In the last three decades, the range of scholarship examining the history of medicine and public health in Latin America has expanded immensely, generating new insights about the region’s role as a producer of medical knowledge and site of medical pluralism, among other things. We have long lacked, however, a monograph dedicated to synthesising this work and providing a comprehensive account of the region’s medical history. Marcos Cueto and Steven Palmer fill this gap with Medicine and Public Health in Latin America: A History. Published as part of Cambridge’s ‘New Approaches to the Americas’ series, their work will be of value to experts and lay readers alike.
Medicine and Public Health in Latin America is organised both chronologically and thematically. The first chapter examines practices of healing in pre-colonial and colonial Latin America, emphasising both the range and depth of indigenous medical knowledge and the diversity of healing traditions that came to characterise the region as European and African populations took root there. By drawing on ethnohistorical studies, research on enslaved people’s healing practices, studies of the Catholic Church’s involvement in medicine, and analyses of how different practitioners and colonial officials engaged the ideas of the Enlightenment, the chapter demonstrates that healing traditions did not simply coexist side by side in colonial society but also mixed and led to the generation of new medical knowledge. Chapter Two builds on this work by examining the formation of national medical traditions and sanitary states in the nineteenth century, after Brazil and most of Spain’s colonies gained independence. This chapter emphasises the centrality of medicine and public health to state- and nation-building processes and outlines various ways that professionalising Latin American healers gained influence in national politics. It also examines how such professionals engaged scientific advances from Europe and North America in their research and contributed to international scientific debates, focusing especially on the example of tropical medicine in Brazil.
Chapters Three and Four cover much of the twentieth century, yet they examine it from distinct angles. Chapter Three traces the rise of the international health movement and outlines how the movement’s approach to disease control and health improvement changed from the early days of the Rockefeller Foundation’s philanthropic hookworm campaigns to the disease eradication efforts of the Cold War. Throughout, Cueto and Palmer argue that Latin America proved central to the development of international health as a larger field, a phenomenon they attribute in part to the pressures of modernisation, changing demographic conditions, and the chronic problem of unequal access to health care for the region’s rural poor. They suggest that Latin American countries constituted attractive sites for the development of overseas medical interventions because they were no longer subject to forms of European colonial domination that persisted elsewhere. This exposed the region to the hegemony of the US on medical matters, but it also meant that Latin American medical professionals, who were amenable to working with outside agencies and experts, became key protagonists in the development of international bodies focused on health. Latin America thus became home to ambitious, creative, and experimental approaches to addressing health needs, which furthered advances in modern medicine. These themes of medical excellence and the contributions of Latin American experts garner additional attention in Chapter Four, which surveys some of the region’s key innovations and profiles those responsible for them. Drawing on the long-standing theme of medical excellence on the periphery, this chapter highlights the work of such figures as the Peruvian high-altitude physiologist Carlos Monge, the Brazilian rural health specialist Carlos Chagas, and the Venezuelan malariologist Arnoldo Gabaldón. A final section discusses the role of medical experts in politics and social movements and highlights, in particular, the example of Ernesto ‘Che’ Guevara.
The fifth chapter of Medicine and Public Health in Latin America examines how the practice of medicine and public health has changed in more recent decades in response to calls for expanded primary healthcare, the introduction of neoliberalism and structural adjustment, the emergence of HIV/AIDS, the return of cholera, the rise of new global health institutions and leaders in medical philanthropy, and the development of alternative models for addressing health inequities. Cueto’s and Palmer’s explanation of how neoliberalism transformed approaches to the provision of medicine in Latin America is excellent, especially when juxtaposed with their discussion of the alternative path Cuba has taken. Of particular note, however, are their overviews of the HIV/AIDS and cholera epidemics, which serve to illustrate the pitfalls of neoliberal approaches to managing, and ultimately trimming and privatising, state-administered healthcare. The chapter thus provides a comprehensive picture of current healthcare challenges in Latin America, the persistence of old problems and inequities inadequately addressed, and the innovative ways in which Latin American medical and public health experts, as heirs to a tradition influenced by medical pluralism, have pursued solutions.
Some of the concepts that are central to the book’s argument will be familiar to those already acquainted with Cueto’s and Palmer’s scholarship. Of particular note, the concepts ‘culture of survival’ and ‘health in adversity’, which figure prominently in the later chapters, have appeared elsewhere in Cueto’s publications. Several of Palmer’s works, moreover, have explored extensively the theme of medical pluralism. These ideas, however, prove indispensable for conveying some of the more important points about the history, implementation, and practice of medicine and public health in the region. In particular, they succinctly describe how populations and health practitioners have overcome structural challenges and obstacles to the attainment of health and provision of care, creating in the process new forms of medical and public health practice that reflect their ingenuity and tenacity.
This authoritative monograph is so well organised that it is difficult to find quibbles with its content and form. Although some readers may wish there were greater coverage of medicine during the three centuries of Spanish and Portuguese rule, the decision to address the colonial period in a single chapter is reasonable given the relative paucity of scholarship in comparison to the nineteenth and twentieth centuries. Others may wish certain works were cited more extensively in the book’s chapters and its useful list of suggested readings. None of these concerns, however, detract from what the work achieves. Indeed, its greatest impact may be in demonstrating to a non-Latin Americanist audience the region’s importance in shaping the broader history of medicine and public health.
