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Hispanic American Historical Review 80.3 (2000) 626-627



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Book Review

A era do saneamento:
as bases da política de saúde pública no Brasil

National Period

A era do saneamento: as bases da política de saúde pública no Brasil. By Gilberto Hochman. São Paulo: HUCITEC-ANPOCS, 1998. Tables. Bibliography. 261 pp. Paper.

How do political power and jurisdiction over public policy shift between state and federal government in Latin America's largest country? Gilberto Hochman's A era do saneamento offers an intriguing analysis of the development of federal authority over health and hygiene in early-twentieth-century Brazil. This is not a history of health and hygiene programs; instead, Hochman explores the campaign to build federal jurisdiction over public health, and shows how this campaign contested the decentralization of public power set by Brazil's 1891 Constitution.

Hochman contends with the political outcomes of an emerging Brazilian consciousness: in the face of several devastating epidemics and a growing awareness of the extent of endemic disease in the country's interior, the Brazilian medical community realized that when one state invested in public health and its neighbors did not, that state's efforts were squandered. Contagious diseases did not respect the decentralized boundaries of political power. This growing consensus about the need for national health programs converged with the statist nationalism that emerged during the First World War. Following the war, the public health and sanitation movement pushed the federal government into creating a nationalized public health and sanitation program that abrogated states' rights.

The movement culminated in 1916 with a speech by Dr. Miguel Perreira declaring that "Brazil is a vast hospital" and with a report by physicians Artur Neiva and Belissario Penna condemning health conditions in Brazil's interior and calling for the creation of a federal Ministry of Education and Health (which would not happen until the Revolution of 1930). While rhetoric could not overcome regionalism and political inertia, disease could. After the 1918 influenza epidemic claimed the life of the president, his successor established the National Department of Public Health and gave it sole jurisdiction over public health and preventive medicine.

The most sophisticated element of Hochman's analysis is his handling of São Paulo, the one state that remained outside of the federal health umbrella. The Paulistas saw their own advanced programs as the locomotive of public health and sanitation, raising the bar for the rest of Brazil. São Paulo's ability to opt out of federal programs created the impression that participation was voluntary and became the key to other states' collaboration: states could choose not to participate, but only São Paulo had the resources to do so. Indeed, far from rejecting federal jurisdiction, São Paulo politicians campaigned for its acceptance by other states in order to reduce the costs to São Paulo of those states' shortcomings. [End Page 626]

Hochman is more sympathetic to the sometimes authoritarian health projects of the era than have been other scholars, who focus on those programs' hostile approaches to gender, race and class. Writing at a time of neoliberal assaults on public institutions, Hochman sees generosity and idealism in the health projects of the era, and reflects that there are few moments in Brazilian history in which so much attention was paid to improving public health.

A era do saneamento won Brazil's National Association of Post-Graduate Research in Social Sciences (ANPOCS) prize in 1996 and is highly deserving of translation into English. There is no comparable work for understanding the politics of public health or the challenges to regionalism in Brazil's First Republic. Indeed, by showing the last years of the First Republic to be a time of growing political centralization, Hochman both challenges us to rethink the model of the Revolution of 1930 as a watershed and invites us to look more closely at public health policy after 1930. Hochman's skillful analysis of both public health and political centralization should make this book widely...

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