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Public health, population, and contested development politics in Cold War Latin America


LASA's XXXVII International Congress


Lugar: Boston, Marriott Copley Place

Mayo 27 de 2019. 10:45am - 12:15pm


Coordinador: Eric D. Carter, Macalester College

The proposed session addresses important questions in Cold War development politics in Latin America: How were Latin American experts incorporated into the new international development institutions of the early Cold War, such as PAHO, the WHO, UNICEF, and the FAO? How did the norms, practices, and strategies of these institutions impact national-level policies in areas such as public health, population policy, nutrition, and agricultural development? To what extent did international institutions "depoliticize" questions of national social development and reconfigure relations in national politics to the advantage of a new generation of technocrats? These questions are inspired by previous examinations of international development institutions in disease eradication (Cueto, "Cold War, Deadly Fevers"), civil engineering and agronomy (Buckley, "Technocrats and the Politics of Drought and Development"), nutritional planning (Escobar, "Encountering Development") and family planning (Necochea, "A History of Family Planning in Twentieth Century Peru"). This panel expands the conversation by bringing together research in several issue domains (social medicine, public health, nutrition, agricultural development, and population policy); examining the expert networks that reached across these domains; exploring frictions between existing tendencies in national politics (ideological configurations, institutional architectures) and the reordering work of international institutions; considering lesser known institutional actors beyond the big UN-associated institutions; and incorporating case study material from various countries (Brazil, Chile, Colombia, and Argentina). 





Eric D. Carter (Macalester College): "Social medicine versus technocracy: Latin American national health systems planning in the early Cold War period"

As the initial gains of social medicine began to be institutionalized in the Cold War context of the 1950s and 1960s, Latin American health policymaking became increasingly technocratic. With the guidance and financial influence of international organizations such as PAHO, the WHO, and CEPAL, the cultivation of health systems professionals became more formalized in such areas of expertise as epidemiology, financing, actuarial science, and hospital design. Other areas that had once been part of social medicine concern, such as child nutrition, were offloaded to specialized organizations such as UNICEF and FAO. Such trends fit within the ideological matrix of mid-century development planning, state scientific managerialism. These tendencies are embodied in the figure of Abraham Horwitz, one of the leaders of Chile's Servicio Nacional de Salud (founded in 1952), who would become an effective and politically pragmatic technocrat at the helm of the PAHO in the 1960s. During this period of technocratic consolidation, the spirit of social medicine persisted in sporadic endeavors, such as rural health projects, "community medicine" programs in urban working class districts, and ethnographic research that challenged the supremacy of biomedical models of health and the hegemony of centralized and hierarchical health systems. Meanwhile, a small cadre of international health technocrats, including Juan Cesar Garcia and Mario Testa (of Argentina) began generating a radical critique from within, which would serve as the genesis of the second wave of medicina social (or saude coletiva).


Jadwiga E. Pieper Mooney (University of Arizona): "Of Pragmatists and Politicos: Demographic Data in the Making of Chilean Social Medicine in the Early Cold War"

In his treatise on the birth of social medicine, Michel Foucault argues that "modern medicine is a social medicine whose basis is a certain technology of the social body; medicine is a social practice, and only one of its aspects is individualistic and valorizes the relations between the doctor and the patient." (Foucault 1974 [2001], 136). This study explores the political dimensions of social medicine practice that extend from doctor-patient relationships to nation-state politics to international institutional networks in the early Cold War. In 1957, the Chilean government signed an agreement on the establishment of a Latin American Centre for Demography (CELADE) with the United Nations and formalized the new attention to demographic data and population studies in public policy formation, including public health. Institutions like CELADE in Santiago, as well as individual medical doctors and health officials, employed statistics for specific projects of preventive and community medicine. I connect some of the institutional and individual initiatives that focused on population control and public health and document how medical doctors negotiated pragmatic as well as the political dimensions of public health planning. Their initiatives uncover some of the complexities of social medicine as both a medical doctrine and a political movement.


Stefan Pohl-Valero (Universidad del Rosario): "The Inter-American Cooperative Health Service, the Instituto Nacional de Nutrición and the "technocratization" of the nutrition problem in Colombia, 1940-1960"

After the 10th Pan American Sanitary Conference, held in Bogotá in 1938, hygienist Jorge Bejarano stressed the urgency of creating a "National Food Council that directs the orientation and solution of this national problem". Several local physicians and politicians perceived that this problem had social, economic and biological aspects that should be addressed in a comprehensive manner. A national food policy should articulate several government institutions; implement social reforms such as the redistribution of land ownership, and the regulation of labor wages and food prices; and support various food hygiene measures, such as a broad nutrition education campaign, food assistance institutions, nutritional surveys and chemical analysis of local foods. This National Food Council was created in 1940; and later, with the financial and technical support of the Inter-American Cooperative Health Service, a nutrition laboratory and the National Institute of Nutrition (INN) were created (in 1943 and 1947). The "fight" against goiter (by adding iodine to salt), was one of the main programs carried out by the INN. In this paper, I want to analyze how the creation and activities of the INN (during the 1950s) reflected the local and international interactions, negotiations and tensions to define and address the "nutrition problem". I will argue that this case study sheds light on the global processes of "technocratization" and "depoliticization" of the so-called "national problems" or "social questions" that occurred in many Latin American countries during the early stages of the Cold War and the discourses of development.


Eve E. Buckley (University of Delaware): "Overpopulation or Overconsumption? A Brazilian Scientist Critiques International Development Discourse during the Early Cold War"

In 1952, Brazilian nutritionist Josué de Castro (who had just become president of the U.N. Food and Agriculture Organization) published an incisive critique of American conservationist William Vogt's 1948 book Road to Survival. Vogt, who would soon direct the Planned Parenthood Federation of America, believed that curbing population growth was an urgent priority for developing nations. De Castro's alternative framing of the relationship between population, hunger, and social peace blamed U.S. and European imperialism for crises in food supply. The Brazilian scholar argued that the resource demands of a growing human population required more equitable distribution of agricultural land and food. Geography of Hunger was translated into over twenty languages during the 1950s; it received both widespread acclaim and scathing criticism in the global press. During the two decades following the publication of this book, De Castro vocally opposed international development policies rooted in the identification of overpopulation as central global challenge. He engaged with a wide-ranging network of left-leaning intellectuals who questioned the scientific and ideological basis of overpopulation discourse. De Castro and his eclectic contacts asserted that the purported concern with overpopulation masked a continuation of eugenicist ideologies and Euro-American imperialism. This paper examines these arguments in the context of early Cold War science and politics, with particular attention to the intellectual network that de Castro cultivated during his years with the FAO in Rome and while exiled to Paris after the rise of Brazil's rightwing military dictatorship in 1964.



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