"HOUSE OF YES" AND REJECTION OF SELECTIVENESS
In PIH speak, we refer to the open-ended optimistic action as the “House of Yes.” Under the House of Yes, we reject a time-bound approach and the selectiveness of scoped medical interventions that are both incompatible with the universality of human rights.
CLICK TO ADVANCE
It is easy to rationalize selectiveness due to perceived scarcity of resources. (“There simply isn’t enough money to help everyone,” or, “This intervention gives us the biggest bang for our buck.”) Resources for health in settings such as Haiti or the Navajo Nation are limited in large part because of a history of oppressive, racist policies and laws. When scarcity of resources is accepted as “the way things are,” a process
of dangerous and cruel prioritization, which worsens injustice, inevitably
follows. Led by the acceptance of scarcity, prevention wins the argument over treatment, primary care over tertiary care, and expensive therapy for diseases such as cancer, mental illness, or organ failure is never even considered as a sustainable option. Socialization of experts to accept massively unequal resource distribution will inevitably result in a “No” to such care.
CLICK TO ADVANCE
As Dr. Farmer frequently pointed out, what ultimately stands in the way of
achieving health equity is not lack of medical technology, resources, or
even will to bring change, but rather a failure of imagination. When we
allow ourselves to dare to imagine a solution that lies past what we think is
currently possible, we become catalysts for radical change.
CLICK TO ADVANCE
This failure, of course, is fatally linked to the idea that some lives matter less than others. Ninety percent of the problems social medicine should address would be lessened by rejecting this notion and insisting on high aspirations for those who haven’t enjoyed the fruits of medicine and public health.
CLICK TO ADVANCE
- Dr. Paul Farmer
At PIH, we like to ask the following question: “What treatment would we seek if this patient were part of our family?” The obvious answer to this question never fails to strengthen our resolve and opens the door to the house of Yes. The requirement that people who live in poverty accept their lot and become socialized for scarcity is often handed down by experts on behalf of poor people. Not only does this rationalization create situations of deep inequality and discrimination, but it also makes no economic sense. It is rather intuitive that healthier communities are empowered to advance more rapidly in all social and economic areas.
CLICK TO ADVANCE
Institutionalized discrimination is bad for people and for societies. Widespread discrimination is also bad for economies. There is clear evidence that when societies enact laws that prevent productive people from fully participating in the workforce, economies suffer.
CLICK TO ADVANCE
- Dr. Jim Yong Kim
Resisting and questioning this dogmatic approach of saying “no” on behalf
of the most vulnerable is part of the fight for social justice that PIH started
more than 30 years ago, and is a requirement to successfully shift the current global health paradigm.
"HOUSE OF YES" AND REJECTION OF SELECTIVENESS
Andrea Tibbetts
Created on November 12, 2025
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Transcript
"HOUSE OF YES" AND REJECTION OF SELECTIVENESS
In PIH speak, we refer to the open-ended optimistic action as the “House of Yes.” Under the House of Yes, we reject a time-bound approach and the selectiveness of scoped medical interventions that are both incompatible with the universality of human rights.
CLICK TO ADVANCE
It is easy to rationalize selectiveness due to perceived scarcity of resources. (“There simply isn’t enough money to help everyone,” or, “This intervention gives us the biggest bang for our buck.”) Resources for health in settings such as Haiti or the Navajo Nation are limited in large part because of a history of oppressive, racist policies and laws. When scarcity of resources is accepted as “the way things are,” a process of dangerous and cruel prioritization, which worsens injustice, inevitably follows. Led by the acceptance of scarcity, prevention wins the argument over treatment, primary care over tertiary care, and expensive therapy for diseases such as cancer, mental illness, or organ failure is never even considered as a sustainable option. Socialization of experts to accept massively unequal resource distribution will inevitably result in a “No” to such care.
CLICK TO ADVANCE
As Dr. Farmer frequently pointed out, what ultimately stands in the way of achieving health equity is not lack of medical technology, resources, or even will to bring change, but rather a failure of imagination. When we allow ourselves to dare to imagine a solution that lies past what we think is currently possible, we become catalysts for radical change.
CLICK TO ADVANCE
This failure, of course, is fatally linked to the idea that some lives matter less than others. Ninety percent of the problems social medicine should address would be lessened by rejecting this notion and insisting on high aspirations for those who haven’t enjoyed the fruits of medicine and public health.
CLICK TO ADVANCE
- Dr. Paul Farmer
At PIH, we like to ask the following question: “What treatment would we seek if this patient were part of our family?” The obvious answer to this question never fails to strengthen our resolve and opens the door to the house of Yes. The requirement that people who live in poverty accept their lot and become socialized for scarcity is often handed down by experts on behalf of poor people. Not only does this rationalization create situations of deep inequality and discrimination, but it also makes no economic sense. It is rather intuitive that healthier communities are empowered to advance more rapidly in all social and economic areas.
CLICK TO ADVANCE
Institutionalized discrimination is bad for people and for societies. Widespread discrimination is also bad for economies. There is clear evidence that when societies enact laws that prevent productive people from fully participating in the workforce, economies suffer.
CLICK TO ADVANCE
- Dr. Jim Yong Kim
Resisting and questioning this dogmatic approach of saying “no” on behalf of the most vulnerable is part of the fight for social justice that PIH started more than 30 years ago, and is a requirement to successfully shift the current global health paradigm.