Paul Farmer

(Courtesy of Possible Health/Flickr)

ust weeks ago, during a February visit to Mexico, Pope Francis gave a Mass at Ecatepec, a slum outside of Mexico City. The teaching he delivered condemned a society “for the few, by the few,” and preached increased concern for the poor. By now, those ideas have become a familiar part of the pope’s repertoire. His 2015 encyclical, Laudato Si, noted “how inseparable the bond is be­tween concern for nature, justice for the poor, commitment to society, and interior peace.” They’re also a part of the papal embrace of liberation theology, a once-scorned philosophy that entwines Catholic spirituality with class politics.

Some 400,000 people prayed with the pope in Ecatepec—a fervor that rivals the one that swept the U.S. last autumn, when the pontiff came here. But few American Catholics have taken up the banner of liberation theology.

A chapter from In the Company of the Poor, a book by prominent public health advocate Dr. Paul Farmer, typifies this. “You do know about Father Gutiérrez?” Farmer asked a group of Notre Dame students after a public talk on his work. Then he offered a personal testimony on the genius of Gustavo Gutiérrez, the Peruvian priest who is credited with creating liberation theology 45 years ago, and who is Farmer’s co-author, as well as a part-time Notre Dame professor. “It’s kind of like having Yoda from Star Wars right here on campus for half the year,” Farmer told the students. “He will rock your world.”

The name didn’t ring a bell for any of them. But Farmer’s enthusiasm for Gutiérrez hints that liberation theology has an impact greater than often recognized. In fact, Farmer himself is one important reason why. The Harvard professor is not a theologian but rather a physician and global health expert; his talk at Notre Dame was on his work fighting TB, AIDS, and other infectious diseases. A founder of an international nonprofit called Partners in Health, he’s helped bolster equality in healthcare in Haiti, Peru, Rwanda, and beyond. Farmer is also Catholic, and as a student with a lapsed faith, he read Gutiérrez and began incorporating the priest’s concepts into his medical work. Years later, the theologian and the doctor would become friends. In an interview, Farmer says he has built his work on “a great deal of inspiration in notions I’ve taken from liberation theology: understanding structural violence, the notion of accompaniment, and a preferential option for the poor.”

Farmer is among the most important figures in global health of the last twenty years, and his embrace of liberation theology with the work of global health has been both visionary and perfectly in key with scientific data. In some sense, liberation theology has transcended the neglect the U.S. has shown it. Liberation theology could be utilized as a secularized form of Christianity, a rough analogy of Hindu’s yoga or Buddhism’s mindfulness. Through Farmer and his work, the concept has already helped shape a few grand successes in global health.

Liberation theology arose in Latin America in the 1960s, amid a revolutionary leftist milieu that included figures like Camilo Torres Restrepo, a Colombian Jesuit who said, “If Jesus were alive today, he would be a guerrillero.” Although many on the continent were less extreme, a rising tide of discontent with inequality provoked the Catholic church to shift leftward. In 1971, Lima priest Gustavo Gutiérrez published his seminal A Theology of Liberation, which entwined religion with that political vision.

“The untenable circumstances of poverty, alienation, and exploitation in which the greater part of the people in Latin America live urgently demand that we find a path towards economic, social, and political liberation,” Gutiérrez wrote. “The Christian community is beginning, in fact, to read politically the signs of the times.” The book articulates liberation theology’s main tenets: that impoverished people are special recipients of God’s grace (part of Catholic social teaching’s “preferential option for the poor”), and that resistance to oppression (here called sin) is central to a Christian life. (Gutiérrez was unavailable for an interview for this article.)

The public embrace of that viewpoint would be brief. Leftists mounted political campaigns in several Latin countries in the 1970s, but soon faltered; the next two decades were defined by dirty wars, dictatorships, then gradual returns to democracy. Although the Catholic Church never rejected liberation theology, the concept soon drew scorn, then neglect. It was only around the turn of the millennium (when leftist movements rose in Argentina, Brazil, and other Latin America nations) that the philosophy regained some ground. Only now has Pope Francis, the first pontiff from Latin America, woven the perspective into his teachings and—to a lesser extent—back into the American mainstream.

That’s not to say nothing happened in the interim. In the 1980s, Farmer was completing an M.D.-Ph.D. at Harvard and working in Haiti. With a few colleagues, he established Partners in Health—intending, as many other NGOs do, to address the gaps in healthcare to the Western hemisphere’s poorest nation. The project offered HIV/AIDS care for a few years, and gradually expanded into comprehensive primary care. Along the way, Farmer, channeling Gutiérrez’s care for the poor, integrated his teachings with strong opinions about how socioeconomic inequality destroys health. In the Company of the Poor includes Farmer’s enduring perspective: “In a world riven by inequity, medicine could be viewed as social justice work.”

By the mid-1990s, Farmer and Partners in Health expanded into a tuberculosis treatment program in Lima, Peru. A colleague knew Gustavo Gutiérrez, who was (and is) still working as a parish priest in his native city. Farmer was eager to meet the author he’d long considered an inspiration. The two men struck up a lasting friendship.

Farmer continued carrying the theology into his work. In the 1990s, that meant saving the lives of people with tuberculosis. A wave of multidrug-resistant TB had arisen in the developing world. Improper treatments heightened the threat of a global epidemic. Observing dangerous relapses in patients, Farmer and his colleagues at Partners in Health pressed the World Health Organization and pharmaceutical companies to change international protocols and drop drug prices, arguing the existing standards were effective death sentences for the TB-infected poor.

Their methods often involved the same provocative solidarity with the poor that had characterized liberation theology at its origins. As Tracy Kidder wrote in his 2003 Pulitzer prize-winning book on Farmer, Mountains Beyond Mountains, “He embodied a preferential option for the poor … Farmer wasn’t put on earth to make anyone feel comfortable, except for those lucky enough to be his patients.”

Afflicting the comfortable while comforting the afflicted is not an easy game to play, but Partners in Health was massively successful. Drug companies dropped prices. The WHO rewrote its protocols. Successful treatments helped prevent a massive global TB outbreak. In Haiti, where even the most well-funded development projects often come to nothing, Partners in Health has sustained itself—and thousands of lives—for more than 30 years.

To hear Farmer tell it, the organization, although secular, could not have pulled it off without key liberation theology concepts—including one it wrote into its mission statement. “Our mission is to provide a preferential option for the poor in health care,” that statement reads in part. The organization strives “to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair.”

The “preferential option of the poor” in question responds to another key concept from liberation theology: structural violence. The term denotes the systematic ways in which entrenched inequality disadvantages and harms some people more than others. As Farmer wrote in In the Company of the Poor: “This is exactly what is meant by the concept of structural violence: inequity that is ‘nobody’s fault,’ that is just ‘the way things are,’ that we live with because we cannot or will not or do not know how to address the conditions that create unequal outcomes for rich and poor.”

The “preferential option for the poor” is Farmer’s preferred term for willfully creating the precise opposite. As a tenet of liberation theology, the “preferential option” means God tends to touch the lives of the poor more vividly than those of wealthier people. For Partners in Health, enacting it has meant designing healthcare that recognizes the fact that economically vulnerable people typically need more care, delivered more attentively, than wealthier people do. Worldwide, the organization has arranged clinics that include assistance with every part of the problems undermining patients’ health, from medication to adequate food to cash grants that permit people to travel to their clinics for care.

The notion of “accompaniment,” the third of Gutiérrez’s key inspirations to Farmer, adds another layer to this careful tending. In liberation theology and in healthcare, accompaniment means being willing to live the life of the poor along with them. It’s intellectually simple but spiritually challenging—and a very large step away from the norm for NGOs, which tend to shepherd foreign workers in air-conditioned SUVs while local workers and patients go without. Partners in Health finds the practice effective.

Many health professionals agree. If Farmer’s ideas arise from religion, they are by no means out of step with science. In the 1960s—just as Latin American bishops were endorsing liberation theology—health researchers were beginning the groundbreaking Whitehall Study. This long-running research showed that workers in lower socioeconomic tiers endure more illnesses and earlier deaths than their more powerful counterparts. Since then, other studies have examined how stress and disempowerment can harm a person across their whole lifespan, down to their DNA. Global health experts also acknowledge that the poorest people are most vulnerable to illness and most in need of care, and yet typically get the least. It’s a phenomenon called the inverse care law. Connectedly, social determinants of health—the “unequal distribution of health-damaging experiences” which are “the result of a toxic combination of poor social policies, unfair economic arrangements, and bad politics,” as the WHO has said—have become a central focus in global health.

The parts of liberation theology that overlap healthcare, in other words, are evidence-based. That’s not unique. Other practices have gained popularity and scientific corroboration after being separated from religious origins. This includes yoga, once part of a mix of devotional practices in Hinduism, but is now often solely a fitness routine. It includes mindfulness, a part of Buddhist monasticism now available in diluted form everywhere from pain clinics to the passenger headsets on airplanes. Robust evidence suggests both augment wellbeing.

Does liberation theology’s preferential option for the poor have the potential to become a part of the mainstream, as yoga or mindfulness have? Farmer says, “I think there’s even more potential than that.”

He adds that the practices of liberation theology “would make poor commodities, but excellent correctives to the commodification of everyday life”—unlikely, in other words, to turn into the status symbol that $200 yoga pants and corporate meditation retreats have become. “It’s not about watering it down to make it interesting to people in a comfortable suburb of California,” he says. “This stuff is a lot more bad-ass.”

That said, moving liberation theology farther into the public discourse has in some ways begun, not least of all at the pope’s behest. Farmer alludes to climate change, which is widely acknowledged as most harmful to the poorest countries, which did the least to create it. Concentration of capital, meanwhile, is rankling millennial voters. And in healthcare, a concept called care coordination aims to offer careful attention to the most ill, impoverished, and underserved Americans on a massive scale—often by enlisting workers from the same communities as the patients. The Obamacare-related initiative can be thought of as a preferential option for the poor and a form of accompaniment (albeit one that arises more from healthcare cost concerns than spiritual compassion). Overall, Farmer says, “I’ve heard more discussion recently in the United States about structural inequality than I have in a long time.”

If the United States brings liberation theology or its tenets farther into its Christian mainstream, it will just be catching up to Mexico, Peru, and other Latin American and Caribbean nations. “It’s certainly not ignored by people living in extreme poverty,” Farmer said. “It’s just in more affluent societies that it’s been sidelined.”

M. Sophia Newman, MPH, is a writer and a public health professional. See more at or @msophianewman.