Medicine and Public Health in Latin America: A History by Marcos Cueto and Steven Palmer (review)

Marcos Cueto and Steven Palmer set out to write an exhaustive history of medicine and health in Latin America and the result is impressive. There is no other such work available. It is authoritative in its knowledge of primary and secondary English, Portuguese, and Spanish sources, broad in its temporal and geographical scope, comprehensive in its overview of different interacting medical systems, and critical in its assessment of national, international, and global health initiatives. The two organizing concepts of the book, “culture of survival” and “health in adversity,” provide the framework to analyze the distinct exchanges, negotiations, and conflicts about health and disease that first emerged in the pre-Columbian era and continue to the present.

Starting with the premise that exchanges among indigenous, African, and European systems of healing in the colonial period laid the foundation for the medical pluralisms that have shaped postcolonial histories to the present, the first chapter demonstrates the ways Western and non-Western medicine were transformed from the early sixteenth to the nineteenth century. The result was a “hybrid medicine” that incorporated elements of different healing cultures and was practiced by the majority of the population. In the second chapter, the authors trace the central role of physicians as educators, politicians, researchers, sanitarians, and medical practitioners in the state-building efforts of the late nineteenth and early twentieth century. Their work in directing professional organizations, founding medical schools, combating “national” epidemics, and sustaining significant research agendas was crucial in the consolidation of their status as modernizing agents. This was particularly important during a time of significant crisis, when migration, urbanization, industrialization, and the abolition of slavery raised questions about who was fit for citizenship, and when popular healing cultures continued to coexist, and even thrive, alongside official medical trends.

The remaining chapters demonstrate with abundant examples that scientific networks, medical innovations, and public health debates led by physicians in Latin America were central to, rather than derivative of, the development of international and global health during the twentieth century. During the post World War II era, for instance, Brazilian physicians such as Geraldo Horácio de Paula Souza and Marcolino Candau, both of whom had collaborated with the Rockefeller Foundation in their country, were invaluable in the creation of the World Health Organization (WHO) and occupied positions of prestige and power within this organization.

Even if the preamble of the WHO constitution proclaimed the lofty goal of health as a right of citizenship, the impact of the health initiatives sponsored were limited. Like the efforts of other international organizations, WHO’s excessive reliance on disease eradication and ephemeral intervention precluded reaching the goal of the charter since these approaches did not improve the overall living conditions of the poor. The social and political implications of this cross-regional pattern become even more evident after the Cold War, when proponents of neoliberal measures advocated for cost-cutting methods and technologies that thwarted calls for comprehensive, community-focused health care.

Cueto and Palmer do not claim to be all encompassing, but woven throughout the book are numerous examples of medical innovations that highlight the significant place Latin America occupies in the history of medicine and public health. Distilled in accessible and engaging prose, these vivid episodes make this a wonderful read for specialized and non-specialized audiences.

This survey of medicine and public health would have been more complete if it had engaged more directly with the literature on the history of medicine, race, and sexuality. While arguing for careful attention to disparities in the assessment of health initiatives, the authors underestimate the significant consequences of racial and sexual anxieties as they influence data gathering, impact scientific research, delineate national borders, and determine access to medical care. These points are more than quibbles: these anxieties informed the “culture of survival” that favored short-term health initiatives over long-term structural change. Yet...