Health and development: Brazil in the eradication era
Oswaldo Cruz Foundation – by Gilberto Hochman
Since the late 19th century, Brazil has maintained a vigorous interaction with international health issues and organisations. Linked to epidemic circles of cholera, smallpox, yellow fever and plague, the focus of these engagements later expanded to cover rural endemic diseases. The mobilisation of public health projects was closely linked to challenges faced by the country in the fields of international commerce and immigration, to the need to integrate politically and culturally an immense country’s territory that was seen to be still partially inhabited by a ‘diseased and illiterate people’, and to intense debates about the search for a positive identity of ‘being Brazilian’.
The continued interplay between national health problems and the international health agenda was crucial. The cooperation with the International Health Board of the Rockefeller Foundation since 1915 also established lasting connections, particularly in the fight against ancylostomiasis and yellow fever; Carlos Chagas’ activism in the Hygiene Committee of the League of Nations in favour of a concerted action against leprosy also ensured a lasting Brazilian role in the international public health agenda.
As a result of its support for the Allies during World War II, Brazil came to forge even closer linkages in international health, highlighted by its close association with the World Health Organization, its Regional Office for the Americas (the Pan American Health Organization) and other UN agencies. Indeed, Brazil was closely attuned to the so-called ‘sanitary optimism’ marking the two decades following the end of the War. The availability of new preventative and therapeutic resources – insecticides, antibiotics, sulphates and antimalarials – stimulated governments as well as international organisations to formulate health programmes that aimed to control and eradicate the diseases of the so- called underdeveloped world. Science, medicine and technology were seen as a fundamental means by which poor countries could ascend to the pantheon of the so-called first world, thereby avoiding growth populism and socialism.
These trends ensured that rural endemic diseases such as verminosis, malaria, Chagas’ disease and schistosomiasis remained at the top of the health agenda in Brazil. From the 1950s onwards, these diseases were presented as obstacles to development that could be removed with the new ‘weapons’ available in the armoury of health departments, such as DDT, chloroquine and penicillin. Plans for the recovery of the labouring capacity of the rural populations that were hungry, ill, poor and illiterate thus dovetailed with governmental projects for agricultural modernisation, national integration and industrialisation. Brasilia, the new modernistic capital built deep in Brazil’s hinterland, was a powerful symbol of this postwar developmental project. By relating underdevelopment to the endemic diseases of rural areas, Brazilian public health became associated with the national capitalist development project.
Brazilian public health also entered the ‘eradication era’ in the 1950s, a move that was actively encouraged by regional and international agencies. The focus, initially, was on yaws and endemic goitre, and specific nationwide interventions were developed early in the decade. From 1958, Brazil joined international efforts such as the WHO’s Malaria Eradication Programme, with financial assistance from the USA; the relationship between Brazil and the USA strengthened after the military coup of 1964, which initiated two decades of authoritarian rule. A hegemonic model was adopted for public health, based on in belief in centralised and well-structured programmes, making use of the new prophylactic and therapeutic methods. These programmes were marked by a systematic disregard for the cultural, hygienic and nutritional practices of the Brazilian rural populations, whose members were expected to passively receive the benefits offered by public medicine. The Brazilian government hoped that such ‘backward’ practices would be modified – or even eliminated – by the development of the country’s interior. The problems produced by this approach were gradually revealed as the campaigns were developed, and the frustrations and failures were announced. Even though some critical voices could be heard, this model was hegemonic until the 1970s and it was reinforced with the success of smallpox eradication. Research into Brazil’s postwar relations with the international health agenda era offers valuable clues about the limits and possibilities of developing more cooperative and innovative global health programmes in the country and across Latin America.
Gilberto Hochman is a Researcher and Professor in the Postgraduate Programme in the History of Sciences and Health, Oswaldo Cruz Foundation.