According to Paul Farmer, What Is Wrong With Charity Medicine?

Question by Max: According to Paul Farmer, what is wrong with Charity Medicine?
According to Paul Farmer, what is wrong with Charity Medicine?

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Answer by Trisha
Paul Farmer, medical anthropologist and physician, is a founding director of Partners In Health, an international charity organization that provides direct health care services and undertakes research and advocacy activities on behalf of those who are sick and living in poverty. Dr. Farmer’s work draws primarily on active clinical practice (he is an attending physician in infectious diseases and chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital (BWH) in Boston, and medical director of a charity hospital, the Clinique Bon Sauveur, in rural Haiti) and focuses on diseases that disproportionately afflict the poor.

Along with his colleagues at BWH, in the Program in Infectious Disease and Social Change at Harvard Medical School, and in Haiti, Peru, and Russia, Dr. Farmer has pioneered novel, community-based treatment strategies for AIDS and tuberculosis (including multidrug-resistant tuberculosis).Dr. Farmer has written extensively about health and human rights, and about the role of social inequalities in the distribution and outcome of infectious diseases. He is the author of Pathologies of Power (University of California Press, 2003), Infections and Inequalities (University of California Press, 1998), The Uses of Haiti (Common Courage Press, 1994), and AIDS and Accusation (University of California Press, 1992). In addition, he is co-editor of Women, Poverty, and AIDS (Common Courage Press, 1996) and of The Global Impact of Drug-Resistant Tuberculosis (Harvard Medical School and Open Society Institute, 1999).

Paul Farmer says he has resigned to publicise his anger at an ‘inhumane system’ that is telling severely ill and disabled they are fit to work Here’s the moral dilemma that faced Paul Farmer, chief executive of the mental health charity Mind, last week: should he continue to sit on a government advisory panel, charged with scrutinising a policy that his charity believes to be inhumane? Or should he resign, publicising his anger at the coalition government’s refusal to listen to the charity’s concerns, and remove himself from the room where improvements are being discussed? Farmer chose to leave the panel responsible for monitoring the functioning of the work capability assessment (WCA), the new fitness-for-work test that determines who is eligible for sickness benefits, frustrated that the government was not paying attention to the growing chorus of alarm over the reliability of the test. His departure from the committee reflects the intensifying anger among charities such as Mind that represent people affected by the government’s commitment to reassessing approximately 1.6 million recipients of incapacity benefit – which is being phased out – to see whether they are eligible for the new benefit, employment and support allowance. Until now, charities have been voicing their concerns but expressing a desire to work with the government to get things right. Farmer’s resignation marks a new, tougher stance. Amid the fallout from his departure last week, there was despondency among campaigners over the government’s failure to implement substantial improvements to a system that charities identified as “not fit for purpose” more than 18 months ago, but which is still being used to assess the fitness of 11,000 people a week. Farmer’s decision has been widely supported by other charities, which are also anxious about the consequences of pushing some of the country’s most unwell and vulnerable people through a “flawed” WCA. There is growing concern about the rapidly rising number of people who appeal against judgments that they are fit for work (up to 50% of all those who go through the test) and of those who are successful in their appeal (around 40% of all those who appeal). At least 390,000 people have gone to appeal since 2009; tribunal courts have been forced to open on Saturdays and to increase staff by 30% since January 2010, to deal with the backlog. Appeals are costing the government around £50m a year, in addition to the £100m it is paying the IT company, Atos, to carry out the largely computer-led test. “The DWP [Department for Work and Pensions] seems absolutely committed to pushing 11,000 people a week through a flawed system. That’s the real problem for us,” says Farmer. “That doesn’t feel fair. I’ve moved from being puzzled about the reluctance to change, to being increasingly frustrated.

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