Pathologies of Power

Paul Farmer's (2005) "Pathologies of Power: Health, Human Rights, and the New War on the Poor" is a "physician-anthropologist's effort to reveal the ways in which the most basic right – the right to survive – is trampled in an age of great affluence" (p. 6). However, Farmer covers much more than the right to survive, this book "is about the struggle for social and economic rights, the neglected stepchildren of the human rights movement. Because social and economic rights include the right to health care, housing, clean water, and education, they are sometimes called the "the rights of the poor."' (p. xxiv). It is highly recommended for academics and practitioners, and I also highly recommend Farmer's book Infections and Inequalities.

For those new to development studies, academics who assume development practitioners are non-reflexive positivists, and for practitioners looking to be more critical of the processes within international development, Farmer's books are essential reads. In the opening pages he sets the tone: "It was not the silence that rankled. It seemed to us that the exercise was demeaning – the participants, having survived genocide and displacement, were now being treated like children. They were being asked to respond to an agenda imported from capital cities, from do-gooder organizations like ours, from U.S. universities with the "right" answers to their every question. No harm done, perhaps, and the topic was important – but how helpful was this exercise, with its aim of changing the mentality of the locals, who were, after all, the victims of the previous decades of violence? A change in mentality was needed, certainly, but it was needed in the hearts and minds of those with power – and they were not here" (p. 3-4).

It is not just the 'others' with power; as a physician, Farmer writes that many "physicians are uncomfortable acknowledging these harsh facts of life and death. To do so, one must admit that the majority of premature deaths are, as the Haitians would say, "stupid deaths." They are completely preventable with the tools already available to the fortunate few" (p. 144). Yet, it is not simply more "development" that is required: "Developmentalism not only erases the historical creation of poverty but also implies that development is necessarily a linear process: progress will inevitably occur if the right steps are followed. Yet any critical assessment of the impact of such approaches must acknowledge their failure to help the poor" (p. 155)

Weaved throughout the book, Farmer expresses his concern with a changing set of norms and values: from rights, respect and dignity to costs and value for money. He writes: "many of the concepts currently in vogue in public health – from "cost-effectiveness" to "sustainability" and "replicability" - are likely to be perverted unless social justice remains central to public health and medicine. A human rights approach to health economics and health policy helps to bring into relief the ill effects of the efficacy-equity trade-off" (p. 18). This view is not just challenged as an opinion, but as an affront to the practice of health care: "the flabby moral relativism of our times would have us believe that we may now choose from a broad menu of approaches to delivering effective health care services to the poor. This is simply not true. Whether you are sitting in a clinic in rural Haiti, and this witness to stupid deaths from infection, or sitting in an emergency room in a U.S. city, and this the provider of first resort for forty million uninsured, you must acknowledge that the commodification of medicine invariably punishes the vulnerable" (p. 152). This book was published in 2005, and parts published earlier, and Farmer foresaw a challenge that has grown (while also shifting names from cost-effectiveness to value for money, to assessments of quality-adjusted life years, and as metrics in results and impact reporting): "As international health experts come under the sway of the bankers and their curiously bounded utilitarianism, we can expect more and more of our services to be declared "cost-ineffective" and more of our patients to be erased. In declaring health and health care to be a human right, we join forces with those who have long labored to protect the rights and dignity of the poor" (p. 159).

For those who work with marginalized and vulnerable people, who voices are excluded, it is challenging to convey experiences to others. In Farmer's earlier book Infections and Inequalities he used vignettes of people's lives as an attempt. In this end, however, "the experience of suffering, it's often noted, is not effectively conveyed by statistics or graphs. In fact, the suffering of the world's poor intrudes only rarely into the consciousness of the affluent, even when our affluence may be shown to have direct relation to their suffering. This is true even when spectacular human rights violations are at issue, and it is even more true when the topic at hand is the everyday violation of social and economic rights" (p. 31). It is both a depressing conclusion – the reality of a lack of concern – and a call to action. The systems that create and entrench poverty, as well as those that ignore suffering when plan to see, will continue lest things change, and change necessitates informed, critical engagement.

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The Politics of Evidence

Evidence is important. We want to know what we are doing works (or doesn't work). But, what happens when particular types of evidence are required to get funding, and what impact does this have on the types of work that is supported by donors? These questions are engaged with in the edited volume "The Politics of Evidence and Results in International Development: Playing the Game to Change the Rules?" (2015) edited by Rosalind Eyben, Irene Guijt, Chris Roche and Cathy Shutt. The book emerged out of a conference and was supported by an on-going blog conversation (one that has died of recent). For anyone concerned about the how evidence could be political, the experiences presented by a range of authors in this book is well worth reading. Alternatively, it would be useful for advocates who believe that RCTs are the only means by which we can determine what we ought to do in development activity.

One of the values of edited volumes is that multiple views can be presented in a single book. Some contributors are critical of the ways in which evidence (and specifically shifts such as the emphasis on "value for money") has been politicized and negatively affected international development activity. Others recognize the benefits that the newfound emphasis on evidence offers. For example: "Love it or hate it, engaging with VfM [Value for Money] is encouraging healthy and long-overdue debates that force practitioners to make explicit the reasons why we think we offer value and the values we use to asses that." (p. 74) In addition to seeing where the conversation about evidence adds benefit, it was further argued that such a shift creates opportunities: "Nevertheless, there is room to manoeuver. It can offer power-aware practitioners opportunities to increase accountability to citizens and each other; VfM [Value for Money] also creates possibilities to influence discourse about links between value and money and to debate what kind of development is valued." (p. 58)

Although human rights did not play a key role in the book, I believe that one of the most important conflicts in the debates around cost effectiveness and value for money is that with human rights. At the outset of the book this was alluded to: "The number of agencies, particularly international NGOs, using rights language has continued to increase, but the contradiction between rights-based approaches and their political and process approach to intangible goals such as empowerment and the increasing popularity of results-based management has become very apparent. It is harder to manage support for transformational approaches when one is required to report tangible, easy-to-measure changes" (p. 9) However, the issue of human rights was not taken up in detail by any of the contributors. In fact, one notes the absence of human rights: "focusing on unit cost and things that can be measured misses the importance of politics, relationships and networks in creating exponential value through difficult-to-measure change… linear, results-based management thinking and associated VfM [Value for Money] assessment techniques may have limited use for complex transformational initiatives." (p. 69) To these concerns, I have raised that of human rights and justice. If donors emphasize value for money and impact per dollar, we tend to focus our efforts – by necessity – on the easiest to reach, but not necessarily those most in need, or those most deserving (based upon local or regional inequality).

Accountability is important. But, accountability to whom? Organizations tend to focus on accountability to donors. But, little accountability to those for whom organizations claim to work is done. One of the chapters in this volume presents an interesting example of an organization that grappled with this question, and largely, where those efforts failed: "My central proposition is that, despite some significant efforts by the organization to become more accountable to those is sought to benefit, this agenda never became 'mission critical.' In part this was because of other organizational priorities becoming more pressing – particularly as growth in funding stagnated – and in part because we failed to recognize and align the many different perspectives on accountability that existed in the agency." (p. 80) As this book highlights, I believe we need to be far more critical not only about what evidence is demanded, but for whom evidence is prioritized.

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The World Bank and Struggles for Social Justice

The World Bank is a favorite target of criticism. Yet, few actually know how the massive organization operates, externally or internally. Michael Goldman set out to do present this information, and specifically in the context of the 'greening' of the World Bank (or its development and promotion of "green neoliberalism") and its funding whereby it had "to come to terms with the environmentally and socially deleterious effects of its projects" (p. 7). The book "Imperial Nature: The World Bank and Struggles for Social Justice in the Age of Globalization" (2005) was the result. The author was driven toward the study by a pervasive praise of development while his own experiences were the opposite: "Whereas I am regularly told that the project of development uplifts the poor and restores the environment, too often I see it impoverishing the majority and enriching the few." (p. x).

In the book, Goldman attempts "to capture and explain the ways in which the World Bank and its partners have worked to create a representation, analysis, and mode of action for the project of development that have become naturalized, legitimate, and durable. I show through ethnographic research how, in response to effective organizing efforts of its critics, the Bank has successfully worked to reinvent itself, tame its critics, and intervene in an ever-growing number of institutions, terrains, and social bodies located across the postcolonial map" (p. 5). A methodological shortcoming, as a self-described ethnography (p. 5) and critical ethnography (p. 25), there was sparse information on what the data collection entailed or reflexivity of the process – beyond sitting in on workshops, conducting individual interviews with staff and visiting projects in one country. The reader does not gain a sense of the extent of the qualitative methods used, or if they are representative of the Bank (or ethnographic in approach). Nonetheless, the book is insightful and is well worth a read for those interested in knowing how the World Bank operates.

One of the common criticisms waged against the World Bank presents a picture of a monolithic power imposing its will upon the globe. While Goldman is critical of the Bank, he offers important nuance in the critical discourse: "People simply do not agree or consent, or fully stand with or against universal notions of progress, development, and modernization. They do not build up the scientific case for a tropical highway or pour the concrete for a megadam without some reflection, reservation, or fight. If we always assume its success or failure without first looking at how hegemony is constituted, we lose all sense of why people offer their consent without force, and why they do not. We lose the ability to discern where the political openings are, the sites and spaces where dominant structures get constituted, how people try to subvert them, and from where alternatives arise" (p. 25). This is an important addition to understand how the Bank imposes and how it is resisted, but lacking from Goldman's narrative is the role of nation-states, as sovereign countries seeking (or at least approving) World Bank projects and packages. Many countries have resisted and rejected the World Bank, and are a loci of important power in-between the international financial institution and the people of the nation. Yet, Goldman tends to focus upon the relationship between people and the Bank, and under explores the important role of governments.

One of the interesting arguments developed by the author is around how the World Bank seeks to dominate the norms and trends of international development ideas, writing that "data collection and analysis, report writing, editing, and the nail-biting process of getting approval from one's superiors (and one's superiors' superior) is less a process of discovery, creativity, and refutation than one of manufacturing consent. From hiring practices, to hierarchical pressures, to funding decisions for research, to the way information flows are manipulated internally and externally, the assembly line of knowledge production is studded with cultural practices of social control as well as incorporations and hegemony-building" (p. 148-149). Later, in the country case study, Goldman continues this train of thought: "with omission there is inclusion; for every concern, data set, interpretation, and recommendation that is omitted or removed from a report, there are as many that fill its pages and circulate as science locally and oftentimes transnationally" (p. 169). This manufacturing of consent is particularly vivid in the case of community consultations, where one independent researcher found that those consulted had little to no idea of what was even being discussed in the meeting, of often held completely different ideas of what was being proposed and approved (p. 172).

Although the book was written in the early 2000s, it provides interesting insight into what would become normalized in the decade that followed the publication of this book: "Since 9/11, the Bank has been compelled to redirect its finances to a handful of countries supporting the U.S. war. In 2002, the World Bank put together loans for an unprecedented $800 million to Pakistan, $2.2 billion to India, and $3.5 billion to Turkey, much of which appears unconnected to plans the Bank had before September 2001. Countries in southern Africa suffering from horrible famine received little financial support. In 2004 and 2005, the Bank's flagship investments have been Afghanistan and Iraq. The future of the Bank seems to be in the mopping up of the destruction caused by the U.S. military, the rebuilding of societies in the name of antiterrorism, development and democracy." (p. 275). Goldman does not explore who most benefits from these shifts and new financial packages, but other works, such as Rashid's Descent into Chaos, does.

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MA & PhD Studentships: Critical Urban Food Studies

Start date will be January 2017 (preferably) or possibly September 2017. Please apply internally to Prof. Dr. Marit Rosol on or before 25 August 2016.


  • Research project idea that fits within the team's focus on critical urban food geographies and food justice
  • Outstanding previous degree performance
  • Enthusiasm for research, including interest (M.A.) or experience (Ph.D.) in producing peer-reviewed publications, as well as willingness to participate in off-campus activities such as conferences, workshops, or meetings
  • Excellent written and verbal communication skills, well-developed organizational skills
  • An ability to work independently, as well as collaboratively, to multi-task, and contribute to research projects in a team outside of your core research

More information on the research can be found here:

Please direct questions to Marit Rosol. Interested applicants are asked to email the following documents in a single pdf-file to me on or before 25 August 2016cover letter/ statement of interest, outline of potential research project (containing a title, topic, research question, background and relevance, research design/ methodology, potential empirical case study including geographical location, max. 1 page + short bibliography), current CV, names and contact details of two potential referees and transcripts.

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Logan Cochrane

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