The book Healthcare in Latin America: History, Society, Culture, edited by David Dalton and Douglas Weatherford, is an eclectic collection of essays that diverge from the traditional public health perspective of the region to instead focus on how the humanities and the social sciences can contribute to understanding healthcare and how it mediates the complicated relationship that exists between Latin American governments and their populations. Of central importance is the clear link between public health and the ability to govern. Indeed, most of the book sets off from the perspective that healthcare is a public good, one that all sides of the political spectrum must embrace in their quest for legitimacy. This is demonstrated in many of the chapters, which lay out the pathways that different countries have followed in their quest to provide healthcare to their populations.
The book divides Latin America into five sub-regions, namely Mexico (four chapters); the United States and its Latino/a/x communities (three chapters); Central America and the Caribbean (three chapters); the Andean region (four chapters); and the Southern Cone (three chapters). The editors write that this book ‘… captures the flavor of public health across the diverse countries of the region’ (p. 4), but it does so unevenly. This is likely due to a lack of scholarship from specific country contexts, which results, for example, in there being only one chapter about Central America. It could also be attributed to the lack of authors based in these countries. It is a key weakness of this volume that all the authors are based in the United States, and it was an oversight for the editors to not look for, and include, authors who still live in their countries of origin. This has affected the different parts of the book differently, and so I would like to spend some time on each one.
Part 1, ‘Healthcare in Mexico’, opens the book. It focuses on the provision of healthcare from the Revolution to the present and on the tension of providing the care demanded by the Mexican population. The chapters present how the medical apparatus was deployed to quell race- and class-based tensions through ensuring access to vaccines, antibiotics and physician-centred care. They also cover how healthcare is used as a motor for development as well as a means of obtaining political support.
The most well-developed part of this book is the second, which addresses healthcare for Latino/a/x communities in the United States. Here, careful thought is given to how these populations came to define their identity while living in the periphery of their country.
In contrast with the previous part, the one on Central America and the Caribbean, with its narrow focus on a single territory, could well have been called ‘Cuba’. The two chapters that deal with healthcare in the island focus on the over-production of human resources for health and the island's disaster preparedness programmes. These two chapters provide a deeper glimpse into the underlying values and structures of the Cuban healthcare system. However, this insight does not carry over into the only chapter about Central America, which looks at maternal health in Guatemala, Nicaragua and Costa Rica, with the remaining countries in this sub-region not represented in this book. Although there is abundant data about maternal health and the services these three countries can provide, the authors instead use diary and movie excerpts to channel the voices of mothers and the type of care they receive. Nevertheless, the authors come to the same conclusion as other scholars: ‘… racial and patriarchal attitudes continue to define the healthcare options available … throughout the region’ (p. 9). This is not a new conclusion, but it is one that is very weakly supported by the data presented in the chapter.
Part 4, on the Andean region, which covers Peru, Ecuador, Bolivia, Colombia and Venezuela, dives deeply into pressing issues for the sub-region. It begins with a chapter on the politics of public health in postrevolutionary Bolivia, but also tackles discourses on transness and disability and the relationship between ancestral knowledge and modern medicine. Finally, Part 5, on the Southern Cone, helps us understand the development of some of the strongest healthcare systems in the region. This includes the underlying architecture and stakeholders that shaped the foundations of the Argentine health system, how it compares to the Chilean system and, most importantly, how the right to health exists in Brazil and Argentina. Given that this right is enshrined in most, if not all, the constitutions of the region, this is timely and interesting, and leaves the reader wanting to know more about how these fit into the structure of all the health systems represented in this book.
This book does well in meeting its overall aim of showing how the various national approaches to public health and healthcare delivery reveal lessons that go beyond the health sector and how historical, cultural, political and economic values shape the health system and how healthcare, in turn, shapes the history, the culture and the politics of Latin America.
