December 2003, Vol 93, No. 12 | American Journal of Public Health 1987
© 2003 American Public Health Association
Latin American Social Medicine
César Gomes Victora, MD, PhD, International Associate Editor
Latin American countries share not only a history and a rich cultural environment, but also a profound division of society. Enormous differences between rich and poor affect all aspects of life in most Latin American countries. Health is no exception, and inequities are recognized as "the leading health problem in the Americas" (Leading Pan American Health. Washington, DC: Pan American Health Organization; 1998. Official document no. 287). This deep social divide has had a major effect on public health thinking and practice in the region.
This month the Journal highlights the Latin American Social Medicine (LASM) movement by publishing several papers presented during the 2002 APHA meeting in Philadelphia, Pa, at the session "Latin American Social Medicine and the Quest for Social Justice and Public Health: Linking History, Data, and Pedagogy." The LASM movement gained force in several countries in the 1970s, when military dictatorships in the region deepened social inequities and suppressed freedom of expression. It represented a strong reaction by members of the public health community not only to inequities in health status and health care in the region, but also to conventional thinking on the causes of ill health. LASM is an eclectic movement that encompasses a variety of professions and currents of thought, along with a strong consciousness of the social determinants of health and disease and the recognition of a clear link between politics and science.
The contributions in this issue’s research forum on LASM include a historical view of the movement and its role in improving health in the region by Débora Tajer, from Argentina; a discussion of how theory and practice interacted when LASM intellectuals gained power in Mexico City by Cristina Laurell, from Mexico; an example of LASM thinking applied to the causes of violence in Colombia by Saul Franco, from Colombia; and a critical bibliometric analysis of the intellectual products of LASM by Naomar Almeida-Filho and colleagues, from Brazil. An editorial by Nancy Krieger and a commentary from Seiji Yamada—both of the United States—reflect, on the relevance of LASM to current public health thinking and practice in developed countries.
At the time this issue was being finalized, one of the major thinkers in LASM passed away in Brazil. Sérgio Arouca (1941–2003) influenced public health in the region through his PhD thesis, The Preventive Dilemma—A Contribution to the Comprehension and Critique of Preventive Medicine, which was published in 1975. Arouca criticized the adoption by Latin American medical schools of the US-based model of preventive medicine, which emphasized measures applied at the individual level within a context of private medical practice. He argued that this preventive model, which is linked to the capitalist mode of production, overlooks the complex social relations underlying disease causation, and that it was unlikely to succeed in Latin America. Arouca left academic life in the mid-1980s to become secretary of health for Rio de Janeiro and later a national congressman. His intellectual work and activism were highly influential in the adoption, in the 1988 Brazilian Constitution, of a unified health system that guarantees free medical care for every citizen as well as community participation in health management decisions at all levels.
Arouca’s contribution to public health, like those of many other LASM authors, deserves to be more widely known outside the region. This issue of the Journal highlights this important intellectual movement that has already led to major changes in the way public health is conceived and practiced in Latin America.
Copyright © 2003 by the American Public Health Association
