Global Health Pioneer Paul Farmer Calls for Improved Care for U.S. Poor

March 13, 2007 -- Renowned for his work in global health initiatives from Haiti to Africa, Dr. Paul Farmer, a founding director of Partners In Health, told a University of Virginia audience Monday that the passion many have for combating disease and poverty around the world can also be applied to improve health care for the poor in the United States.

Farmer spoke to a packed house in the School of Nursing’s McLeod Hall, as well as an overflow room showing a live video feed of the talk, under the sponsorship of U.Va.’s Center for Global Health. A MacArthur "genius grant" winner and medical anthropologist, Farmer is a champion of health and human rights and an expert on the role of social inequities as they relate to infectious diseases. He is the subject of the best-selling book, "Mountains Beyond Mountains," by Tracy Kidder, which tells the story of his incredible accomplishments.

Responding to a question following his prepared remarks, Farmer said that the model first introduced in Haiti — where he established a community health project two decades ago while he was a medical student at Harvard — is equally valid for rural or inner-city U.S. communities.

“The fire that many people have and that I think I still have about health and social justice isn’t about boundaries,” he said. “It’s about the right of poor people to health care.” The United States, Farmer said, has far to go as an affluent country in the promotion of basic social economic rights, including the right to health care, and added that “maybe we can get some of the fire that is in the global health movement and bring it home.”

Since its founding in Haiti, Partners in Health has been successful in expanding the model to Peru, Russia and South Africa.

People are not going off to Africa and forgetting about the health problems in the United States, he said. “The difference is that we have the resources, by and large, to address these problems. It certainly is imperative that we do so given that we have so many people who are not protected but we are also spending a ton of money to provide mediocre health care to poor people in a rich country.”

Farmer noted that Partners in Health brought the model used in Haiti of employing community health workers to Boston. Community health workers are nonprofessionals who are paid to offer a broad range of services, including drug distribution and the social support that is crucial to people with chronic illnesses such as HIV/AIDS.

Farmer said it was imperative that the lessons learned in the fight for global health be employed in the United States, where there is such a “frayed safety net.”

Partners in Health is considered different from some other charities involved in such international work because the organization partners with public health officials in the countries where it establishes programs rather than operating independently.

“If we want to promote basic rights,” Farmer said, “then we had better think about rebuilding the public sector because that’s where poor people get their rights.”

Farmer said that while many research universities have indicated that they want to put global health on their agendas, the fact is research universities are ill prepared to do such work in Africa or Haiti. Universities have strengths in the arena of teaching and research but, with few exceptions, lack experience with service and are averse to risk.

“It’s a big challenge. It’s not as if students who want to do this work want to go and be spectators to poverty. They want to do something useful to the people they are around,” he said. “We need to have ‘effector arms’ so that we can have an impact on poor communities.”