A Review of When Misfortune Becomes Injustice

Taking care of patients in rural Haiti or in southwest Uganda, say, who are sick from diseases long since vanquished from the United States, in communities that did not get much access to Covid-19 vaccines when they were most critical, a healthcare practitioner might easily fall into despair. 

Similarly, at the close of 2023, working in city hospitals in the United States, faced with racial, ethnic and economic class disparities in health outcomes, it can be hard at times to see progress in social and health equity.  Although, undoubtedly, some progress has been made, the gaping wounds of inequity can often seem insurmountable. It’s in that context that Alicia Yamin’s volume on health and human rights, When Misfortune Becomes Injustice , comes to us as a pragmatic call to action and an antidote to resignation and any misplaced tendency to fall into inaction. The book is, as she writes, “an invitation to take part in the struggle” for the world we want, and she succeeds in making the case that positive change remains possible through collective action.

When Misfortune Becomes Injustice by Alicia Ely Yamin (2nd Edition. Stanford: Stanford University Press, 2023, 296 pages)

Yamin interweaves the personal, her lived experience and those of her clients and colleagues, the historical record and the future path in an accessible yet highly authoritative book on human rights approaches to achieving progress for health. She describes in a deeply researched way the challenges faced in the early 1990’s for those—herself included—who were advocating for economic, social and cultural rights, including health, to be framing human rights alongside more traditionally recognized civil and political rights. Those challenges included establishing that health and other such economic and social rights were “real, legal rights and not just programmatic aspirations,” demonstrating what it would mean to apply human rights to health in laws, policies and institutions and deploying human rights to promote new norms of greater egalitarianism. 

Moving through a history of these aspirations for economic and social human rights from the 1970’s through to the recent Covid-19 response, Yamin describes the basis for her argument through examples that reframe historical exploitation into terms of reparative justice. She argues that human rights approaches may be used to face modern challenges to equity through “constructive disruption” of existing strategies. 

Throughout the factual and case-based narrative, Yamin shares examples that resonate. Vinicio, whose father—also named Vinicio—died in a public hospital in Chile having not received the kind of intensive care that the hospital had available but did not avail to him, offers a moving story, emblematic of the injustices pervading ill-health in communities around the globe. 

Quoting the younger Vinicio, Yamin describes their conversation after a legal hearing on the matter. “My family was destroyed by injustice, we were discriminated against, humiliated for being poor…The state never investigated [my father’s death]…For them, [my father] was just another poor man who died in a public hospital.” This anecdote brings the human connection of Yamin’s argument into the human rights narrative, taking what can be sometimes abstract—at least for those of us outside the specialty—and makes it very real. A skill in the writing is that Yamin highlights the tensions between what she describes as “the extraordinary ability of humans to collectively innovate practical progress, and the unequal costs of that progress,” yet never lets us fall into despair. Writing again about Vinicio and people like him, who face seemingly unending setbacks, it seems clear what inspires her approach: that so many “ordinary people” manage the extraordinary feat of picking themselves up again and again. Yamin seems driven by purpose around collective action, and shares with us that it is here in the choice to deny nihilism and continue to live and love—and to struggle—that dignity lies.

Chapter by chapter, decade by decade, Yamin sets a clear path forward, recounting what has been achieved to date and all that we have left to do. She makes a strong case for targeting all forms of inequality, focusing on infrastructures, including organizing care economies and democratizing knowledge and authority. To understand where we are going, we must understand where we have been. Her own continual reflection is one of the special characteristics of the book. Yamin’s deep and personal experience in praxis of human rights is infused in the narrative, while not overly inserting her experiences she draws on them and her proximity to the issues through enlightening vignettes. She presents a clear view over our shared commitments to equal dignity, the relationship of dignity to rights, and the role of transnational as well as national forces in the work. During this important moment in the trajectory of “global health” as a discipline, Yamin reflects on the role of outside actors in advancing the right to health and considers the outsized role of philanthro-capitalism while the public capital required to invest in public and individual health has faltered. 

In 2008, Harvard physician anthropologist Paul Farmer wrote “health and human rights must move beyond the traditional exhortatory role, which stems from insisting on respect for conventions to which most states are signatory, to considering such prosaic issues as supply chains for sutures, generators, magnesium sulfate, and operating room lights…I advocate challenging the present priorities that place civil and legal rights first and adjourn substantive social and economic rights for another day. It is when people are able to eat and be well that they have the chance to build democratic institutions”. Yamin’s book is a “must read” for those emerged in the struggle for a healthy society, and for students of any stage of learning who seek to understand the history of and the potential of the human right to health. 

Louise C Ivers MD, MPH is faculty director of the Harvard Global Health Institute and director of the Massachusetts General Hospital Center for Global Health. She provides care for patients in the United States, Haiti, and Uganda and works on the design, implementation and evaluation of public health programs.