International Health and Local Actors: Latin American
Public Health During the Second Half of the 20th Century
The purpose of my participation in the Fulbright New Century
Scholars Program is to write and discuss an historical essay
on the development of international health programs in Latin
America during the second half of the 20th century. I will
concentrate in two experiences that have had a lasting influence:
first, the malaria eradication campaigns begun in the late
1950s and second, the Primary Health Care Movement that
can be traced to the late 1970s. I will asses the similarities
and differences of these two types of health work in a less-developed
region of the world. I believe that an integrated analysis
of these experiences is instrumental for understanding the
influence of reductionistic and holistic approaches in international
health and their role in fragmented public health systems.
Although this essay will concentrate in four countries
of Latin America, it is part of a larger study on the history
of public health in the region that will become a manuscript
for a book. The essay will identify both the assumptions
behind international health programs and the main features
of the negotiation process between international agencies
and local institutions. I will argue that the transference
of international programs to developing countries has not
been a one-way street. Technical authority has been frequently
accommodated by recipients who redefined the content and
scope of these programs.
Malaria campaigns were influenced by the notions of cultural
diffusion and modernization that can be traced to the work
of the Rockefeller Foundation during the early 20th century.
One of the assumptions of these campaigns was that change
came from outside backward societies. Traditional cultures,
lay healing practices and health institutions of a developing
country were considered inconsistent with modernization.
Primary Health Care appeared as a radical departure of technically
self-contained vertical campaigns. The Alma Ata meeting,
organized by the World Health Organization and UNICEF in
1978, defined Primary Health Care as essential care based
on socially acceptable technology. However, the goals of
self-reliance and self-determination became more restricted
in the 1980s when "Selective Primary Health Care"
appeared. The latter limited health interventions to: growth
monitoring of infants; oral rehydratation techniques; breast
feeding, and immunization.
I believe that I can contribute to the NCS Program by providing
an historical perspective to the present-day problems and
challenges of international health. In addition, I hope
to offer insight into the relationship between international
agencies and local institutions interested in promoting
health and development. I will benefit from my participation
in the NCS Program by learning more about contemporary and
future discussions on international health.