Health, Hygiene and Sanitation in Latin America, c.1870 to c.1950

This Research Paper sets out to examine transitions within health care in Latin America between c. 1870 and c. 1950 and offers a preliminary synthesis. Whereas a powerful historiography has evolved over the past thirty years that strives to synthesise diffuse materials on the insertion of Latin America into the world economy and subsequent 'de-linkage', there are few attempts to summarise the historiography of social policy. Given the embryonic nature of the subject, the author is trying to avoid premature generalisation and excessive claims, and is fully conscious that more questions are raised than are resolved by this paper. A broad chronological canvas is adopted, which is useful in clarifying diversity within the continent, but can also obscure issues of periodisation. The first section enquires into the relationship between the genesis of a modern public health policy and the experience of tackling epidemic and endemic diseases, and reviews the motives behind ameliorative health measures undertaken by the state and business, especially foreign enterprise, and their significance. The second section investigates the interaction between external forces and domestic changes: both the role of an international voluntary agency in tackling prostitution and, by implication, venereal diseases; and the significance of missions from developed countries that aimed to raise an alertness to modern methodology and investigation in 'tropical medicine', to institutionalise public health laboratories, and to undertake 'campaigns' against targeted diseases. This section concludes with an analysis of a specific example of externally inspired innovation in hygiene and sanitation: the Panama Canal. There follows a section that uses the special case of Rio de Janeiro to elucidate problems of evolving a public health policy for cities; and from that vantage point looks at the beginnings of public health policy in the Brazilian countryside. The penultimate section looks at the diffusion of scientific knowledge, the limits to its impact and the resilience of Luso-Hispanic, Amerindian and Afro-Latin American traditions of healing and curing. The final section consists of notes on the nature of the relationship between levels of health and of nutrition and housing.