” (Derman 2012).

The point is captured by anthropologist G. Derrick Hodge in a 2011 review of “the Continuing Career of Jim Yong Kim (Hodge 2011). Hodge salutes Kim’s “staggering success” in a “remarkable career” that has extended and enhanced the lives of many. However he also notes Kim’s “strange bedfellows.” Hodge makes a theoretical critique of Kim commenting that “he has been quite willing to support the profitability of already very wealthy corporations if it means saving a life in the here and now” (Hodge 2011).

“Yet, by not challenging the ways in which profit-motivated economic processes cause the kind of illness that they claim to cure,” he said, “this kind of pragmatism risks sacrificing future generations for current exigencies” (Hodge 2011).

In other words, by accommodating with established power and capitalist relations of production, Kim (and Farmer) may be causing more harm than good over the long sweep of history. Hodge wonders if Kim “is willing to risk alienating wealthy donors [and whether] he might feel morally compelled to use his new pulpit to tell the truth about global capitalism, as he did in Dying for Growth” (Hodge 2011). These are important questions and reflect the “problem posing” element of Freire.

It is for reasons like these that journalist Patrick Bond named his popular CounterPunch article “Why Jim Kim Should Resign from the World Bank” (Bond 2012).

What kind of “Structural Violence” are we talking about?  

Drs. Farmer and Kim work closely with  Presidents Obama and former President Clinton. When he was president, Clinton forced Haiti to drop tariffs on imported subsidized U.S. rice. This neoliberal policy destroyed Haitian rice farming and seriously undercut Haiti’s ability to become a self-sufficient country. It is widely viewed as contributing to Haiti’s forced urbanization, an event that increased the earthquake toll. Clinton, of course, also passed NAFTA which hurt the US working class. He destroyed welfare and in 1999 was responsible for tearing down the firewalls between investment and commercial banking which opened the banking system to speculators and contributed to much human misery associated with the 2008 financial meltdown.

Obama raised more than $600 million for his election, most from corporations, and has served those same corporations as well as his Republican predecessor. He has stood by while those same corporations loot the treasury and has done little to help the millions of Americans who have lost their homes to Liars Loans and bank repossessions. The list of accommodations to capital is very long and could take many books.

While Kim and Farmer work closely with these elites – two of the most powerful men in the world – they simultaneously ignore the wealth of theory and practice by Paulo Freire and his closest colleagues around the globe. As Macedo puts it, “the misunderstanding of Paulo Freire’s leading theoretical ideas is also implicated in the facile dismissal of Freire’s legacy and influence, which has actually shaped a vibrant field of critical pedagogy that has taken root throughout the United States and the world in the last two decades or so . . . .[including] contributions of scholars such as Henry Giroux, Stanley Aronowitz, Michele Fine, Antonia Darder, Linda Brodkey, and Peter McLaren” (Freire: xvi-xvii).

The term “structural violence” is part of medical anthropologists Paul Farmer and Jim Kim’s arsenal of development theory. Loic Wacquant critiqued this concept in a special forum at which Farmer was present (Wacquant 2004). Anthropologist Michael D’Arcy

amplified Wacquant’s criticism saying, “the analytic of structural violence is a wonderful way to begin a conversation about the role of institutions in producing social change and redressing wrongs, but . . .specific dimensions of these structural . . . .violences should also be enumerated in the name of producing concrete effects and not merely garnering donations from a concerned but relatively uninformed general public. If integrating critique into action is truly part of what differentiates Farmer and Kim’s organization from other forms of humanitarian intervention, then one would think that the organization and its directors would welcome constructive feedback from colleagues, allies, and intellectual fellow travelers.”

A Freirean approach to improving the world would no doubt ask these questions. As Freire himself pointed out, “any situation in which some men prevent others from engaging in the process of inquiry is one of violence. . .the movement of inquiry must be directed towards humanization – man’s historical vocation” (Freire 1970:73).

What about the structural violence of capitalism?

As David Harvey argues in The Enigma of Capital, “A youthful, student led revolutionary movement, with all of its evident uncertainties and problems, is a necessary but not sufficient condition to produce that revolution in mental conceptions that can lead us to a more rational solution to the current problems of endless growth, the first lesson it must learn is that an ethical, non-exploitative and socially just capitalism that redounds to the benefit of all is impossible. It contradicts the very nature of what capital is about” (Harvey 2009:259).

Liberalism contradicts the very nature of what Freire is about.

Kim: Anthropologists Don’t Often Act, but Physicians Do

Drs. Kim makes a strong criticism of anthropologists who do not “act.” Speaking on PBS television in 2009, he told Bill Moyers that, “Anthropologists are a little bit different [than physicians]; we don’t often act on what we do.” Similarly, Dr. Farmer presents himself as a doer. He says, “I’m an action kind of guy,” he told Tracy Kidder.

The implication seems to be that Drs. Kim and Farmer model the work – biomedical-dominated work — that anthropologists should be doing, work that is allegedly in the tradition of Paulo Freire.

Is it? What do they mean by “act”?

In the past year, several anthropologists and former students have begun to publicly challenge Drs. Kim and Farmer’s views on social action. One is physician/anthropologist Sam Dubal who wrote that “I was initially tremendously excited about the ‘Introduction to Social Medicine’ course. But it turned out to be an enormous disappointment. First, its level of engagement with the social determinants of healthcare was (perhaps appropriate to a politically conservative institution like HMS) superficial. We were taught little more than the banal fact that poverty is a major etiology of disease. Second, instead of being taught careful methods of engaging with poverty as physicians, Jim Kim presented to us, in conjunction with Michael Porter of Harvard Business School, ‘global health delivery’ models, ways of using logistical tools of commercial production to improve efficiency and efficacy of the ‘delivery’ of global health care. Instead of urging us to engage in deeper scholarship of history, anthropology, and philosophy, Kim – who later left to become president of Dartmouth College, and now, tellingly, stands president-elect of the World Bank – encouraged first-year HMS students to pursue MBAs.”

In terms of public health or social medicine, much of the thunder of the political economy of health literature that began to emerge in the early 1970s and inspired both critical medical anthropologists and critical medical sociologists has been subtly co-opted in the guise of the social determinants of health discourse. In 2004 the WHO Commission on Macroeconomics and Health created the Commission on Social Determinants of Health. Unfortunately, this approach tends to ignore the political economy of health. The social determinants of health that are repeatedly identified in the literature include poverty, employment and unemployment, stress, inequalities in housing, education, social inclusion, nutrition, as well as various lifestyle factors, such as ethnicity and sexual behavior. In essence, this perspective fails to look further upstream and certainly does not posit the various social determinants as ultimately being rooted in the capitalist world system.

Writing on July 17 in The Dartmouth, the student newspaper of Kim’s former Presidential post, philosophy student Becca Rothfeld, provides additional information about Dr. Kim’s view of action. It is worth quoting at length (Rothfeld 2012). “In March 2010, former College President Jim Yong Kim spoke at The Washington Post lecture series on leadership. He addressed the Dartmouth undergraduate population, counseling its constituents to abandon their starry-eyed ambitions. ‘It’s great to have all these great ideals,’ he noted, with a tinge of condescension. ‘But when you go to Haiti, when you go to Africa, they don’t ask you, ‘How much do you feel for my people?’’ He concluded by chastising any Dartmouth students hopelessly naive enough to maintain an affinity for the liberal arts, whom he advised to ‘get a skill.’ One casualty of this brutal methodology is philosophy, an entire field that Kim casually dismisses as practically useless. He describes his erstwhile interest in the discipline as the passing passion of a ‘smart-aleck sophomore.’ Apparently, it doesn’t require what Kim would qualify as ‘skill’ to author works like ‘A Critique of Pure Reason’ and ‘A Discourse on the Method.’ In Kim’s view, thinkers like Kant, Descartes and Rousseau would have done better to stop thinking and start acting” (Rothfeld 2012).

Like Rothfeld, Theodor Adorno, arguably the 20th century’s greatest philosopher, would also have critical comments for Kim. Adorno, and the Frankfurt School of critical theory, of which he was a part, was of immense influence to Paulo Freire and the current critical pedagogy school. Given the towering influence of Kim and Farmer in anthropology and on the world stage, and given their self-described association with Paulo Freire, arguably the 20th century’s most important anthropologist, an extended review of Adorno’s critique of “action,” is warranted. Much of this comes from his 1963 essay, Resignation (Adorno 1963).

“Distance from praxis is disreputable to everyone,” said Adorno, “Whoever doesn’t want to really knuckle down and get his hands dirty, is suspect, as though the aversion were not legitimate and only distorted by privilege. [the demand is to become] an active, practical person . . .[like] an industrial leader or an athlete. One should join in. Whoever thinks, removes himself, is considered weak, cowardly, virtually a traitor” (Adorno 1963:290).

Adorno worried that such an admonition might be “quickly transformed into a prohibition on thinking” itself (Adorno 1963:290). He warned that “The much invoked unity of theory and praxis has the tendency of slipping into the predominance of praxis” (Adorno 2963:290). Such a “forced primacy” stopped “the critique Marx himself practiced” as in places like the former Soviet Union. Eventually, once on this road, the criticism against critique “is not tolerated anymore except for the criticism that people were not yet working hard enough. So easily does the subordination of theory to praxis invert into service rendered to renewed oppression” (Adorno 2963:290).

He went further. “Whoever criticizes violates the taboo of unity, which tends towards totalitarian organization. The critic becomes a divisive influence and, with a totalitarian phrase, a subversive” (Adorno 1963:283).

The material forces at work on the individual’s consciousness are massive. Again Adorno captures elements of the hegemony it in a piece that is overly pessimistic, but still worth quoting at length, “The economic order . . .renders the majority of people dependent upon conditions beyond their control, and thus maintains them in a state of political immaturity. If they want to live, then no other avenue remains but to adapt . . .they must negate precisely the autonomous subjectivity to which the idea of democracy appeals; they can preserve themselves only if they renounce their self. To see through the nexus of deception, they would need to make precisely that painful intellectual effort that the organization of everyday life, not least of all a culture industry inflated to the point of totality, prevents. The necessity of such adaptation, of identification with the given . . .creates the potential for totalitarianism” (Adorno 1963:98-99).

To this the Dartmouth president advised the student/philosopher to “get a skill.”

The idea seems to be that college youth should focus on mastering practical skills that privilege instrumental rationality, not critical pedagogy, the humanities or philosophy. Moreover, Dr. Kim seems to be saying, one should arm oneself with as many hard-skill based degrees as possible, preferably: MD, Ph.D. and MBA. But who can afford this but the rich? And for the rest, isn’t the debt peonage from all this graduate education another form of structural violence?

Freire’s Genius 

Bond wrote, “Indeed we will soon learn whether Kim’s commitment to progressive change is as strong as his record suggests, or whether he will instead repeat his deplorable role in the notorious Dartmouth fraternity hazing scandal whereas the College president apparently intimidated by rich alumni and bolshi ‘vomelette’-making students, he did nothing at all, deploying the bizarre excuse, ‘One of the things you learn as an anthropologist, you don’t come in and change the culture.’”

In fact thousands of applied anthropologists work daily in a wide array of jobs to “change the culture,” as they challenge hierarchy, injustice and ignorance (Ervin 2005). Many of these anthropologists employ Freirean approaches as discussed above. How could Kim make this kind of statement in good faith? Is he not aware of all the widespread applied work taking place to transform cultures in nearly every country of the world? Moreover, how might Kim reconcile the fact that Paulo Freire himself renounced the World Bank and refused to take money from them when he was Secretary of Education in Sao Paulo, Brazil?

All are radical humanists and neo-Marxists, highly critical of the “petty infighting, the dishonesty, the desire for self-promotion, [and] orthodoxy” which Farmer accuses Marxists of portraying. In his important 2010 offering “On Critical Pedagogy,” Henry Giroux underscores the ecumenical openness of Freire’s thought, “Freire’s genius was to elaborate a theory of social change and engagement that was neither vanguardist nor populist. Combining theoretical rigor, social relevance, and moral compassion, Freire gave new meaning to the politics of daily life while affirming the importance of theory in opening up the space of critique, possibility, politics, and practice” (Giroux 2010:163).

In other words, Freire was as critical of the Left as he was of the Right. Moreover he insisted that students incessantly criticize his ideas in order to develop better theory and praxis. Said Macedo, “A humanizing pedagogy . . .must attempt to create educational structures that would enable . . .student to equip themselves with the necessary critical tools to unveil the root causes of oppression, including the teachers’ complicity with the very structures from which they reap benefits and privileges” (Freire 2004:xx).

A Rigorous Detour through Marx is Essential

Despite homage to Freire, Dr. Farmer has vigorously renounced Marxist approaches for diagnosing and transforming the world. In a text from the bestselling New York Times book, “Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World”  ,”  Kidder writes of Dr. Farmer, “He had studied the world’s ideologies. . . . .But years ago he’d concluded that Marxism wouldn’t answer the questions posed by the suffering he encountered in Haiti. And he had quarrels with the Marxists he’d read: ‘What I don’t like about Marxist literature is what I don’t like about academic pursuits–and isn’t that what Marxism is, now? In general, the arrogance, the petty infighting, the dishonesty, the desire for self-promotion, the orthodoxy: I can’t stand the orthodoxy, and I’ll bet that’s one reason that science did not flourish in the former Soviet Union.’

Like Kim, Farmer’s assertions distort Freire’s essential message. In Freire’s final publication, a posthumous collection of letters titled, “Pedagogy of Indignation, published in 2004, Freire’s colleague Donaldo Macedo puts the issue succinctly, “. . . . one cannot understand Freire’s theories without taking a rigorous detour through a Marxist analysis, and [any] offhand dismissal of Marx is nothing more than a vain attempt to remove the sociohistorical context that grounds Pedagogy of the Oppressed” (Freire 2004:xiv-xv). Macedo underscores that “the misunderstanding, even by those who claim to be Freirean, is not innocent. It allows many liberal educators to appropriate selective aspects of Freire’s theory and practice it as a badge of progressiveness while conveniently dismissing or ignoring the ‘Marxist perspectives’ that would question their complicity with the very structures that created human misery in the first place” (Freire 2004:xvi).

Standing Alone

In fact, to be a Freirean is to be prepared to stand alone. As Giroux notes, “Academics who assume the role of public intellectuals must function within institutions, in part, as an exile, as someone who raises uncomfortable questions, makes authority responsible, encourages thoughtful exchanges, connects knowledge to the wider society, and addresses important social issues” (Giroux 2010:101).

One who often stands alone is Ezili Danto, Founder and President of the Haitian Lawyers Leadership Network. She is an organic intellectual and artist who was born in Port au Prince. Her organization once awarded a medal to Paul Farmer, but today she is one of Dr. Farmer’s most vocal critics. Danto cites Freire to inform her practice, choosing a quote to countermand Farmer’s focus on “true charity” work. Here is the quote, “Transformation is only valid if it is carried out with the people, not for them. Liberation is like a childbirth, and a painful one. The person who emerges is a new person: no longer either oppressor or oppressed, but a person in the process of achieving freedom. It is only the oppressed who, by freeing themselves, can free their oppressors” (from Freire 1970).

In his recent book, The Death of the Liberal Class, (Hedges 2010), Hedges says that “the liberal class was always compromised by its embrace of the power elite, as well as its deep hostility to American radicals.” He goes further, arguing that “the corporate coup d’etat [of the United States] is complete [and] we must not waste our time trying to reform or appeal to systems of power (Hedges 2010:193). He quotes social activist Norman Finkelstein, fired from DePaul University for his public praxis: “There are two sets of principles. They are the principles of power and privilege and the principles of truth and justice. If you pursue truth and justice, it will always mean a diminution of power and privilege. If you pursue power and privilege it will always be at the expense of truth and justice (Hedges 2010:36).

Denouncing and Announcing 

In his last publication, the posthumous Pedagogy of Indignation (2004), Freire still spoke of the revolutionary fight: “Denouncing and announcing, when part of the process of critically reading he world, give birth to the dream for which one fights. This dream or vision, whose profile becomes clear in the process of critically analyzing the reality one denounces, is a practice that transforms society, just as the drawings of a unit factory worker. . .makes possible the actual manufacturing of the unit” (Freire 2004: 18).

Yes, poverty must be vanquished. And structural violence, eliminated. However, how if at all, are the curers committing structural violence themselves? How can we achieve health and liberation without naming and renaming the world theoretically, over and over, on higher planes of action and reflection, ad infin? When we do, we more clearly recognize that poverty is part of a darker constellation of forces that resists being fully named. And we understand that violence is a cultural phenomenon as much as it is material, having murky roots in necrophilic matter. As Giroux argues, “America needs to talk more about how and why violence is so central to its national identity, what it might mean to address this educationally and tackle the necessity of understanding this collective pathology of violence not just through psychological and isolated personal narratives, but through the wider ideological and structural forces that both produce such violence and are sustained by it (Giroux 2012).

Studying Up

“In a situation of manipulation, the Left is almost always tempted by a ‘quick return to power,’ forgets the necessity of joining with the oppressed to forge an organization, and strays into an impossible ‘dialogue’ with the dominant elites. It ends by being manipulated by these elites, and not infrequently falls into the elitist game, which it calls ‘realism.’”

Paulo Freire, Pedagogy of the Oppressed, p. 146

In short, there is a major conflict (mostly unreported in the anthropology literature) between two leading Leftist intellectuals on Haitian health and politics, Paul Farmer and Ezili Danto. Both cite Paulo Freire to justify their positions. Clearly, an independent assessment to ascertain the strength of their respective arguments is called for.  As anthropologist Victor Braitberg said, “I don’t think we (anthropologists) really understand the sociocultural impact and the broader political-economic dynamics that are bound up with Paul Farmer’s work and PIH more generally. I think it would be worthwhile to critically and ethnographically examine the impact that this organization is having in the Haitian context as well as the other contexts where they operate. What is the relationship of PIH to local organizations, other NGOs, the public health institutions of the country, etc. In other words, what is the political-economy of Paul Farmer and PIH in the context of international health as a global field of actors with competing interests where, like it or not, poor sick people are often defacto symbolic and economic capital on a global stage.” One must ask why are so many anthropologists reluctant to investigate the claims?

Drs. Farmer and Kim fight gallantly for their patients and fight hard against cold and heartless governments, bureaucracies and ideologies to improve the lives of a great many people. They are incredible in so many ways. But so are thousands of other MDs and thousands of other social scientists whose work is always under scientific scrutiny, as it must be. And so are the protestors of Occupy Wall Street whose message is resistance against some of the very same actors and corporations who give such generous support to Partners in Health.

Freire was adamant about the fundamental importance of Marx. In one of its last video interviews, Paulo Freire says he always comes back to Marx in his work with the people of the slums” (see: http://www.youtube.com/watch?v=pSyaZAWIr1I )

Brian McKenna is an anthropologist who teaches at the University of Michigan-Dearborn and can be reached at mckenna193@aol.com

Han Baer is also an anthropologist and a faculty member at the University of Melbourne. His email is: hbaer@unimelb.edu.au


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Adorno, Theodor W. 1981 [1951] Negative Dialectics. New York: Continuum.

Baer, Hans. 2001. Review of ‘Jim Yong Kim et al’s Dying for Growth: Global Inequality and the Health of the Poor.” Medical Anthropology Quarterly 15(1)126-127, March.

BBC. 2012. “New World Bank chief to focus on ‘market-based’ growth,” April 17.

See: http://www.bbc.co.uk/news/business-17737660

Bond, Patrick. 2012. “Why Jim Kim Should Resign from the World Bank,” Counterpunch, April 16.

See: https://www.counterpunch.org/2012/04/16/why-jim-kim-should-resign-from-the-world-bank/

Danto, Ezili. 2011. “Paul Farmer is not a god but the Face of the UN/USAID/World Bank.” Haiti News Blog. August 27.

See: http://www.ezilidanto.com/zili/2011/08/paul-farmer-is-not-a-god/

Derman, Bill 2012. “The Bank and Gibe 3.” Environmental Anthropology Listserv. July 18.

Dubal, Sam. 2012. “Renouncing Paul Farmer: A Desperate Plea for Radical Political Medicine.” Being Ethical in an Unethical World Blog. May 27.

See: http://samdubal.blogspot.com/2012/05/renouncing-paul-farmer-desperate-plea.html

Ervin, Alexander M. 2005. Applied Anthropology: Tools and Perspectives for Contemporary Practice. Boston:Pearson.

Farmer, Paul, 1995. “Medicine and Social Justice.” America, The National Catholic Weekly. July 15.

See: http://www.americamagazine.org/content/article.cfm?article_id=12080

Farmer, Paul and John Gershman. 2012. “Jim Kim’s humility would serve World Bank well,” Washington Post. April 11. See: http://www.washingtonpost.com/opinions/kims-smart-stance-on-growth/2012/04/11/gIQA6SqABT_story.html

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