Introduction

Eric D. Carter

Welcome to Public Health in Latin America: a Research Encyclopedia. This web resource was originally developed by students at Macalester College, as part of the seminar course Public Health in Latin America in 2019. Our goal is twofold. First, we seek to offer introductory essays on selected key topics on public health in modern Latin America, spanning from the late 1800s to the present. Second, we wish to guide scholars, at all levels, towards additional resources for research, whether written in English, Spanish, or Portuguese. We draw on the expertise of an international community of scholars in such fields as the history of public health and medicine, medical anthropology, and health policy.

Why focus specifically on health in Latin America, rather than "global health"? While "Latin America" is always a contested term, we find that studying the region offers many historical lessons that are relevant for addressing persistent public health challenges.

One leitmotif of this history, as historians Marcos Cueto and Steven Palmer have explained, is that many Latin American countries have managed to achieve "health in adversity": remarkably good population health conditions and robust health institutions despite unfavorable political-economic factors (poverty, inequality, instability). Essays in this research guide explore some important success stories in the annals of Latin American public health, from the control of yellow fever during the building of the Panama Canal, to the Gota de Leche (Drop of Milk) societies that improved infant nutrition, to the control of the ancient scourge of leprosy. More recently, there have seen substantial gains in improving maternal health in Mexico and curtailing the HIV/AIDS epidemic in Brazil. Costa Rica's universal health care system and Cuba's international medical brigades have become widely known models of health in adversity. Biomedical research in Latin America is advanced and innovative -- as exemplified by the rapid diffusion of discoveries on Zika virus from Brazilian scientists in the last few years, in spite of relatively scarce funding for basic science. The high quality of medical care has spawned a lucrative medical tourism industry in some parts of Latin America and the Caribbean.

One reason for these achievements is the strong social justice orientation of Latin American public health and medicine. The notion of "health as a human right" -- enshrined in the constitutions of many Latin American countries -- is more than mere rhetoric. The social medicine movement in Chile (where Salvador Allende was a key player) and across the region has helped to promote more equitable and inclusive health systems, as demonstrated by the work of Asa Cristina Laurell in Mexico. Nevertheless, many health systems continue to be fragmented and uneven in quality, and struggle to accommodate ideas and practices outside of the conventional biomedical paradigm, including indigenous medicine.

Another important theme explored in this research guide is the role of international networks and institutions in shaping public health strategies and health policy in the Latin America. Historically, organizations such as the PAHO (Pan American Health Organization) and the Rockefeller Foundation have reflected US geopolitical and economic hegemony in the region, as critical scholars, including Juan Cesar Garcia, have pointed out. But international organizations outside of the US sphere of influence have also thrived, including the IIPI, an inter-American child health association founded by Luis Morquio of Uruguay; the various groups that gave eugenics in Latin America a specific regional character; and the Latin American School of Medicine in Havana, Cuba, which carries Che Guevara's vision of revolutionary medicine to the classrooms, clinics, and barrios across the hemisphere and around the world.

Against this optimistic reading of the region's trajectory in public health, new issues and challenges arise. Although fertility rates in Latin America have declined appreciably, due in part to the wide availability of contraceptives, access to safe and legal abortion is a rarity. Natural disasters generate special challenges for the health sector, as in the aftermath of Hurricane Maria in Puerto Rico (2017), or the cholera epidemic in Haiti following the 2010 earthquake. Due to economic and political crisis in Venezuela, diseases like malaria have been recently resurgent. More common still are conditions associated, to some extent, with rising standards of living, like the obesity epidemic in Mexico and Central America. Mental health issues, including so-called culture bound syndromes like "ataque de nervios", do not receive nearly enough attention; the acute mental health crisis among indigenous peoples is almost completely ignored. Meanwhile, global climate change threatens to undermine many of the gains in public health across Latin America.

To navigate this site, use the drop-down menus at the top of the page, or click below to see articles by category. We have also included cross-referencing between articles in the guide, as well as links out to scholarly sources and other resources.

The research guide you see here, completed in May 2019, is just the beginning. We hope that students in future iterations of the Public Health in Latin America course will expand on this work, adding new articles and bringing old ones up to date. We welcome any comments and suggestions you might have, to improve the usefulness of this website.