OVERVIEW - the Conference Exchange...Annu. Rev. Sociol. 2015.41:271-290. Downloaded from by ${individualUser.displayName} on 08/22/15. For personal use only. Imperialism’s Health

Resisting Empire and Building an Alternative Future in Medicine and Public Health

Rebeca Jasso-Aguilar and Howard Waitzkin

APHAChicagoNovember 3, 2015

Presenter Disclosures

(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

Howard Waitzkin

No relationships to disclose

OVERVIEW

• Public health and health services have played important roles during the rise of empire and during its subsequent decline.

• Conditions during the 21st century have changed so that a vision of a world without empire has become part of an imaginable future.

OVERVIEW

• Latin America became an especially fertile ground for resistance against neoliberal policies that favored privatization and cutbacks in public services, and for the emergence of alternative policies not based on the neoliberal model.

Background

In addition to these struggles against, groups in several countries have moved to create alternative models of public health and health services.

These efforts – especially in Latin America – have moved beyond the historical patterns fostered by capitalism and imperialism.

RECENT PUBLICATIONS

Medicine, Public Health, and the End of Empire? Building an Alternative Future

“A critical and timely book that illuminates the realities and consequences of treating health and health care as commodities. Waitzkin powerfully reveals the global political and economic forces shaping even the most private of patient-provider encounters. He offers an invaluable reminder that alternatives are possible—and can be achieved through collective efforts linking social justice, public health, and medicine.” N A N C Y K R I E G E R, Harvard School of Public Health

“Health reform is a lively and contentious topic, but, as Waitzkin shows in this informative study, our debates on reform are too narrowly framed. His thoughtful analysis raises important questions about con-ventional assumptions of doctrine and practice, scrutinizing alternatives—among them notably the record of social medicine in Latin America.” N OA M C H O M S K Y, MIT

“This book is a thoughtful addition to the social medicine canon. Dr. Waitzkin makes an elegant and fasci-nating argument for the importance of recognizing politics as a determinant of health.” S A N D R O G A L E A, Columbia University

“Waitzkin offers a comprehensive overview of the political economy of health with revealing examples from the U.S. and Latin America. He shows the fundamental logic of progressive and of commercial health poli-cies and their bearing on human flourishing.” A S A C R I S T I N A L AU R E L L, former Secretary of Health, Mexico City

“Waitzkin’s analysis of the ways in which capitalist development has produced and reproduced huge global inequalities is original and thought-provoking. His involvement in social medicine in the U.S. and in Latin America provides a fertile perspective for comprehending the rise and demise of neoliberalism and a hope-ful basis for organizing a more humane and democratic global society. C H R I S C H A S E D U N N, University of California–Riverside

“A welcome contribution to the thorny debate on health care reform. When national leaders overcome com-placency, catalyze genuine social participation, and apply ethics to undermine inequities, the public good is rewarded, and revitalized health systems are the inevitable and natural consequence.” M I R TA R O S E S, Director of the Pan American Health Organization

“Medicine and Public Health at the End of Empire presents a vision for a healthier and more just future.” C H A R L E S B R I G G S, University of California–Berkeley

H O WA R D WA I T Z K I N is Distinguished Professor at the University of New Mexico and a primary care practi-tioner in rural northern New Mexico. His work focuses on social conditions that lead to illness, unnecessary suffering, and early death. Dr. Waitzkin’s books include The Second Sickness, The Politics of Medical Encounters, and At the Front Lines of Medicine.

HEALTHCARE / SOCIOLOGY MEDICINE and PUBLIC HEALTH at the END OF EMPIREHoward Waitzkin

Cover art courtesy of Sofia BorgesCover design by Todd Lape / Lape Designs

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EDICINE and PUBLIC HEALTH at the END OF EM

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Howard Waitzkin

MEDICINE and PUBLIC HEALTH at the END OF EMPIRE

SO41CH13-Waitzinkin ARI 5 August 2015 13:1

Empire, Health, and HealthCare: Perspectives at the End ofEmpire as We Have Known ItHoward Waitzkin1,2 and Rebeca Jasso-Aguilar1

1Department of Sociology and 2School of Medicine, University of New Mexico, Albuquerque,New Mexico 87131; email: [email protected], [email protected]

Annu. Rev. Sociol. 2015. 41:271–90

First published online as a Review in Advance onMay 4, 2015

The Annual Review of Sociology is online atsoc.annualreviews.org

This article’s doi:10.1146/annurev-soc-071913-043243

Copyright c⃝ 2015 by Annual Reviews.All rights reserved

Keywordsempire, imperialism, health care, health, public health

AbstractHealth and health care have played important roles during the rise of empireand during its subsequent decline. Research has emphasized the underde-velopment of health in less developed countries, the opening of new marketsfor medical products manufactured in dominant nations, the contribution ofpublic health in enhancing the productivity of labor, the impact of medicinein reinforcing international class relations, and the adverse effects of militaryinterventions on health and mental health. Latin American social medicine,especially work by Salvador Allende, has clarified the social origins of ill-ness and early death in the context of empire. Connections among empire,health, and health care have operated through key mediating institutions:trade agreements and international financial institutions, foundations, andinternational public health organizations. Several popular struggles show adiminishing tolerance among the world’s peoples for the health policies ofempire and a growing demand for health systems grounded in solidarityrather than profitability.

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Imperialism’s Health ComponentHOWARD WA I TZ K I N a n d REBECA JA S S O - AG U I L A R

Monthly Review 67,3 (July-August 2015): 114-129.

Resisting the Imperial Order and Building an Alternative Future in Medicine and Public HealthREBECA JA S S O - AG U I L A R a n d HOWARD WA I TZ K I N

Monthly Review 67,3 (July-August 2015): 130-143.

8/23/15, 2:04 AMNotes from the Editors, July-August 2015

Page 1 of 5http://monthlyreview.org/2015/07/01/mr-067-03-2015-07_0/

Sunday August 23rd, 2015, 3:01 am (EDT)

Dear Reader,

We place these articles at no charge on our website to serve all the people who cannot affordMonthly Review, or who cannot get access to it where they live. Many of our most devotedreaders are outside of the United States. If you read our articles online and you can afford asubscription to our print edition, we would very much appreciate it if you would considerpurchasing one. Please visit the MR store for subscription options. Thank you very much. —EDS.

NOTES FROM THE EDITORS

July-August 2015 (Volume 67, Number 3)by The Editors

topics: Imperialism, Movements, War places: Asia, Global, Vietnam

» NOTES FROM THE EDITORS BUY THIS ISSUE

May’s Review of the Month, “Honor the Vietnamese, Not Those Who KilledThem” by MR Associate Editor Michael D. Yates, has elicited manyresponses. One writer said that Yates had written the best, but perhapsthe first, Marxist analysis of the war. Another praised Monthly Review forhaving the courage to publish this article. Still a third predicted that inthe more distant future, humanity would embrace the essay’s judgmentand honor the Vietnamese people for their heroic struggle against theoverwhelming might of the U.S. military.

In light of these comments, as well as the subject matter of this double issue of Monthly

Review on imperialism, we thought it might be worthwhile to say something more about whatthe Vietnamese themselves naturally enough call the American War, with an eye towarddrawing important lessons useful for contemporary radicals.

First, the war was clearly one of imperial aggression. Although President Eisenhower spoke ofthe global importance of Vietnam’s raw materials—such as tin, tungsten, and rubber—rawmaterial imperialism was not a significant reason why the United States wreaked such havoc ona poor, peasant nation. Vietnam’s resources were not critical to the U.S. or any other richcapitalist nation’s economy. Rather, what the United States saw at stake in Vietnam was thechallenge the Vietnamese presented to the imperial power of the world’s greatest capitalistnation. The Chinese Communists had seized power in 1949, followed by Cuba, while radicalnationalism had arisen throughout the global South as former colonies demandedindependence, both political and economic. The United States drew a line in Vietnam and said,in effect, that this small peasant nation would not be permitted its freedom. And it certainlywould not be allowed to become socialist. What followed was a savage onslaught, an orgy of

Also in this issue…

The New Imperialism of GlobalizedMonopoly-Finance Capital, JohnBellamy Foster

Contemporary Imperialism, Samir Amin

Behind the Veil of Globalization, IntanSuwandi

Imperialism and the Transformation ofValues into Prices, Torkil Lauesen andZak Cope

Imperialism in the Era of Globalization,Utsa Patnaik and Prabhat Patnaik

Imperialism in the Twenty-FirstCentury, John Smith

Imperialism and Anti-Imperialism inAfrica, Horace Campbell

Imperialism’s Health Component,Howard Waitzkin and Rebeca Jasso-Aguilar

Resisting the Imperial Order andBuilding an Alternative Future inMedicine and Public Health, RebecaJasso-Aguilar and Howard Waitzkin

The New Stage of Globalization, HarryMagdoff

The Creation of the Next Imperialism,Jayati Ghosh

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Background

We have selected countries that have not pursued a path of violent revolution, such as Cuba

because the non-violent path has predominated in recent popular struggles focusing on imperialism and health.

Background

All the struggles that we describe remain in process of dialectic change and have continued to transform toward more favorable or less favorable conditions.

However, all show a common resistance to empire and a common goal of public health systems grounded in solidarity, not profitability.

Background

Neoliberalism (1980s to present): seeks to assert the superiority of the market over the state aims to reduce drastically the role of state in the economy and to favor:

austerity fiscal discipline deregulation privatization dismantling the welfare state

Background

Neoliberalism (1980s to present) led to: massive transfer of resources from the public to the private sector reduction or elimination of the safety net worsening social and economic inequalities

Background

Latin America became a fertile ground for resistance against neoliberalism. We analyze several popular struggles in which we have participated during the past decade as researchers and activists.

Background

This work conveys a picture very different from that of the historical relation between imperialism and health:

Diminishing tolerance for the public health policies of imperialism and growing demand for public health systems grounded in solidarity rather than profitability.

Participation of common citizens in social issues usually discussed and decided by political and economic elites.

Background

As one Bolivian participant put it, people have seized the right to decide on matters of the public policy (“el derecho de decidir sobre lo público”).

The struggle against privatization of health services in El Salvador

Theme: maintenance of strong public sector in health and public health to provide access to services

World Bank’s structural adjustment program proposal (late 1990s) Coalition of professional and non-professional unions Reversal of privatization process 2009: Election of Mauricio Funes as President, representing the political wing of the Farabundo Martí National Liberation Front (FMLN)


Dr. María Isabel Rodríguez returned from exile as national Minister of Health. 2014: Salvador Sánchez Cerén, a former guerrilla leader with the FMLN, won the election for President. Ministry of Health: more initiatives to strengthen the public sector in health services


Dr. Salvador Allende Movement of Health Professionals Selection of San Salvador as the site of the November 2014 congress of the Latin American Social Medicine Association

thousands of progressive health workers to advance the struggle against neoliberal policies and in behalf of alternative models that strengthen public services


Resistance to privatization of water in Bolivia

Theme: availability of clean water supplies as a fundamental goal of public health; resistance to privatization of water

Regantes (“irrigators”); usos y costumbres (uses and customs) World Bank’s privatization proposal Multinational corporation (subsidiary of Bechtel) 2000: “War of water” - Cochabamba, then national 2005, 2009, 2014: Elections of Evo Morales


Novel processes of democracy and participation have taken place during the Morales administration.

New cabinet position: Minister of Water. Ministry included a social-technical

commission formed by social movements, social organizations, and academics with expertise in water issues.


To exercise “control social” = co-management between government and civil society

One of several exercises in community participation to exert control and demand accountability from the Bolivian government



Social medicine’s coming to power in Mexico City

Theme: vision of health services and public health from progressive perspective of Latin American social medicine

2000: Party of the Democratic Revolution (PRD) – Andrés Manuel López Obrador (AMLO) Versus neoliberal orientation of Party for National Action (PAN) – Vicente Fox, Felipe Calderón – and Institutional Revolutionary Party (PRI) – Enrique Peña Nieto


Asa Cristina Laurell as Secretary of Health Major expansion of public services and institutions, food, medications, pensions Financing: reduced administration, corruption (“the government isn’t robbing you anymore”) Elections of 2006, 2012. Continuing dialectic: “Legitimate Government of Mexico”; Movement of National Regeneration (MORENA).


Sociomedical Activism at the End of Empire as We Have Known It

Confirm core principles of public health: right to health care right to water and other components of a safe environment reduction of illness-generating conditions such as inequality and related social determinants of ill health and early death


Activism that seeks alternatives to neoliberalism and privatization encourages participation emphaszes solidarity rejects traditional political forms

Challenge: to develop strategies for activism that can

extend these “counter-hegemonic” spaces to broader social change.


Goal of social movements is not simply to win but also to encourage public debate and raising the level of political consciousness. This new consciousness

rejects the inevitability of empire fosters a vision of medicine and public health constructed around principles of justice rather than commodification and profitability.


As the era of empire passes, no other path will resolve our most fundamental aspirations for healing.

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OVERVIEW - the Conference Exchange...Annu. Rev. Sociol. 2015.41:271-290. Downloaded from by ${individualUser.displayName} on 08/22/15. For personal use only. Imperialism’s Health