Oops, forgot these wise tough-love words (making me look like a naive
Kim fan!):
148 /American Anthropologist/ . Vol. 113, No. 1 . March 2011
Walking the Line between Accommodation and Transformation: Evaluating
the Continuing Career of Jim Yong Kim
G. Derrick Hodge
In several early speeches given last year as the new president of
Dartmouth College, Jim Kim quoted one of his predecessors, John Dickey:
"Make the world's troubles your troubles." This, he informed his
audiences, is what he has tried to do for much of his career. And it has
been a remarkable career, indeed: Kim has not only rhetorically embraced
the troubles of the world's sick and dying poor but also has actual
extended and enhanced the lives of millions. What better description
of---and prescription for---a practicing and public anthropology than to
take on the troubles of the world and try to solve them? What is
uncertain is whether Kim's new role as an Ivy League president will
facilitate or stifle this vision of a critically engaged anthropology.
The staggering successes of Kim and his colleagues---for he seldom
discusses his own work without giving credit to his colleagues and
collaborators---are well-known in a number of fields, not least medicine
and anthropology. In 1987, Kim cofounded Partners in Health (PIH) with
Ophelia Dahl, Paul Farmer, and others to support the work that Farmer
and Dahl had been doing in their clinic in rural Haiti. In the
mid-1990s, Kim took the lead on the organization's work with
multidrug-resistant tuberculosis (MDR-TB) in Lima. There, he rejected
the conventional wisdom of the medical establishment by insisting that
slum dwellers with MDR-TB could be successfully treated and would
complete prescribed drug regimens. He accomplished this by following the
lead of his Peruvian partners in hiring community health workers and by
negotiating a 90 percent reduction of the price of MDR-TB drugs. The
protocol that Kim and his colleagues developed in Lima is now a standard
of care worldwide.
Within six years of having been appointed assistant professor at Harvard
Medical School (2000), Kim was a full professor (2006--09); in 2003, he
was awarded the MacArthur Foundation's "Genius" Fellowship; in 2005, he
was one of U.S. News and World Report's 25 "Best Leaders"; and in 2006,
he was named one of Time magazine's 100 most important people in the
world. He was chair of three departments at Harvard (simultaneously) and
head of its Division of Global Health Inequity.
Kim took two years' leave from Harvard and PIH (2003-- 05) to become,
initially, advisor to the director general of the World Health
Organization (WHO) and then head of HIV/AIDS for WHO. It was in this
capacity that he designed and implemented the "3×5" program. Under Kim's
leadership,WHO---andits related organization UNAIDS--- established a
goal of treating three million persons with HIV from poor countries with
antiretroviral therapy by the year 2005. This bold move drew widespread
skepticism, silenced only by its enormous success (although the goal was
not reached until 2007). In this work, Kim was cheerleader, diplomat,
fundraiser, physician, anthropologist, humanitarian, and administrator.
Importantly, 3 × 5 was not merely a vertical health-emergency
intervention but, rather, an opportunity to improve health
infrastructure through regulatory and policy development within host
countries. Thus, Kim's time at WHO was not merely about typical public
health intervention, consisting of service provision, prevention, and
palliative care; it was also an attempt to implement the kind of
structural transformation that many anthropologists have as their goal.
Yet even Kim's boldness and innovation at WHO, although it saved many
lives, was limited in its ultimate effect in that it did not call into
question the legitimacy of the economic structures that impede human
well-being.
Kim's 2002 coedited volume Dying for Growth went further in this
direction, attacking the structural roots of global health disparities
and positing capitalism---particularly in its neoliberal and
developmentalist guises---as the underlying source of poor health
outcomes. Although the volume laid bare the ultimate source of death and
suffering, Kim's work at WHO had far more direct impact on human life
than his scholarly interventions. Herein lies a tension in anthropology:
our analyses make clear that nothing less than dramatic transformation
can save the world, but the immediate needs of human life require a
direct and pragmatic engagement with existing structures of power. Kim's
career embodies one solution to this dilemma but one that might not be
entirely satisfactory to more revolutionary-minded anthropologists.
For instance, Kim has lauded the effectiveness of the radical AIDS
activist movement ACT UP, and some activists extol Kim for his visionary
leadership at WHO. But it is not at all clear that there will be any
lasting institutional improvements as a result of his efforts. The ACT
UP activists he praised are those who, in fact, left the radical edge of
the movement to pursue conciliatory engagements with the pharmaceutical
industry. Indeed, in his 3 × 5 initiative and in his work in Lima, Kim
partnered with pharmaceutical companies and several times affirmed the
profit motive and market mechanisms as helpful tools in addressing
public health emergencies. Although Kim seems to understand that
neoliberal capitalism is the source of much death and dying, as a
physician and public health administrator he has been adept at making
strange bedfellows in the interest of saving human lives. He has been
quite willing to support the profitability of already very wealthy
corporations if it means saving a life in the here and now. Yet by not
challenging the ways in which profit-motivated economic processes cause
the kind of illness that they then claim to cure, this kind of
pragmatism risks sacrificing future generations for current exigencies.
Kim's work reveals another tension in anthropology: the desire of many
of us to contribute to dramatic structural transformation versus the
paucity of actual change that most of us accomplish. Contrasting
medicine to anthropology, Kim told the journalist Bill Moyers in 2009
that "Anthropologists are a little bit different [than physicians]; we
don't often act on what we do." Unfortunately, that statement may be
more accurate than we would like to believe.
Most anthropologists are deeply committed to the wellbeing and
liberation of the people with whom we work; yet few of us can claim that
our work actually makes a difference in people's lives. Our books bring
us tenure in privileged places, but the changes proposed in
ethnographies are almost never realized, even in part. Kim is quite
correct that most anthropologists "don't often act on what [they] do."
If Kim is vulnerable to the critique that he has conceded ground to
those who seek profit from sickness, then he is also to be praised for
having had profound effect on very many lives---far more than most of us
can claim.
Kim's astonishing successes indicate one way to creatively mediate the
tension between ideological rigor and pragmatic accommodation. It is yet
unclear whether he will be unable to continue this engagement in his new
institutional context. Dartmouth---and most other universities--- is
deeply embedded in the political economies that produce the suffering
that anthropologists denounce. Because Dartmouth now has a claim on
Kim's many talents, it would seem unlikely that he will launch a serious
challenge to the same structures that sustain his new institution. He
has stated that his goal as president is to train students to "do great
things," but it is not clear whether those "great things" include
overturning the structures of material inequality on which the
institution depends.
Jim Kim, at age 50, has already given profound legacies to the world: he
has saved countless lives and challenged several institutions to
consider their responsibilities to the losers in this violent global
political economy. Hopefully, in the next phase of his career, Kim will
not allow institutional strictures to dull his critical edge. If he is
able to avoid the temptations of power and privilege, his new position
could allow him to do far more than just mentor students to "do great
things"; as president of Dartmouth, he could in fact launch an
unflinching critique of dominant structures of knowledge production and
the ways in which universities contribute to the reproduction of
inequalities. To do this, he would have to upset the apple cart even
more than he did at WHO. If he is willing to risk alienating wealthy
donors, he might feel morally compelled to use his new pulpit to tell
the truth about global capitalism, as he did in Dying for Growth.
G. Derrick Hodge Department of Sociology and Anthropology, University of
Missouri at Kansas City, and the Mount Sinai School of Medicine, New
York; [email protected]
REFERENCES CITED
Kim, Jim Yong, Joyce Millen, Alec Irwin, and John Gershman, eds.
2002 Dying For Growth: Global Inequality and the Health of the Poor.
Monroe, ME: Common Courage.
Moyers, Bill
2009 Transcript. Bill Moyers Journal, September 11. http://
www.pbs.org/moyers/journal/09112009/transcript2.html
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