Social medicine then and now: Lessons from Latin America

The accomplishments of Latin American social medicine remain little known i n the English-speaking world. In Latin America, social medicine differs fro m public health in its definitions of populations and social institutions, its dialectic vision of "health-illness," and its stance on causal inferenc e. A "golden age" occurred during the 1930s, when Salvador Allende, a patholog ist and future president of Chile, played a key role. Later influences incl uded the Cuban revolution, the failed peaceful transition to socialism in C hile, the Nicaraguan revolution, liberation theology, and empowerment strat egies in education. Most of the leaders of Latin American social medicine h ave experienced political repression, partly because they have tried to com bine theory and political practice-a combination known as "praxis." Theoretic debates in social medicine take their bearings from historical ma terialism and recent trends in European philosophy. Methodologically, diffe ring historical, quantitative, and qualitative approaches aim to avoid perc eived problems of positivism and reductionism in traditional public health and clinical methods. Key themes emphasize the effects of broad social poli cies on health and health care; the social determinants of illness and deat h; the relationships between work, reproduction, and the environment; and t he impact of violence and trauma.