AW

Paul Farmer – An Anthropology of Structural Violence (Study Notes)

Introduction / Lecture Context

  • Lecture: Sidney W. Mintz Lecture in Anthropology (Nov 27, 2001) later published Current Anthropology 45(3):305–317
  • Lecturer: Paul Farmer – physician‐anthropologist, co-founder of Zanmi Lasante / Partners in Health, Harvard Medical School, Brigham and Women’s Hospital
  • Central Aim
    • Develop a “properly biosocial” anthropology able to explain modern epidemics (AIDS & TB) in post-colonial settings (esp. Haiti)
    • Link ethnography to history, political economy, epidemiology, biology, clinical medicine, and human-rights analysis
    • Operationalise “structural violence” for anthropological inquiry

Ethnographic Vignette – Morning Clinic in Rural Haiti

  • Setting: Squatter settlement near hydro-electric dam, Central Plateau, Sept 2000
  • Contrasts
    • Most regional hospitals empty → patients cannot pay
    • Zanmi Lasante/Clinique Bon Sauveur (free medicines + labs) → courtyard overflowing; >100 people slept overnight to be seen
  • Triage ritual: Farmer scans crowd for the sickest
  • Patient “Anite”
    • Presents with fungating left-breast mass; axillary nodes – likely metastatic breast cancer
    • Wears hand-me-downs, supported by other patients; wants to tell story publicly
    • Story components
    • Fall carrying millet → discovered “small, hard” lump while breastfeeding
    • Visited 14 clinics; surgery quoted at 700 in Port-au-Prince; unaffordable
    • Dreams, houngan consultation; instructed to seek doctors who “work with both hands” (biomedicine + spiritual)
    • Travelled a week from Jérémie (far SW) to central Haiti
    • Structural insights
    • Poverty, gendered caretaking obligations, lack of surgical services, delayed diagnosis
    • Public storytelling as coping & social performance (Jeremiad tradition)

Haiti’s Political Moment (2000)

  • Historical precedent: President René Préval about to finish full term – 1st time in Haitian history
  • Daily reality for rural poor: erosion, lower yields, hunger, sickness; clinic lines lengthen
  • Foreign portrayal: tragedies seen as local; macro-historical causes (slavery, debt, imperialism) erased

Defining Structural Violence

  • Concept traces back to Johan Galtung (1969) & Latin-American liberation theology
  • Violence exerted systematically and indirectly by social orders → poverty, racism, gender oppression
  • Discomfort in moral economies that prefer individual blame/praise
  • Analytical Tasks
    • Reveal “social machinery of oppression”
    • Examine erasure of historical memory & desocialisation enabling violent structures
    • Balance studies of resistance (“weapons of the weak”) with material body counts
  • “Materiality of the social”
    • Avoid romanticism; attend to who wins/loses and by which weapons
    • Pursues deeply materialist (not narrowly economic or biological) explanations

Anthropology’s Epistemic Duties

  • Follow Kroeber’s triad “anthropology, biology, history”
  • Danger of specialisation → erasure of history & political economy in social sciences (anthro, sociology, epidemiology)
  • Call for integration: epidemiology, demography, clinical medicine within anthropological analysis
  • Ethnographic present problem: need geographically broad & historically deep analyses (Mintz critique)
  • Media sound-bites vs long contextual scholarship; importance of recognizing links across time/space

Historical Roots: French Wealth & Haitian Slavery (1780s)

  • Vignette 1: French elite excess
    • Three-foot coiffures with model warships; lavish 5-service dinners for 15 (menu detailed)
    • Required 7 servants for modest bourgeois dinner; Bordeaux rebuilt on slavery profits
  • Vignette 2: Saint-Domingue productivity
    • Late 1780s: rac{2}{3} of Europe’s tropical produce from Haiti
    • Slave population ≈ 460,000 (½ of all Caribbean slaves)
    • >600 vessels/year exported sugar, coffee, cotton, indigo, cacao
    • French visitors noted opulence; Moreau de Saint-Méry commentary on servant excess
  • Slave testimony: Pompée Valentin Vastey (1814) lists tortures – boiling syrup cauldrons, anthills, dog mauling, spiked barrels

Post-Independence Structural Sequelae

  • Haitian Revolution 1791–1803 → independence but ruined infrastructure; >½ population dead
  • 1825 Indemnity: 150\,000\,000 francs demanded by France for loss of slaves/colony; plunged Haiti into debt
  • 19th-century embargo & diplomatic quarantine (US & Europe)
  • U.S. dominance
    • Continuous naval presence → Military occupation 1915–34; creation of modern Haitian army (1916)
    • Post-occupation: US-backed dictatorships culminating in Duvaliers (1957-86)
  • Template of slave colony persists → peasants “socialised for scarcity”

Neoliberalism & Development Ideology

  • “Neoliberal economics” = ideology of competition-driven markets, managing (not resolving) inequality
  • Bourdieu quote: Western scientific-rationalist arrogance legitimates structural power and “monopoly of legitimate violence”
  • Haiti as extreme casualty: GDP decline, life-expectancy drop, >70\% unemployment (CIA est.)

Contemporary Aid Embargo & IDB Loans

  • 1994 pledge: 500\,000\,000 aid to rebuild Haiti; largely undelivered
  • Since 2000 elections, U.S. blocks \text{IDB} loans via disputed senatorial run-offs (8 seats) → de facto embargo
  • Example: IDB Loan 1009/SF-HA “Reorganisation of National Health System”
    • Value: 22.5\,\text{million} signed July 1998
    • Goals: reduce infant mortality from 74 \to 50/1000; juvenile 131 \to 110/1000; birth rate 4.6 \to 4; general mortality 10.7 \to 9.7/1000
    • Blocked until Haiti pays prior regime debts + “commission fees” (e.g., 185\,239.75 on undisbursed funds)
  • Contrasting leniency: Pakistan sanctions lifted post-9/11 despite military coup
  • Consequence: overflowing clinic courtyard; collapse of public health sector

Biosocial Pathologies: Tuberculosis & AIDS

  • Global stats
    • TB: 8{-}10\,\text{million} new cases/yr; 2{-}3\,\text{million} deaths; \frac{1}{3} world infected
    • HIV/AIDS: leading infectious killer of adults; combined with TB produce ≈15,000 adult deaths/day worldwide
  • Anthropological critiques
    • Over-focus on “cultural beliefs” (sorcery, vodou) vs structural determinants
    • Ethnographic shift: where effective treatment delivered, sorcery explanations decline, stigma reduced (Bertrand study)
  • HIV in Haiti
    • Early U.S. media blamed voodoo & migrants; wrong epidemiologically & stigmatizing
    • Introduction via North American sexual tourism; 17 % of early Haitian AIDS cases reported sex with NA tourists (Guérin et al. 1984)
    • Viral subtype evidence: Haitian epidemic a sub-epidemic of U.S. outbreak
    • Spread aided by economic ties, urban poverty, slum conditions, offshore assembly industry replacing agriculture
    • Caribbean trade dependency correlation: tightest U.S. ties = highest HIV prevalence; Cuba (low dependency) lowest prevalence
  • Treatment & “will” debates
    • TB curable; requires resources + political commitment
    • Antiretroviral therapy success in rich nations; costs < one day of U.S. airline bailout
    • Discourses blocking therapy: Africans lack clocks (USAID’s Andrew Natsios); fear of noncompliance & resistance; infrastructure excuses

Material Embodiment of Structural Violence

  • Outcomes: premature death, metastatic cancers untreated, epidemic disease, hunger, stigma, psychological terror
  • “Habitus” (Bourdieu): structured & structuring; scarcity disciplines dreams, decisions, even ailments (Anite’s story)
  • Haitian proverb: “Grangou se mizè; vant plen se traka” (“Hunger is misery; a full belly brings trouble”)

Ethical, Philosophical, Practical Implications

  • Need for reparations/solidarity (Durban Declaration 2001 acknowledges slavery’s legacy; Haitians see hypocrisy vs current embargo)
  • Anthropology’s obligation
    • Meticulous documentation of hidden linkages and body counts
    • Resist erasure of history & biology; avoid romanticism; integrate epidemiology & political economy
    • Expose contradictions of global power (e.g., aid conditionalities, neoliberal justifications)
  • Call to action
    • Treatables must be treated; resources exist; obstacle is political will & structural inequity
    • Scholars must fight amnesia, make violence visible, and support practical interventions

Key Terms & References

  • Structural Violence – systemic, indirect violence embedded in social structures creating unequal life chances
  • Biosocial – integrating biological processes with social, historical, economic contexts
  • Neoliberalism – ideology advocating market supremacy, fiscal austerity, reduced public spending; often deepens inequality
  • World-Systems Theory – analytic framework (Wallerstein) situating local phenomena within global capitalist core-periphery relations
  • Major scholars cited: Sidney Mintz; Alfred Kroeber; Johan Galtung; James Scott; Pierre Bourdieu; Johannes Fabian; Katherine Ott; Luc Montagnier; Katherine Ott; Alan Klein; Alfred Métraux

Numerical & Statistical Highlights (LaTeX format)

  • Initial indemnity to France (1825): 150\,000\,000\;\text{francs}
  • Slave population in Saint-Domingue 1780s: \approx 460,000 (≈\tfrac{1}{2} Caribbean total)
  • Ships visiting Saint-Domingue/yr: >600
  • Current Haitian unemployment (CIA): \sim 70\%
  • TB global burden: 8{-}10\times10^{6} cases/yr; 2{-}3\times10^{6} deaths/yr
  • HIV/TB combined daily deaths: \approx 15,000
  • IDB health loan: 22.5\,\text{million USD}; commission fee already owed 185,239.75; total fees 2,311,422
  • Clinic surgery quote for Anite: 700\,\text{USD}

Connections to Previous Lectures & Broader Relevance

  • Builds on Mintz’s Caribbean scholarship linking plantation slavery to modern capitalism
  • Extends Rudolf Virchow’s dictum “Medicine is a social science” with contemporary data
  • Resonates with liberation theology, social epidemiology (Krieger), and critical development studies
  • Provides empirical grounding for debates on global health equity, TRIPS/medication access, and post-colonial reparations