The Vicissitudes of Public Health Policy in the Americas

Historically, public health policies in the Americas have emerged as a result of political and economic forces rather than a narrow concern for the objective improvement of public health and the prevention of illness. Specifically, public health policies have interconnected with the needs of business and foreign policy as formulated during different historical periods. The four books reviewed here show an awareness of the nonautonomous nature of public health policies in the Americas. On the basis of these excellent books, we assess the origins and impacts of public health policies in furthering economic and political goals.

Economic Impacts of Public Health Policies

Public health policies in the Americas have focused on the economic benefits of preventing and eradicating disease. International health agencies originated in large part from the need to create a system to stop the spread of disease, which was hindering trade. Marcos Cueto's The Value of Health provides a detailed history of the creation and continuation of the Pan American Health Organization (PAHO) and its role in the use of health policies to advance trade and economic benefits. Cueto provides a nonjudgmental look at this history that historians, Latin Americanists, and health-policy professionals can enjoy. The book is easy to read and does not require previous knowledge of Latin America or public health. Cueto uses varied resources in compiling a chronicle of the international organization, separating its history into the eras of PAHO's directors. Each director's background, including education, other organizational affiliations, and personal passions, is included as a significant part of the story. This information provides a look not only at policy directives but also at the factors contributing to the organization's choices in health-policy decisions.

Cueto provides details concerning the forces that initiated the organization, specifically the system of quarantining ships to block the spread of disease that, as stated previously, limited trade and created a loss of materials. Different countries were blamed for spreading disease because of the deficient cleanliness of their ports. Medical posts, set up at ports, checked ships and immigrants, and single companies established processes to sanction and authorize ships entering these ports so as to minimize trade difficulties. Walter Wyman, the first Director of PAHO, known then as the Pan American Sanitary Board, focused on the creation of public health policies that would exert minimal adverse impacts on commerce. The policies eventually moved away from concentrating only on port activities as diseases such as bubonic plague, hookworm, and yellow fever spread throughout nations, but they still focused on the economic benefits of preventing and curing diseases. The prioritization of diseases that had to be controlled resulted from considerations of commerce.

Cueto's clarification of PAHO's creation based on trade provides some background for looking at the economically motivated health policies portrayed in Natalia Molina's Fit to Be Citizens? Public Health and Race in Los Angeles, 1879–1939. Public health professionals will benefit from Molina's historical look at the treatment of Chinese, Japanese, and Mexican immigrants in Los Angeles under evolving public health policies. The book provides an outstanding historical account, which historians, particularly those focused on medical or public health history, will enjoy. Much like Cueto...