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An Anthropology of Structural Violence

Paul Farmer
Current Anthropology
Vol. 45, No. 3 (June 2004), pp. 305-325
DOI: 10.1086/382250
Stable URL:
Page Count: 21
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Any thorough understanding of the modern epidemics of AIDS and tuberculosis in Haiti or elsewhere in the postcolonial world requires a thorough knowledge of history and political economy. This essay, based on over a decade of research in rural Haiti, draws on the work of Sidney Mintz and others who have linked the interpretive project of modern anthropology to a historical understanding of the largescale social and economic structures in which affliction is embedded. The emergence and persistence of these epidemics in Haiti, where they are the leading causes of youngadult death, is rooted in the enduring effects of European expansion in the New World and in the slavery and racism with which it was associated. A syncretic and properly biosocial anthropology of these and other plagues moves us beyond noting, for example, their strong association with poverty and social inequalities to an understanding of how such inequalities are embodied as differential risk for infection and, among those already infected, for adverse outcomes including death. Since these two diseases have different modes of transmission, different pathophysiologies, and different treatments, part of the interpretive task is to link such an anthropology to epidemiology and to an understanding of differential access to new diagnostic and therapeutic tools now available to the fortunate few.

Notes and References

This item contains 108 references.

References Cited
  • ['Agamben, Giorgio. 2000. Remnants of Auschwitz: The witness and the archive. New York: Zone Books. [pb, ns]']
  • ['Arendt, Hannah. 1963. Eichmann in Jerusalem: A report on the banality of evil. New York: Viking Press. [pb, ns]']
  • ['Basaglia, Franco, Nancy ScheperHughes, and Anne Lovell. 1987. Psychiatry inside out: Selected writings of Franco Basaglia. New York: Columbia University Press. [pb, ns]']
  • ['Bauman, Z. 1998. Globalization: The human consequences. New York: Columbia University Press. [lk]']
  • ['Bernier, Olivier. 1981. Pleasure and privilege: Life in France, Naples, and America, 17701790. Garden City: Doubleday.']
  • ['Birns, Larry, and Michael Marx McCarthy. 2001. Haiti needs U.S. aid, not ineffective manipulation. Miami Herald, December 21.']
  • ['Bourdieu, Pierre. 1998. Contrefeux: Propos pour servir la rsistance contre linvasion nolibrale. Paris: Raisons dAgir.']
  • ['. 2000. Pascalian meditations. Stanford: Stanford University Press. [pb, ns]']
  • ['Bourdieu, Pierre, et al. 1993. La misre du monde. Paris: Editions de Seuil.']
  • ['. 1999. The weight of the world: Social suffering in contemporary society. Oxford: Polity.']
  • ['Bourgois, Philippe. 1996. Confronting anthropology, education, and inner city apartheid. American Anthropologist 98:24958.']
  • ['. 1998. Families and children in the U.S. inner city, in Small wars: The cultural politics of childhood. Edited by Nancy ScheperHughes and Carolyn Sargent, pp. 33151. Berkeley: University of California Press.']
  • ['. 2003. 2d edition. In search of respect: Selling crack in El Barrio. Cambridge and New York: Cambridge University Press. [pb, ns]']
  • ['Burns, John F. 2001. U.S. envoy sees her role reverse. International Herald Tribune, November 26.']
  • ['Butler, Katherine. 2000. Grand Marnier workers toil for pounds 2 a day on Haiti plantation. Independent (London), July 16.']
  • ['Cohen, Lawrence. 1998. No aging in India: Alzheimers, the bad family, and other modern things. Berkeley: University of California Press.']
  • ['Conrad, Joseph. 1969. Heart of darkness. New York: Bantam Books. [pb, ns]']
  • ['Csordas, Thomas. 1990. Embodiment as a paradigm for anthropology. Ethos 18(1):547. [df]']
  • ['Davis, David Brion. 1975. The problem of slavery in the age of revolution, 17701823. Ithaca: Cornell University Press. [lw]']
  • ['Diamond, S. 1974. In search of the primitive: A critique of civilization. New Brunswick: Transaction Books. [hkh]']
  • ['Donnelly, John. 2001. Prevention urged in AIDS fight: Natsios says fund should spend less on HIV treatment. Boston Globe, June 7.']
  • ['Eisenberg, L. 1984. Rudolf Ludwig Karl Virchow, where are you now that we need you? American Journal of Medicine 77:52432. [hkh]']
  • ['Fabian, Johannes. 1983. Time and the other: How anthropology makes its object. New York: Columbia University Press.']
  • ['Fanon, F. 1961. The wretched of the earth. New York: Grove Press. [hkh]']
  • ['. 1964. Toward the African Revolution. New York: Grove Press. [hkh]']
  • ['Farmer, Paul. 1992. AIDS and accusation: Haiti and the geography of blame. Berkeley: University of California Press.']
  • ['. 1999. Infections and inequalities: The modern plagues. Berkeley: University of California Press.']
  • ['. 2000. Epidemics and inequalities. Berkeley: University of California Press. [lw]']
  • ['. 2001. La violence structurelle et la matrialit du social (Leon inaugurale, Chaire internationale, vendredi 9 novembre 2001). Paris: Collge de France. [lw]']
  • ['. 2003a. Douze points en faveur de la restitution Haiti de la dette Franaise. LUnion, November 11.']
  • ['. 2003b. Pathologies of power: Health, human rights, and the new war on the poor. Berkeley: University of California Press.']
  • ['. 2003c. Pestilence and restraint: Guantnamo, AIDS, and the logic of quarantine, in Pathologies of power: Health, human rights, and the new war on the poor, pp. 5190. Berkeley: University of California Press.']
  • ['. 2003d. 2d edition. The uses of Haiti. Monroe, Me.: Common Courage Press.']
  • ['. 2003e. Unjust embargo of aid for Haiti. The Lancet 361:42023.']
  • ['Fassin, Didier. 2003. The embodiment of inequality: AIDS as a social condition and historical experience in South Africa. EMBO Reports, Science and Society 4:S4S9. [df]']
  • ['Foucault, Michel. 1978. The history of sexuality. New York: Pantheon Books. [pb, ns]']
  • ['Fromm, E. 1955. The sane society. New York: Fawcett. [hkh]']
  • ['Galeano, Eduardo. 1973. Open veins of Latin America: Five centuries of the pillage of a continent. New York: Monthly Review Press.']
  • ['Galtung, Johan. 1969. Violence, peace, and peace research. Journal of Peace Research 6:16791.']
  • ['Gilligan, James. 1997. Violence. New York: Vintage Books.']
  • ['Goodman, Alan L., and Thomas L. Leatherman. Editors. 1998. Building a new biocultural synthesis: Politicaleconomic perspectives on human biology. Ann Arbor: University of Michigan Press.']
  • ['Green, Linda. 1999. Fear as a way of life: Mayan widows in rural Guatemala. New York: Columbia University Press.']
  • ['Green, R. H. 1991. Politics, power, and poverty: Health for all in 2000 in the Third World? Social Science and Medicine 32:74555. [hkh]']
  • ['Gurin, J., R. Malebranche, A. Elie, et al. 1984. Acquired immune deficiency syndrome: Specific aspects of the disease in Haiti. Annals of the New York Academy of Sciences 437:25461.']
  • ['Hartog, Franois. 2003. Rgimes dhistoricit: Prsentisme et expriences du temps. Paris: Seuil. [df]']
  • ['Heggenhougen, H. K. 1979. Therapeutic anthropology: Reaction to Shilohs proposal. American Anthropologist 81:64751. [hkh]']
  • ['. 1984. Will primary health care be allowed to succeed? Social Science and Medicine 19:21724. [hkh]']
  • ['. 1999. Are the marginalized the slagheap of economic growth and globalization? Disparity, health, and human rights. Health and Human Rights 4:20513. [hkh]']
  • ['Jha, P., B. Stirling, and A. S. Slutsky. 2004. Weapons of mass salvation: Canadas role in improving the health of the global poor. Canadian Medical Association Journal 170:6667. [lk]']
  • ['Kawachi, I., and B. P. Kennedy. 2002. The health of nations: Why inequality is harmful to your health. New York: New Press. [hkh]']
  • ['Keane, John. 1996. Reflections on violence. London: Verso. [lw]']
  • ['Kernaghan, Charles. 1993. Haiti after the coup: Sweatshop or real development? New York: U.S. National Labor Committee.']
  • ['Kim, J., J. V. Millen, A. Irwin, and J. Gershman. 2002. Dying for growth: Global inequality and the health of the poor. Monroe, Me.: Common Courage Press. [hkh]']
  • ['Kirmayer, L. J. 2003a. Reflections on embodiment, in Social and cultural lives of immune systems. Edited by J. Wilce, pp. 282302. New York: Routledge. [lk]']
  • ['. 2003b. Failures of imagination: The refugees narrative in psychiatry. Anthropology and Medicine 10:16785. [lk]']
  • ['Klein, Herbert S. 1986. African slavery in Latin America and the Caribbean. New York: Oxford University Press.']
  • ['Kleinman, A. Editor. 1996. Social suffering. Daedalus 125(1). [hkh]']
  • ['Kleinman, Arthur, Veena Das, and Margaret M. Lock. 1997. Social suffering. Berkeley: University of California Press. [pb, ns]']
  • ['Koselleck, Reinhart. 1997. Lexprience de lhistoire. Paris: Hautes Etudes, GallimardSeuil. [df]']
  • ['Kroeber, A. L. 1963 (1923). Anthropology: Culture patterns and processes. Orlando: Harcourt, Brace Jovanovich.']
  • ['Lawless, Robert. 1992. Haitis bad press. Rochester, Vt.: Schenkman Books.']
  • ['Le Carr, John. 2001. A war we cannot win. The Nation, November 19.']
  • ['Levi, Primo. 1986. Survival in Auschwitz: The Nazi assault on humanity. New York: Collier Books. [pb, ns]']
  • ['Lock, Margaret. 1993. Encounters with aging: Mythologies of menopause in Japan and North America. Berkeley: University of California Press.']
  • ['Margalit, A. 2002. The ethics of memory. Cambridge: Harvard University Press. [lk]']
  • ['Martin, Emily. 1987. The woman in the body: A cultural analysis of reproduction. Boston: Beacon Press.']
  • ['Mtraux, Alfred. 1972 (1959). Haitian voodoo. Translated by Hugo Charteris. New York: Schocken.']
  • ['Mintz, Sidney W. 1972. Introduction, in Voodoo in Haiti, by Alfred Mtraux. New York: Schocken.']
  • ['. 1974a. Caribbean transformations. Baltimore: Johns Hopkins University Press.']
  • ['. 1974b. The Caribbean region, in Slavery, colonialism, and racism. Edited by Sidney Mintz, pp. 4571. New York: W. W. Norton.']
  • ['. 1977. The socalled world system: Local initiative and local response. Dialectical Anthropology 2:25370.']
  • ['. 1985. Sweetness and power: The place of sugar in modern history. New York: Elisabeth Sifnon Books, Viking.']
  • ['. 1997. The localization of anthropological practice: From area studies to transnationalism. Critique of Anthropology 2:25370.']
  • ["Moreau De SaintMry, Mdric Louis Elie. 1984 (179798). Description topographique, physique, civile, politique et historique de la partie franaise de lisle SaintDominigue. 3 vols. Edited by B. Maurel and E. Taillemite. Paris: Socit de l'Histoire des Colonies Franaises and Librairie Larose."]
  • ['Nguyen, V., and K. Peschard. 2003. Anthropology, inequality, and disease: A review. Annual Review of Anthropology 32:44774. [hkh]']
  • ['Ott, Katherine. 1996. Fevered lives: Tuberculosis in American culture since 1870. Cambridge: Harvard University Press.']
  • ['PAHO (Pan American Health Organization). 2004. The Haiti crisis: Health risks., accessed March 13, 2004.']
  • ['Patterson, Orlando. 1982. Slavery and social death. Cambridge: Harvard University Press. [lw]']
  • ['PriceMars, Jean. 1953. La rpublique dHaiti et la rpublique dominicaine: Les aspects divers dun problme dhistoire, de gographie et dethnologie. 2 vols. Lausanne: Imprimerie Held.']
  • ['Rohde, David. 2002. Musharraf redraws constitution, blocking promise of democracy. New York Times, August 22.']
  • ['Rosaldo, Renato. 1986. From the door of his tent: The fieldworker and the inquisitor, in Writing culture. Edited by James Clifford and George E. Marcus, pp. 7797. Berkeley: University of California Press.']
  • ['Roseberry, William. 1988. Political economy. Annual Review of Anthropology 17:16185.']
  • ['ScheperHughes, N. 1990. Three propositions for a critically applied medical anthropology. Social Science and Medicine 30:18997. [hkh]']
  • ['. 1992. Death without weeping: The violence of everyday life in Brazil. Berkeley: University of California Press.']
  • ['. 1995. The primacy of the ethical: Propositions for a militant anthropology. current anthropology 36:40940. [pb, ns, hkh]']
  • ['. 1996. Small wars and invisible genocides. Social Science and Medicine 43:889900. [pb, ns, hkh]']
  • ['ScheperHughes, Nancy, and Philippe Bourgois. Editors. 2003. Violence in war and peace. Malden, Mass.: Blackwell. [lw]']
  • ['. 2004. Introduction: Making sense of violence, in Violence in war and peace: An anthology. Edited by N. ScheperHughes and P. Bourgois, pp. 127. Oxford: Blackwell. [pb, ns]']
  • ['Schmidt, Hans. 1995. The United States occupation of Haiti, 19151934. New Brunswick: Rutgers University Press.']
  • ['Scott, James. 1976. The moral economy of the peasant: Rebellion and subsistence in Southeast Asia. New Haven: Yale University Press.']
  • ['. 1985. Weapons of the weak: Everyday forms of peasant resistance. New Haven: Yale University Press.']
  • ['. 1990. Domination and the art of resistance. New Haven: Yale University Press.']
  • ['Shiloh, A. 1977. Therapeutic anthropology: The anthropologist as private practitioner. American Anthropologist 79:44345. [hkh]']
  • ['Singer, M. 1998. Beyond the ivory tower: Critical praxis in medical anthropology, in Understanding and applying medical anthropology. Edited by P. Brown, pp. 22539. Palo Alto: Mayfield. [hkh]']
  • ['Singer, M., F. Valentin, H. Baer, and Z. Jia. 1992. Why does Juan Garcia have a drinking problem? The perspective of critical medical anthropology. Medical Anthropology 14(1):77108. [hkh]']
  • ['Stockman, Farah, and Susan Milligan. 2004. Before fall of Aristide, Haiti hit by aid cutoff. Boston Globe, March 7.']
  • ['Swoboda, Frank, and Martha Mc Neil Hamilton. 2001. Congress passes $15 billion airline bailout. Washington Post, September 22.']
  • ['Taussig, Michael T. 1986. Shamanism, colonialism, and the wild man: A study in terror and healing. Chicago: University of Chicago Press. [pb, ns]']
  • ['. 1992. The nervous system. New York: Routledge. [pb, ns]']
  • ['Treichler, Paula. 1988. AIDS, homophobia, and biomedical discourse: An epidemic of signification, in AIDS: Culture analysis, cultural activism. Edited by Douglas Crimp, pp. 3137. Cambridge: MIT Press.']
  • ['UNDP (UNITED NATIONS DEVELOPMENT PROGRAM). 1999. Human development report. New York: Oxford University Press. [hkh]']
  • ['U.S. Central Intelligence Agency. 2002. The world factbook 2002. Washington, D.C.']
  • ['Vastey, Pompe Valentin. 1814. Notes Monsieur le Baron Malouet, Ministre de la Marine et des Colonies. Haiti: Cap Henry.']
  • ['Vissire, Isabelle, and JeanLouis Vissire. Editors. 1982. La trait des noirs au sicle des lumires. Paris: A. M. Mtaili.']
  • ['Wacquant, Loc. 2004. Body and soul: Notebooks of an apprentice boxer. Oxford and New York: Oxford University Press. [pb, ns]']
  • ['Wallerstein, Immanuel. 1974. The modern worldsystem: Capitalist agriculture and the origins of the European worldeconomy in the sixteenth century. San Diego: Academic Press.']
  • ['Weise, Jean. 1971. The interaction of Western and indigenous medicine in Haiti in regard to tuberculosis. Ph.D. diss., University of North Carolina at Chapel Hill, Chapel Hill, N.C.']
  • ['Willis, Paul E. 1981. Learning to labor: How working class kids get working class jobs. New York: Columbia University Press.']