The Right to Live in Health: Medical Politics in Postindependence Havana

Abstract

Historians of Cuba have been prolific in documenting changes in the late nineteenth century and in the years around the 1959 Cuban Revolution, with the early republic—the years following the US occupation of 1898–1902—relegated, with a few exceptions, to a footnote of intellectual stagnation. But in The Right to Live in Health: Medical Politics in Postindependence Havana, Daniel A. Rodríguez shows how during this time Cuba was in fact at the forefront of medical and social advancements, alongside some of the most advanced democracies.This story of the Cuban-driven modernization of medicine and public health begins with a view into the lives of those who had been relocated by the Spanish to the concentration camps outside Cuba's large cities during the Cuban War of Independence. Rodríguez brings us details of the lives of reconcentrados that show how their struggles to survive in spaces without health infrastructure, away from their homes and sources of income, helped shape the postwar reconstruction of a nation around public health. This book makes clear that it was not only the US and Cuban sanitarians and policymakers whose actions and interests influenced how the nation conceptualized national health. By placing the recipients of policy at the beginning of the story, Rodríguez centers living conditions, nutrition and food security, and the individual health of the poorest—that is, social determinants of health—as the core shaping principles in the modernization of public health and the establishment of health as a right in Cuba.By looking at the actions of physicians and sanitarians, health officials, and caretakers in the second half of the 1800s—when bacteriology and its related medical advancements had started to rapidly change the ability to provide health to mostly urban populations—and setting the political and military events to the story's background, Rodríguez shows that it was Cubans who had articulated a vision for a nation that included health rights. During the US occupation of the island from 1898 to 1902, Cuban physicians were active in working with and sometimes against US health authorities to secure those rights for Cubans, responding first to the needs of their own. The centrality to Cuban nationalism of the right to health, Rodríguez shows, had been articulated before the wars of independence and shaped medicine and politics. War and US intervention are therefore only part of a larger story. Cuban physicians operated within the constraints of the US occupation government's priorities (mainly protecting commerce and preventing another outbreak of yellow fever) but also pushed back to address the health threats to the Cuban population, in particular the conditions that made diseases like tuberculosis and enteritis the biggest killers of Cubans. The country's physicians had, after all, been articulating a medical nationalism for decades. In a careful dance between authority and ability, those who participated with US authorities in sanitation were able to incorporate nationalist goals in the public health institutions that they established. Rodríguez teases out Cuban physicians' individual motivations and roles in government through the first decades of the twentieth century until the years around when the Platt Amendment was abrogated. He shows us the individuals who shaped policy as well as those whose lives were changed by these actions. All of this comes together very effectively, as the work describes chapter by chapter how specific public health issues in the early twentieth century—reconcentrados, yellow fever, plague, infant mortality, tuberculosis, professionalization of nursing, hospitals—all are part of a larger quest toward shaping a Cuban medical modernity. And the book is beautifully written, using an impressive array of sources. Each chapter begins with a vignette, the details of which take the reader to a very specific sensation, whether to envision what Cubans saw, smelled, read, or felt.The Right to Live in Health is an important contribution to the history of Cuba and the history of medicine and public health. For historians of Cuba it provides a view of Habaneros—we learn about aspects of the lives and health of people from various races, immigrant groups, social classes, gender, and age in a persuasive, thorough, and well-researched argument. Rodríguez also shows us how medical professionals, charity and beneficence organizations, politicians, and ordinary citizens pushed and influenced the shaping of a Cuban nation where health was to be a right, a nation that could be a model to others in the time of global health. Although at times perhaps veering too much into a story of Cuban exceptionalism, Rodríguez, by highlighting the Cuban story of social medicine, demonstrates that Cubans were in real conversation with the advances in twentieth-century social medicine in other parts of the world.