Social medicine versus technocracy: Latin American national health systems planning in the early Cold War period

• In Event: Public health, population, and contested development politics in Cold War Latin America

Abstract

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).

Author

• Eric D Carter, Macalester College