The first edition of The Sanitation of Brazil was released in Portuguese in 1998, based on Gilberto Hochman’s award-winning PhD dissertation in political science. A second edition of the book was published in 2006 and a third in 2012. Considering this trajectory of Hochman’s book, almost 30 years in the making, this English edition is also the best version of his most recognisable publication. The Sanitation of Brazil is not just a very good translation of a solid work in history and social sciences, but also a well-taken opportunity to refine an important socio-historical approach to Brazilian public health development in the period known as the First Republic (1889–1930).
The work that has gone into Diane Grosklaus Whitty’s translation is outstanding. The addition of an appendix with the name of the institutions, agencies and departments in Portuguese and the English long form helps avoid the extensive use of acronyms in Portuguese presented in the previous editions. The tables are better designed and more elegant. The new English subtitle adds more information than the previous edition in Portuguese, highlighting the First Republic years and the keywords nation, state and public health. This seems to be a thoughtful decision that reflects the scholarly maturity of Hochman’s book.
The main question posed by The Sanitation of Brazil is: when does public health become public? Hochman develops his theoretical and historical analysis through an argument about decision-making, public health and the complexities of Brazilian national integration. Theoretically, Hochman uses the concepts of Abram De Swaan and Nobert Elias to understand the process of collectivisation of health and reciprocal dependence. The historical backdrop is of a time in Brazilian politics when public health was concerned with rural sanitation and the relation between the national and local was worked out by the federative regulations of the First Republic.
The book succeeds in presenting the interplay between emergent health issues and the process of political integration. At the centre of the narrative is political anxiety about how public health issues could be shaped in the face of more certain knowledge about the communicability of diseases. The image of an abandoned and plagued country is portrayed as the symptom of an underdeveloped nation-state in need of state intervention. The process of taking health as a public issue, expanding the public health services and the responsibility of the federal government was fundamental to the effort for national integration. However, as Hochman demonstrates, the process of a nationwide policy of sanitation was not born of growing public health consciousness only, but rather of resources provided by the federal government and negotiations with the local elites, to face public health problems that plagued Brazil.
Chapter 1 provides a concise introduction of his theoretical framework and the structure of the book. Chapter 2 shows how health issues took centre stage with the campaign for sanitation and how public awareness about the communicability of disease strengthened the public health movement. Narrating the process of constitution of the Pro-Sanitation League, in the second chapter ‘The Microbe of Disease and Public Power’, Hochman presents the core of his narrative and analytical argument, explaining how the notion of communicability of disease was a powerful idea that promoted a policy of social interdependence. Public health was a tool that could potentially solve the challenge of national integration in the face of a backward, underdeveloped countryside. The political process that fostered a growth of coercive power by means of public health is developed in Chapter 3, with a good overview of the historical development of the political and administrative sanitation procedures in the First Republic. Chapter 4 analyses the expansion of the sanitation policies and the interplay between the states and the federal government, opening up to the exceptionalism of the São Paulo state, which is detailed in Chapter 5. The final chapter concludes with consideration of the negotiation and the convergence of interests between the elites and the federal authority.
In Hochman’s analysis, the understanding of communicable diseases as a national matter is a not just a process of institutions, laws and policies supported by a formal political argument. His narrative is enacted and shaped by the decisive role of historical characters like Belisário Penna, the most prominent exponent of the rural sanitation movement. Penna’s leadership and capacity to organise a consensus was important for shaping ideas into policies and also in the constitution of the Pro-Sanitation League.
The League was a founded by a group composed of political, educational and medical elites, including members of the National Academy of Medicine, professors of Brazilian medical schools, Oswaldo Cruz Institute scientists, military officers, lawyers, educators and journalists. This movement became the ‘organized expression of the rural sanitation movement’ (p. 43) and championed the idea of cleaning the sertões (a sociopolitical and medical term to define abandoned areas) plagued by endemic diseases – hookworm (ancylostomiasis), malaria and Chagas disease (American trypanosomiasis). The concerns about the communicability of the diseases that plagued the sertões was a strong argument in favour of the necessity of the intervention and escalation of the state’s coercive power.
The author’s confessed professional identity tied to the social sciences stresses a theoretical craftsmanship that is even more intertwined with his historical expertise. Hochman’s conceptual synergy and historical analysis has stood the test of time, but not without the challenges as discussed in the last chapter of the book, such as the discussion about the ‘natural’ duties inherent to the state (p. 150). This translation gives a wider community of scholars the opportunity to have a fruitful dialogue with the ideas orchestrated in The Sanitation of Brazil. The renewed interest in spatial categories in history and approaches that highlight tensions between the national, local and supranational scales, will stimulate fresh readings and questions. This new edition showcases the refinement of Hochman’s scholarship and also the necessity of bringing cogent ideas to history from outside the discipline, particularly at a time when Brazil’s universal health care system is facing great political challenges.
