A review of Curing a Sick Nation: Public Health and Citizenship in Colombia, 1930-1940 by Hanni Jalil
In 1930, Colombia entered a new period of Liberal politics after five decades of Conservative rule, known as the “Conservative Hegemony” (1880-1930). While this shift was a clear moment of political transition, in Curing a Sick Nation Hanni Jalil shows that it was also a moment in which the state redefined its relationship and responsibility to Colombian citizens. Looking at the expansion of both urban and rural public health campaigns during the presidency of Alfonso López Pumarejo (1934-1938 and 1942-1945) Jalil argues that public health was an essential component of the Liberal party’s modernizing agenda. In particular, Jalil examines how public health programs were tied to national economic concerns, ongoing political divisions, and programs of social inclusion targeting the country’s rural and urban poor.
As a way of measuring this project of social and political inclusion, Jalil demonstrates a clear connection between public health programs and Liberal rhetoric. Above all, Liberals created narratives of redemption—that improved public health would uplift the Colombian population and thereby help modernize the nation. However, other rhetorical strategies that helped advance the Liberal political agenda were also embedded within these larger redemption narratives. For instance, Liberals often blamed their political rivals, the Conservatives, for Colombians’ poor state of health. In doing so they claimed that the Conservatives had neglected the Colombian people for generations as a way to promote the idea that the Liberals were a party of the people. Yet this strategy of courting popular political support was undermined by counter-narratives that blamed workers’ and peasants’ poor state of health on their own ignorance and backwardness. In doing do, the Liberals reproduced prevalent race, class, and gender stereotypes that had characterized Colombian state-society relations for generations. As Jalil explains, “the reproduction of these prejudices in reform rhetoric illustrate tensions between Liberal discourses that claimed to promote a more egalitarian or inclusive society, and the maintenance of discriminatory practices and prejudice in social practice” (pp. 3-4).
Yet Jalil’s study also asserts that the period of Liberal rule is essential to understanding the development of Colombian history. By analyzing this sixteen-year period between the Conservative Hegemony and the eruption of the ten-year civil war between Liberals and Conservatives known as La Violencia (1948-1958) that started with the assassination of the populist Liberal presidential candidate Jorge Eliécer Gaitán, she shows that there is more to the story of Liberalism in Colombia than that of Gaitán’s charismatic and fiery populism. As she states, “it is easy to fall in love with Gaitán’s populism and dismiss López Pumarejo as a timid elite reformer. But doing so runs the risk of silencing or dismissing the changes that López Pumarejo started during his first term in office, changes that polarized Colombian politics, started the democratization of this country’s political system, and enshrined the social function of the state in the Constitution” (p. 21). In explaining how public health formed an integral part of the Liberal party’s strategy of social rule, Jalil asserts that this period is a defining moment in the creation of the Colombian social contract, one that ultimately set the stage for the emergence of the modern Colombian welfare state and created a generation of citizens comfortable with demanding that the government fulfill its social obligation.
Chapter 1, which acts as the dissertation’s introduction, provides important background information about Colombia’s nineteenth- and twentieth-century history, demography, and economic and political structures. The early part of this chapter traces the country’s changing social and economic conditions, including industrialization, urbanization, and Colombia’s increasing integration into global markets as a coffee and banana exporter. These changes led to growing social mobilization and labor agitation that challenged the existing political rule, which set the stage for the return of the Liberals to power in 1930. The chapter then examines the period of Liberal rule (1930-1946) with specific attention the presidency of Alfonso López Pumarejo (1934-1938), who embraced progressive and leftists elements and embarked on a period of government expansion that “helped redefine the state’s role to include not only mediation between conflicting social groups, but also the responsibility of ensuring its citizens’ welfare” (p. 15). It is in this chapter that Jalil outlines the Liberal party’s main agenda items: placate rural and worker unrest, court popular support, and modernize the nation. The dissertation will examine these points by looking first at national rhetoric and state-driven public health programs more broadly, then by turning to a specific discussion of the city of Cali, which provides an “excellent case study because of the city administration’s identification with Liberal politics during the 1930s, and its history of social mobilization and labor unionization” (p. 2).
Public health journals and publications by doctors and intellectuals are the specific subject of chapter 2, which Jalil uses to demonstrate the way that elites conceptualized the country’s masses. During the early period of Liberal rule (1934-1938), these publications argued that Conservatives had neglected peasants and workers and emphasized that the Liberal party would redeem the nation. One publication written by Dr. Laurentino Muñoz Trujillo, entitled The Biological Tragedy of Colombian People, described peasants and workers as passive and ignorant individuals that required state intervention to transform them into economically productive citizens. Despite the tract’s title, Muñoz did not argue that Colombians were biologically inferior, but instead suffered from a history of state neglect. Like proponents of positive eugenics in other parts of Latin America, Jalil’s analysis of Muñoz’s work shows that Liberals in the mid-1930s thought the population could be redeemed and improved through state action. This state intervention took the form of publications like Salud y Sanidad, a free medical pamphlet distributed as a means to educate the masses about health issues and preventative medicine via straightforward language, stories, and pictures. Yet paradoxically, as the 1930s continued, Liberals also retreated to narratives that blamed the country’s backwardness on these same peasants and workers, thereby exonerating Liberals from any responsibility for lack of development. Jalil documents this point specifically in her discussion of campaigns against alcoholism, which shows how these redemptive narratives still carried prevalent stereotypes about class, gender, and race. As she explains, “reform literature and the campaigns featured in these journals reproduced stereotypes about workers and peasants as either passive actors in need of the state’s redemption or as problematic and recalcitrant subjects” (pp. 42-43).
Chapter 3 documents several shifts in the state’s approach to health care during the 1930s. First, the state moved from single disease campaigns to a more holistic approach to health focused on preventative medicine. Second, Liberals defined health care as a state responsibility, thereby breaking a long-standing reliance on charities and Churches to fund such campaigns. This chapter analyzes the expansion of public health infrastructure as a means to increase state intervention in rural inhabitants’ daily lives and redeem these supposedly uneducated, ignorant and dirty peasants that were a threat to the nation. Jalil demonstrates that an increase in the allocation of resources to public health led to sanitary units and rural commissions patrolling the countryside, and an emphasis on training more medical professionals meant that sanitary inspectors and visitadoras sociales could supplement the work of doctors and nurses. Ultimately, this chapter shows the centrality of public health to Lopez Pumarejo’s presidency, which “helped redefine state responsibility with respect to its citizens in the Liberal era…. [and] laid the foundations for the establishment of a welfare state in Colombia” (p. 89).
The case study of the city of Cali is the subject of chapters 4 and 5. Chapter 4 explains how city leaders embarked on a process of urban planning following a period of rapid expansion of the city, while also detailing the way that local residents petitioned authorities to improve access to health care and urban sanitation services. Urban residents attempted to impact the spacial reorganization of the city and to insert themselves into discussions about how public space should be organized. Jalil shows that petitioners actively engaged and negotiated with local authorities; they begged for access to services, offered to build public works themselves in exchange for state provision of resources, and blamed the state for inadequate care. In many cases, these petitioners drew rhetoric directly from authorities’ own playbooks: “They appealed to individual and collective health as a right, to the provision of sanitation and hygiene as a state responsibility, to images of children and the family as important for the nation’s future, and of the local state as protector of the city’s vulnerable classes, arbiter of morality, and provider of basic services and necessities” (p. 120). Many also identified themselves as Liberal party supporters as a way to bargain for access to state-sponsored health care. This chapter clearly indicates that Caleños embraced the idea public heath was both a right and a government responsibility.
Chapter 5 delves into the heart of state-society negotiations over public space in Cali. Jalil looks specifically at prostitutes and workers, who were among the most prominent petitioners during the 1930s. As she argues, “these petitioners identified themselves as workers, emphasizing their honorability, honesty, and poverty in hopes that doing so would give them an advantage over other petition writers, and that their political identity would move council members to grant their petitions. They presented themselves as model-citizens who deserved the council’s favor and when their petitions pitted their interests against other petitioners, they asked the council to exclude people they considered should be denied social membership, and thus access to these benefits” (pp. 180-181). One example details the contestation over the location of a venereal disease clinic. Local residents claimed that proximity to these spaces, and to prostitutes themselves, insulted the honor of their respectable, decent and hardworking communities. Yet prostitutes themselves also petitioned the city council to request a halt to their forced relocation, claiming that there was “no reason for the authorities” to treat them “like beasts.” As Jalil explains, “while aware of their proscribed status in a society that treated them as outsiders, denied them access to certain privileges, treated them as threats, and at times stripped them of their humanity, they asserted their right to be treated with justice, to seek redress from their local council, have government officials listen to their petitions, and recognize their humanity” (p. 201). Contestations over public space, citizenship, and state authority reveal the limits of social inclusion in Cali. Caleños did not necessarily embrace Liberal rule on an ideological level, but they did use their relationship with the state and the Liberals’ reform rhetoric to advance their own personal agendas and reinforce the social hierarchy as they understood it.
The conclusion returns to the dissertation’s main questions: what was the Liberal agenda in relation to health and sanitation? How did these programs impact state-society relations? And how did individuals and communities use these programs to negotiate or bargain with the state? In all, Jalil asserts, the answers to the questions as discussed in the five preceding chapters tell us that Liberals, although in power for only a brief period, irrevocably changed Colombia’s political culture. Liberals defined themselves as modernizers and redeemers of the nation. Yet, in seeking popular support for their national projects, the Liberal party gave popular groups the opportunity and the language with which to make demands of the state, or at the very least, criticize state neglect. Ultimately, Jalil claims, this reality ushered in a new era of political engagement in Colombia. Under the Conservative regime, it was highly uncharacteristic for individuals to make appeals to the state by identifying with a specific political project; however, during the Liberal tenure, the number of petitioners identifying specifically with the Liberal party increased. In this way, the Liberals helped create an active Colombian citizenry, as protests against state neglect and popular criticism of the government’s abandonment of the social contract have continued into the neoliberal era.
Curing a Sick Nation is a deeply researched and well-argued contribution to both Colombian history and the study of public health’s relationship to politics and political culture. As both a national study of public health during the Liberal period and a local study of the particular dynamics of the city of Cali, this dissertation gives an overall picture of the place of public health in the Liberal party’s national agenda and satisfies the desire for nuanced analysis of the way public health programs played out on the ground. This study is unique in the sense that it provides new information that links public health programs specifically to the Liberal project in Colombia. Furthermore, by using the tools of social history to explain social conditions in Cali, it provides new insight into the history of health and medicine in Colombia, which has been dominated by institutional and government sources. For this reason, the dissertation will be of interest to a broad range of scholars, including Latin Americanists, historians of science and medicine, and those interested in the complex interplay between states and their societies and both the national and local level.
Nicole L. Pacino
Department of History University of Alabama in Huntsville
Archivo General de la Nación (Bogotá)
Archivo Histórico de Cali Biblioteca del Banco de la Republica- Cali
Cali regional and national newspapers (El Liberal, El Diario del Pacifico, El Crisol)
Medical publications (Salud y Sanidad: Mejor es Prevenir que Curar, Revista de
Higiene, Revista Cromos, Repertorio de Medicina y Cirugía)
University of California, Santa Barbara. 2015. 267pp. Primary Advisor: Gabriela Soto Laveaga.
Image: Marcha de la Federación Departamental del Trabajo del Valle por la elección de Alfonso López Pumarejo, ca. 1941. Fondo Fotógrafico Alberto Lenis, Banco de la Republica, Colombia.