EDITORIAL To Latin America’s Health Fernando Borgia

Latin America has been an immense laboratory Political changes in the application of the neoliberal economic This worsening crisis and the evidence of policies promoted by the World Bank, the economic interests in the invasion of Middle East International Monetary Fund and the countries, both contributed enormously to what Interamerican Development Bank. These policies Eduardo Galeano3 called “the end of fear”. This were followed and promoted through cooperation has been symbolized in Bolivia by the assumption missions by multilateral agencies with the of power by President Evo Morales, representative complicity of sitting governments and local of the indigenous peoples of America. According bourgeoisie. to public opinion polls, in the presidential election However, nowadays Latin America is held on 18 December 2005, none of the candidates witnessing a series of experiments in “counter would obtain the absolute majority (50% plus one) reform.” These can be understood as “progressive necessary to be directly elected, therefore, the reforms” in reaction to former neoliberal programs president would be appointed by the new and some of them are summarized in this editorial. Congress. However, election results gave Evo Morales an absolute majority with more than the Neoliberal heritage 54% of the vote, instead of what previous polls In order to understand their originas it is had showed (37%). Nearly 30% of the electorate important to carefully example a typical example Quechua, and 25% are Aymara. Political of the results of neoliberal policies in Latin instability had been a characteristic of Bolivia’s America: the Argentinean crisis after the Menem recent past. There were five presidents in four era1. This crisis had economic, social and health years as a consequence of the neoliberal economic consequences, consequences which had parallels reforms known as “shock therapy” instituted by in the rest of the continent. Possibly the greatest President Gonzalo Sánchez de Lozada. These paradox was that while on the one hand there was reforms led to the privatization of former public a significant increase in the production of utilities, and eventually to what has been called agricultural and fishing products, this was “the Gas War” when in October 2003, protests accompanied by a marked increase in hunger and forced Sánchez de Lozada to resign. Most chronic, severe malnutrition, principally in protesters were indigenous peasants and miners. children under five. On the other hand there were Carlos Mesa Gisbert served briefly as Interim record tax collections resulting from the sale of President. During his brief administration, Mesa many public companies and decreased social organized a referendum on the nationalization of spending as social responsibilities were transferred industrial hydrocarbon. Although he claimed the to the market sector. This caused the enrichment of referendum was a success [voters approved a few and generated “the social holocaust”2, nationalization], critics noted that the wording of moving the country towards a market society in the referendum with respect to absolute which human rights are redefined from a nationalization of hydrocarbons was vague and commercial perspective, thus producing an ambiguous. A new social and political crisis increase in social vulnerability of a considerable developed. A second Gas War broke out in May number of inhabitants. 2005, when the Congress declared there would be an increase from 18% to 32% in the taxes on foreign companies. Protesters led by Evo Morales

and Felipe Quispe considered that the law was not 1 Carlos Menem was President of Argentina for two consecutive ten-year-periods (1989-1995, 1995-1999) 2 Borón, Atilio A., “Estado, capitalismo y democracia 3 Uruguayan writer known for his book “The Open en América Latina”, CLACSO Buenos Aires, 2003. Veins of Latin America”

Social Medicine (www.socialmedicine.info) - 142 - Vol. 1, No. 2, December 2006 sufficiently beneficial to the country and set up USA), loyal army officersre took power and roadblocks to cut off La Paz. In June 2005 protests Chávez was returned to the presidency. finally forced Mesa to resign. After the Presidents On 15 August 2004 59.1% of the voters of the Senate and the Chamber of Deputies approved a referendum which authorized Chávez declined the post (both constitutional successors of to remain as President until 2006; six-year the President), Eduardo Rodríguez, the Chief presidencies were established by the new Justice of the Supreme Court, was appointed constitution but he had been elected under the President. He called for presidential elections, former, which provided otherwise. By the end of which Evo won categorically. the year 2004, elections were held at a municipal Prior to that, the political scene of Chile had and state level; most of the elected governors and been altered by Michelle Bachelet’s (Socialist mayors were supporters of Chávez. At a different Party) election to the Presidency. She has become date in September 2005, town councilors and the first woman President in the country’s history, parish committees were elected for the first time in winning runoff elections held on 15 January 2006 the country’s history. In December 2005, all with 53.5% of the vote. Her election was partly the National Assembly seats were won by supporters result of previous coalitions by Patricio Alwin of Chávez. 75% of the electorate did not vote; (1990-1994), Eduardo Frei (1994-2000) and most candidates of the opposition resigned their Ricardo Lagos (2000-2006). Some important candidacies claiming that Venezuelan elections changes can be foreseen; for example, the gender was not valid. Supporters of Chávez considered equality among members of the Council of this was a boycott to the country’s electoral Ministers. system. The next presidential elections are being In the Bolivarian Venezuela, Hugo Chávez held on December 3 of this year, and the elected was the presidential candidate of the Political candidate shall rule Venezuela until 2013. All Party of the Fifth Republic (Movimiento opinion polls show Chávez as winner, although Quinta República, MVR) in coalition with they state that many voters could change their other political parties and organizations that option. In Brazil, on 27 October 2002, Luiz Inàcio Lula formed “the Patriotic Pole” (Polo Patriótico). Da Silva – candidate of the Workers’ Party Chávez took office on 2 February 1999. On 25 (Portuguese: Partido dos Trabalhadores – PT) – July of that year, a Constituent Assembly met was elected President with 61.34% of the vote, in a and in December of 1999 a new constitution runoff election. He became the first worker and was approved in a referendum and came into socialist President in Brazil’s history. On October force. In July of 2000, there were new general 29, 2006, he was re-elected President for another elections and Chávez won with 59.7% of the 4-year-period with 60.74% of the vote, again in a vote, starting his six-year presidential term on runoff. 17 August 2000. His party - the MVR – has In Panama, Martin Torrijos – member of the won a majority of positions in municipal, state opposition – won the elections held on May 2, 2004, with 47.44% of the vote. Torrijos belongs to and congressions elections since then. a center-left alliance called “New Country” On 11 April, 2003 protesters, from both sides, (Patria Nueva) formed by the Democratic were killed in a general strike organized by Revolutionary Party (Partido Revolucionario FEDECAMARAS (Venezuelan Federation of Democrático, PRD) and the People’s Party Chambers of Commerce) leading to the (Partido Popular,PP). Ex-President Guillermo announcement by General Lucas Rincón Romero Endara – Solidarity Party (Partido Solidaridad, that Chávez’s had resigned. There was an PS) lostt with only 30.86% of the vote. immediate coup d’ètat by dissident army officers In Uruguay, the coalition of left-wing parties and Pedro Carmona Estanga (President of and progressive forces called Progressive FEDECAMARAS) was named President. On 14 Encounter-Broad Front-New Majority (Encuentro April 2002, after two days of social protests and Progresista-Frente Amplio-Nueva Mayorìa, EP- lacking any international support (except the FA-NM) led Tabaré Vázquez to win the elections

Social Medicine (www.socialmedicine.info) - 143 - Vol. 1, No. 2, December 2006 held on 31 October 2004. He obtained an absolute FSLN obtained 40% of the vote, defeating Lawyer majority of the vote in the first round and the José Rizo, candidate of the right-wing majority of Parliament seats in both Chambers. Constitutional Liberal Party (Partido Liberal The Party in the government – the traditional Constitucional, PLC). Rizo’s was a protégé of Colorado Party – was roundly defeated rival former President Arnoldo Alemán (1997-2002) obtaining only 10% of the vote. In July 2005, after who had been found guilty of corruption. Other the results of local elections held in the 19 losers in this election included: the right-wing departments, the Left, which had governed in Nicaraguan Liberal Alliance (Alianza Liberal Montevideo, now assumed power in seven more Nicaragüense), led by banker and ex-civil servant Departments (Treinta y Tres, Rocha, Maldonado, ; the Sandinista Renewal Canelones, Florida, Slato y Paysandù). Movement (Movimiento Renovador Sandinista, All these changes have been preceded by MRS), which was once part of the FSLN and experiences in local, municipal and provincial whose candidate was the economist Edmundo governments with counter-hegemonic char- Jarquín; and the acteristics, but also by failures like the Alliance4 in (Alternativa por el cambio, AC), whose candidate Argentina or Lucio Gutiérrez’s government5 in was the former guerrilla fighter Edén Pastora who Ecuador. had distanced himself from the Sandinistas a long Winds of change are blowing in time ago. where elections held last November were won by In Costa Rica elections held on February 5, the Sandinista National Liberation Front (Frente 2006 were narrowly won by social democrat ic Sandinista de Liberación Nacional,FSLN), which candidate Oscar Arias – former President [1986 - ruled the country between 1979 and 1990, after 1990] – who obtained 1.1% more than his main defeating the dynastic dictatorships of the Somoza opponent, Otton Solís Fallas of the Citizen’s family which they had fought since the ‘60s. The Action Party (Partido de Acción Ciudadana) who obtained 40% of the vote. In 1987, Arias was 4 Political force formed by the Radical Party and the awarded the Nobel Peace Prize due to his coalition of left-wing parties gathered in the Front for a participation in the peace processes of armed Country in Solidarity (Frente País Solidario, conflicts in Latin America. Otton, who has a FREPASO) created to avoid Menem’s re-election. The Alliance won the elections, but afterwards its economic position against CAFTA, has an important support policies increasingly followed Washington’s guidelines in Parliament. The candidate who obtained the and Domingo Cavalo – Menem’s Economy Minister – lowest number of votes was Ricardo Toledo was named Minister of Economy. Changes in economic Carraza of the Social Christian Unity Party policies alienated Vice President Carlos Álvarez (Partido Unión Social Cristiana – PUSC). He (FREPASO) and led to his eventual resignation. In December 2001, the economic and social crisis forced obtained 5%, while former President Abel Pacheco President Carlos de la Rua (Radical Party) to resign. (of the same party) obtained 58% of the vote in the 5 Lucio Gutiérrez supported the rebellion of indigenous second round. peoples on 21 January 2000, which overthrew President In Ecuador the right-wing millionaire and Jamil Mahuad’s government. Gutiérrez was elected businessman Álvaro Noboa, candidate of the President on 20 October 2002 with the support of indigenous people’s movements and he appointed a Institutional Renewal Party of National Action male and a female minister from indigenous (Partido Renovador Institucional Acción backgrounds. On 20 April 2005, he was dismissed by Nacional,PRIAN), obtained only 3.9% more than the Congress after serious social protests caused by his the left-wing economist Rafael Correa of Country failure to carry out the governmental program, nepotistic attitudes, the proposal of a Free Trade Alliance (Alianza País, AP) in the first round of Alliance with the United States, the alliance with ex- the presidential elections held last 15 October; President Abdalá Bucaram (found guilty of corruption), they got 26.8% and 22.9% of the valid votes, and other causes. Alfredo Palacio was then appointed respectively. The runoff is held next 26th Deputy President. Gutiérrez took refuge first in Brazil November. and then in Colombia. He was captured when he returned to Ecuador in October 2005. He was charged Health reforms and counter reforms with sedition; however, he was released after the The health reforms implemented during the Superior Court of Quito dismissed the case in March ‘80s and ‘90s tended to reduce state responsibility 2006.

Social Medicine (www.socialmedicine.info) - 144 - Vol. 1, No. 2, December 2006 for social policy, including health policy. The ethical foundations of patriarchy and Responsibility was transferred to individuals and Neoliberalism to the private sector which was seen as the Latin America owes its dramatic situation to a privileged administrator. crisis in social justice. This, in turn, is based on an The Bolivarian counter reform in Venezuela is ethical crisis which occurs when market efficency based on a constitutional reform which is seen as more important than collective welfare. acknowledges a state responsibility for a series of This ethical crisis was fed by the “red fear” which social rights, including the right to health and served as an excuse for inhuman and cruel acts of social welfare. torture, kidnapping, forced disappearance of In Brazil, the Single Health System was born people and children trade, during the bloody civic- during the democratic recovery process and was military dictatorships of the ‘70s and ‘80s, and included in the 1988 constitutional reform. Its which continued with the approval of impunity implementation and the neoliberal offensive took laws and corruption among members of the place almost at the same time; fundamental laws governments. creating the new system health came into effect in 1990. This gave the system a counter hegemonic Social and Ethical grounds for “the change” character. It guaranteed the access to health As a way of example on how the different services and was based on a major public perspectives have developed in the political scene investment, governmental and municipal of Latin America: administration of resources, and the obligation In Bolivia, the election of Evo, representative placed on the private sector to keep part of its of the Bolivian indigenous peoples, not only capacity for the public sector. demonstrates political change and the The counter reform in Uruguay seeks to acknowledgement of an ethnic majority formerly gradually extend the health insurance system and excluded from the executive power, but also to equalize the quality of health services by suggests the creation of a strong State with the creating an Integrated Health System and a legalization of coca production and the protection National Health Insurance. of natural resources – mainly hydrocarbons. This In Chile, Bachelet’s government has announced strong State should regulate the industrial its intention to modify the insurance model economic expansion, absorb its surplus and implemented by the AUGE Plan; this requires transfer it to the communitarian sector in order to health service providers to offer the insured promote self-organized ways of Amazonian individuals a set of at least seventeen benefits free commercial development. of charge. The government has the intention of In this sense, we can see how foreign requiring more integrated coverage. interference, no matter where it comes from, has In Bolivia, the creation of a National Public been rejected. Prior to the Bolivian elections, Health Insurance is being discussed. It would public statements made by the American Embassy replace the current partial insurances (children were rejected by the population. Such statements under five, pregnant women) and would include were intended to be warnings of institutional and funding of traditional indigenous medicine. economic instability, however, they widened the In Mexico, a successful health policy was electoral grounds for the Movement Towards developed in the capital city (Distrito Federal) Socialism (Movimiento al Socialismo, MAS) and during a progressive government. This occurred eventually led to Evo’s victory. At the same time, through the Medical Services and Free Medicine in Bolivia, both sides have fulfilled their pre- Law. This success led to the political growth of electoral promises. 1) The USA has withdrawn its the Mexican left which was seen as a credible and support to the country and turned cooperation into trustworthy opposition force. an extortion and confrontation tool against the government. Support had been provided mainly via USAID, whose headquarters have now been moved to those provinces where the opposition is in the majority. 2) Evo is gradually reforming the

Social Medicine (www.socialmedicine.info) - 145 - Vol. 1, No. 2, December 2006 models of development, hydrocarbon production, Mexico proves to have an important health, etc. polarization of its population and a complete lack In Uruguay, political changes have re- of guarantees and transparency in its electoral implemented “Salary Councils” whose byproduct processes. Andres Manuel López Obrador’s has been the creation of 400 new trade unions persecution has been a good example of this. He during the 10 first months of the government. was forced to face a political trial organized by the “Salary Councils” are tripartite committees which Right, which he later dismissed. Subsequently, deal with issues such as pay raises and working Mexican presidential elections results showed a tie conditions. between Obrador and Felipe Calderón, candidate In Venezuela, the Bolivarian Revolution of the government. However, the latter was brought about a historic access to literacy, social quickly appointed president and there was a welfare and health care for formerly excluded refusal to count “vote by vote” “ballot by ballot” – people. all of which raise justified doubts about the In Chile, Bachelet’s renewal has introduced outcome. gender equality into political leadership, in the In the meantime , the White House had first country under a “left-wing” regime to sign a promptly acknowledged Felipe Calderón’s bilateral trade agreement with the USA. electoral triumph, paying no attention to all the Surprising the rest of the continent, Brazil and accusations of fraud and inconsistency of results Argentina have paid their debts with the IMF and made by several observers of the electoral process. changed the historical position of the Left Had Manuel López Obrador won the elections, the replacing the “don’t pay the debt” position with Left in Latin America would have had another “pay cash and in advance.” This led to a debate on triumph and the Imperial relationships with the governments’ priorities and social cost of such Mexico, which have been stimulated by NAFTA payments. Unfortuantely, these countries have not (North American Free Trade Alliance) would have yet been able to change the long established been in trouble. traditions of corruption within the state apparatus. Another regrettable antidemocratic event has taken place in Oxaca (Mexico). Gobernor Ulises Fragility of Latin American Integration Ruiz did not acknowledge the legitimacy of the However, the potential vulnerability of these Chamber of Deputies which had demanded his processes is demonstrated by the changes in two resignation after the murder of a teacher and the countries which have been left deliberately abusive use of force made by the police. In this unmentioned: Peru and Mexico. case, popular resistance was strengthened by a Peru’s case shows how the learning process Supreme Court decision, which dismissed the with respect to Latin American integration is far claim by the governor that constitutional issues from over. Once again we have seen a rejection of were at stake. foreign influence on occasion of the public and publicized cross-accusations between Hugo Economic political integration in the Southern Chávez, President of the Bolivarian Venezuela, Common Market: MERCOSUR and Alan García, Former Peruvian President and The public confrontation between Chávez and presidential candidate. Chávez supported Peruvian García deepened the distances between Venezuela presidential candidate Humala and this led to the and the Andean Community (CAN), although this confrontation between Chávez and García. The process had already begun to develop with the conflict, fed by media comparison of Humala with widening political distance between Venezuela, Chavez, ended up favoring García in both the first Ecuador (after its president adopted positions round of voting in which he defeated Lourdes favorable to the United States) and Colombia Flores (Officialist Candidate), and in the second (where Álvaro Uribe was re-elected with a clear round, when he defeated Humala. Humala had majority of the vote). obtained the most votes in the first round, At the same time, Venezuela became a member providing him with a plurality of seats in of MERCOSUR formed by Argentina, Uruguay, Parliament.

Social Medicine (www.socialmedicine.info) - 146 - Vol. 1, No. 2, December 2006 Brazil and Paraguay as well as associate countries time, it proves that solidarity is possible among the – Chile and Bolivia – which are not full members. countries without elaborate preconditions. This does not mean that everything is working This initiative can be added to the experiences properly in the South. There are strong made by the Cuban Latin American School of controversies between Chile, Argentina, Brazil and Medicine and the multiple examples of Cbuan Bolivia regarding the costs of distribution and technical cooperation, mainly in the fields of development of hydrocarbons. On the other hand, tropical diseases and natural disasters (hurricanes there still exists Bolivia’s historical claim to a and earthquakes). Exemplary of this kind of pathway to the Pacifc through Chile; this is cooperation has been Cuban’s “Mission into the currently being negotiated within the OAS. There neighborhood” (Misión Barrio Adentro) in also exists a conflict between Argentina and Venezuela. Uruguay regarding the installation of cellulose The extreme situation in Uruguayan is another paste plants along the Uruguay River (a border case in point. Cuba donated vaccines against between the two countries). The MERCOSUR meningitis even though Uruguay had broken Arbitration Court award has sustained Uruguay’s diplomatic relations with the island. position, however, the controversy has been taken to The Hague, as provided by the Uruguay River The Empire: Celebrations and Contradictions Treatment. The list goes on. Paradoxically, it is Fidel Castro’s health that is However, MERCOSUR appears to be a sub- in the spotlight now. This has led to premature regional space where there are “ideological celebrations by anticastrists organized in Miami; similarities.” This is true despite the fact that one and Condolezza Rice’s call for insurrection and could not say Nicanor Duarte has a Left ideology government usurpation on CNN Spanish. and Néstor Kirchner can only be seen as a It seems that there still exist people who think progressive within his own party (Peronist) and that an imposed model of republican democracy – only if compared to his predecessor – Menem. like the one attempted in Iraq – is the solution to In spite of that, MERCOSUR, which the prosperity and happiness of the world’s people, encompases 75% of South American GDP, has put although the experience in Iraq has proved this is on its agenda the discussion of topics which go false. And thus the elected government in beyond commercial agreements and which suggest Palestine has not been acknowledged as it is that it is a vehicle for social and political considered to be composed of terrorists – although integration. it was elected in a multiple party regime election Ideological similarities have been evidenced by which was observed by international watchers. the commercial agreements with Cuba signed during the 25th Summit of Presidents of the Conclusions Common Market. Cuba’s integration to Strong winds of change in Latin America are MERCOSUR was proposed during the summit,. blowing whatever the weather up north might be; This constitutes the strongest political action taken they swirl around and reappear just when their against the economic embargo imposed to that spirit seems to be vanishing. In each country, the country by the United States. changes combine the experiences of struggle and resistance against neoliberalism with imperfect New alliances for health and incomplete projects of alternative develop- The Health sector demonstrates most clearly ment. The inconsistent process of integration is that new alliances are necessary in order to inconsistent, its backwards and forward steps, achieve further changes in this part of the South. serve to highlight the tensions between Latin The so called Cuban “Miracle Operation” provides American nationalisms even while the focus is on eye operations free of charge for poor people from economic and commercial issues. With respect to every country in the continent. This program health policies an increasing number of parties, shows how the insurance and market models have municipalities, cities, provinces, states, left behind those people in need, and at the same departments and countries are moving along a complex way to decomodify health. No matter

Social Medicine (www.socialmedicine.info) - 147 - Vol. 1, No. 2, December 2006 how incipient, contradictory, vulnerable or All things considered, a toast is proposed. dependant on external cooperation or Latin Wishing that Latin America would be more American solidarity, these changes may be, they integrated on the grounds of solidarity among its are all auspicious – specially if compared to the peoples and hoping the history, culture, struggle prior political-ideological scene set by the reforms and resistance that unites this continent are given implemented under the influence of the World their proper importance... to Latin America’s Bank, the International Monetary Fund and United Health! States strategic interests. Montevideo, Uruguay Fernando Borgia [email protected]

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