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Finn Odum
Latin American social medicine is a multifaceted field that grew out of political unrest, academic theories, and religious paradigms. The movement critiques of the assumption that public health will improve with economic growth (Laurell, 2003). Today’s Latin American social medicine movement builds upon a variety of scholars, the most famous of those being Salvador Allende. Allende and other politicians contributed to an accessible public health system, reflecting the best example of how social medicine can be used to benefit everyone.
Early forms of Chilean social medicine were prompted by political unrest among the lower class (Waitzkin, 2001). Radical leftist labor movements Workers strikes in 1918, for example, sparked discussion around proper healthcare and sanitation. Luis Emilio Recabarren, an organizer for marginalized workers, started an outcry against unsafe conditions and malnutrition. Recabarren connected high mortality rates among the poor with uneven economic conditions. In the years following, he and his allies would advocate for economic reforms that they believed would help better the health of the lower class.
Another important development in Chile came in 1922, thanks to the Chilean chapter of the Industrial Workers of the World, or the IWW (Pavez, 2009). The IWW developed a clinic for their members that provided workers and their families with basic medical care. When developing his reasoning for creating a separate clinic, IWW doctor and renowned anarchist Juan Gandulfo said, “medical science is monopolized by capital with the consequent detriment to the majority of humanity” (Pavez, 2009). Gandulfo discovered anarchy at a young age and became a prominent activist, often getting arrested for his political protests. The doctor helped establish chapters of the IWW polyclinic and worked as a surgeon in his local hospitals. Gandulfo's work set the precedent for Chilean labor unions to come, and for public medical health.
Salvador Allende entered Chile’s political scene amid this unrest. Allende came from a family of radicals and activists; he was kicked out of medical school for his political protests and later jailed for treason (Tedeschi et al., 2003). The young activist channeled his energy into working for the medical union; in 1933, he furthered his passion for justice and co-founded the Chilean socialist party. In 1939, he was appointed Minister of Health, Prevention, and Social Assistance. That same year he published La Realidad Médico-Social Chilena, where he, according to scholar Howard Waitzkin, conceptualized illness as “a disturbance of the individual fostered by deprived social conditions” (Tedeschi et al., 2013). La Realidad is cited as a key document outlining ideal social medicine policies. A later iteration of those proposals written for the International Labor Review, “Social Medicine in Chile”, detailed the various accomplishments achieved during his time in the ministry of health. Allende noted that since 1937, infant mortality declined significantly (Allende, 1942). During his time in the ministry, he passed The Preventive Medicine Act, a bill that helped provide the population with diagnosis and care for the three largest causes of adult mortality: syphilis, tuberculosis, and cardiovascular disease. Though this was originally the work of his predecessor, Eduardo Cruz Coke, Furthermore, financial investments in the hospitals improved the quality of technology and accessibility for the people.
Allende left Ministry of Health in 1942, only to be elected as senator in 1945. In the 1950s, he used this role to establish one main healthcare program for the entire country, de-privatizing the industry (Waitzkin, 2001). He linked his proposal to other reforms aimed at economic equality and attempted to decentralize the national hospital system. This is his most referenced accomplishment, as the universal healthcare program was revolutionary for its time and still somewhat in place today.
Despite praise from some scholars, Allende’s work was not universally appreciated. Private doctors felt misrepresented and believed there was a significant gap in pay for private and public physicians. In addition, the United States and other capitalist nations disliked Allende and his leftist policies. The US contributed thousands of dollars to organized medical groups that opposed the school of Chilean social medicine (Tedeschi et al., 2003). The backing of Allende’s political opponents eventually led to the 1973 military coup. Pinochet’s military dictatorship repressed public health workers and, as some scholars would have it, put up a severe roadblock on the journey to develop strong policies based on social medicine (Waitzkin, 2001).
Pinochet’s dictatorship negatively impacted the development of social medicine, at least temporarily. Chilean health workers and officials aligned with Allende were exiled, imprisoned, or tortured during Pinochet’s regime (Waitzkin et al., 2001). When Pinochet’s regime ended, exiled officials returned, hoping to reinvigorate the movement. Because of Chile’s current, national right-wing policies, modern social medicine has formed in local governments and in NGOs. One of the larger NGOs was GICAMS or the Group for Research and Training in Social Medicine. GICAMS advocated for the de-privatization of healthcare services and environmental education for agricultural workers, warning them of the dangers of pesticides. Local level politicians are also fighting back in the name of social medicine. In an interview with the socialist magazine Jacobin, mayor Daniel Jadue of Recoleta detailed his immersion of leftist policies into the district (Denvir, 2019). Jadue highlighted the construction of noninvasive primary care clinics in areas that lacked medical access, in addition to financial investments in making specialized medicines more available. Though Jadue does not directly refer to his policies as social medicine, they do reflect a modern interpretation of the former movement. He and other local leaders like him hope to step up and fight back against the right-leaning government, in order to better the lives of workers and low-income families that aren’t receiving the assistance they need.
Chilean social medicine was made possible by passionate doctors, workers, and politicians who demanded a change in healthcare. The complicated history of social medicine in Chile is just one part of the conversation; though Chile is currently lacking a socialized medical system, former Chilean leaders have inspired modern Latin American politicians. Today, social medicine is growing as a discipline and a form of policy-making. It’s only a matter of time before politicians in Chile and around the continent fully take up the banner of accessible health care once more.
References
Allende, S. (1942). Social Medicine in Chile. International Labour Review, 1-43.
Denvir, D. (2019). A Communist Mayor in Chile Explains How to Govern Locally From the Left. Jacobin. Retrieved from https://www.jacobinmag.com/2019/04/communist-party-chile-left-governance-recoleta
Laurell, A.C. (2003). What Does Latin American Social Medicine Do When It Governs? The Case of the Mexico City Government. American Journal of Public Health, 93(12), 2028-2031.
Pavez, F. (2009). Self-Management and health: Gandulfo's legacy in the "Sanitary Page" and worker's polyclinic (1923-1942). Revista Médica de Chile, 137(3), 426-432.
Tedeschi, S.K, Brown, T.M, & Fee, E. (2003). Salvador Allende. American Journal of Public Health, 93(12), 2012-2015.
Waitzkin, H. (2001). 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). Social medicine in Latin America: productivity and dangers facing the major national groups. The Lancet, 358, 315-323.
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