The field of social medicine has produced broad-based public health improvements across Latin America throughout the 20th century and continues to do so today. But social medicine in Latin America has received scant attention from scholars, despite its deep historical roots, political influence, and public health achievements. Dr. Eric Carter, Edens Professor of Geography and Global Health, who has decades of extensive research experience in the region, embarked on a years-long effort to change that. The result is his new book, In Pursuit of Health Equity: A History of Latin American Social Medicine (University of North Carolina Press, 2023), which is a first-of-its-kind attempt to bring together the varied histories, influential figures, and remarkable achievements in health care in Latin America. 

How do you define social medicine, which is often conflated with what we think of as socialized medicine? 

Just defining social medicine can be challenging, but here is my take. Social medicine is an academic field that focuses mainly on the social and structural determinants of health. What’s interesting is that it often challenges the boundary between academia and politics, so it tends to be populated by scholar-activists. They don’t see such a strong barrier between research and working for the kind of change that they want to see in the world to address the problems that they’re researching. As a result, often people in the social medicine field are working towards what we might call “socialized medicine,” which is a state-managed health care system that puts universality as its first principle. Even though you can distinguish them conceptually, in reality sometimes socialized medicine and social medicine combine into the same project, depending on the country we’re talking about. 

In what big ways do the social medicine movements vary between countries in Latin America? 

To show the degree of variability, I’ll make a distinction between Costa Rica and Argentina. In Costa Rica, there was a very strong idea of social medicine that guided reform efforts going back to the 1940s. A small cohort of doctors and health technocrats built up a very efficient health care system that has become world famous. Costa Rica’s achievements in population health were far beyond what you would expect considering the budgets they had to work with and the initial lack of trained health professionals. But today, the doctors there aren’t very political. They’re much more focused on the daily work of continuing to build a more effective health system. 

In contrast, social medicine in Argentina is much more politically active because the politics are much more contentious. There are these huge swings from neoliberal, free-market oriented policies starting in the 1980s and then shifting towards more leftist, state-centered approaches in the mid-2000s. The social medicine movement in Argentina was outspoken against neoliberal reforms because they were essentially gutting the public health system. Then you get this tremendous change when the Kirchners take power, and a lot of the social medicine advocates were suddenly elevated into positions of authority. 

Your book highlights the stories of individuals who helped lead the movements in Latin America. What’s one pioneer’s story that stands out to you? 

There are so many stories, but the one that still stands out the most is the story of Juan Cesar Garcia who was an Argentinean health bureaucrat. He grew up in Argentina and had a conventional medical career until his early twenties. Then, in the 1960s, he became involved with the Pan American Health Organization. Superficially, his job was to go around to different medical schools in Latin America and essentially make sure they were conforming to the standards for medical education at the time. But he was a very intellectually curious person. He read lots of Marxist social theory, like Antonio Gramsci to the Peruvian scholar José Carlos Mariátegui and even the Marxist geographer David Harvey. Garcia began to develop this view that Latin America’s lagging in international health was a result of an unjust international system marked by imperialism, militarism, and U.S. domination. As he visits these medical schools, he begins to hold informal seminars, which were almost like covert operations, to spread different ways of thinking about the health field. A new wave of social medicine began to spread across Latin America, and he’s probably the one figure most responsible for this. 

As you write in the book, the Global South and its developing countries are often portrayed as “sources of problems” and “bastions of infectious disease” rather than as intellectual inspirations and policy models. What are some of the main lessons we can learn from Latin America’s social medicine movements? 

I think one lesson is that when the medical profession is organized with the goal of creating more egalitarian and universal health systems that really respond to the needs of a whole population, they can almost always succeed because medical professionals have such an outsized influence on what happens in the health system. 

In the U.S., just for comparison, it’s not until recently that the organized medical profession has started to voice the opinion that there’s something fundamentally unfair about the U.S. system. In fact, quite the opposite. For decades, the American Medical Association fought tooth and nail to prevent the so-called socialization of medicine in the U.S. – the group once fought to prevent Medicare and Medicaid. Because of social medicine, a lot of doctors in Latin American countries seem less afraid to go out on a limb politically. And we see major health systems reforms propelled by progressive or leftist doctors, as in the construction of Brazil’s unified health system in the 1980s and 1990s. In the U.S., there is still a sense that doctors have to stay politically neutral. I can understand the need for that, but that attitude might also prevent us from having a health system that works for everybody. 

Dr. Eric Carter will be giving his inaugural lecture as Edens Professor of Geography and Global Health on Thursday, November 16, 2023.

October 26 2023

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