DOCSLIB.ORG

Smallpox Eradication Policies in Brazil (1962-1973)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Smallpox Eradication Policies in Brazil (1962-1973) ARTICLES / ARTÍCULOS SALUD COLEC T Chronicle of a consolidated success: smallpox IVA. 2019;15:e2167. doi: 10.18294/sc.2019.2167 eradication policies in Brazil (1962-1973) Crónica de un éxito consolidado: las políticas de erradicación de la viruela en Brasil (1962-1973) Jonatan Sacramento1 1PhD Student, Social ABSTRACT The aim of this article is to understand actions taken towards smallpox eradica- Sciences Postgraduation Program, Philosophy and tion in Brazil, in the framework of the Smallpox Eradication campaign that took place in the Human Sciences Research 1960s and 1970s. The article argues that, in addition to the bifurcated needle and the lyo- Institute, Universidade philized vaccine, epidemiological surveillance – based on the construction of instruments Estadual de Campinas, São Paulo, Brazil. * and protocols for health surveillance – was the third key element that guaranteed the eradi- cation of the disease. The hypothesis is that the actions taken towards the control and erad- ication of smallpox contributed to the construction of new health institutions within Brazil. As an exercise of socio-historical analysis, this research was based on documentary sources (reports, newsletters and legislation), interviews with professionals directly involved in the eradication of smallpox, and part of the intellectual production on the subject. KEY WORDS Smallpox; Eradication; Epidemiological Surveillance; Health Policy; Brazil. RESUMEN El objetivo de este artículo es comprender las acciones del combate contra la viruela en Brasil en el marco de la Campaña de Erradicación de la Viruela, que tuvo lugar entre las décadas de 1960 y 1970. A partir de la construcción de instrumentos y protocolos de vigilancia en salud, se intenta argumentar que, además de la aguja bifurcada y de la vacuna liofilizada, la vigilancia epidemiológica fue el tercer elemento clave que garantizó la erradicación de la enfermedad. La hipótesis que se pretende sustentar es que las acciones de control y erradicación de la viruela contribuyeron a la construcción de nuevas instituciones de salud en el interior de Brasil. Como un ejercicio de análisis sociohistórico, la investigación se basó en fuentes documentales (informes, boletines y legislaciones), en entrevistas con profesionales directamente involucrados con la erradicación de la viruela y en parte de la producción intelectual de estos respecto del tema. PALABRAS CLAVES Viruela; Erradicación; Vigilancia Epidemiológica; Políticas de Salud; Brasil. Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2019.2167 2 SACRAMENTO J. INTRODUCTION with power and as an object of knowledge through the control of smallpox in the 18th century.(9) As a chronicle of a consolidated success, If taking actions to combat smallpox in smallpox eradication occupies a unique place that century helped to constitute the new in the history of international public health. form of the State and the State power, in Bra- However, research studies on this subject zil, at the beginning of the 20th century, the seem to have a marginal place in the historiog- fight against smallpox had the same role in . 2019;15:e2167. doi: 10.18294/sc.2019.2167 A raphy of public health in Brazil, only dealing promoting the creation of scientific institu- IV with analyses that emphasize a major episode tions to produce the vaccine and generating ECT L known as the “The Vaccine Revolt,” which oc- the need to maintain a team of civil servants CO curred in the year 1904, when the population to fight epidemics. As shown by Hochman,(10) LUD A of Rio de Janeiro of the newly-born republic the “sanitation of Brazil” enabled not only S rose in rebellion against the mandatory vac- the fight against the main diseases that dev- cination measures imposed by the municipal- astated the inner territories of Brazil, but also ity of Rio de Janeiro.(1,2,3) Interest in discussing the construction of the whole State public smallpox eradication is recent and, until now, health bureaucracy in the 1920s and 1930s, there have been few research studies seeking which would be consolidated in the insti- to recover the history of the Smallpox Eradica- tutions that even today, one hundred years tion Campaign in Brazil.(4,5,6,7,8) later, are still active in the country. Keeping However, observing smallpox and its in mind the relative importance and the his- eradication campaign helps us to understand torical context, something similar seemed to the relations between health, society, the have happened with smallpox eradication. State, and its institutions, as well as the actors As I will show throughout this article, the that were involved in such experiences. As fight against smallpox, starting in 1965, made shown by Foucault,(9) the response adopted possible the redefinition of health institutions by the State to smallpox epidemics in Europe at a national scale, the production of immu- in the 18th century led to one of the most sig- nological materials, and the creation of pub- nificant political and organizational changes lic health statistics, apart from organizing a in terms of the conception of power and its new public health routine for reporting and connection with the people. controlling diseases. The emergence of the idea of population, The Brazilian production on smallpox as an entity that should be managed through eradication has shown how this action was in- a security apparatus as a new technique of tegrated into a broader scenario of discussion power, brought along the need to combat within the international public health sphere smallpox in order to control death rates, as a regarding eradication of diseases,(4,5,6,7,8) in result of the disease outbreaks. Furthermore, which epidemiological surveillance became, this safety device enabled, after establishing at least in terms of smallpox eradication, a vital statistics records and probability calcu- methodology applied to control diseases.(4) In lations for life expectancy, not only a direct this sense, Gazeta(5) affirms that the Smallpox control of the population health, but also the Eradication Campaign in 1966 was used as a protection of health and a less dangerous public health policy in a context of interna- type of the disease. tional articulation and efforts to control and According to Foucault, smallpox started eradicate the disease, subject to the coordi- to be understood as a collective phenome- nation by the World Health Organization non, and as a result it was included in the (WHO). In this way, according to the author,(6) social dynamics of a safety device that was the structure within which the Campaign was born at that time, focused on the demogra- established was inversely proportional to the phy of the disease and its control. Hence, the seriousness of the disease in Brazil, where the concept of population was born as a correlate “benign” version was already predominant as CHRONICLE OF A CONSOLIDATED SUCCESS: SMALLPOX ERADICATION POLICIES IN BRAZIL (1962-1973) 3 SALUD COLECTIVA. 2019;15:e2167. doi: 10.18294/sc.2019.2167 a consequence of the control measures im- process, the aim was to understand the intel- plemented in the 1962-1965 period. lectual trajectories of the participants in erad- It is along those lines that Hochman(7) icating the disease as well as the international shows how such changes within the national public health context in which such actions and international context of disease eradi- were taken. cation and control policy referred not only to public health, but also to issues linked to economic development and international re- METHODOLOGY lations between the main political and eco- nomic powers of that time, mainly the USA and the Soviet Union, and other countries. Using a qualitative approach, the research In the case of Brazil, even without a consen- was based on three procedures: a review sus between physicians and national author- of national and international literature deal- ities on the health significance of eradicating ing with smallpox eradication in Brazil and smallpox, control of the disease materialized worldwide; documentary analysis of epi- as an opportunity to create a good image of demiological newsletters published by the the military regime at that time, apart from Smallpox Eradication Campaign between having been a contribution to the construc- 1967 and 1974, of federal and state legis- tion of an “immunization culture” in Brazil.(8) lation relating to smallpox eradication, and In this context, this article seeks to under- of statements made by physicians and other stand the process of eradication of smallpox health care professionals working in the in Brazil, based on the construction of epide- Campaign; and an interview with one of the miological knowledge and the institutional- Campaign coordinators. ization of a public health apparatus within the policies to combat smallpox in the national territory. In order to discuss the dynamics of From center stage to backstage: the production of epidemiologic knowledge smallpox as a national public health and public health policies, the goal is to priority show how the combat against smallpox and, mainly, the rediscovery of smallpox as a pub- In the history of Brazilian public health, lic health problem enabled the consolidation smallpox followed a priority, invisibility and of the bureaucratic and intellectual apparatus eradication triad.(7,8) It was a priority at the of Brazilian public health, through the insti- beginning of the 20th century, along with tutionalization of protocols and public health yellow fever, as it was the target of the man- practices. The hypothesis presented here is datory vaccination campaign imposed by the that, in addition to the bifurcated needle and federal government in the actions directed by the lyophilized vaccine, indicated in the Bra- public health officer Oswaldo Cruz (1872- zilian literature as being essential for eradi- 1917), in the transformation process under- cation, epidemiological surveillance was the taken in the city of Rio de Janeiro during the third key element for its consolidation.
Load more

Recommended publications
  • UCLA Electronic Theses and Dissertations
    UCLA UCLA Electronic Theses and Dissertations Title Growing Taller, yet Falling Short: Policy, Health, and Living Standards in Brazil, 1850-1950. Permalink https://escholarship.org/uc/item/7nn3b9g6 Author Franken, Daniel W. Publication Date 2016 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA Los Angeles Growing Taller, yet Falling Short: Policy, Health, and Living Standards in Brazil, 1850-1950 A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in History by Daniel William Franken 2016 ! © Copyright by Daniel William Franken 2016 ABSTRACT OF THE DISSERTATION Growing Taller, yet Falling Short: Policy, Health, and Living Standards in Brazil, 1850-1950 by Daniel William Franken Doctor of Philosophy in History University of California, Los Angeles, 2016 Professor William R. Summerhill, Chair The emergence of regional inequities and the genesis of modern economic growth in Brazil have remained shrouded by a dearth of historical evidence. Although quantitative scholars have revealed the efficacy of the First Republic (1889-1930) in fomenting economic progress, the extent to which Brazil’s early economic growth fostered improvements in health remains unclear. My dissertation fills this void in scholarship by relying on hitherto untapped archival sources with data on human stature—a reliable metric for health and nutritional status. Heights offer an excellent source of knowledge regarding human development for Brazil in the 1850-1950 period—an era of deep social, political, and economic transformations. My analysis centers heavily on a large (n≈17,000), geographically- comprehensive series compiled from military inscription files, supplemented by an ancillary dataset drawn from passport records (n≈6,000).
    [Show full text]
  • 54 Manguinhos, Rio De Janeiro, Brazil
    NEW USES FOR SCIENTIFIC AND HEALTH HERITAGE : A SMALLPOX VACCINE SAMPLE AS AN OBJECT OF INTERDISCIPLINARY STUDY Pedro Paulo Soares Casa de Oswaldo Cruz/Fundação Oswaldo Cruz, Manguinhos, Rio de Janeiro, Brazil In 1900, Brazil had the hideous titles of a pestilent country and a foreigners’ grave, due to the poor sanitary conditions that were a part of the daily life in Rio de Janeiro, the country’s capital city. Among the main sanitary/salubrious issues faced by the Carioca people and that concerned the medical officials, there were diseases such as yellow fever, typhoid fever, malaria, smallpox, bubonic plague and tuberculosis. Yellow fever and smallpox, with endemic focal points all over the country, were especially aggressive to foreigners and migrants from other states that had come to the capital looking for work and investment opportunities (1). To organize the fight against the diseases, which were a huge problem for the country’s image and with great impact on its economic activities, President Rodrigues Alves appointed Oswaldo Cruz, MD, to lead the Diretoria Geral de Saúde Pública (Federal Health and Sanitation Department) and promote campaigns against bubonic plague, yellow fever and smallpox in Rio de Janeiro. Sructured in a military way, with brigades and sanitary guards, the division of the city in medical districts, the enforcement of laws and regulations to extinguish the main outbreaks and vectors of those diseases, the sanitary campaigns were successful, but faced a strong rejection and a lot of criticism from medical, political and popular classes in Rio de Janeiro. The local press 54 recorded the turmoil in articles, editorials, letters from readers and many humorous drawings, which criticized Oswaldo Cruz, his theories and sanitation policies, as extremely authoritarian.
    [Show full text]
  • Clinical Biotechnology and Microbiology ISSN: 2575-4750
    Page 144 to 155 Volume 1 • Issue 4 • 2017 Mini-Review Clinical Biotechnology and Microbiology ISSN: 2575-4750 Limitations for Biotechnology Innovations in Brazil Luiz Antonio Barreto de Castro* CEO of Agriculture Biotechnology Consultant and Projects, Brazil *Corresponding Author: Luiz Antonio Barreto de Castro, CEO of Agriculture Biotechnology Consultant and Projects, Brazil. Received: October 24, 2017; Published: October 31, 2017 Abstract Four years ago I and others have published an Ebook for Bentham E Books: Opportunities and Limitations for Biotechnology Inno- vation in Brazil. Since 2011 I have contribute to the Bioentrepreneur Tradesecrets blog of Nature: http://blogs.nature.com/trades- ecrets/author/lbarreto. To date thirty one contributions for the blog were produced mostly dealing with Biotechnology. The context move so fast that I feel stimulated to review the subject to analyze if Biotechnology Innovation in Brazil has progressed lately. We can start with the statement that Brazil has built intelligence in Biotechnology during the last half of century. In the seventies Brazil Brazil during four decades and more important, this happened challenging political diversity that normally caused alternation in sci- contributed with 0, 4% of the global scientific output. Today this contribution jumped to 2.6%. Nothing has been multiplied by six in entific policies for ideological reasons. As a National Secretary in Research and Development working for the Ministry of Science and Technology for fifteen years I experienced lack of continuity in our programs because new Ministers always wanted to introduce new ideas. It will be difficult for our Sc & Tech to survive if the selection of SC & T Ministers is not technical but political.
    [Show full text]
  • Whelden, Schuyler
    UNIVERSITY OF CALIFORNIA Los Angeles The Political Voice: Opinião and the Musical Counterpublic in Authoritarian Brazil A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Musicology by Schuyler Dunlap Whelden 2019 © Copyright by Schuyler Dunlap Whelden 2019 ABSTRACT OF THE DISSERTATION The Political Voice: Opinião and the Musical Counterpublic in Authoritarian Brazil by Schuyler Dunlap Whelden Doctor of Philosophy in Musicology University of California, Los Angeles, 2019 Professor Tamara Judith-Marie Levitz, Co-Chair Professor Timothy D. Taylor, Co-Chair This dissertation investigates how music making shapes political participation during periods of democratic crisis and authoritarianism. It examines the musical theater production Opinião, which was staged nightly in Rio de Janeiro from December 1964 to April 1965 at the onset of the Brazilian military dictatorship. Rather than examining Opinião as the reflection of its director’s or authors’ politics, I take an intersectional approach that focuses on the performers and audience members, who came from different gender, racial, geographic, and class backgrounds. Through an analysis of the show’s performances, I demonstrate how people from diverse populations enacted political protest. I put their diverse strategies for intervening in the Rio de Janeiro public sphere into dialogue with one another to demonstrate how authoritarian regimes impact different ii sectors of society. My inquiry combines both ethnographic and archival research methods. I draw on hundreds of archival documents and recordings—including newspaper and magazine clippings, theater programs, advertisements, and other ephemera—to reconstruct details of the show and investigate in depth the discourse that the show engendered.
    [Show full text]
  • History of Health and Disease in Modern Latin America
    Swarthmore College Works History Faculty Works History 2012 History Of Health And Disease In Modern Latin America Diego Armus Swarthmore College, [email protected] Follow this and additional works at: https://works.swarthmore.edu/fac-history Part of the History Commons Let us know how access to these works benefits ouy Recommended Citation Diego Armus. (2012). "History Of Health And Disease In Modern Latin America". Latin American Studies. DOI: 10.1093/obo/9780199766581-0094 https://works.swarthmore.edu/fac-history/266 This work is brought to you for free by Swarthmore College Libraries' Works. It has been accepted for inclusion in History Faculty Works by an authorized administrator of Works. For more information, please contact [email protected]. History of Health and Disease in Modern Latin America - Latin America... https://www.oxfordbibliographies.com/view/document/obo-9780199766... History of Health and Disease in Modern Latin America Diego Armus LAST REVIEWED: 05 MAY 2017 LAST MODIFIED: 30 SEPTEMBER 2013 DOI: 10.1093/OBO/9780199766581-0094 Introduction Since the early 1980s, historical studies on disease and health in modern Latin America have produced a significant body of scholarship. Efforts to renew the traditional history of medicine and the spread of historical studies of population with a social and cultural emphasis are some of the trends that explain this historiographical process. Three ways of writing define the field: the history of public health, biomedical history, and the sociocultural history of disease. There is a good deal of overlap among these three approaches, because all three tend to discuss diseases, health, and medicine as socially generated processes of grouping biomedical and sociocultural phenomena.
    [Show full text]
  • Brazilian History
    Brazilian History Brazilian History: Culture, Society, Politics 1500- 2010 By Roberto Pinheiro Machado Brazilian History: Culture, Society, Politics 1500-2010 By Roberto Pinheiro Machado This book first published 2017 Cambridge Scholars Publishing Lady Stephenson Library, Newcastle upon Tyne, NE6 2PA, UK British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Copyright © 2017 by Roberto Pinheiro Machado All rights for this book reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. ISBN (10): 1-5275-0349-6 ISBN (13): 978-1-5275-0349-6 To Cláudia Mendonça Scheeren CONTENTS Introduction ................................................................................................. 1 Chapter One ................................................................................................. 9 The Colonial Period (1500–1822) 1.1 From the Discovery to the Colonization 1.2 The French Invasions (1555–1560 and 1594–1615) 1.3 The Dutch Invasions (1624–1625 and 1630–1654) 1.4 The Iberian Union and the Portuguese Territorial Expansion 1.5 The Discovery of Gold and the Minas Gerais 1.6 The Conspiracy of Minas Gerais and Brazilian Neoclassicism 1.7 The Conspiracy of Bahia and the Emergence of the Notion of Citizenship 1.8 A European Monarchy in the Tropics and the End of Colonial Rule Chapter Two .............................................................................................. 49 The Brazilian Empire (1822–1889) 2.1 The Costly Independence 2.2 The First Empire (1822–1831) 2.3 The Regency (1831–1840) 2.4 The Second Empire (1840–1889) 2.5 Culture and Society in the Brazilian Empire Chapter Three .........................................................................................
    [Show full text]
  • National Immunization Program: Vaccination, Compliance and Pharmacovigilance
    Rev. Inst. Med. Trop. Sao Paulo 54(Suppl. 18):S22-S27, October, 2012 NATIONAL IMMUNIZATION PROGRAM: VACCINATION, COMPLIANCE AND PHARMACOVIGILANCE Carla Magda Allan S. DOMINGUES(1,2), Antonia Maria da Silva TEIXEIRA(1) & Sandra Maria Deotti CARVALHO(1) The vaccine is one of the main control measures available for a major diseases was the subject of pressure in the sector. A remarkable fact was portion of infectious and transmissible diseases. It stands out as one of an epidemic of meningococcal meningitis that spread in the country in the great discoveries of public health for the benefit of the population. the mid 70’s, the so-called “epidemic under censorship”. The insufficient doses of vaccines in the country and of the capacity to import vaccine In Brazil, more than two centuries have passed since the first time doses to attend the population, made the current military government to (1804) the vaccine was administered as a control measure to prevent prevent any disclosure of the fact in the media. However, this was only smallpox. Exactly a century later (1904), an epidemic of this disease possible while the occurrence of cases did not reach different social strata led the President of the Republic Rodrigues Alves, to establish the of the population; when this began to occur, the information reached obligation of the vaccination. In the same year, the hygienist Osvaldo the media, which generated population pressure on the government3,4. Cruz coordinated the mass vaccination of the Rio de Janeiro`s population in order to control the epidemic. This movement generated a historical Despite these contrasts, it was in this context that important episode known as “The Vaccine Revolt” characterized by population advances occurred regarding the organization of the structure and rebellion and rejection to the measure adopted, culminating in the actions of immunization in Brazil.
    [Show full text]
  • Priority, Invisibility and Eradication: the History of Smallpox and the Brazilian Public Health Agenda
    Medical History, 2009, 53: 229–252 Priority, Invisibility and Eradication: The History of Smallpox and the Brazilian Public Health Agenda GILBERTO HOCHMAN* Introduction This article describes three periods in Brazil’s modern history when governmental action was (or was not) taken against smallpox: first, when smallpox control became a priority in the Brazilian sanitary agenda from the nineteenth century to the beginning of the twentieth century; second, when it was rendered politically invisible during decades when greater attention was given to yellow fever and malaria control; third, when it reappeared at the cen- tre of Brazilian health policy in the 1960s until its eventual eradication in 1973. Smallpox control in the latter two periods is suffused with paradox. For example, evidence suggests that the nearly fifty-year absence or lack of policies and agencies to deal with smallpox actually favoured the mobilization of local, national and international resources once the era- dication programme was launched in 1966; these new approaches were accelerated from 1969 until the completion of eradication in 1973. Equally paradoxical, it was during the spe- cific context of the military regime after 1964 that the Brazilian health system developed the capacity to mobilize existing but dispersed resources and flexibly to innovate, incorporate, and adapt new policies. Another important element in this period was institutional learning based on other vertical programmes such as the malaria eradication campaign. Although the Brazilian smallpox eradication programme was constrained by international agencies and by bilateral co-operation with the United States, the period after 1964 offered opportunities for the realization of a new and wide-ranging national health capacity including the creation of a national system of epidemiological surveillance and a national childhood immunization programme.
    [Show full text]
  • Uma Cultura Da Imunização?: Vacinas, Programas De Saúde E Cidadania*
    Uma Cultura da Imunização?: vacinas, programas de saúde e cidadania* Gilberto Hochman Casa de Oswaldo Cruz-Fiocruz Av. Brasil 4036/403 21045-900 Rio de Janeiro Brasil [email protected] Resumo em português: O objetivo dessa apresentação é discutir como as campanhas de vacinação em massa produziram o que denomino de "cultura da imunização", principalmente a partir da campanha de erradicação da varíola no Brasil (1966-1973) que ocorre no período da ditadura militar. Essa "cultura" se construiu ao longo de décadas e se expressou mais claramente quando a população aderiu aos programas governamentais de imunização e demanda cada vez mais vacinas do poder público. Isso contrasta com a resistência a vacinação que foi tão bem expressa pelo episódio da "Revolta da Vacina" de novembro 1904 no Rio de Janeiro e de alguns episódios subsequentes e anteriores de vacinofobia. Meu interesse é especular o que teria mudado no Brasil para que, 60 anos depois, a população, ao invés de fazer barricadas, não só saiu de suas casas e entrou em filas para ser vacinada entre 1967 e 1973 como, depois da erradicação da varíola (certificada em 1973), continuou a participar de campanhas públicas de vacinação, em particular as contra a poliomielite desde os anos 80, e mais recentemente as de sarampo, rubéola, inluenza, entre outras doenças imunopreviníveis. A demanda por mais vacinas vem sendo associada a compreensão, consagrada na Constituição de 1988, de que a saúde (e a imunização) é um direito a ser garantido pelo Estado. No caso brasileiro, a cesta de vacinas oferecidas gratuitamente pelo serviços públicos de saúde é maior do que aquela recomendada pelas organizações de saúde internacionais como a Organização Pan- Americana da Saúde e a Organização Mundial da Saúde (OPAS/OMS).
    [Show full text]
  • Looking for Democratic Inclusion in the Squatter Settlements of Rio De Janeiro, Brazil
    THE CHALLENGE OF THE SLUMS: LOOKING FOR DEMOCRATIC INCLUSION IN THE SQUATTER SETTLEMENTS OF RIO DE JANEIRO, BRAZIL By BRYAN CHRISTOPHER WILLIAMS A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2008 1 Copyright 2008 by Bryan C. Williams 2 To all of the good people who shared their lives with me and made my work possible. 3 ACKNOWLEDGMENTS Although there is only one author of this dissertation, and consequently only one individual to assume the blame for all of its inaccuracies and oversimplifications, there are many people who contributed in various ways to any success in capturing any small part of ‗truth‘ that may be found herein. My most grateful thanks goes to my two mothers, my father, and my beautiful wife whose support was essential to the completion of this document that represents a lifetime of education and pondering. I am thankful to be surrounded by an intellectually stimulating family that understands the importance of long journeys of exploration in order to develop greater personal understandings of the world around. Of equal importance to my study was their generosity with their time, patience, and their cooking that allowed me to concentrate on struggling with ideas rather than the maintenance of my body and home. I would also like to thank my dissertation committee for their instruction and personal insight on how I might decode the complexity of the great blooming, buzzing confusion of the world. More specifically, I owe a large debt of gratitude to the Chairperson of my committee, Dr.
    [Show full text]
  • Priority, Invisibility and Eradication: the History of Smallpox and the Brazilian Public Health Agenda
    Medical History, 2009, 53: 229–252 Priority, Invisibility and Eradication: The History of Smallpox and the Brazilian Public Health Agenda GILBERTO HOCHMAN* Introduction This article describes three periods in Brazil’s modern history when governmental action was (or was not) taken against smallpox: first, when smallpox control became a priority in the Brazilian sanitary agenda from the nineteenth century to the beginning of the twentieth century; second, when it was rendered politically invisible during decades when greater attention was given to yellow fever and malaria control; third, when it reappeared at the cen- tre of Brazilian health policy in the 1960s until its eventual eradication in 1973. Smallpox control in the latter two periods is suffused with paradox. For example, evidence suggests that the nearly fifty-year absence or lack of policies and agencies to deal with smallpox actually favoured the mobilization of local, national and international resources once the era- dication programme was launched in 1966; these new approaches were accelerated from 1969 until the completion of eradication in 1973. Equally paradoxical, it was during the spe- cific context of the military regime after 1964 that the Brazilian health system developed the capacity to mobilize existing but dispersed resources and flexibly to innovate, incorporate, and adapt new policies. Another important element in this period was institutional learning based on other vertical programmes such as the malaria eradication campaign. Although the Brazilian smallpox eradication programme was constrained by international agencies and by bilateral co-operation with the United States, the period after 1964 offered opportunities for the realization of a new and wide-ranging national health capacity including the creation of a national system of epidemiological surveillance and a national childhood immunization programme.
    [Show full text]
  • The Brazilian Health System: History, Advances, and Challenges
    Series Health in Brazil 1 The Brazilian health system: history, advances, and challenges Jairnilson Paim, Claudia Travassos, Celia Almeida, Ligia Bahia, James Macinko Lancet 2011; 377: 1778–97 Brazil is a country of continental dimensions with widespread regional and social inequalities. In this report, we Published Online examine the historical development and components of the Brazilian health system, focusing on the reform May 9, 2011 process during the past 40 years, including the creation of the Unifi ed Health System. A defi ning characteristic of DOI:10.1016/S0140- the contemporary health sector reform in Brazil is that it was driven by civil society rather than by governments, 6736(11)60054-8 political parties, or international organisations. The advent of the Unifi ed Health System increased access to health See Comment pages 1721, 1722, and 1724 care for a substantial proportion of the Brazilian population, at a time when the system was becoming increasingly See Online/Comment privatised. Much is still to be done if universal health care is to be achieved. Over the past 20 years, there have been DOI:10.1016/S0140- other advances, including investments in human resources, science and technology, and primary care, and a 6736(11)60326-7, and substantial decentralisation process, widespread social participation, and growing public awareness of a right to DOI:10.1016/S0140- health care. If the Brazilian health system is to overcome the challenges with which it is presently faced, 6736(11)60437-6 strengthened political support is needed so that fi nancing can be restructured and the roles of both the public and This is the fi rst in a Series of private sector can be redefi ned.
    [Show full text]