In sickness and in wealth

Ann Zulawski finds many ailments when she takes the dressing off the relationship between politics and health policies in Bolivia


Unequal Cures: Public Health and Political Change in Bolivia, 1900-1950
Ann Zulawski
2007, Duke University Press
253 pages

Reviewed by Jay Kerr

THE CONNECTIONS between the historical-political development of a new nation-state and the development and implications of its public health policies are not immediately obvious. Few students of history and politics will see such policies as an instrumental part of national political development.

For this reason one may be forgiven for having reservations when embarking on Ann Zulawski’s study of public health and political change in Bolivia between 1900 and 1950.

However, such reservations are soon swept aside when reading this work. As the fascinating nature of the subject becomes glaringly obvious, the reader soon realises that the blurb on the back cover that this “is an original and well-crafted historical study that opens fresh new perspectives on old issues” is entirely fitting.

The popular impression in the developed West of many Latin American countries, particularly Bolivia, is of an underdeveloped region renowned for its extensive virgin rainforest and exotic “Indian” tribes. This attitude is highlighted by the author with the comment: “Despite the gradual ascendancy of biomedicine over the course of the twentieth century… almost invariably when I told people I was going to Bolivia to do research on the history of medicine, they responded with interest thinking I was studying Andean herbal or spiritual healing.” This book goes a long way to dispelling such notions.

Impressive account

Unequal Cures covers a wide range of diverse but interrelated topics such as the impact of war on medical development (both biomedical development and medicines’ social impact); the role of women in relation to the deterioration of public health; and the progress of attitudes toward mental health alongside the development of new democratic and populist politics.

Zulawski provides a detailed social analysis of these issues, drawing them together in an impressive account of a nation still in the early stages of industrial development.

This is a well written piece of historical research that remains highly objective. It has a strong focus on the everyday experiences of ordinary people, and its inclusion of high politics and the opinions of top medical practitioners serves to re-emphasise how social and economic progress was made at a grassroots level. At the same time, the author throws up intriguing observations about Bolivian life at all levels that will capture the interest and imagination of the general reader as well as the student of Latin American history and politics.

Unequal Cures provides the reader with a good understanding of the way “health issues and problems affect almost every aspect of national, social and economic life in an emerging nation state”. For this reason it is an important work, capably demonstrating the divisions and distinctions of class, ethnicity and gender in early 19th-century Bolivia.

As Brook Larson comments: “…[it is] a first rate contribution to the fields of Andean studies and the social history of medicine in Latin America”.

Unequal Cures will be read with keen interest by the general reader with little knowledge of the region while also serving as a solid guide to those wishing to study Latin American history and politics, especially as Zulawski’s epilogue brings the issues discussed up to date with the ever changing situation in this volatile and fascinating country.

Jay Kerr is writing a history of anarchism in Latin America