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Unequal Global Exchange: Colonization, Politics, and Economics

By Amy Bhatt, Women Studies, University of Washington

What can you learn from exploring this topic?

How do themes raised within postcolonial studies relate to Dr. Paul Farmer’s quest to “cure the world” in Tracy Kidder’s Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World?

  • Briefly learn about the field of postcolonial studies.
  • Understand what sorts of questions postcolonial scholars ask about the relationship between ex-colonies and former colonial powers in the West.
  • Consider Dr. Paul Farmer’s perspective on the political and economic imbalances between ex-colonies and the West.


The term postcolonialism has roots in philosophy and literature as a theoretical approach to understanding the condition of nations that were once or continue as colonial possessions of another nation. While there is considerable debate over what constitutes the boundaries of the field of postcolonial studies, broadly speaking, postcolonialism refers to the study of interactions between European nations and the nations that have been colonized in the post-Enlightenment period of history.
European colonization can be broken into two general periods: first, with the early European explorers from the 15th to the 17th centuries; and second, in the latter half of the 19th century beginning with European imperial expansion and culminating in the “scramble for Africa” through the end of World War I. Decolonization refers to the process by which a former colony asserts its independence from its ruling empire. In the late 20th and early 21st centuries, decolonization has largely occurred in Africa and Asia following World War II and the creation of the United Nations. It is imperative to remember, nonetheless, that several colonies remain today; for instance Puerto Rico’s status as a colony of the United States of America and the plight of native and indigenous groups in places like the Americas and Australia complicate any discussion of “post”colonialism.
Many scholars attribute the beginning of postcolonial studies to the publication of Edward Said’s book Orientalism (1978), though previous influential treatises such as Frantz Fanon’s Black Skin, White Masks (1952) have long considered the impact of colonization on the psychological and living conditions of the colonized. Considering the long period of colonial occupation and the widespread reach of European empires, postcolonial studies grew out of an interest in the cultural, philosophical and literary production of those people within the colonized world.
Postcolonial studies has been interested in questions that consider how colonial powers have been able to gain so much control over large parts of the non-Western world. Postcolonial scholars have documented how Western culture, ranging broadly from the implementation of colonial education and languages to the importation of technology, science, and medicine, has impacted colonized societies. Some argue that colonization was not all negative; rather, the infrastructure built and maintained by colonial powers has helped poor regions of the world develop into more modern and industrialized nations. Other scholars argue that while some good did come from colonial occupation for some sectors of colonized societies, the impact of colonization has been fairly detrimental to existing indigenous social, economic and political systems. In particular, some postcolonial scholars and activists point to the question of how “free” ex-colonies can ever be from their colonizers. That is to say, some scholars contend that new forms of imperialism and domination constitute a neo-colonialism that includes the spread of global trade, the development and aid industries, and military occupations. Such neo-colonization has implications along gender, race, and class lines that impact not only the relationships between the West and the developing world, but also create new inequalities within ex-colonies themselves.
Contemporary scholars have considered how some development projects, intended to modernize former colonies (also called the “Third World”), carry with them traces of colonial missions. Development, or the transfer of ideas and technologies from developed to underdeveloped countries, is intended to help these disadvantaged countries that are mostly former colonies. Postcolonial scholars of development, such as Arturo Escobar, have noted that the era of development began as the era of colonization ended. The driving idea behind development has been based on the assumption that the rest of the world can follow the same patterns of industrialization as the West did to become developed. The problem, according to Escobar, is that this assumption ignores the historical conditions of colonization that have helped create “backward” conditions within the underdeveloped world. More than that, this assumption also does not take into account the unequal economic and political conditions between the developed world and developing countries, or the inequalities within nations.
As for ex-colonies such as Haiti, Mexico, and Peru, development has played a very important role in increasing access to Western medicines and technologies. Paul Farmer’s particular “quest to cure the world” might be considered by postcolonial scholars as an attempt to develop those areas of the world that have been the sites of historical and current imperial struggles, while also giving attention to the specific conditions that create deep inequality. At the same time, postcolonial scholars might contend that there are still legacies of colonialism, including the predominance of Western ideas and science over indigenous or local ideas, that linger in this particular “quest” as well.

Postcolonialism and Mountain Beyond Mountains

I think of myself more as a physician than as an American. Ludmilla and I, we belong to the nation of those who care for the sick. Americans are lazy democrats, and it is my belief…I think that the rich can always call themselves democratic, but the sick people are not among the rich…Look, I’m very proud to be an American. … I can travel freely throughout the world, I can start projects, but that’s called privilege, not democracy. (Paul Farmer, in Tracy Kidder, Mountains Beyond Mountains, p. 229)

Farmer’s philosophy of giving preferential treatment to the poor in developing countries is rooted in his understanding of the continuing legacy of colonialism on poor countries. More personally, Farmer’s recognition of his relative privilege as a citizen of a powerful nation combined with his identification as a physician first and foremost amplifies his concern for continuing inequities between rich countries and poor. Thus, Farmer’s prescription for correcting the imbalances in health between the West and the poor of the world would require attention to the postcolonial context.
Two themes related to postcolonialism stand out in Farmer and Partners in Health’s mission: the relationship between global politics and the perpetuation of poverty and the concentration of wealth in the West to the detriment of the world’s more needy populations.

Democratic Politics and Poverty

Paul laid out a comprehensive theory of poverty, of a world designed by the elites of all nations to serve their own ends, the pieces of the design enshrined in ideologies, which erased the histories of how things came to be as they were. And he knew the details for Haiti, a catastrophe covered with the fingerprints of the Western powers, most of all those of France and the United States.
– Tracy Kidder, Mountains Beyond Mountains, p. 73

Within the postcolonial perspective, understanding poverty in Haiti requires relating its current status to its legacy as an ex-colony of the French empire. (For more information on the colonial and postcolonial history of Haiti, see “Mapping Global Mountains Beyond Local Mountains” by Dr. Matthew Sparke.) For Paul Farmer, poverty cannot be considered outside of the conditions that helped create and perpetuate it.
Farmer’s use of the term “structural violence” points to the complicated relationships between the multiple factors that lead to negative outcomes for individuals living in poverty. More importantly, these relationships are not accidental but have specific histories and purposes that benefit some and hurt others; as Kidder notes, “these circumstances all had causes, and the nearest ones were the continuing misrule of the Duvaliers and the long-standing American habit of lavishing aid on dictators” (p. 73). Thus, Farmer argues that the political relationship between the United States and Haiti has had a detrimental effect on the health of the citizens of Haiti.

Economics and Unequal Global Exchange

“There are more billionaires today than ever before,” Jim declared. “We are talking about wealth that we’ve never seen before. And the only time that I hear talk of shrinking resources among people like us, among academics, is when we talk about things that have to do with poor people.”
– Jim Kim, in Tracy Kidder, Mountains Beyond Mountains, p. 164

Partners in Health and Farmer’s efforts to bring modern medicine to an ex-colony such as Haiti must be considered in the current moment of globalization, where countries are growing more interconnected and financially dependent than ever before. Farmer works extensively to bring down the cost of TB-related drug pricing. This struggle over pricing highlights the challenges faced by poor countries in an increasingly global market where most drug companies are protected by patent laws safeguarded by the World Trade Organization.
According to Oxfam International, roughly 14 million people in developing countries die each year from infectious diseases that could be prevented with wider access to medical treatments and medications. However, as part of the Trade-Related Aspects of Intellectual Property Rights agreement, the WTO has ensured that the patent regulations for mostly Western pharmaceutical companies should be protected over measures to increase wider availability of drugs to poor nations.
Thus, Farmer’s struggle to bring down drug pricing globally reflects another postcolonial concern: the inability of ex-colonies and the poorer nations of the world to effectively receive the same standard of care and access to medical advances as the rich. For Farmer, this is a problem of neo-colonization, where wealth continues to be accumulated in the nations of the West, or the former colonizers, while poor nations, or the bulk of the colonized world, continue to suffer.

What does this mean for you?

  • How might the political legacies of colonization shape our understanding of problems of health inequity today?
  • Do current economic formations have roots in historical processes? If so, what sorts of solutions to addressing inequity might you suggest?
  • Think about how the so-called “ Third World” is represented in the media and popular culture. What assumptions are made about why some nations are poor and others, like the U.S., have so much wealth?
  • Has colonialism impacted your life and the lives of people you care about?

Resources for further study

Escobar, Arturo. Encountering Development: The Making and Unmaking of the Third World. Princeton : Princeton University Press, 1995.
Esteva, Gustavo. “Beyond Development, What?” with M.S. Prakash, in: Development in Practice, Vol. 8, No. 3, Aug. 1998.
Fanon, Frantz. Black Skin, White Masks. Trans. Charles Lam Markmann. New York: Grove Press, 1967.
Kidder, Tracy. Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World. New York: Random House, 2003.
Said, Edward. Orientalism. New York: Vintage Books, 1978.
Spivak, Gayatri Chakravorty. A Critique of Postcolonial Reason: Toward a History of the Vanishing Present. Cambridge , Mass.: Harvard University Press, 1999.
Young, Robert. Colonial Desire: Hybridity in Theory, Culture, and Race. New York: Routledge, 1995.

Web sites

Emory University’s Postcolonial website:
National University of Singapore’s “Contemporary Postcolonial and Postimperial Literature in English” website:
Oxfam International website:
The Institute of Postcolonial Studies:

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