In the same week that the first edition of When Misfortune Becomes Injustice was launched at Harvard Law School in early February 2020, I participated in the first meeting of the Commissioners of the Lancet-Dartmouth Commission on Arctic and Northern Health.1 It was a grim meeting in the sense that we discussed the sweeping social and health impacts of centuries of colonialism, and the climate crisis that was wreaking devastation on the Arctic and the indigenous communities’ lands, health, and ways of life. At the same time, the world urgently needed the policy insights and epistemic approaches that arctic indigenous leaders, scholars, and health providers bring to bear on the intersecting health, social, economic, and climate challenges that the world faces.
On the margins of that meeting, some of us discussed emerging evidence about a novel SARS virus that had been identified in Wuhan, China, that was producing a bilateral pneumonia and appeared to be quickly spreading. The virus was named by WHO that same week, on February 11, 2020, and was declared a pandemic a month later. COVID-19 would upend lives and livelihoods across the globe and prove to be the greatest global crisis in a century, leading UN secretary-general António Guterres to call it “the biggest international challenge since the Second World War.”2
As of this writing, over 15 million people had died of COVID-19 directly and from other conditions left untreated or caused indirectly by the pandemic. The massive disruption of lives and livelihoods as well as challenges to the rule of law, democratic norms, and the multilateral system, represent a profound inflection point for all of us.
SARS-CoV-2 struck a hyper-globalized world pervaded by intersecting inequalities within and across countries, with many governments shackled by waves of debt and austerity and dependent on the miserly charity of the economic North. Already, before Russia’s invasion of Ukraine in 2022, the pandemic had laid bare the need to reimagine the post−World War II order that had evolved in the subsequent decades.
Thus, with Stanford University Press we agreed that the pandemic lent urgency to the arguments in the first edition regarding how we came to find ourselves with our current institutionalized social order, as well as the need to revisit strategies for human rights in promoting greater health and social equality.
Well before the pandemic, profoundly morbid symptoms of our conjoined political, economic, ecological, and social crises were visible not just to indigenous people in the Arctic and around the globe but to anyone who was paying serious attention. Indeed, the genesis for writing When Misfortune Becomes Injustice was the tracing of the dual trajectory of progressively developing and deploying rights to advance population health on the one hand and on the other the shifting structural constraints that undermined the political possibilities to realize them. Nonetheless, the way the world responded to a global pandemic and the social and economic crises it triggered have elevated these interconnected issues.
On a more personal level, people across geographic regions and students across disciplines—law, public health, nursing, sociology, gender studies, anthropology, and the like—were faced with grappling with how to make sense of all the losses, big and small, that they themselves and their communities were experiencing, as well as diverse people across our shared world. Questions about how we understand our own personal narratives, and those of others, were central concerns of the first edition. But, again, COVID-19 raised these questions with greater urgency for a far broader group of people.
During the pandemic, I had the privilege of teaching not just Harvard students but students from Argentina to Mexico, from Norway to South Africa. Some of these students lost family members and faced displacement from their homes; others began rethinking career paths as their futures were suddenly upended; some were working in hospitals and on COVID-19 wards; still others were struggling with the overwhelming feeling of impotence that comes with seeing overfilled emergency rooms and makeshift morgues on televisions and smart phones without being able to do anything. The discussions in this significantly revised edition are deeply informed by diversely situated students’ insights and questions not just about the effectiveness of human rights law but about how to respond ethically to the suffering of our fellow human beings and the natural world.
If When Misfortune Becomes Injustice was already focused on the need to translate the lofty aspirations of human rights law into the “immanent regularity of practices,” to use Pierre Bourdieu’s term,3 this revised edition adds further reflections on that challenge in crisis and “normal” times. Drawing heavily on advocacy work during the pandemic with Partners In Health (PIH) as well as on reproductive justice coalitions in Latin America, which achieved landmark gains in abortion rights, this edition addresses more squarely what makes human rights strategies successful in achieving social change in different contexts and in turn what that tells us about the many challenges that lie ahead.
Reflecting on the legacy of my beloved friend and colleague Paul Farmer, the co-founder and chief strategist of PIH, who passed away suddenly in 2022, reinforces the imperative of repeatedly coming back to the question of why it matters to treat health as a matter of rights. Centering the question of why the equal dignity of diverse people matters pushes us to ask what we should do to advance global health justice and how we should do it, in ways that call for profoundly disrupting the status quo. Paul literally connected the world through his extraordinary work and life, driven by the profound belief that the idea that some lives matter less is the root of all that is wrong with the world.
At a time when the world seems so broken, it could not be more urgent to carry forward a transformative praxis of human rights in global health based upon our common destiny and shared humanity.
Alicia Ely Yamin Cambridge, Massachusetts, 2022
1. Lisa V. Adams, Dalee Sambo Dorough, Susan Chatwood, Willy Erasmus, Heidi Eriksen, Selma Ford, Ross A Virginia, and Siila Watt-Cloutier, “Accelerating Indigenous Health and Wellbeing: The Lancet Commission on Arctic and Northern Health” Lancet (British Edition) 399, no. 10325 (2022): 613–14.
2. “Global Cooperation Must Adapt to Meet Biggest Threat since Second World War, Secretary-General Says on International Day, as COVID-19 Transcends Borders,” un.org, April 23, 2020, https://www.un.org/press/en/2020/sgsm20058.doc.htm.
3. Pierre Bourdieu, Forms of Capital (Cambridge, UK: Polity Press, 2021).