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Over the course of the twentieth century, Cali, located in Colombia's southwest, became one of the nation's largest and most important urban centers. The city's rapid demographic expansion stemmed from multiple factors: the opening of the Panama Canal; the city's proximity and railway connection to Buenaventura, Colombia's major port on the Pacific; and the consolidation of a political and economic elite whose fortunes were tied to sugarcane production and the commercialization of coffee. As Cali's elites worried over how to modernize the city, the municipality's growth often outpaced its ability to guarantee and protect its residents' health. Tuberculosis, smallpox, syphilis, cholera, typhoid, dysentery, and other diarrheal diseases were common. The implementation of hygiene and sanitation measures in Cali reveals tensions and contradictions between, on one hand, elite imaginaries about the role hygiene and public health would play in defending the city's and nation's "human capital," and on the other, institutional practices that relied on careful bargaining between state officials and local communities. This article analyzes 1930s municipal council records to show how, for residents of Cali's working-class neighborhoods, claiming the right to health and protection relied on negotiations with local authorities through institutional means that allowed them to respond to, adapt, and at times contest official discourses and practices. Health and disease gave petitioners a language with which to construct individual and collective identities, talk about citizenship, and defend their rights.