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In the rich world, public health workers battle fat; where people are poor, they fight starvation.  

“Obesity and famine are happening at the same time in this era of globalization,” said Dr. Paul Farmer, physician, anthropologist, human rights activist and author, speaking in Zellerbach Hall Saturday at commencement ceremonies for UC Berkeley’s School of Public Health.  

Farmer encouraged graduates to look for solutions to health problems “by connecting the dots” between rich and poor nations. To cure ill health, much of it linked to social ills, the doctor prescribed a heavy dose of activism for the graduates—and the will to work for social justice to blunt the inequities.  

Farmer knows both the rich and poor—the powerful and impuissant—worlds. He has lived and worked in rural Haiti, which he calls home, for two decades, and he spends time each year treating low-income patients in Boston and teaching at Harvard University Medical School; he also finds time to work at clinics his organization, Partners in Health, has established in Peru, Mexico, Guatemala and Rwanda and to care for tuberculosis patients in Siberian prisons.  

“Public health activism needs to be global and local at the same time,” Farmer said. It’s local in the sense that the doctor pays close attention to patients and the social and cultural milieu in which they live—and universal because healthcare is a human right. Understanding the global power balance is critical because political and economic priorities of rich countries either help or hinder healthcare delivery in poor countries, he said.  

“To say that people as people have a right to health care is a radical message,” said Farmer, who also received a human rights award from Global Exchange in San Francisco Thursday evening.  

Naturally, good science is important in curing illness, but science must be paired with activism and social justice, Farmer said, using new and effective AIDS medications as an example. This medicine “is at risk of commodification, something to be bought and sold.” Farmer has worked to bring generic, low-cost drugs to the poor.  

Beyond obtaining medicine for patients, the activist public heath worker may need to create a system to deliver the medication as needed. This is what Farmer has done in central Haiti. His group of about 1,000 Haitian healthcare workers has not only improved delivery of services, but has boosted the general standard of living by providing jobs.  

Farmer’s standard for equitable health care goes beyond the right of people to see a healthcare professional and get drugs. These rights take on meaning only in the context of a patient’s getting nutritious food, drinking clean water and becoming literate. Farmer’s vision also addresses mental health needs, particularly for “those who are damaged by violence and oppression.”  

He rejects the notion—sometimes suggested to him—that patients would appreciate healthcare services more were they charged a fee. The doctor said he not only looks at free healthcare as a right, but he believes patients in rural Haiti, like patients in East Oakland, deserve high quality, modern care. Farmer is equipped to perform cesarean sections in his operating room in central Haiti. And he has a modern blood bank there as well.  

Farmer also refuses to accept the idea that only some can benefit from care. So when a patient, Ti Joseph, appeared to be on his deathbed, dying from AIDS and drug-resistant tuberculosis, Farmer did not hesitate to treat him. The message once again: healthcare is a human right—for everyone. (Today Ti Joseph is one of Farmer’s healthcare workers.)  

When people understand they have rights to food, education, healthcare, economic stability and to live without fear of violence, they become empowered. “But we don’t want to empower people from Marin County,” Farmer quipped, adding levity to his message. “There is no universal right to Pilates classes.”  

Farmer looks at war and violence from a public health perspective. “Those of us who are in public health are called to have certain standards regarding what may be considered a just war,” he said, citing the article published last fall in the British medical journal, Lancet, that estimated that some 100,000 civilian Iraqis, mostly women and children, have died during the war in Iraq. 

“Passion and indignation have a place in public health,” Farmer said.  

An activist for democracy in Haiti, Berkeley resident Andrea Spagat, who works in San Francisco in the field of teen violence and substance abuse prevention, met with Farmer in a private meeting with members of the Haiti Action Committee. There Farmer was asked to address the current political situation in Haiti. (The exiled democratically-elected president says he was forced out of office by the United States, France and Canada, whereas spokespersons for these countries say he resigned.)  

“(Farmer) said he takes his cue from the poor in Haiti—so few respect the needs as articulated by the very poor,” Spagat said. “He says the very poor of Haiti want (President Jean-Bertrand) Aristide back.”  

Farmer’s popularity was most evident at his Friday talk in a Public Health School auditorium, where students and faculty filled the seats, crowded into aisles, sat behind him on the podium and strained to hear him outside the doorways. During the question and answer session, one student acknowledged that he decided to go into public health after reading one of Farmer’s books and asked for advice, and he would graduate the next day.  

“You don’t have to follow anyone’s example,” Farmer answered, noting there are many ways to approach public health. The important thing is to choose something you feel passionate about. “For me, it’s the mix of delivering services directly and thinking about the broader social implications of the work or the social roots of disease and suffering.”  

Wael El-Nachef, an undergraduate in public health, was familiar with Farmer’s work; Friday’s lecture reinforced his admiration. “His recognition that social justice relates to health is very impressive,” El-Nachef said. “Not everyone (in public health) recognizes that.”  

For more information, see Farmer’s Website www.pih.org and his latest book, Pathologies of Power: Health, Human Rights and the New War on the Poor (University of California Press). Farmer was also the subject of Tracy Kidder’s Mountains Beyond Mountains: Healing the World: The Quest of Dr. Paul Farmer (Random House).