Christopher Abel

Welfare, poverty and development in Latin America

Acknowledgements - Notes on the Contributors - Introduction C.Abel & C.M.Lewis - Evolution of Aggregate Welfare and Development Indicators in Latin America and the OECD, 1950-1985 J-M.A.Bertrand - Determinants of Social Insurance/Security Costs and Coverage C.Mesa-Lago, M.A.Cruz-Saco & L.Zamalloa - Urban Wages and Welfare I.Roxborough - Self-help Housing during Recession A.Gilbert - Growth, Distribution and Basic Needs in Peru and Columbia R.Thorp - Bonos, Beneficios y Bienestar A Study of Wages, Work and Welfare on Peruvian Sugar Plantations C.D.Scott - Social Insurance: Ideology and Policy in the Argentine, c. 1920-1960 C.M.Lewis - Welfare, Oil Workers and the Labour Movement in Venezuela S.Ellner - Utopia in Uruguay Redefined: Social Welfare Policy after 1940 H.Finch - Education and Training in Colombia, 1940s to 1960 A.Helg - Puerto Rico: A Model of Welfare Capitalism, C. 1945-1970 C.Abel - Social Equality, Agrarian Transition and Development in Cuba, 1945-1990 J.Stubbs - Social Security in Haiti: Informal Initiatives in a Welfare-less State M.Lundahl - Market Modernization Policy in Bogota: Welfare Consequences for Low-Income Market Sellers C.O.N.Moser - Politics, Equity and Social Security Politics in Brazil J.M.Malloy & C.A.Parodi - Welfare in Nicaragua: The Somocista and Sandinista Experiences Compared P.Sollis - The Campaign Against Absolute Poverty in Colombia: An Evaluation of Liberal Social Policy A.Puyana - Mobilization and the Quest for Recognition: The Struggle of Rural Women in Southern Brazil for Access to Welfare Benefits A.Brumer - Non-Governmental Organizations and Development in Brazil under Dictatorship and Democracy A.Hall - Chilean Education Policy: Authoritarianism and Democracy A.J.Weitzman - Index

Book Review: Health and Medicine in the Circum-Caribbean, 1800–1968

This addition to the literature is especially welcome, since, compared to most of Latin America and sub-Saharan Africa, the Caribbean and circum-Caribbean is a region that is understudied by historians of healthcare and medicine. This audacious set of consistently high-quality essays aims to introduce readers to a wide diversity of issues with regard not only to the Spanish-, English-, French-, Danish- and Dutch-speaking Caribbean, but also the Yucatan peninsula in Mexico. The themes broached by the volume range from the control of midwifery and obstetrics, to environmental and occupational health in the mining sector, and from debates over control and repression of prostitution to the evolution of infant welfare. The editors are only too aware of the risk that the book would be as fragmented as the region. They confront this problem head-on by writing an invaluable introduction that synthesises the state of the subject most effectively, and which places the evolution of the Caribbean historiography of health and medicine within a global framework, that places a special emphasis upon Latin America and sub-Saharan Africa. The bulk of the book consists of essays that examine problems in specific islands and territories, apart from one chapter that looks at the French Antilles in general. A focus on gender is one continuous theme of the book: the history of women and children in the region is approached through such topics as the evolution of health services for women in Trinidad and Tobago, and of infant welfare in British Guiana; but men are not overlooked, with one chapter addressing the production of Cuban medicine during the nineteenth century, and another inquiring into the impact of the First World War in the French Antilles and looking especially at military medicine. A second theme that is fruitfully explored throughout the book is interactions between the islands and territories of the circum-Caribbean and the dominant powers in the region. This reader found especially rewarding the accounts of tensions between local medical elites and US occupying forces in the Dominican Republic between 1916 and 1924 over the handling of prostitution, and the analysis of conflicts involving local physicians and the US colonial government over the conceptualisation and formulation of policies of professionalisation after the occupation of 1898. Fascinating, too, is an essay investigating the impact of anti-hookworm campaigns led by the Rockefeller Foundation in the Dutch colony of Suriname in the early twentieth century. It seems that the Rockefeller Foundation could count on more consistent and reliable co-operation from independent governments in Mexico and Colombia than a European colonial administration in Suriname. One underlying theme that recurs throughout the book is poverty and lack of resources. The Danes in St Croix stigmatised enslaved midwives and blamed them when deaths occurred, but failed to fund the training of either the slaves or of other women. The regional government in Yucatan went to considerable pains in 1933 to impose more legal requirements than before on titled physicians, but lacked the resources and political will to rein in the operations of ‘charlatans’ without titles who served a large part of the population. The evolution of infant welfare services in British Guiana after the abolition of slavery was so gradual as to be close to imperceptible for want of resources both material and human. This new work is so successful that a sequel looking more closely at the period since the 1940s merits consideration. Certain themes deserving close attention in such a volume spring immediately to mind. They include epidemiological shifts from degenerative to infectious diseases, international migrations and healthcare, mental health, the role of international NGOs and local governments in the promotion of contraception and the improvement of public services. So, too, the performanceof the Cuban Revolution in healthcare from cradle to grave, the impact of the global pharmaceutical industry, and the role of international institutions, especially the PanAmerican Sanitary Bureau and the Pan-American Health Organisation, merit inclusion. Haiti – an important omission from the present book – could be approached by a medical anthropologist with historical interests,as well as comparative essays – also a significant omission from the book in review – investigating areas such as the role of political parties, professional organisations, and interest groups in fomenting debate about healthcare in the newly independent states of the region, would be instructive. The editors and contributors to this volume (who are too numerous to name here) and the excellent Routledge Studies in the Social History of Medicine are to be congratulated on a refreshing contribution to the literature.

Ann Zulawski, Unequal cures: public health and political change in Bolivia, 1900–1950 , Durham, NC, and London, Duke University Press, 2007, pp. x, 253, £53.00,

This new monograph on the history of medicine and health care in Latin America is a welcome addition to a rapidly evolving historiography. Where most of the literature on the subject addresses the major and intermediate countries of the continent, this examines a minor republic that was the poorest in South America in the period covered. Building on the ground-breaking work of Nancy Leys Stepan, the author broaches both issues that have been tackled by scholars in other contexts, like the role of the Rockefeller Foundation and the relationship of women and the public health apparatus, and themes barely touched on elsewhere, especially the medical crisis caused by the one major international war in the continent in the first half of the twentieth century—the Chaco War between Bolivia and Paraguay—and the history of mental illness, especially at the Manicomio Pacheco, located in the city of Sucre. Ann Zulawski gives a largely convincing account of the ideological and social changes that altered medical thinking between the turn of the nineteenth and twentieth centuries and the Revolution of 1952, which presaged the beginnings of universal suffrage, together with the nationalization of the tin mines—the main source of export revenues—and the onset of an agrarian reform designed to benefit the indigenous and mixed-race rural poor. Bolivian medical elites and their allies were influenced by conflicting international trends ranging from socialism and reformist liberalism to various kinds of thinking rooted in eugenics. By the late 1930s and 1940s an expansion of provision of public health care that was fostered by a modernized and enlarged profession of medical doctors became essential to the consolidation of a state that was still fragmented, weak and insecure, even by the standards of most of Bolivia’s neighbours. Entrenched racial and gender prejudices, however, made for and exacerbated inequalities in health care, with women and the indigenous poor often being the victims of low-quality care and concentration of access in the major urban centres. The book makes a useful contribution on diverse issues. One example is the ways in which Bolivian physicians saw contracts from the Rockefeller Foundation as means of avoiding political interference and overcoming political rivalries between national and departmental officials. When the Foundation left the country in 1952 it was the object of criticism from outside that it had failed to act comprehensively on its assumption that health care was a right for all Bolivians, and from within that its resources were spread too thinly over too many health issues to be effective. Another example is the analysis of the role of midwives and of the attempts of professional physicians to limit their professional independence. Pragmatic recognition that in some rural provinces a shortage of physicians meant that doctors aiming to proscribe prescription of medication by midwives had to accommodate local realities that graduate physicians were unable to supply all the obstetrical services needed. Zulawski’s discussion of mental health contains the tantalizing paradox that in the 1930s the most frequent cause of admission to the mental hospital at Sucre was epilepsy, even though it was no longer considered a mental illness. Fierce debate about psychoanalysis and its uses in the 1940s had only a slender impact because policy innovation was inhibited by the extreme poverty of Bolivia and by competing pressures on budgets, especially in the aftermath of the Chaco War. The significance of questions of race and ethnicity in health uses gives rise to a similarly rewarding discussion. Bolivian intellectuals argued strongly that the behaviour of Amerindians made them both susceptible to disease and resistant to conventionally prescribed treatments, and went on to acknowledge the structural causes of ill health—poverty and inequality—while never fully relinquishing racial explanations of the diseases suffered by specific indigenous groups. The book makes a valuable contribution to the subject, but is published prematurely. It is marred by some looseness of expression: for example (p. 76): “If people in Bolivia were eager to disassociate themselves from the Indians, from the poor …”, were the Indians and the poor not people? More significantly, it is regrettable that the author follows the social history conventions of the 1980s in dismissing “the older institutional history” (p. 14) so lightly and so casually. Had she shown more alertness to it, she would have used such terms as “democracy”, “oligarchy”, “authoritarianism” and especially “populism” with more care and rigour, and to sharper effect. She would also display a more nuanced grasp of complex relationships between branches of government, especially at national, provincial and local levels. A greater alertness to recent literature on social policy would also have helped considerably.

78.95 (hardback 978-0-8223-3900-7), £13.99,

The Soviet Union’, The Times informs us, ‘is a third world economy with first world weapons.’ That statement may indicate what a slippery concept is ‘the third world’. The term has been used in three ways: as a residual category after the abstraction of the Old World and the New; as another residual category after the abstraction of the Communist East and the Capitalist West; and as a shorthand for describing those parts of the world with the lowest standard of living. Depending upon which definition is chosen different countries will comprise the third world and, although the categories overlap, decisions about inclusion and exclusion will always be arbitrary. The historian of the third world needs an axe before a pen.

21.95 (paperback 978-0-8223-3916-8).

This unique study of a sector of the Cuban working class links its history to that of the tobacco industry in the wider national and international context. Dr Stubbs, who has lived and worked in Cuba for fifteen years, tells the story of the agricultural and industrial development of the industry from its nineteenth-century beginnings to the establishment of the communist regime. She traces the growth of a strong tobacco oligarchy, peasant grower class and urban salaried work force alongside slave and indentured labour, and examines how a prestigious manufacturing country was transformed into an exporter of leaf. The study penetrates the finer socio-political aspects of the changing nature and composition of peasantry and proletariat, including the peculiar interlacing of race, gender and skill, to take a closer look at hitherto obscure areas of class action and national and class consciousness, be it reformism, anarcho-syndicalism, revolutionary nationalism, socialism or communism.

What is Third World History

Far too often we solely focus on major events, wars, and conflict from the point of view of the elite, those in power, or the victors who literally wrote down their version of history for posterity. This course seeks to reclaim the history of modern Latin America for those who resisted, suffered, and lost. This course explores modern Latin American history (from Age of Independence until the present) using a variety of historical documents, texts, music, visuals, and literature in which marginalized people and the disenfranchised occupy an important space of representation.