Eric D. Carter’s new book is a thought-provoking synthesis of the history of the changing and contested perspectives on addressing health problems in Latin America throughout the twentieth century. The novelty of the book is that it focuses not on national histories of medicine and healthcare systems, but rather on the history of a transnational academic field and political movement: Latin American social medicine (LASM). In general terms, Carter aims to “examine the intellectual roots of social medicine and its development as a scholarly field, the expert networks and institutions that sustained or advanced social medicine ideas, and how these ideas translated into policy” (11). The book is divided into two sections, which examine a “first” and “second wave” of social medicine, between 1900 and 1940 and between 1970 and 2000, respectively. An intermediate chapter (chapter five) is devoted to exploring how “social medicine receded in the face of increasingly technocratic modes of health policymaking in the early Cold War era” (17).
One of Carter’s central arguments is that there exists a distinctly Latin American social medicine, which is not simply a copy of a European version. The main characteristics of LASM have been: the ideological pluralism of its proponents in the first wave and left-wing progressivism in the second; a special concern for the structural determinants of health and illness; a commitment to political action and to achieving social reforms in line with its models of health and illness; and a strong orientation toward a welfare state and social justice. These characteristics have sometimes coincided with the conceptual and institutional development of medicine and public health in some Latin American countries. It is precisely because of this that the “roots,” “hiatus,” and “revival” of LASM (to use some of the chapter titles in Carter’s book) follow a periodization similar to that proposed by panoramic works on these topics, such as Marcos Cueto and Steven Palmer’s 2015 book Medicine and Public Health in Latin America: A History. However, it is important to mention that recent research, such as Anne-Emanuelle Birn and Raúl Necochea López’s Peripheral Nerve: Health and Medicine in Cold War Latin America (2020), have challenged the conventional historiography on the dominance of the United States during the Cold War in thinking about the field of health in Latin America.
In the book’s first chapter, Carter traces the origins of LASM’s first wave to the region’s hygienist movement (higienismo) in the early twentieth century. According to the historiography, this movement articulated a biologized view of national problems and helped to deploy biopolitical strategies for social control and/or human welfare. Carter argues in chapter two that, during the1930s, some European international organizations oriented LASM more toward improving people’s well-being than toward social control and helped consolidate locally the idea of expanding the welfare state. Focusing on the Chilean and Argentinian cases, chapters three and four explore and compare the influence of local actors and institutions related to LASM on the development of the welfare state in these two countries. Special attention is given to the health reforms pursued by physician–politicians Salvador Allende and Eduardo Cruz-Coke in Chile and Ramón Carrillo, Juan Perón’s health minister in Argentina.
The history of the second wave of LASM begins with the activities of Argentinian physician and sociologist Juan César García, who played a central role in the systematic incorporation of Marxist social theory into the movement and the creation in 1984 of the Latin American Social Medicine Association (ALAMES). Drawing on an extensive bibliography on this renewed movement (mostly produced by members of ALAMES) and interviews with key figures in ALAMES, Carter provides in the last chapters of the book an ambitious overview of the struggles, achievements, and limitations of LASM as an academic and political field. Chapter six connects García’s efforts during the 1970s and 1980s to overcome the prevailing models of medical education and public health, which were often uncritical and functional to the capitalist system, with the ideas and activities of a few health workers and scholars from Chile, Argentina, and Brazil—many of whom were in exile during their countries’ dictatorships. Finally, in chapter seven, Carter explores a series of recent progressive health reforms in Brazil, México, Venezuela, and Bolivia, which were directly related to ALAMES. Possibly as a cautionary tale of ALAMES’ own self-portrait, this chapter also includes a brief mention of two different healthcare systems, one in Cuba and the other in Costa Rica. Both have been successful, though unrelated to ALAMES and LASM.
Because of its subject matter, regional scope, and interdisciplinary perspectives, Carter’s book may appeal to a wide range of historians. In particular, the book contains thought-provoking insights for the social history of the state, social policy, and the social sciences. In addition, Carter draws on an impressive body of historical work, much of it published in Spanish and Portuguese, which provides sophisticated theoretical and historiographical perspectives about these issues. His hard work in connecting all this literature is admirable, and especially relevant for an Anglo-Saxon audience, because it makes visible a rich local and regional tradition that is often overlooked by historians from the Global North.
