The Preferential Option for the Poor beyond Theology

Chapter 11: Health, Healing, and Social Justice: Insights from Liberation Theology

199 C h a P T e r 1 1 health, healing, and social Justice Insights from Liberation Theology Paul FarMer If I define my neighbor as the one I must go out to look for, on the highways and byways, in the factories and slums, on the farms and in the mines—then my world changes. This is what is happening with the “option for the poor,” for in the gospel it is the poor person who is the neighbor par excellence. . . . But the poor person does not exist as an inescapable fact of destiny . His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat , robbed of the fruit of their labor and despoiled of their humanity . Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different kind of social order. —Gustavo Gutiérrez, The Power of the Poor in History Not everything that the poor are and do is gospel. But a great deal of it is. —Jon sobrino, Spirituality of Liberation This chapter originally published in Paul e. Farmer, Pathologies of Power: Health, Human Rights, and the New War on the Poor (Berkeley: university of California Press, 2004). reprinted with permission. 200 Paul Farmer MakinG a PreFerenTial OPTiOn FOr The POOr For decades now, proponents of liberation theology have argued that people of faith must make a “preferential option for the poor.” as discussed by Brazil’s leonardo Boff, a leading contributor to the movement, “the Church’s option is a preferential option for the poor, against their poverty.” The poor, Boff adds, “are those who suffer injustice. Their poverty is produced by mechanisms of impoverishment and exploitation. Their poverty is therefore an evil and an injustice.”1 To those concerned with health, a preferential option for the poor offers both a challenge and an insight. it challenges doctors and other health providers to make an option—a choice—for the poor, to work on their behalf. The insight is, in a sense, an epidemiological one: most often, diseases themselves make a preferential option for the poor. every careful survey, across boundaries of time and space, shows us that the poor are sicker than the nonpoor. They are at increased risk of dying prematurely, whether from increased exposure to pathogens (including pathogenic situations) or from decreased access to services—or, as is most often the case, from both of these “risk factors” working together.2 Given this indisputable association, medicine has a clear—if not always observed— mandate to devote itself to populations struggling against poverty. it is also clear that many health professionals feel paralyzed by the magnitude of the challenge. where on earth does one start? we have received endless, detailed prescriptions from experts, many of them manifestly dismissive of initiatives coming from afflicted communities themselves . But those who formulate health policy in Geneva, washington, new york, or Paris do not really labor to transform the social conditions of the wretched of the earth. instead, the actions of technocrats—and what physician is not a technocrat?—are most often tantamount to managing social inequality, to keeping the problem under control. The limitations of such tinkering are sharp, as Peruvian theologian Gustavo Gutiérrez warns: latin american misery and injustice go too deep to be responsive to palliatives . hence we speak of social revolution, not reform; of liberation, not development; of socialism, not modernization of the prevailing sys- health, healing, and social Justice 201 tem. “realists” call these statements romantic and utopian. and they should, for the reality of these statements is of a kind quite unfamiliar to them.3 liberation theology, in contrast to officialdom, argues that genuine change will be most often rooted in small communities of poor people; and it advances a simple methodology—observe, judge, act.4 Throughout latin america, such base-community movements have worked to take stock of their situations and devise strategies for change.5 The approach is straightforward. although it has been termed “simplistic” by technocrats and experts, this methodology has proved useful for promoting health in settings as diverse as Brazil, Guatemala, el salvador, rural Mexico, and urban Peru. insights from liberation theology...