Shereen Shojaat, a Dowling Catholic High School alumna and World Food Prize intern, wrote the following paper that argues healthcare is a human right and, through the lens of liberation theology, one can better understand and address conditions that prevent people all over the world from enjoying good health care. Shojaat's paper was part of a final exam in a program at Notre Dame University in which she participated in, the Eck Institute for Global Health graduate program.
2 May 2014
Discuss critically the ways in which ONE of the following social justice theorists is
important for the implementation of health care, explaining clearly which approach they use
and why (e.g Human Rights, Procedural (i.e. John Rawls), Capabilities or a combination),
and drawing on ONE or TWO specific case studies at a national and/or local level in order to
illustrate your answer: PAUL FARMER
Paul Farmer, co-founder and chief strategist of Partners Health or PIH, brings his ever powering prospect to the international discussion regarding healthcare and development that “the idea that some lives matter less is the root of all that's wrong with the world.” (Partners in Health. 2014). With this viewpoint at the center, Paul Farmer, his fellow PIH colleagues, and other likeminded individuals throughout the world share the virtue that health is a human right. When implementation of healthcare is considered in this context, Paul Farmer, as a social justice theorist utilizes the human rights approach and in particular liberation theology. The human rights approach aims to consider what factors, such as social, political, cultural, and economic, strengthen or hinder the opportunity to live healthily. More specifically, the human rights approach to health encompasses three interconnected principles concerning the characteristics of health including the solidarity of political, socioeconomic, and civil rights, consistently engaging with individuals most vulnerable to violations of human rights, and creating responsibility for freedoms and protections (London. 2008). In addition, Farmer thoughtfully examines and advocates for an individuals need for conversion and morality for global health development by liberation theology (Deane-Drummond. 2014).The Universal Declaration on Human Rights fully recognizes that all members of society have an inherent dignity and right to equality, which is the fundamental element for justice, freedom, and peace throughout the world. Health as a human right is further addressed under article 25 and undoubtedly claims every individual has right to health and well-being accomplished through attainment of clothing, housing, medical care, social services, food, and security (United Nations. 2014).
In order to contest medicine and public health disparities, Paul Farmer thoughtfully demonstrates how liberation theology can reconcile and advance healthcare through three vital components including a preferential option for the poor, structural violence, and accompaniment. Farmer first considers that “The poor have the right to have rights.” (In Company of the Poor, 2013). Generally poverty sufferers are sicker and more diseased than affluent individuals, leading to premature death in many instances due to deadly pathogenic exposures, lack of healthcare access, or both. Therefore, those attentive to health need to make a “preferential option for the poor,” by laboring and advocating for these individuals in the medical realm (Farmer, 1995). If healthcare systems, as well as foundations, governments, non-governmental organizations, and educational institutions, made a preferential option for the poor, much of the world’s marginalized would not experience continual hardship (Farmer. 2013).
As the human rights approach explores how structured social powers lead to the marginalization of people throughout society, it reveals the outstanding importance of combating structural forces and violence to progress healthcare (Deane-Drummond. 2014). Farmer builds upon the human rights approach with liberation theology and integrates the importance of the role structural violence has in the advancement of medicine and healthcare. As structural violence puts disproportionate amounts of individuals and populations in harmful circumstances due particular societal social structures, Farmer and other liberation theologians seek to lessen these structures through providing a basic human right: health. Since political and economic powerhouses and groups (structural) have a setup that causes harm and injury to individuals, usually the less powerful or marginalized, healthcare workers have a growing obligation to understand structural violence and act to adjust these structures aims. Numerous current public health interventions and medical developments are stagnant as they ignore social determinants of diseases. A disparity that perpetuates this is due to medical personnel not being trained on applicable structural interventions. Therefore, Farmer advocates that medical and public health professionals must push for incorporating structural interventions, in combination with clinical interventions, to properly account for the determinants, distribution, and outcomes of disease (Farmer et al. 2006). Farmer calls for an interdisciplinary approach to medical advancement, as global health is considered by many as “a collection of problems,” and not a holistic discipline. Global health, in the eyes of Farmer and his colleagues, will become a holistic discipline with incorporation of anthropology, sociology, history, and political economy, as such re-socializing disciplines will better account for the structural violence barriers that inhibit global health advancement (Farmer et al. 2013). Once the world realizes that the creation of just institutions will prosper with the destruction of unjust institutions and that allowing the poor to have abundant opportunity is a human right, then we can eliminate the basis of structural violence and create structures that embody health as human right (Farmer. 2013).
Finally, Farmer acknowledges accompaniment, in order to make solidarity functional in society. Accompaniment involves a level of trust, faith, and honesty while simultaneously realizing the real-world challenges, the existence and devastation associated with power and privilege, and therefore, acknowledging and focusing on the marginalized “while walking with them.” One central tenant for Farmer, “From Aid to Accompaniment,” urges a social movement that revolutionizes how countries think about development (Farmer & Gutierrez. 2013). When thinking critically about accompaniment in healthcare, Farmer relates chronic disease and poverty to this idea. Medical professionals throughout the world often question why their patients miss appointments or fail to comply with recommended treatments and thus, blame health problems on the patient. However, Farmer proposes that medical professionals instead of inquiring why the patients don’t do certain things or follow stringent recommendations, should inquire how they can accompany the patients through the life journey, on their journey to recovery, and on their journey to less suffering (Farmer. 2013).
The deliverance of AIDs care in the United States, as Farmer suggests, may be utilized as a case that demonstrates the human rights approach, in conjunction with liberation theology. Estimates indicate that more than 636,000 individuals have AIDS in the United States and 15,529 individuals die each year as a result with the most common form of transmission due to unprotected sex (CDC. 2013). As understanding the social determinants and arrangements of unprotected sex and behavioral patterns are imperative for AIDS treatment, many clinicians in the United States forget to focus on the risk behaviors of individuals and have contrasting understandings on the social nature of AIDS. AIDS in the United States unjustifiably impacts those in poverty. Gender inequality and race are additional social factors that have undeniable associations with AIDS development. Therefore, the question is raised on how can clinicians use the medical knowledge about the disease and identify why and how the poor, racially different, and gender different individuals in America are most affected. The reasoning for the repetitive HIV infections leading to AIDS development include a variety of factors including availability of post exposure prophylaxis, malnourishment, immune system deficiency, risk for or co-infection of tuberculosis, and the availability of opportunistic infection prophylaxis as well as the availability of antiretroviral therapy. The human rights approach would inform that this lack of availability should cease to exist, as every AIDS patients has a right to health and consequential treatment. Risk for HIV infection and the aligned social forces have significantly directed diagnosis, disease staging, and treatment outcomes. More specifically, a study conducted on the HIV population of Baltimore, Maryland found that blacks were less associated with receiving ART treatment, suggesting a discrepancy in healthcare delivery. African Americans lacking insurance had the highest mortality rate, further demonstrating how racism and poverty marginalize an individual’s right to healthcare. The resulting interventions improved access to healthcare and community-based healthcare and in turn, the racial and socio-economic burdens to treatment vanished (Farmer et al. 2006). A preferential option for the poor, or in this case the marginalized African Americans, was granted, by creating interventions that target those suffering most from HIV/AIDS. It’s through the recognition by these interventionists and policymakers in Baltimore (that race and poverty influenced AIDS in this population) that structural violence was lessened and African Americans received their human right of health. Lastly, the African Americans as the worst sufferers of AIDs were accompanied, through continual support of healthcare staff who applied a mindset that unified and aimed to reduce AIDS in Baltimore cohesively. The Baltimore case shows that targeting what contributes most to an individual’s suffering has monumental benefits and restores health as a human right to the marginalized. Ultimately, through this case and Paul Farmer’s transformative perspective on the human rights approach as well as liberation theology, healthcare will be implemented in a way that is just and dignifying for all.
Centers for Disease Control. (2014). HIV/AIDS. Retrieved from: http://www.cdc.gov/hiv/risk/behavior/index.html.
Deane-Drummond, C. (2014). Global perspectives on social justice. [PowerPoint slides]. Retrieved from https://sakailogin.nd.edu/xsl-portal/site/a84504e0-d086-4304-9d35-2f6ec01b3504/page/e07da897-0923-4e52-a926-a9a5a4496cf8.
Farmer, P. (1995, July 15). Medicine and Social Justice. America. Retrieved from http://americamagazine.org/issue/100/medicine-and-social-justice.
Farmer, P. , Nizeye, B. , Stulac, S. , & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), 1686-1691.
Farmer, P., Yong Kim, J., Kleinman, A., & Basilico, M. (2013). Reimagining global health. Berkeley: University of California Press.
Farmer, Paul. (2013, December 23). Dr. paul farmer: how liberation theology can inform public health. Retrieved from: http://www.pih.org/blog/dr.-paul-farmer-how-liberation-theology-can-inform-public-health.
Farmer, P., & Gutierrez, G. (2013). In the company of the poor: Conversations with Dr. Paul Farmer and FR. Gustavo Gutierrez. Maryknoll: Orbis.
London, L. (2008). What is a human-rights based approach to health and does it matter?. Health and Human Rights, 10(1), 65-80.
Partners in Health. (2014). Health is a human right. Retrieved from http://www.pih.org/.
United Nations. (2014). The universal declaration of human rights. Retrieved from http://www.un.org/en/documents/udhr/resources.shtml.
ANSWER ONE QUESTION ONLY FROM THIS SECTION. Do not use the same case
studies as you used for section A. (See also qualification above about use of the case studies
you have personally or in a group exercise have already covered in other assessments)
3. Discuss the potential impact of liberation theology on global health care ethics.
Through the application of moral value to issues concerning health, global health ethics encompasses a wide scope of the world’s most concerning health-related disparities including natural disasters, pandemics, and the underlying root cause of poor health perpetuation: poverty (Stapleton et al, 2014). Ethicist Lisa Cahill provides a solid discussion and foundation for global ethics by presenting how theological and philosophical approaches are incorporated to finding a moral agreement across cultures and countries throughout the world. Concepts such as, solidarity emerging in various global situations and the common ideal failing due to economic disparity, showcases how integrating religious thought in global ethics is essential (Deane-Drummond. 2014).
A religious thought, like liberation theology, demonstrates the positive potential influence on global health care ethics. Building on praxis with faith at the center, liberation theology dives into discerning how current “policies, practices, and structures” lead to the marginalization of countless individuals and successively suggest new theoretical theories and transformed praxis. Founding father of liberation theology, Gustavo Gutierrez, explains that through truly understanding that we all have the moral obligation to relay the message, “God loves you,” to those who suffer from poverty and oppression. The marginalized of society must be liberated from the sins of social injustice, as they often suffer from the direct structure of violence in which they have no role. (Farmer & Gutierrez. 2013). The outstanding poverty lies with structural barriers, including lack of nutrition, lack of clean water access, and lack of sanitation, and these barriers negatively influence a person’s health. With respect to healthcare deliverance and global health ethics, public health therefore needs to not only include health interventions, antibiotic therapies, or immunizations, but generate the conditions for sustainable health (Cochrane. 2006). By first creating conditions for the sufficient health among the poor, we liberate their capacities to live a life where health barriers don’t mask their inherent dignity. Further, the a fundamental principle offered by liberation theology, “preferential option for the poor,” displays how we are all called by the gospel to emanate God’s universal love to the most vulnerable of the world and work to break the structures that marginalize them. As liberation theology and Christians place much significance on the concept that life is a gift from God, accompaniment is then necessary to alleviate premature death and suffering, due to ill health. Health in this realm encompasses all aspects of the human experience and death resulting from insufficient resources or income is a horrendous injustice.
Liberation theology offers salvation and liberation for the sin of injustice cultivated through a renewed life with Jesus Christ. Through consciousness raising and assuaging oppressive structures, there can be a collective push to offering humane living conditions and a more fruitful life promised by Christ. It’s also imperative to consider that those most vulnerable don’t all suffer from similar experiences or situations and through including all backgrounds and traditions, we can cohesively discern and emanate God’s salvation (De La Torre. 2013). The idea of structural sin, or the sin of selfishness, exhibits how humanity is disenfranchised and thus, many are prohibited from making their own decisions or choices. This is largely attributed to the social structures that exist to maximize the powerful and affluent of society, leaving those with little resources disadvantaged and most vulnerable to structural sin. Liberation theology calls us to understand that by excluding ourselves from participating in acting to reduce suffering, we are augmenting structural sin and allowing for salvation to be withheld from the marginalized. Since suffering ensues as a result of illness, global health ethics should refer to liberation theology’s stance on suffering and aim to provide healthcare that abolishes suffering and limits the capacity for healthcare institutions propagation of health disparity.
An illustration of structural sin and social injustice comes from a case study on access to health services and a medical laboratory installment project in Kenya’s marginalized populations, particularly the indigenous population. The goal of increasing access to health services for the marginalized have begun by project implementation focusing on the health sector, laboratory improvements, and AIDS. However, the methods of implementation and subsequent results further expose and marginalize the communities’ health, as monitoring and evaluations found. These communities suffer from transportation barriers to the major hospitals, which are far distances from their homes. Transportation is a structural barrier that leaves the vulnerable at an injustice, as the right to access of health is lessened because the structural power didn’t account for distance in the implementation of the healthcare project. Project services haven’t been fully disclosed to the population and therefore the population is highly unaware that health services exist for them to utilize. Without informing the vulnerable population on the available services, we further disenfranchise them, as it doesn’t allow for them to make a decision whether to utilize the health services. In addition, nearby laboratories are producing hazardous wastes with virtually no method of sufficient waste disposal or sewage, polluting the vulnerable communities and increasing their risk for environmental health consequences. By failing to allocate an infrastructure that abstains from purposeful environmental pollution, conditions can’t be created that alleviate suffering and the structural sin that the vulnerable population experiences. It’s through such examples that we understand how vulnerable groups are subject to structural sin and oppressed from others neglect to address the structural barriers that hinder health access and the right to health (EAPHLN. 2009).
Until we sit, walk, and stand ever tall with those that are marginalized, accompanying them in their suffering will be a mere unrealistic picture. With the minimal capability to surpass their oppression, in combination with lack of resources, those in poverty must live to survive. In most cases, the majority of their days are filled with allocating the next meal for their families, the next water source, or where to dispose of waste. Structural barriers, proliferate structural sin, and hence, deny the marginalized their inherent dignity, a right to health, and an opportunity to live in the capacity in which they were called by God.
How may liberation theology and global health ethics intersect to acquire solutions to mitigate the suffering caused by poor health outcomes? In order for global health ethics to properly account for disease disparity, a global state of mind must be developed by healthcare professionals. Through making a “preferential option for the poor,” liberation theology addresses the need to eliminate the denial of proficient health services and by doing so, health outcomes will significantly develop. Thus, solving health barriers paves the path for improving other areas of one’s life and social justice is brought to the optimal forefront (Farmer and Gutierrez. 2013). Expanding on the current ideology that only political and civil factors contribute to human rights, through the realization of the contributions social, economic, and cultural factors make to liberating the marginalized capacities, will the basic health needs that the vulnerable inherently deserve be met. (Benatar et al. 2003)
Benatar, S. , Daar, A. , & Singer, P. (2003). Global health ethics: The rationale for mutual caring. International Affairs, 79(1), 107-138.
Cochrane, J. (2006). Religion, public health and a church for the 21st century. International Review of Mission, 95(376/377), 59-72.
De La Torre, M. (2013). Liberation Theology for Armchair Theologians. Westminster: John Knox Press.
EAPHLN. (2009). A case study on access to health services by vulnerable and marginalized groups (world bank supported initiative). Retrieved from: http://www.eaphln-ecsahc.org/kenya/?p=527.
Stapleton, G. , Schroder-Back, P. , Laaser, U. , Meershoek, A. , & Popa, D. (2014). Global health ethics: An introduction to prominent theories and relevant topics. Global Health Action, 7, 1-7.