Juan César García

Latin American social medicine would not exist in its same definition and form today without the contributions of Juan César García. Cueto and Palmer assert that “any discussion of Latin American reception, and sometimes anticipation, of primary health care has to take into account the Argentine physician and sociologist Juan Cesar Garcia” (2015, p. 214). Born in Argentina, García pushed the boundaries of thought and theory across the disciplines of medicine, public health, history, and sociology. Because of García’s dedication to public health and progressive thinking, social medicine was reinforced conceptually and institutionally in Latin America and to this day holds a strong presence in public health. Looking back at García’s formative years and career provides insight to the foundational theory of Latin American social medicine and its integration into public health. Juan César García’s remarkable career involved a unique trajectory across multiple disciplines and subjects in his work which ultimately culminated in his legacy as a founder of Latin American social medicine.

Juan César García was born in Necochea, Argentina, on May 7, 1932 (Nunes, 2013). He grew up in a low-income family, as his father was a field worker and his mother was a housewife (Galeano, Trotta, & Spinelli, 2011). Galeano, Trotta, and Spinelli theorized that Garcia’s less privileged background may have played an influential role in the development of his inclusive political and social ideology, especially as he formed an activist identity around his low socioeconomic experience (2011). Additionally, it is possible that figures in García’s life influenced his beliefs as well, as García “experienced a very particular climate of the time in which politics began to permeate the educational sphere” (Galeano, Trotta, & Spinelli, 2011). The head of his secondary school was a socialist leader, and thus García was exposed to radical political theory at a relatively young age. A close uncle, the leader of the Communist Party of Mar Del Plata, also made a big impact on his politics (Geleano, Trotta, & Spinelli, 2011).

García engaged with social and political activism early on in his education and career; during his undergraduate years at university in La Plata, he was an advocate for a student union that brought together students with different backgrounds and different ideologies (Geleano, Trotta, & Spinelli, 2011). García’s university years were especially impactful for his trajectory into social medicine as his education coincided with the first Perón regime, which introduced an opportunity for additional activism and networking with other anti-Peronist students such as himself (Galeano, Trotta, & Spinelli, 2011). His time in medical school in La Plata was spent “immersed in this context of university access amplification and politicization” (Galeano, Trotta, & Spinelli, 2011, p. 291).

García’s activism during the early stages of his life are reminiscent of other prominent leaders in social medicine. Another Argentine social medicine icon, Juan Lazarte, was part of the original group of radical students who pushed for the Reforma Universitaria of 1918. Notably, Salvador Allende--a key figure in social medicine and eventual president of Chile--was active in student politics at the University of Chile during the 1920s and 1930s. By gaining a reputation of a student leader and activist, García followed in the footsteps of previous leaders in social medicine.

It can be said with certainty that García’s interdisciplinary educational experience was imperative to the formation of his ideology and career trajectory. He studied medicine in Argentina, completed a residency in pediatrics, and then began working in public health research (Nunes, 2015). Following this, he embarked on studying sociology at La Facultad Latinoamericano de Ciencias Sociales (FLACSO) in Santiago, Chile, where he completed his Master’s degree in sociology (Nunes, 2015). An expert on the life of Juan César García, Nunes writes, “To a large extent, his facility in establishing a dialogue between health sciences and the social sciences was certainly due to his double educational background, in medicine and sociology” (2015). The culmination of García’s “double educational background” is evident in his ideology and contributions to public health and Latin American social medicine.

Juan César García was instrumental in solidifying the definition of social medicine in Latin America. García gives a basic synopsis of the "fundamental objects" of social medicine: "the study of the social determinants of health and of health services" (César García, 2007, p. 138). García’s perception of Latin American social medicine is intertwined with his Marxist ideology. Cueto and Palmer called him a “prolific Marxist writer,” an accurate conception that is evidenced throughout García’s literary works (2015, p. 214). García saw social medicine as a continuation of his Marxist ideology with its potential for social change, as he believed that Latin American social medicine could "transform societies" (Galeano, Trotta, & Spinelli, 2011, p. 310). García’s own analyses of social medicine are profound; in one case he describes the relationship between capitalism and medicine as follows,

The medical language is also transformed and a new idea arises: the price of life and the cost of protecting it. The economic calculation then enters as a basis for a 'rational' decision in the distribution of health services, reinforcing social inequality by considering that human life has a different price according to the individual's contribution to their society (Nunes, 2007).

García is well-known for his work as a research coordinator at the Pan American Health Organization (PAHO), which he joined in 1966 and worked at until his death in 1984 (Nunes, 2015). García’s ideology often conflicted with the hegemonic views of PAHO, a tension that he learned how to navigate in his official position at PAHO (Galeano, Trotta, & Spinelli, 2011). Rather than allowing his affiliation with PAHO and their relatively conservative norms to suppress his activism, García strategically used his position and research projects to network with like-minded individuals throughout Latin America, to distribute bibliography of leftist literature, and to direct financial support towards social medicine groups, one of several ways that he proliferated social thinking of health (Waitzkin et al., 2001b). Waitzkin et al. also notes that García “produced seminal works on medical education, the social sciences in medicine, social class determinants of health outcomes, and the ideologic bases of discrimination against Latinos” (2001a). In addition to financial support to organizations, he “facilitated fellowships and grants that were crucial to social medicine scholars and activists in the region, and creating training centers in social medicine” (Cueto & Palmer, 2015, p. 214). García sealed his legacy through not only scholarly contributions to the field of social medicine, but also through ensuring the longevity of the field by creating space and support for other scholars and public health workers to carry on his work.

García is cited considerably in scholarly works on Latin American social medicine in addition to being generally known in Latin America as one of the architects of Latin American social medicine (Galeano, Trotta, & Spinelli, 2011). Institutionally, Juan César García was the inspiration for the founding of the Latin American Social Medicine Association (ALAMES) in 1984, as well as the Juan César García Institute – Fundación Internacional de Ciencias Sociales y Salud [International Foundation of Social Sciences and Health], in Quito, Ecuador in 1984, and the Ateneo Juan César García in Havana, Cuba (Tajer, 2003; Nunes, 2015). Nunes notes these institutions “as well as numerous chairs which bear his name in various Latin American countries, bear witness to the fact that his legacy in social medicine/collective health remains alive” (2015). Juan César García’s legacy of prolific thought and interdisciplinary approaches to health lives on in academia and institutions, in medicine and sociology, in Latin America and beyond.

Juan César García died when he was only 52 years old. His death was unexpected and shocking to the Latin American medicine community, who memorialized him in an obituary published in in Educación Médica y Salud:

Juan César always found time to guide and help anyone who asked. Through his training and diverse and up-to-date knowledge, he exerted an enormous influence on Latin American thinking in the field of the participation of the social sciences in health. His political vision and understanding of Latin American communities will serve as a lesson for those who believe in the possibility of a more just world and society (In Memoriam, 1984).

Because of his early death, García did not get to witness the impact of his life’s work on the social medicine community, as much of his work was not published until later on after his death. However, many of his works have been published and received (and cited) enthusiastically by scholars in the fields of medicine and sociology, which shows that the spirit of his ideals and efforts lives on through his writings’ influence on those who came after him. His influence is evident in the reverence with which scholars have commemorated his life and contributions. On this final note, José A. Lloréns Figueroa of Cuba wrote perfectly that,

“Death surprises Juan César in a moment of profuse intellectual production, in full effervescence of his already matured scientific thought, but his work has proved imperishable as a guide for Latin American representative groups of the social sciences. There is no doubt that he exerted a great influence on Latin American thought in the field of the participation of the social sciences in health” (1986, p. 255).

Related Articles

• Salvador Allende
• Pan American Health Organization
• Social Medicine in Chile

Additional Resources

“La Medicina Estatal en América Latina (1880-1930)” by Juan César García

“Miguel Márquez ‘Juan César García y la Medicina Social durante la década de 1960 y 1970”

“Características generales de laeducación médica en la América Latina” by Juan César García

References

Cueto, M., & Palmer, S. (2015). Medicine and Public Health in Latin America: A history. New York: Cambridge University Press.

Figueroa, J. A. L. (1986). Juan César García y la formación de cuadros en medicina social. In M. Márquez & F. R. Ochoa (Eds.), Juan César García: su pensamiento en el tiempo, 1984-2007 (pp. 195-209). La Habana, Cuba: Sociedad Cubana de Salud Pública.

Galeano, D., Trotta, L., & Spinelli, H. (2011). Juan César García and the Latin American social medicine movement: Notes on a life trajectory. Salúd Colectiva,7(3), 285-315.

García, J. C. (2007). Juan César García interviews Juan César García. Classics in Social Medicine,2(3), 138-143.

Garcia, J. C. (2008 [1972]). Las ciencias sociales en medicina. Revista Cubana de Salud Pública, 34(4).

García, J. C., & Nunes, E. D. (1994). Pensamiento social en salud en America Latina. México: McGraw-Hill Interamericana.

In Memoriam. (1984). Educacíon Médica Y Salud,18(3), 236-237.

Nunes, E. D. (2015). Juan César García: Social medicine as project and endeavor. Ciência & Saúde Coletiva,20(1), 139-144.

Nunes, Everardo Duarte. (2013). Social thinking in health in Latin America: revisiting Juan César García. Cadernos de Saúde Pública, 29(9), 1752-1762.

Nunes, Everardo Duarte. (2007). Salud y sociedad en América Latina: Juan César García y las primicias de una sociología de la salud. In M. Márquez & F. R. Ochoa (Eds.), Juan César García: su pensamiento en el tiempo, 1984-2007 (pp. 195-209). La Habana, Cuba: Sociedad Cubana de Salud Pública.

Portillo, J. (1994). Review of Pensamiento Social en Salud en América Latina: Juan Cesar García. Revista Médica de Uruguay, 10, 205-206.

Tajer, D. (2003). Latin American Social Medicine: Roots, Development During the 1990s, and Current Challenges. American Journal of Public Health,93(12), 2023-2027.

Waitzkin, H., Iriart, C., Estrada, A., & Lamadrid, S. (2001 b). Social Medicine Then and Now: Lessons From Latin America. American Journal of Public Health,91(10), 1592-1601.

Waitzkin, H., Iriart, C., Estrada, A., & Lamadrid, S. (2001 a). Social medicine in Latin America: Productivity and dangers facing the major national groups. The Lancet,358(9278), 315-323.