FEBRUARY 6, 2005

MR. JOHN SHATTUCK: Good afternoon and welcome to the John F. Kennedy Presidential Library on this beautiful Sunday afternoon where there are no other things happening in your attention, I’m sure.  We’re very pleased and delighted and honored that so many of you have come here today.

I’m John Shattuck, the CEO of the Kennedy Library Foundation and on behalf of myself and Deborah Leff, the Director of the Library Museum, we’re very pleased to present to you and to our listening audience throughout New England this afternoon’s very special program, Combating Global Poverty.  We’re honored to have with us today three of the foremost experts in the world on this daunting topic.  But before introducing them, I’d like to offer thanks to the institutions that make these forums possible, beginning with our lead sponsor, Bank of America.  In addition, I want to thank Boston Capital, the Lowell Institute, and our newest sponsor, Corcoran Jennison, along with media sponsors the Boston Globe,, and 90.9 WBUR, which now broadcasts all of our forums on Sunday evenings at eight, although of course tonight the eyes and ears of New England will be glued on Jacksonville, Florida.

We all know that in his inaugural address, President Kennedy laid out a series of challenges for himself, for his fellow Americans, and as he put it, for his fellow citizens of the world.  No challenge on that bitter cold January morning 44 years ago has reached farther or had greater resonance and greater difficulty across the decades than this one.  “Now the trumpet summons us again, not as a call to bear arms, though arms we need; not as a call to battle, though embattled we are, but as a call to bear the burden of a long twilight struggle against the common enemies of man, tyranny, poverty, disease, and war itself.  Can we forge against these enemies a grand and global alliance,” he said.  “North and south, east and west, that can assure a more fruitful life for all mankind.  Will you join in that historic effort?”  And for the next thousand days, Kennedy kept pressing that question as part of his effort to promote peace and prevent nuclear war.  Relentless with allies, he told European leaders that, “The time has come for us to associate in a massive and concerted attack on the poverty and justice and oppression which overshadow much of the globe.”  He was equally clear with Americans, and he told us that, and I quote, “Acting on our own, we cannot establish justice throughout the world.  But joined with other nations, we can assist the developing world to throw off the yoke of poverty.”

From the Peace Corps to the Alliance for Progress to the Agency for International Development to the United Nations Development Program, Kennedy was constantly searching for ways of translating this rhetoric into action, always with the goal of narrowing the gap between the world’s richest citizens and its poorest.  Today, that search continues with more than half the world’s population lacking access to safe water and more than 800 million people malnourished and at risk of starvation.  And in the case of the United States, there's a greater gap between rhetoric and action.  Three years ago at the U.N. Millennium Summit, the U.S. joined with other wealthy countries in promising to increase its foreign aid to seven-tenths of one percent of the gross domestic product by the year 2015.  Today, a number of European countries have already reached that goal, but the U.S. lags far behind with a foreign aid budget of less than fifteen one-hundredths of one percent of GDP.  So we have a lot to talk about this afternoon.

And to lead our discussion, we are deeply honored by the presence of three visionary leaders in the struggle against global poverty.  Paul Farmer has dedicated his life to treating some of the world’s poorest populations; he’s seated in the middle, by the way.  And in doing so, he has helped raise the standard of healthcare in some of the most underdeveloped parts of the world.  In 1983, he began a lifelong committee to Haiti, working in villages in Haiti’s central plateau.  And then while he was a medical student founding Partners in Health, a rural health complex that now includes a hospital and a series of clinics and schools that have pioneered the treatment of drug-resistant tuberculosis and HIV/AIDS.  The success of Partners in Health, which now treats 220,000 patients a year in Haiti, has created a model for poor communities worldwide, challenging the longstanding public health policies that had been based on the assumption that quality care is impossible to deliver to resource-poor areas.

While Farmer’s one of the world’s foremost strategists for combating disease and conditions of extreme poverty, as a professor of anthropology at the Harvard Medical School he’s authored over 100 publications and trained thousands of medical students, residents and fellows at the Brigham and Women’s Hospital. Working with the World Health Organization and the Open Society Institute, he has developed tuberculosis treatment programs in Haiti, Peru, Russia, Azerbaijan, Latvia and Kazakhstan, as well as programs -- this is the one that certainly captured my attention most – for the prison population in Siberia, and is one of the leading practitioners of a multidisciplinary approach towards treating HIV/AIDS in situations like those of Haiti where the disease is most rampant.

Paul’s relentless work on behalf of the world’s poorest populations has been recognized with many awards and honors, including a MacArthur Genius Award.  He’s the subject of a 2003 book by Pulitzer Prize-winning author Tracy Kidder, Mountains Beyond Mountains: The Quest of Paul Farmer: A Man Who Would Cure the World. 

Amartya Sen, seated on my far left, is one of the world’s leading economists and social philosophers.  He virtually invented the field of development and welfare economics, receiving the Nobel Prize in 1998 for his path-breaking explanation of the factors that lead to famines and poverty.  The citation that accompanied his Nobel Prize commended him for, and I quote, “Restoring an ethical dimension to the discussion of vital economic problems.”  In one of his most famous books, Poverty and Famines, Dr. Sen challenged the traditional view that an unavoidable shortage of food is the cause of a famine.  He demonstrated instead that a complex set of man-made and often avoidable economic and political conditions are what cause most famines and much poverty.  He’s the architect of the renowned U.N. Human Development Reports, which annually chart progress across many development fronts from literacy to disease control to gender equality to the spread of democracy, all of which, he’s written, are essential to combating global poverty.

Dr. Sen was born in India, where he was educated and where he taught at the beginning of his career.  He’s written that the sectarian violence and famines that he witnessed as a youth had a disproportionate impact on India’s poorest classes and that this basic fact has had a profound influence on his scholarship.  For more than 40 years, Dr. Sen has been one of the world’s preeminent development economists first in England, then in India, and in the United States.  He is now university professor at Harvard, Harvard’s top academic rank.  Dr. Sen is the author of scores of books and hundreds of articles and has received more than 30 honorary degrees from universities around the world.

Our moderator this afternoon, to my immediate left, is Dr. Lincoln Chen who directs the Global Equity Center at the Kennedy School of Government and also chairs the Board of Directors of Care International, the world’s largest and, I believe, most prominent humanitarian organization.  Early in his career, Dr. Chen was executive vice president of the Rockefeller Foundation where he directed worldwide programs on food, health and poverty.  He’s also served as Director for Harvard’s Center for Population and Development Studies, and is the Ford Foundation’s representative in India and Bangladesh.  He’s written that his experience in witnessing the catastrophic 1970 cyclone in Bangladesh, that like this year’s South Asian tsunami killed hundreds of thousands of people, altered the course of his life and made him decide to devote his career to international relief and development.

Paul Farmer, Amartya Sen, and Lincoln Chen are all leaders in the great struggle against the common enemies of humanity:  poverty, disease and oppression, a struggle that captured the attention and commitment of President Kennedy.  Please join me in welcoming them to the stage of the Kennedy Library.  (applause)

DR. CHEN:  Thank you very much, John.  It’s obviously a privilege and an honor.  I think we should get started immediately, and I wanted to begin by asking about global poverty and our response to it in comparison to the tsunami disaster that took place just a month ago.  We had a huge outpouring around the world.  I was in India, where a huge outpouring from within India took place.  And this mobilization doesn’t seem to be as energetic for global poverty.  And so I wanted to begin by asking Paul and then Amartya, what is it about the tsunami that is generating this response, and why is it that we have so much more difficulty with global poverty?

DR. FARMER:  You know, one place I think from which to regard both the impact of the tsunami and the social responses to it, a good place perhaps is from Haiti.  And as many of you know, this past year was marked in Haiti by two enormous and natural disasters.  They weren’t natural at all, of course, as both of you, Amartya and Lincoln, have pointed out in examining catastrophes and disasters.  Just to recap briefly:  Haiti was probably in 1492 a fully forested island and it was at that point inhabited by -- some demographers think maybe eight million people -- which would be a terrible … If that were true, that would be terrible because none of them survived even a hundred years after 1492.  And it was a forested … I mean, according to Columbus and Spanish reports at the time.  And now the western third, which is modern day Haiti, is completely deforested.  Estimates are that about 1 percent of the forest cover remains.  And, of course, there's a history to that.  And the history of the creation of poverty over time, that is the political economy of poverty, if one can use what sounds almost to be jargon-like, that's the part that I think we often don’t want to examine -- the chronic tsunamis, and in this case the chronic tsunamis of slavery, expropriation of land, of genocide, genocide that did take a better part of a century, all of that would be central to an examination of what would be very likely to happen in Haiti in 2004. 

And so I’ll just give the numbers and then pass it on to Amartya.  Some of you remember that Hurricane Jean, I believe was her moniker, Jean in Haiti, touched down in the Dominican Republic and in Florida, but did not actually make landfall in Haiti.  And in the Dominican Republic, I think, some ten people lost their lives and in Florida, six people lost their lives.  But in Haiti where the hurricane never actually made landfall, an estimated 3,000 people perished mostly from the massive flooding that, of course, ensues when you have no tree cover and a very heavily mountainous area.  So this wasn’t a natural disaster.  The responses to it, some people in this auditorium were involved in the responses to it, sitting up in rural Haiti watching a little bit aghast as people came from the coast inland eight hours probably at least by public transportation, to receive basic first aid from us in central Haiti.  Just amazing at how ineffective poverty and structural violence, if I can use that term, rendered the relief efforts.

And so, you know, I think certainly Haiti and other unfortunate places in the world are going to be vulnerable to these sorts of disasters.  The responses to them, 45 percent of American households responding to the tsunami, that's pretty wonderful.  It says something good about humanity, I think, about … I don't know from other nations, but it says something good about this nation.  There has to be some disconnect, then, between our ability to take on these acute problems like the tsunami that comes out of a sudden event and the chronic tsunamis of poverty and disease.  And those involve, again, racism, gender inequality, history.  They all have this history that I think is probably very unappealing to examine, and yet examining them would be a necessary prolegomenon to really responding effectively.

DR. CHEN:  Amartya?

DR. SEN:  Well, I agree very much with what Paul said.  Just extending the last bit of his comments and related also to your question that what is it about the tsunami which make human sympathy across the world come so dramatically gushing forward, which doesn’t happen in standard cases of poverty and even people dying of illnesses with remedies known, or at least ways of dealing with known illnesses and which may kill many more people with the tsunamis, how come it produces that kind of reaction in a way that the tsunami does, in the way that global poverty doesn’t.

I think to some extent it’s connected to the fact that ability to sympathize with the predicament of others depends on our understanding of what that predicament is.  And one of the reasons why I think some of the statistics that people often quote about how many millions of people live below $2 a day or $1 a day, I’ve always thought it was a very peculiar way of thinking about it because it really doesn’t convey anything very much because people … You know, prices are different; it’s not easy to understand what the predicament is.  On the other hand, people being washed away or people dying of illnesses of a kind that you can understand and in a way you can graphically see rather than their dying in a kind of … in their home, in their bedroom without any drama going on.  There's a big difference, and people don’t even seem to recognize that many more people on 9/11/2001 died of AIDS than died of violence, and yet the violence drew attention and rightly so partly because this was an actual attempt at really people being killed rather than just dying.

But partly also, it was easy to sympathize with what's going on.  So if that is the right way of understanding it, then certainly the lesson to come through about that is that it’s very, it’s tremendously important for the media and for communication, those involved in communication, to make the suffering of people in poverty much more graphic and more easy to understand.  Because it’s really that communication that's lacking as the world looks unmoved, and the point John Shattuck raised about governments not carrying out their commitment about what they had agreed to do, that's a different issue, and it’s a very important one, too, and I’m very glad you mentioned that.

But in terms of basic human sympathy of ordinary people, your ability to sit up and listen and do something about that and drop everything, it really depends on comprehension.  So I think the epistemic basis of ethics is powerful and I think we can do a lot more to bring the predicament of suffering humanity from poverty, from disease, from illiteracy and so on much more graphic.  So I think that's the positive lesson I would tend to take from the tsunami.

DR. CHEN:  Would the HIV epidemic and the suffering and the linkages that it has to poverty be a particular entry to that question of generating an identity, a sympathy?  Paul, you're working on HIV, and, Amartya, I know you spent part of Christmas on public health problems in India.  And so the question of human illness and suffering, does it come through more vividly with specific infections?

DR. FARMER:  You know, I think that the challenge of rendering experience that's distant to our own more graphic, as was just said, remains even when we choose a very specific illness.  I’ve been heartened … you know, I don’t want to sound like I’m looking only for positive lessons.  It’s certainly been not a good start to the millennium, but I have been heartened by seeing how many students are interested in AIDS, global AIDS.  Because as AIDS becomes -- and I mean American students; I don't know about European students or students from Asia -- But in the industrialized world, young people living in an industrialized world, even as the epidemiologic risk for that disease moves away, the interest continues to build.  So there's more interest now in global AIDS at Harvard, for example, than I’ve ever seen in all the two decades I’ve been there as a student or faculty member.

And, again, that must be the result of some rendering vivid or graphic or meaningful that goes beyond merely identification with risk.  Because, as I said, the risk is diminishing here.  Pediatric AIDS, for example, HIV deaths among American children have almost disappeared completely, even as this one pathogen, HIV, becomes the leading infectious killer of children in Africa.  So seeing a rising tide of interest among young people is, I think, a result, as you said Lincoln, of this being a specific illness, something one can fasten onto.  At the same time, you know, one could -- thinking back on Amartya’s comments about living on less than a dollar a day, sometimes these statistics become so mind-numbing and I was just about to catch myself doing something I do a lot with medical students who say, “Well, you know, as many children die of diarrheal disease and measles and … ” you know, I could go through the grim list, and so it still becomes a question, I think, again echoing Amartya, of making this more palpable and real for people who are actually shielded from risk.

I’ve just read Susan Sontag’s essay on The Suffering of Others; I’m not sure if I’ve got the title right, Regarding the Pain of Others, I believe, and I think that she says in that essay, which I found very compelling, that the politics of … that pity is an unstable sentiment and I think she’s arguing, of course, for this contextualized understanding of the suffering of others, of pain and unnecessary suffering and war.  Pity is an unstable sentiment, granted, but it may be less appealing certainly than solidarity.  But empathy, pity, compassion, I don’t think those are terrible ways into the problem of global poverty.  I think, in fact, they would be welcome as long as they were linked -- pity, sympathy, compassion -- to an honest, historical assessment of how poverty came to take its current shape.

DR. SEN:  I agree with that.  I think our ability to comprehend what's going on is quite central to pity and sympathy, in fact, and I take the same view.  There's nothing wrong with pitying being a major factor.  And, you know, we sometimes overlook major, profound things; changes have happened, observing that and seeing the predicament up here.  And just to give an example from my own country, 2500 years ago when Gautama Buddha leaves his home, what makes him do that?  He’s a prince, he had the comfortable life.  As a young man, he goes around in the bazaar, he sees an extremely ill person one day, a person being carried to a crematorium for cremation the other day.  And the third day, I think he watches a person debilitated by old age, completely infirm.  And it makes him wonder why this happened and how could we deal with it.

And in some ways, you know, as a well educated prince in the foothills of the Himalayas, there was no reason for him not to have known about disease and illness and death and old age.  But I think it’s the graphic presentation which happened to be in this case accidental, of running into them that starts a train of thought which, as it happened in his case, makes him question profoundly the nature of the universe.  And, you know, an aspect of religiosity which is actually frightening, which often is missed out in comparison, that one of the particularly departing points for this thinking is that none of the obligation to do good things turns on your duty to God.  In fact, Buddha himself remained an agnostic throughout his life, and indeed he’s quite explicit on why that would be a wrong way of understanding, that it would be … It’s almost like a self interest at the higher level, that God will treat you better if you do things that you want to do rather than you have to have a morality which does not invoke.  But what it does invoke is the immediate need for human sympathy, for not just human suffering but suffering of all animals.

So I think that issue of centrality of comprehension of peoples and more broadly sentient beings, pain and doom, it’s very central.  So I mean, I think the media has a central role in that.  I think it has a central role even in relation to John’s question.  Again, the United States is in a way a preeminent example that a number of other countries, too, which have fallen very far short of what they promised to do.  And you don't really see much media discussion about that.  It’s mentioned as a number sometimes, but it really goes away. 

An interesting article in The New Yorker, I think about seven, eight years ago when people were being asked, Americans being asked, does America give too much aid, and the answer was most people said absolutely, far too much.  And then there was a question of whether it should be slashed by 10 percent, by 50 percent, by 80 percent, 90 percent?  I think they mostly wanted aid to be severely slashed by 90 percent.  And then they were asked what proportion of GDP does America give away as aid?  And the number, I think, the median answer was 17 percent or some incredible number like that.  So that after cutting it by 90 percent, they were really proposing something like a thirty-fold increase in the total amount of aid to be given. 

So I think basically what has gone wrong there is the epistemic basis of ethics, that there's a complete lack of comprehension as to what is going on, both at the level of what are we doing and at the level of what's happening to these people for whom it’s being suggested that we ought to do something.  So I think the need for public discussion really comes through.  I mean, that’s not the way to think about tsunamis primarily, but I think that is a big lesson to emerge out of that.  And I think you asked a question about AIDS and so on.  There is a certain amount of reluctance to get engaged in what looks like a perennial problem going on and on in a country as opposed to something that comes suddenly and then goes away, which is also why you get much more sympathy from famine, from reporting famine ... (inaudible) and undernourishment.  When I was privileged to be honorary president of Oxford, I was very struck by how much easier it is if there's a crisis, if there's a famine, to raise money than if there is an ongoing problem in which many more people may be dying if you add some years together than in a famine.  And yet, it doesn’t generate that kind of sympathy … it doesn’t generate a similar kind of reaction.  And I think the problem of bringing it in a real way is a difficult one but it has to be challenged, and I really do think that the media does not do a very good job in dealing with this.  I think it’s a failure.

DR. CHEN:  Is this challenge particularly American in the sense that 2005 is the year of the millennium development goal revisited -- the halving of poverty in the world?   The British government, Tony Blair, Gordon Brown, are proposing -- like Kennedy’s Great Alliance 45 years ago -- a massive global assault on poverty through the Africa Commission, the G7, G8, and Britain being head of the European Union.  It seems like the European public supports this very strongly.  But as John pointed out at the beginning, America as a government is only providing one-fifth the normative standards that we ourselves have obligated ourselves to.  And so the question I ask is is there something about America that’s simply more reluctant than, let’s say, our European or even our Asian counterparts?

DR. SEN:  I leave that question to be answered by an American.  (laughter)

DR. CHEN:  Paul?

DR. FARMER:  Why did I know that that would follow?  Well, you know, it’s interesting to contemplate this.  I just mentioned a figure that I found very revealing of at least the potential for American engagement, North America, the United States, of course I’m talking about.  The Canadians and Mexicans get quite cross when we refer to ourselves as the Americans.  When I was up in the United States very briefly from Haiti on a college campus in the Midwest and I read in the local paper, which was a Grand Rapids, Michigan paper, that 45 percent of American households had already donated to the tsunami relief, and this was a couple of weeks ago, so a full month or one might say less than two months after the event itself.  And, again, I think that you're not going to find that occurring throughout Europe or Asia. 

Now, one may immediately argue that there's more formal support for relief, but I’d like to be critical of both my own home country, which I’m told at the end of World War II controlled about half of all the world’s wealth -- one country – and, again, there are people who know these data far better than I do.  There's ample reason to focus on U.S. obligation and the U.S. role in this process, and that is that really for a long time, if one country controlled half the world’s wealth even then, then that was reason alone to put special obligations on one country.  But I would challenge my own country and Europeans and those in wealthy Asian nations to be more honest about what has created much poverty and inequality.  I think it’s important to add inequality because one can say, you know, it’s always a good idea to be optimistic and cheerful, I reckon, certainly in my line of work.  But to look at the glass half full and say, well, infant mortality has dropped globally and life expectancy has risen very dramatically, but John Shattuck in launching this discussion gave us some figures and we would do well to note that since 1980 global inequality has risen very dramatically and continues to rise if the economists I read, and I do read some very sketchy ones, are correct.  (laughter)  And so if global inequality is rising for now decades and very sharply and you have the European Union saying, well, we should do something ambitious about poverty in Africa, I would say one of the ambitious things to do is to stop sponsoring poverty and stop fomenting inequality -- if there can be such a conjugation of verb and noun.  (applause)  So, you know, if someone like Walter Rodney can write a book called How Europe Underdeveloped Africa, maybe he is wrong on details, I don't know, but I suspect that there are many, certainly many I know in Africa, who believe that to be the case in the places where I’ve worked there. Haiti, of course, has five centuries, not one, in dealing with this sort of unequal development which spells to poor people underdevelopment. 

So the onus of debt, the arrangement of the international financial institutions, the policies of rich countries after World War II, all of these are the things that we’re too reluctant or cowardly to examine in a forthright manner.  And, you know, I applaud Tony Blair and others who are leading an effort to reduce poverty in Africa in the most heavily indebted and impoverished nations, one of which is Haiti -- the only one in the western hemisphere by many accountings.  But again, we have to have this honest -- again, what Amartya said -- I think, this honest assessment of how modern poverty and inequality came to be.

DR. CHEN:  Amartya, who’s written about inequality reexamined, extensively?

DR. SEN:  Yeah.  No, Paul’s point is very well taken.  It’s also quite important not to just look at the whole thing in terms of just the magnitude of aid.  I think the present initiative which actually the main leadership has come from ... (inaudible) is a very positive one, so one should welcome that, definitely.  And it is disappointing that the United States was quite good ... (inaudible) in the initial discussion that took place.  So these are early days in debating about that.  But I think Paul’s initiative is just right, to broaden the discussion.  This requires looking at the economic and social policies generally -- economic policies like trade policies in general.  There are still many countries who have great difficulty selling commodities not just to the United States, but also to Europe because of the protection of agriculture and because of the various types of restriction that are imposed on it.

In addition to those economic issues, one ought to look also at not just the sponsoring of economic inequality, but the issue of the fomentation of the kind of military conflict that we see in Africa.  I mean, we tend to overlook to what extent Africa, the continent, paid the heaviest price for the Cold War.  Because a lot of the war, the Cold War, was fought in a proxy over Africa.  So any strong-armed guy, military guy, who happened to displace a legitimate civilian government would immediately get support either from the Soviet Union or from the United States and NATO on grounds of the global strategy then.  And when I first visited Africa in ’63 in Kenya, Uganda and so on, what looked like the promise of a democratic continent to come, by the time I was writing about finance in the ‘70s, had really turned the page in a completely backward direction and they were just being run by the military dictatorship one place after another of various kinds sponsored by the Soviet Union or the United States and the United Kingdom and so on.  And which to a great extent is still suffering from that, we haven’t fully emerged.

But on top of that, in the conflicts which are civil wars which have been a big problem in Africa -- the world over, but Africa in particular, it’s worth remembering that in the armament that is used for this purpose, it’s when the … During the G8 summit in Genoa, the leading countries were grumbling about the responsibility of the anti-globalization protestors, and indeed they are quite irresponsible, often producing slogans of an extreme kind.  The G8 countries sitting down there could have also asked what proportion of the armament that go out in killing each other in Africa and so on are sold by the eight countries.  I’d say at the moment 85 percent and, you know, United States alone exports more than 50 percent of the world armament. 

Now, of course, there has to be demand as well as supply, but supply could be very powerful.  We know from lots of cases in different countries in the world to what extent the armament dealers can actually manage to sell and the inability, even Kofi Annan’s proposal of wanting an agreed ban on illegal small weapons, was actually accepted by the United States.  And so we are in a situation … By the way, more than 80 percent reclassify the armament -- somewhat less than the G8 -- but more than 80 percent of the armament is exported by the five dominant members of the Security Council.  It makes it not hard to see why the Security Council never was able to take a strong position. But when you have got the political power of the Security Council of the U.N., as it were, the global powers, and then the G8, even if you take the Soviet Union out, Russia out, G7, you are in a situation where there's a kind of organized sponsorship of that.

Now, it would be very nice, if in addition to thinking about aid and so on, some steps were taken in that direction -- that the world is not made worse in a process to which nearly all the money is made by the richest countries in the world.

DR. CHEN:  Both of you have suggested different types of theories and the causes of poverty, a range from political conflict to the global order to economic trade to aid relationships.  There have been other theories about geography or disease, and gender inequality sometimes enter into debates.  Obviously the lack of work opportunities, enumerative work.  Are there many, many theories of deprivation, the causes of deprivation?  And does one have to deal with all of them, or are one or two more predominant and the others more subsidiary?

DR. FARMER:  I defer to the economist on that one.

DR. CHEN:  He raised it first.  (laughter)

DR. SEN:  Basically, I mean I think it’s an enormously complex picture.  But there's also some forest, if by the presence of large trees, and I think the two forests to look at, I would say, are the following.  One is that basically for the bulk of humanity, the only means of earning an income is to sell your labor power, to get the job, to be employed.  So that that puts the whole issue of centrality of employment.  And absent employment, whether there should be an opportunity of some kind of social support into the story.  So that's the first thing to look at.

The second thing is that in addition to the income, the lives of people are affected by what the society in an organized way provides, and that would be basic education, often basic health care.  And so the other thing to look at … and since poverty isn’t just low income … I mean, if the general public is skeptical of the two dollar, one dollar a day, they are right to be skeptical.  Because poverty is really basic denial of human freedom to lead the kind of life that you have reason to value.  So availability of education and health care become very central.

So I think when you are looking at the central features of poverty, you're looking on one side at employment for private income, and you are looking at the social arrangement for education, health care, and related to it such things as micro credit, land reform, and so on.  And there, of course, the state and the public sector has a very strong role.  And I think it is brought out very sharply.  I mean, let me give you an example.  No country has done as much to reduce poverty in terms of income as China in terms of economic growth.  Its economic growth has been phenomenal, and the number of poor people has declined.  Certainly the inequality level has increased, that's certainly true.  And yet in terms of dollar per day figures, the numbers have declined.

And yet, if you look at the same change that brought about that economic expansion in ’79, economic reform, that came at a time when the Chinese moved quite rightly to let’s say a greater use of the global market economy and use of the private sector.  But along with that, they also removed the social health insurance, which every citizen had.  And in the rural areas, it came from the support from ... (inaudible) the collective, and suddenly you had to buy your insurance, which you didn't have to buy earlier.  So you find the oddity that even my miserable country India where the growth rate has not been as fast, it’s been fast enough, 6, 7 percent as opposed to China’s 9 and 10 percent.  And yet in this period, from ’79 to today, life expectancy in India has grown about three times as fast as that in China.  It’s not because India was doing anything terribly right, and I’ve written again and I’ve promised to write again, again and again, on how many dreadful things happen in India.  But what happened is that China managed at one stroke to go from the Canada-type health system to a U.S. type one, which in this case was not an improvement.  (laughter)  And suddenly, you find an oddity of while the private income prosperity was growing, other things were dramatically, in terms of life expectancy, infant mortality coming down.  And it becomes very clear if you compare, as I was mentioning, India’s life expectancy which was lower than China, but the gap was halved in this period.  And if you look at states -- primarily Kerala but not the only one -- in which there is a combination of greater social effort, plus a kind of democratic practice which is, after all, I would say a lack of democracy that comes into the story.  Because I don’t think China could be able to abolish public health insurance just one morning like that if there was an electoral process.  No country, no party, can survive an election after having just done away with public health service.

Now, if you take a state like Kerala which has the advantage of being a multi-party democratic system, plus a left wing commitment of the kind that put China on the map first in the pre-reform period, having freed of the health care, you find that now the Kerala life expectancy is much ahead of China; they're 76 compared with China’s 71, as China is ahead of India’s average.  In ’79, Kerala and China both had an infant mortality rate of 37.  China’s now is 30 and Kerala now is 10.  Now, in that dramatic change you have to bring in the social services, the role of the government as well as the role of democracy as a protection of public policy, public criticism of these steps.

So I think you're not going to get one answer to the question what causes global poverty.  But if you take a broad enough view of poverty … and, by the way, your reaction, what you began with, tsunami reaction, indicates the broad world public sees poverty not in terms of low income, but in terms of the kind of life people are leading, the kinds of ... (inaudible) they are in, and the kind of lives they end up living.  And in that broad picture you have to bring in the market economy, you have to bring in the political system, the democratic system, and the role of the state and see it as a multiple institution arrangement in which, after all, human society relies on.  It relies in order to deal with this problem.

DR. FARMER:  I would say that even if one were not inclined to have a theory of poverty or theories of poverty, say because you didn't have time to develop one or …

DR. CHEN:  Too busy curing it.

DR. FARMER:  Or to write several books on the topic.  (laughter)  So even if you don’t have a theory of poverty or just steal one from others, I think as a provider of, say as a physician, as a provider of services, working with the very destitute, you're really given a very rapid lesson, whether you're working in Roxbury or rural Haiti or rural Rwanda or a prison in Siberia.  And the lesson should be more rapid, of course -- I’m ashamed to say that it took me a while -- but the lesson is that some things are seen as commodities for sale.  And, you know, the examples that were just given, suddenly on one morning if China’s central committee can abolish public health as a public good and say now it’s for sale.  And so there are commodities that one buys, and there are also rights that one has.

And in our very affluent and egalitarian society, it’s not for no reason, it’s not for naught, that we focus largely on civil and political rights.  But there are other sets of rights.  There are social and economic rights.  The right to health care, again, freedom from want.  The right to basic education, clean water; you can make a long list.  At the end of that list would be the right to employment, which is regarded as a very radical position by those who are now stewards of power.

Now, as a physician, it seems to me that every physician should be very vocally, obstreperously for national health insurance. (applause)  And yet, if you look sociologically at professional behavior, you’ll find that among the most vocal opponents of national health insurance have been various political groupings of physicians.  Now that is, I think, attenuated as we look at the current situation here in this country.  And I think someone, maybe John, mentioned that the numbers are very upsetting.  There are 40 million Americans, 45 some say, with no health insurance at all.  But a study by the Institute of Medicine suggested twice as many had inadequate health insurance.  And, you know, this in a very affluent society.

And so the idea of moving from commodity to right, I think, is very important to anyone interested in serving those who are the current victims of poverty and inequality.  And, you know, you really just can’t get anywhere in my line of work without the notion of rights.  Because without that, you have to say, “Well, we can treat AIDS in country X but not in country Y.” Or if you say, “Well, we’re already inside country X, we can treat AIDS for these people and not for others.”  So you immediately run into this in medicine, and I’m sure educators feel the same way looking at higher education, specialized education, etc.  So the notion of a right, and particularly a socioeconomic right, I think is important regardless of what theory of poverty or inequality to which one ascribes.

DR. SEN:  ... (inaudible) before that actually. 

DR. CHEN:  Please?

DR. SEN:  It seems to me that the thinking often in terms of rights has three very clear advantages.  One is that the focus is immediately on things that are important because you have rights to health care or rights to education and so forth, so it really cuts out all that ... (inaudible) $2 a day, etc.  I mean people won’t talk about it like the $2 a day.  That's not the way it will go.  So it concentrates on the right thing. 

Secondly, if we are talking of these in terms of human rights, something which is really quite old -- some people don’t seem to recognize how old -- I mean Tom Paine when he was writing about it in the 1780s and so on -- it’s not a question that these rights came into being thanks to the Constitution, but these rights existed but they were being recognized, which is also the language of the U.S. Constitution and the French statement about the “rights of man,” as it were, quote unquote.  Plus really also recognition of something which the legality was giving a recognition to.  But, in fact, we can see that it’s more than legality because it also depends on activism.  When Paul is working with his patients, he is actually promoting the rights of these people.  He’s doing the duties that relate to the rights.  So that's the second advantage:  along with the idea of rights comes the idea of duties that other people have.  And that's not just a matter of legal right, rather something which you recognize as a human right, generally a kind of human obligation to deal with it, which is a good way of thinking about it.  Even tsunami, it’s not just a question of charity, it’s a question that I really ought to do this, it’s an obligation, what Immanuel Kant would have called an imperfect obligation as opposed to a perfect obligation, not a specific obligation.  If you are to borrow the book, you ought to return it, but it’s a general obligation that applies to humanity.

But I think the ... (inaudible), the rights ... (inaudible) is very good because any kind of general acceptance of certain things as rights is based on public discussion.  And in promoting public discussion, the human rights dialogue can make a real difference in making people interested, involved, and what I have been trying to argue for earlier, trying to understand what's going on.  And the connection between seeing people in a state of distress and then discussing isn’t it a right?, isn’t it something which requires me to do a duty?, is a very constructive thought.  And the person who discusses it with great clarity is Mary Wollstonecraft.  Her more well known book is, of course, Vindication of the Rights of Women.  But that followed two years after A Vindication of the Rights of Man, which was supposed to cover the general area, but by 1791 she was persuaded that women’s rights had some specific issues.  She wasn’t arguing that all these should be put into a Constitution or a law, but she was talking about the need for public education, public health care, and so forth.  So it’s generally getting the public involved.  But part of the thing, which in her case, both her own thinking as well as William Godwin, her husband’s thinking, were very involved in getting the public into the story and the right dialogue, the right language is enormously powerful and we know that.  Having been involved with Oxfam for many years, I think the kind of work that Oxfam, and this is the fourth year and it’s the human rights ... (inaudible) to do, it is really tremendously dependent in getting the public interested and involved in something.  I very much agree with Paul that that's the direction to go.

DR. CHEN:  And that's a perfect note for me to indicate we do want more public engagement.  So there are microphones here for those in the audience that would like to ask Paul and Amartya questions; there is one on each side.  I might just remind us that this is really intended to be questions, not statements, and so I’ll interrupt if people don’t focus on questions.  I would also encourage people to ask questions of both of our guests, because it would be very interesting to hear their comparative responses and replies.  If that's all right, then please feel free to queue up and we can start on this side.  Please, sir?

AUDIENCE:  Where we live in a favorable country, presumably, why should we be interested in the poverty of other people?  What's in it for us?  What's pragmatic for us instead of just being altruistic?

DR. CHEN:  Thank you.  So, you know, we have our own problems here.  Why are we extending this out?

DR. FARMER:  Well, you mentioned the right to property.  And, you know, I think there are a number of self-interested arguments that one can … You know, you can just read, say for example, the CIA and its reports on AIDS as a security threat, just taking that as an example.  I actually prefer not to log on to that web site, but feel free to do so.  (laughter)  And so it is many have argued, again this is in the corridors of power by and large, that it's in our interest to diminish social inequality.  Working in, say, in a squatter’s settlement in rural Haiti, you know, you can just see that palpably.  If everybody shares a condition, and in this case it’s misery, there's a certain kind of conflict that one can expect.  But once inequality is visible and palpable right in front of you, where some people have jobs or rights of some sorts and others do not, then there comes a tension which can be, you know, can be good and it can also be violent.

And let me -- just so I’m not being too arcane -- it’s good in that say, for example, the framers of the Constitution, by and large they did not acknowledge the two great crimes on which our country, my country, was founded, which are slavery and genocide.  And this made the rights language of the framers of the Constitution vulnerable to critique.  But I would say that's good.  It was quite right for people to write books about the rights of women, the rights of African-Americans, the abolition of slavery, etc.  And so that sort of tension, to me, is only going to be a good thing because obviously you're hiding away important social facts.

So in the self interest argument in response to the question, we may have come by many of our rights and much of our affluence through, let’s just say … I was thinking about saying illegal means and I don't just mean those two great crimes, but I mean the 20th century crimes that were mentioned in passing by Amartya, the proxy wars of recent decades that devastated many of the places in which I’ve worked, Guatemala, Haiti and now Rwanda.  These places were all damaged very badly, Afghanistan, by proxy wars, cold wars.  And so I think that the argument that we’re unrelated to the rest of the world to the creation of modern inequality and suffering is just not true.  It’s no more true than you could argue that alcoholism among Native Americans now is unrelated to the fact of genocide.

So we should do this, in answer to your question, because it is analytic; it has the added advantage of being correct.  (applause)

DR. SEN:  May I try to respond to that, too?  It seems to me that there are really two different planes on which this question could be addressed.  One is the one which Paul has concentrated on, particularly namely is there a kind of enlightened self interest view which justifies that?  I think I would like to argue that that's the smaller of the two answers.  But dealing with the smaller answer, let me mention that it’s often not perceived.  I mean people say if you look at terrorism and violence today, you know, Osama bin Laden isn’t a poor person, there isn’t any connection, really.  And look at those people who on 9/11 did all those things.  They all often came from comfortable families.

I think it’s overlooked to what extent the general sense of resentment makes a tolerance … makes a social atmosphere in which violence is tolerated.  People normally, in fact, leading perfectly normal lives, very peaceful lives, suddenly find that political violence is acceptable, especially addressed at very rich countries.  Because they somehow have a sense that they have not really treated the world well, so I think there is that issue. We often forget … I mean the 1840s when the Irish famines took place were the most peaceful time in Ireland.  Ship after ship sailing down the River Shannon carrying food from starving Ireland to rich England, none of them were stopped.  And one could have easily said that this famine had no effect in violence, but for more than 150 years after that Irish discontent, violence, terrorism would be fed by the memory not only of famine, but the inability of the ruling powers, particularly London, to deal with it.  So I think the self interest argument has more reach than one often accepts on the basis of the immediate, forefront statistic. 

But the bigger answer is really that, you know, when we say that why should we … I mean, who is this we?  At one level, you could say we is just me or my family, but you're saying somehow the nation is the right thing.  But, you know, we have many different groups to which we belong.  When a feminist activist from America goes to Somalia to do something about women there, she is not acting on behalf of the United States, she’s not acting on as an American citizen.  She is not doing it on behalf of the American nation something for the Somalian, she is doing something where the identity of being a woman, of being involved in a feminist cause, is very important.  I think this multiplicity of identity is extremely important. We have the same person, maybe an American citizen of Korean, Norwegian or African ancestry, a Christian, a left wing political thinker, a heterosexual, a believer in gay and lesbian rights, a historian, you know, and a believer of the urgent necessity to talk with people, intelligent people in outer space immediately.  (laughter)  Preferably talking in English.  Now, each of these gives this person a certain identity and the “we” question can come up in different ways.  The whole idea that the citizens form everything else is really a profoundly narrowed way of looking at human beings.

DR. CHEN:  Please?

AUDIENCE:  Yes, and let me just thank you both for all the work that you’ve done.  Dave Magnani (?).  Given the tsunami example is really powerful.  My question is why does the media do such a terrible job of educating the public about the severity of the problem of world and global poverty, particularly given the relatively small commitment that is needed to dramatically mitigate the problem?  And secondly, what can we do to change that?

DR. CHEN:  Get a better media.

DR. FARMER:  Better media.  Well, I think that … First of all, thank you for the question, and I don’t know the answer.  I think there are obviously instances in which crass propaganda is the goal of those who control the media.  But I don’t think those are the majority.  I just want to say that we have to acknowledge up front that power inevitably relies upon certain distortions of truth and outright propaganda.  And there have been studies of this, looking at, for example, the 1991 war in the Persian Gulf and reporting on that, scholarly studies and reflections on this which I think are important.  But the outright propaganda is not the majority of the problem, I don’t think. 

There is also a political economy of media ownership whereby it’s becoming more and more concentrated in fewer and fewer hands.  Again, I know very little about this, but you can sense the impact of that.  So leaving aside these explanations, I want to ask how we can be more self-critical.  Lincoln just said get a better media, but Lincoln just had an experience that was similar to the one I had whereby a reporter who is on what she herself describes as the poverty beat for a very important daily which I won’t name but which is based in New York City (laughter) has, you know -- We’ve both had interactions with this reporter who has been, you know, it’s been incumbent upon us to say, say she chooses to write about AIDS or chooses to write about the brain drain, whereby African professionals end up leaving Ghana and going to the United Kingdom and ending up in Canada or the United States.  You know, part of the burden should be on those who have the greatest control over the information or the greatest access to accurate information.  And that would include certain people in this room, I'm quite sure.  Certainly, it would include universities and other repositories and generators of information.  So I think we do need a better media, we need a more democratic media.  Sure, we need all that.  We have to fight for that and worry about our first amendment rights, etc.  Again, I’m saying the “we” here as citizenship trumps all as an American.  But at the same time, all of us are responsible to some extent for this, especially those with the most agency and control over information and information flows, whether that be the generation of information as in science and medicine or the transmission of information as in teaching.

DR. SEN:  I could have added something to it, but I see the number of people standing there and since I’m happy with Paul’s answer, I’ll leave it like that.  (laughter)

DR. CHEN:  There is a media tsunami effect.  When I was in India visiting the tsunami area, how many of us remember that four years ago there was a devastating earthquake in Gujarat?  And when I asked about what happened in Gujarat after the media had left, I found out that of the 300 NGOs that were doing relief work in Gujarat, there are only 28 left and the Gujaratis themselves say that much of the aid that was promised to be delivered simply faded, not only from the media but from Gujarat earthquake relief.  I’m glad to report that CARE is one of those organizations that has stayed behind.  Please?

AUDIENCE:  My name is Nicholas Oss (?), and I do some work in Ecuador and something that I sort of struggle with from time to time is the thought that although there are a lot of poor people in Ecuador, there are poorer people in places like Haiti or India.  And something that I’m interested in kind of gaining your perspectives on is this seems like it’s something that a lot of Americans deal with.  Poverty is such a complex issue and it’s something that’s so difficult to take that first step and say, “I'm someone that cares and I want to help, but I’m not sure how.”  And so something that, in my own particular interest, and I’m sure in many people, is how do we assess where to start, which communities to begin with?  I mean do we rank suffering by $2 a day and we shouldn’t help the $2 a day countries because there's $1 a day countries?  I guess what I'm driving at is what is the criteria, and using those criteria, how would you recommend taking that first step for people?

DR. CHEN:  I might supplement that by underscoring that we have two speakers who have themselves taken leadership roles in doing something, in making that selection.  Paul started not only with his clinical work, but a non-governmental organization called Partners in Health.  Amartya Sen has created a foundation called Pratichi Trust, which works on poverty issues in India and Bangladesh.

AUDIENCE:  If I could add to that, and also to what extent is it a personal connection that helps people take that first step?  Or continue taking that step?

DR. SEN:  Well, you know, the last is a predictive question as to how would you predict who are the guys who will help others.  And, you know, that's an interesting question, but I think your first question as to where do you begin and isn’t it far too complex, both are important ones in engaging.  And I think where to begin is not really such a complicated question because of the fact that they exist.  We live in a world of many institutions.  I’m very grateful that Lincoln mentioned my little two trusts that I started with the Nobel Prize money.  The Pratichi Bangladesh Trust gave scholarship to 32 young women just out of school who were going to write about the village condition in Bangladesh.  Five of them, of the 32, have never been to the capital city of Dhaka at all.  And it seems to me that the real question there wasn't is it the ideal, is it the best thing I could have done with the Nobel money?  The question was whether it’s what I would be happy to see being done.  And so we can make things look too complicated.  If you are trying to say what is the very best thing that I can do, I think that's not necessarily a right way of thinking about it.

The other thing I’ll mention is that many things look in abstract as immensely complicated.  I’ll ask the question, how easy would it be for a government to set up a production which produces one billion times one billion, that’s one billion squared, distinct products?  And the answer is just you can’t even begin to think of it.  But India’s post office does exactly that -- anyone can write to anybody else, and my letter being delivered to Paul would not be the same product.  So it has to go from one person to another.  In principle, it looks absolutely impossible.  There are a billion people, anyone can write to anybody else generating a tremendously complicated system.  But it isn’t, in fact, as complicated as it is.  So that the fear that it’s immensely more complicated than we can possibly understand is not a real fear, and I think one should try to avoid that.  I think fear, and not only in this case, but fear is indeed a major enemy in this case.

DR. CHEN:  Paul?

DR. FARMER:  You know, 20-something years ago trying to borrow helpful ideas from people who were trying to be discerning in the way that you mentioned, you know, I have to say that I agree that it’s really not as complex to get started in something that's good, that's not a bad thing.  In medicine, they say do no harm.  Above all, do no harm, and I think that is not so complex as one might think in Ecuador or Haiti or Bangladesh or Dorchester, Roxbury, whatever, doing something that's not harmful.  But I confess, I was and am plagued by the same sort of question you asked.  Not plagued to inaction, mind you, but to reflection.  Otherwise, why would we be working with prisoners in Siberia and also in squatter settlements in Haiti and Peru and violence-torn regions of Guatemala or Rwanda, say?  So this idea that we ended up borrowing was we took from liberation theology, although it showed up in international sociology about the same time just as a notion, a very simple one.  A preferential option for the poor, the idea that it’s, you know, in theological terms on which I am not well versed, the idea was, well God loves everyone, but especially the poor.  And you could make the same argument for certain pathogens that I encounter in everyday medical practice.  But the question was could you use that idea in a place, say, riven by inequality like urban Ecuador?  Could you find people who are more needing than others without letting yourself be paralyzed by this quest to find the really poorest of the poor?  So I have this pragmatic view of it, that in most settings riven by inequality, which is to say much of the world that I know, all of the world that I know, it’s always possible to do something that isn’t harmful.

AUDIENCE:  Thank you.

DR. CHEN:  Please?

AUDIENCE:  Hi.  First let me say that I’m honored to be able to ask you this question in public.  Thank you very much for being here.  It’s a two-part question and it goes to famine in general.  First, I’d like to know if either of you are vegan and secondly, I’d like to know …

DR. SEN:  Are we what?

AUDIENCE:  Vegan or vegetarian?  And the second part is would you agree with the statement that famine can only be avoided if the rich give up meat, fish and dairy?

DR. SEN:  Okay.  I’m not a vegan, I’m afraid, yeah. 

DR. FARMER:  And a pleasure to dine with him.  (laughter)

DR. SEN:  For example, it’s very difficult for me to communicate to anyone in America that I do not like chicken and given the choice between red meat and white meat, I prefer red meat.  Now, I prefer no meat to any of them.  Now, that's very complicated to convey, especially since it’s not the case that, you know, I will eat any meat that's given but by and large, I prefer vegetarian food.  So extremely complicated. 

On the other hand, your second question is much simpler to answer; namely, can famine be avoided without all those things?  Yes, I think so.  I think famine is extraordinarily easy to avoid, and I’m sorry, I’m turning your question around a little.  That it’s absolutely amazing that famine can occur, because a government with the mildest goals of public pressure on it can prevent the famine from occurring.  First of all, there has never been a famine in a democratic country in the history of the world.  Secondly, it doesn’t even require certain intelligent policy.  Basically, the idea that … again, John was being very kind and mentioned something of my research.  What I was saying there was the most perfectly obvious thought: people die because they’re poor.  They can’t buy food.  It doesn’t depend on how much food there is in the country.  It’s like saying America has a lot of houses, and therefore there is no housing problem.  It really depends on whether people have entitlement to get into such a house, to own one or not.  So that issue is the one to deal with. 

And in terms of the answer to the first question that Lincoln asked, since most of us rely on selling our labor power to earn an income, to produce emergency jobs, and this is the way that has ... (inaudible) from the 14th century on within different parts of the world, famine has been dealt with, you can eliminate famine almost overnight.  So that the issue of whether people should lead a vegetarian life, and there are moments I can see the strength of that argument, are very serious.  But you should not make it parasitic on the idea that otherwise we cannot eliminate famine.  As Paul finished one of his answers by saying that has the merit of also being true.  Now, in this case, probably the argument will have the demerit of being false.  So I think one has to be careful that there are very many good arguments that you can find for being vegan, but otherwise the famine I don't think is one.

DR. CHEN:  Paul, what's your dietary background?

DR. FARMER:  I’m not a vegan.  I wanted to add, I’m not a vegan, I confess.  And then I was thinking, well, why am I not a vegan?  And one of the answers may be that meat tastes too good, but I wasn’t quick to think of that.  What I was thinking about was how often I find myself a guest, whether in someone else’s country, for, say, long years on end, or in someone else’s house or someone else’s library.  And, you know, we were just reflecting a little bit, but I’m not a vegan.  Of course, on famine prevention, I defer to the world’s authority.

DR. SEN:  Let me also say that there is the moral position that I must say I find it much easier to take is not vegan but vegetarian, on the idea that if it involves killing a sentient being; that’s a responsibility which is quite serious.  Where vegan, of course, isn’t like that, which takes the form of not having honey, not having milk, which does not involve any killing.  And it raises other types of questions.  And the typical argument that came in the 19th century with veganism was not doing good to the world, but doing good to yourself because it’s terrible for your body to ingest some kind of animal product.  And that, again, you know, it may be a good prudential reason, or I believe a bad prudential reason in this case, but it’s not a moral reason of the kind that vegetarianism or not killing, I would tend to think, might be.

DR. CHEN:  We have long queues here, and I’m going to apologize.  I think we’re only going to be able to take a few more.  Please?

DR. SEN:  We may have to give shorter answers quickly then.

AUDIENCE:  I have a question about the role of women in poverty.  I’ve read that …

DR. SEN:  Role of what?

AUDIENCE:  Women in poverty.  I read that poverty is generally much more severe on the health and the education and the civil rights of women as opposed to men.  And also that AIDS is rapidly becoming the women’s disease in Africa.  And I’m wondering if you could discuss sort of why that is, what structural or cultural underpinnings that may have?  And also, what aid can do to try to ameliorate that.

DR. SEN:  Well, I think a good way of thinking about it is that there are certain disadvantages creating the conditions.  Being a woman is one of them in traditional social arrangements where men’s interests have been favored.  That is not the only one.  There's class, being born without property and without social status could be another.  Having handicaps in other forms of living in an epidemiologically strained part of the world could be another.  But when these things accumulate, when it’s a lower class woman in an epidemiologically strained situation, you get a dreadful situation.  I had the privilege of reading and writing a forward to what I regard is a truly great book, Paul Farmer’s Pathology of Power, and it discusses just such a combination of adversities that you might have. 

And I think it’s one other point.  I quoted Mary Wollstonecraft earlier.  One of the things she discusses is why it’s a great mistake for people who are concerned with disadvantage, whether they are women or whether at that time in terms of class division, to just think of one cause and overlook others.  You have to see the combination of predisposing conditions which makes deprivation become so acute.  So gender is a very serious consideration within that bigger structure.

DR. CHEN:  Paul?

DR. FARMER:  I just have one tiny thing to add, because you mentioned structural forces is that ten years ago, our group wrote a book called Women, Poverty and AIDS and I know you’ve all read it based on the sales figures.  (laughter) I think most of the copies were purchased by my mother.  But in any case, this was ten years ago and the prediction was made then and alas all too true, that given various -- again, a combination of factors, not gender and inequality alone, but the question we asked is how do gender, inequality and poverty act together in an epidemiologically strained situation to create an epidemic that is gendered?  It was never an epidemic that was gendered without other power differentials.  You know, whether you want to talk about property, class, whatever.  It was always tied tightly to poverty and inequality, but there's no question that this was a slow motion tsunami.  And so it’s a little tardy in 2005 -- not for you, mind you -- but I mean it’s tardy for the world to wake up to the notion that this is a woman’s disease in Africa when really it was possible to predict what was going to happen just with a basic and really even a crude structural analysis of the situation.

DR. CHEN:  Thank you.  I’m afraid this is going to have to be, and I apologize because of the long queues, but this will have to be the last question simply because of time constraints.  Please?

AUDIENCE:  Ansfadal Buchenesi (?).  I’d like the panelists to say more about the role, if any, of businesses, private businesses given that we are told by economists that most of the wealth in the world is in private hands.  In the same vein, the role of the poor countries, poor country governments and people in poor countries in regions of poverty.

DR. CHEN:  Thank you.  And I think as part of that question is, of course, the huge press coverage of Davos and ex-Presidents, chief executives, even movie starts now making speeches about global poverty.

DR. SEN:  Um …

DR. CHEN:  You went to Davos?

DR. SEN:  I went to Davos twice and then have given up.  But one of my most distressing experiences was that when my wife and I wanted to have a glass of water toward the evening of one of those celebratory days, and I went to a place where they were serving all this and they said they didn’t have any water.  So well then in that case could we possibly have some bit of champagne?  And I said, no actually I don’t like champagne – it’s not liking chicken, I guess – “Could I have some chilled white wine?”  And this woman looked very pathetically at me and she said, “No, we only have champagne.”  And I think that single-mindedness is one of the causes of the problems there.  But what they have tried to do recently, of course, is to dress up Davos as serving water; I don’t know if drink-wsie they do it, but politically it’s always talking about poverty as it was this year.  I think whether it is successful as not I don’t know since I don’t go.  It seems to me for businessmen it’s quite important to think, to ask the question, what should they do.  It’s opposite from the question with which we began, “I’m comfortably off; why should I think about it?”  I think the answer is you are a human being, you have all kinds of affiliations and different people in different parts of the world belong to the same group in one affiliation or another, and you ought to think about it.  So while that’s extremely important to do, I think at the same time it’s important for us not to rely particularly on the benevolence of the businessmen to deal with that.  It’s like that attitude I take about aid.  That is, I think it’s the duty of the rich countries to ask the question, “How much can they give? and “How much should they give and why not more?”  And I think it’s the duty of the poor countries not to rely on aid at all.  And I think it’s that combination that I would apply here.  That is, we do know – and I think businesses are very important, the market is very important.  It’s very good for us to have good regulation, good incentive structure, good government, good distribution of mechanism including taxation and social policy and not to rely on the benevolence of the rich.  And yet that question that was asked is a question that I would believe a businessman who also thinks of himself as being a human being ought to ask constantly.

DR. FARMER:  You know we mentioned already the centrality of employment as a criteria or a basis for leaving poverty behind.  Obviously, you know, I can’t help thinking of slavery every time I hear the word employment because there’s lots of ways to abuse labor, and that’s just the most extreme example.  But there are also ways to use labor fairly, I would imagine.  I highly recommend tenured university positions.  (laughter)  Just kidding.  I think there are ways of being fair about labor and that some business people – businessmen and business women – who control the means of production are asking the question that you did.  How can we behave responsibly in world that is riven by inequality and poverty?  I work for -- Partners in Health was mentioned -- and when you do an analysis of the means by which we transfer wealth from rich to poor, it’s largely with the assistance of people who have made money in business.  I think even Alfred Nobel was a businessman, if I’m not mistaken.  Amartya?

DR SEN:  Absolutely.

DR. FARMER:  Was he?

DR. SEN:  He was an explosive businessman.  (laughter)

DR. FARMER:  There you go.  At the same time as has already been signalled, those of who are the beneficiaries of the largesse from people in the business community have to always keep some sort of prophetic interrogation ongoing, because it would be unwise to rely any more on the business elite than on the elites of powerful governments to reckon honestly and seriously with global poverty. 

DR. CHEN:  Well, on behalf of all three of us we would like to thank you all for joining us today on Superbowl Sunday.  The three of us would also like to thank the Kennedy Library, particularly John Shattuck, Deborah Leff, and Amy Macdonald and their staff.  And I’d like to thank our two guests.  In one way or another, there questions and answers to this conversation have answered three questions:  What is the concept and what are the causes of poverty?  What can one do about it?  And most important of all, why we should do something about it.   Both of them – I don’t know how many of you are aware – won awards in the last week.  I’ll close with reading them.  Paul Farmer won the Isaac Hecker Award from the Paulist Center and the quote from that award is, “Paul, a gifted man who is in love with the world and has set out to do all he can to cure it.”

Amartya Sen was listed in the United Kingdom on the 2005 Wise List, which I’ll give as a quote.  “Amartya Sen, the sage, the brilliant, the curator of common sense.”  Thank you both for sharing.  Thank you so much.