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Social scientists and the new tuberculosis


  • Farmer, Paul


In much of the world, tuberculosis (TB) remains the leading killer of young adults, in spite of the fact that effective chemotherapy has existed for 50 years. The epidemiology of TB, with its persistence in poor countries and resurgence among the poor of many industrialized nations, causes consternation among those charged with protecting the public's health. Two factors, ostensibly biological in nature, are commonly cited to explain this setback: the advent of HIV and the emergence of TB strains resistant to multiple drugs (MDR TB). But the strikingly patterned occurrence of MDR TB--in the United States afflicting those in homeless shelters and in the inner city, for example--speaks to some of the large-scale social forces at work in the new epidemic, which began before the advent of HIV. These forces (which include poverty, economic inequality, political violence, and racism) are examined through the experience of a young Haitian man with MDR TB, a disease never before described in Haiti. Insights from this case, and from other research on TB and HIV disease, are considered in the light of past anthropological writings on TB. It is argued that, often, social scientists mar contributions to an understanding of TB by making "immodest claims of causality" regarding its distribution and course. Alternative strategies for future sociomedical research on MDR TB are proposed.

Suggested Citation

  • Farmer, Paul, 1997. "Social scientists and the new tuberculosis," Social Science & Medicine, Elsevier, vol. 44(3), pages 347-358, February.
  • Handle: RePEc:eee:socmed:v:44:y:1997:i:3:p:347-358

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    Cited by:

    1. M. Pacione, 2011. "Introduction: Urban Growth Patterns – Trends and Policy Issues," Chapters,in: International Handbook of Urban Policy, Volume 3, chapter 1 Edward Elgar Publishing.
    2. Austin, Kelly F. & DeScisciolo, Cristina & Samuelsen, Lene, 2016. "The Failures of Privatization: A Comparative Investigation of Tuberculosis Rates and the Structure of Healthcare in Less-Developed Nations, 1995–2010," World Development, Elsevier, vol. 78(C), pages 450-460.
    3. Banerjee, Albert & Daly, Tamara & Armstrong, Pat & Szebehely, Marta & Armstrong, Hugh & Lafrance, Stirling, 2012. "Structural violence in long-term, residential care for older people: Comparing Canada and Scandinavia," Social Science & Medicine, Elsevier, vol. 74(3), pages 390-398.
    4. Yong Kim, Jim & Shakow, Aaron & Mate, Kedar & Vanderwarker, Chris & Gupta, Rajesh & Farmer, Paul, 2005. "Limited good and limited vision: multidrug-resistant tuberculosis and global health policy," Social Science & Medicine, Elsevier, vol. 61(4), pages 847-859, August.
    5. Armelagos, George J. & Brown, Peter J. & Turner, Bethany, 2005. "Evolutionary, historical and political economic perspectives on health and disease," Social Science & Medicine, Elsevier, vol. 61(4), pages 755-765, August.
    6. Wolf, Meike, 2015. "Is there really such a thing as “one health”? Thinking about a more than human world from the perspective of cultural anthropology," Social Science & Medicine, Elsevier, vol. 129(C), pages 5-11.
    7. Viladrich, Anahí, 2012. "Beyond welfare reform: Reframing undocumented immigrants’ entitlement to health care in the United States, a critical review," Social Science & Medicine, Elsevier, vol. 74(6), pages 822-829.
    8. Engel, Nora, 2008. "Flexibility and innovation in response to emerging infectious diseases: Reactions to multi-drug resistant Tuberculosis in India," MERIT Working Papers 076, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    9. Lönnroth, Knut & Jaramillo, Ernesto & Williams, Brian G. & Dye, Christopher & Raviglione, Mario, 2009. "Drivers of tuberculosis epidemics: The role of risk factors and social determinants," Social Science & Medicine, Elsevier, vol. 68(12), pages 2240-2246, June.
    10. Engel, Nora, 2009. "Innovation Dynamics in Tuberculosis Control in India: The Shift to New Partnerships," MERIT Working Papers 040, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    11. Richardson, Eugene T. & Morrow, Carl D. & Ho, Theodore & Fürst, Nicole & Cohelia, Rebekkah & Tram, Khai Hoan & Farmer, Paul E. & Wood, Robin, 2016. "Forced removals embodied as tuberculosis," Social Science & Medicine, Elsevier, vol. 161(C), pages 13-18.
    12. Engel, Nora, 2008. "Drivers and Barriers of Innovation Dynamics in Healthcare - Towards a framework for analyzing innovation in Tuberculosis control in India," MERIT Working Papers 077, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
    13. Carla Treloar & Rebecca Gray & Loren Brener & Clair Jackson & Veronica Saunders & Priscilla Johnson & Magdalena Harris & Phyllis Butow & Christy Newman, 2014. "“I can’t do this, it’s too much”: building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(2), pages 373-379, April.
    14. Coreil, Jeannine & Mayard, Gladys & Simpson, Kelly M. & Lauzardo, Michael & Zhu, Yiliang & Weiss, Mitchell, 2010. "Structural forces and the production of TB-related stigma among Haitians in two contexts," Social Science & Medicine, Elsevier, vol. 71(8), pages 1409-1417, October.


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