Why must the poor be sick? Paul Farmer's exhortations sound familiar, and hopelessly idealistic, until you realize they are backed up by evidence and practical action

Natural History, Feb, 2004 by Jeffrey D. Sachs

Farmer's genius was to treat his HIV/AIDS and MDR-TB patients without asking permission from the official aid agencies. They would surely have said no. He was one of the first to introduce antiretroviral combination therapy for low-income AIDS patients, mainly with donated drugs. And his clinical results were extremely positive. His pioneering work with MDR-TB patients led to intense squabbles in the international health community, which felt that MDR-TB would be too hard and too expensive to tackle in places lacking substantial economic resources. Yet through persistence and vision (and with the help of a few pilfered supplies along the way), Farmer and his colleague Jim Kim, of the Harvard Medical School, not only demonstrated clinical efficacy in treating MDR-TB and HIV/AIDS, but also showed that drug prices could be sharply reduced through aggressive negotiations.

As their successes have become apparent, Farmer, Kim, and their colleagues have increasingly focused on persuading policy makers to make a bold commitment to improved health care among the world's poor. Hence, the third theme of Farmer's collected essays is his message for the human rights community: that human rights are indivisible, that so-called social and economic rights must accompany civil and political rights. Making such a shift of emphasis would be a sea change for a community that has traditionally been organized around the defense of civil and political rights alone.

Once more Farmer is an acute observer and a compelling advocate. Again and again he shows that when poor people are abandoned to their economic fate, merely defending their civil rights will not keep them alive--much less give them a chance for a dignified and prosperous life. Farmer is surely being strategically wise to reach out to the civil rights community: the codifications of human rights that have emerged from the UN (both the 1948 Universal Declaration of Human Rights and the 1976 International Covenant on Economic, Social and Cultural Rights) are potent tools that can bolster Farmer's case for greater global attention to the health needs of the poor.

An alliance of public health and human rights will not be enough, however. Farmer's arguments will need to prevail in the capitals and international institutions of the rich world as well. Billions of dollars of rich-world income will have to be channeled to the poorest countries to fight the multiple challenges of AIDS, malaria, TB, and other disease killers that hold poor societies in thrall. And funding on such a scale is not the impossibility it might seem. On the contrary, I have direct and personal evidence that Farmer's successes, properly explained, can help move mountains.

At the end of 1999, the presiding director general of the World Health Organization (WHO), Gro Harlem Brundtland, asked me to chair a Commission on Macroeconomics and Health. The commission was designed explicitly to bridge the worlds of high finance and global health. I advocated large increases in development assistance for health in the poorest countries, and I recommended, in mid-2000, that a global fund be established to fight AIDS.