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date: 19 February 2019

Health, Malaria Campaigns, and Development in Brazil

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Latin American History. Please check back later for the full article.

Since the early 20th century, Brazilian public health has focused on rural areas and populations, and the so-called rural endemic diseases that plague them. These diseases—particularly malaria, hookworm, and Chagas disease—were blamed for negatively affecting Brazilian identity (“an immense hospital”) and for preventing territorial integration and national progress. For reformist medical and intellectual elites, health and educational public policies could “save” the diseased, starving, and illiterate rural populations and also promote Brazil’s entry into the “civilized world.” In the mid-20th century, public health has secured a renewed place in the Brazilian political agenda, one associated with the intense debates about development in Brazil in conjunction with democratization following World War II (1945-1964). In particular, debate centered on the paths to be pursued (state or market; nationalization or internationalization) and on the obstacles to overcome underdevelopment. A basic consensus emerged that development was urgent to be pursued by modernization and industrialization.

In 1945, Brazil remained an agrarian country, with 70 percent of the population living in rural areas and a significant part of the economy still dependent on agricultural production. However, associated with urbanization, beginning in the 1930s the Brazilian government promoted policies of industrialization and social protection of organized urban workers, the latter entailing a stratified system of social security and health and social assistance. Public health policies and professionals continue to address the rural population, which has been excluded from social protection policies. The political and social exclusion of this population did not change significantly under the Oligarchic Republic (1889–1930) or during the first government of President Getúlio Vargas (1930–1945). The overall challenge remained similar to the one confronting the government at the beginning of the century—but it now fell under the umbrella of “developmentalism” both as an ideology and as a modernizing program. Economic development would be perceived, on the one hand, as a driver of improvements in living conditions and income in the rural areas. It entailed efforts to stop migration to large urban centers was considered one of the great national problems in the 1950s. On the other hand, disease control and even eradication of “rural endemic diseases” campaigns aimed to facilitate the incorporation of sanitized areas into projects of agricultural modernization and to underpin building the infrastructure for development. Development also aimed to promote the transformation of the inhabitants of rural Brazil into agricultural workers or small farmers. During the Cold War and the anti-communism campaign, the government sought to mitigate the revolutionary potential of the Brazilian countryside by promotion of public health policies. This more general developmental program was supported by important sectors and organizations, including the National Conference of Bishops of Brazil (CNBB) and, in particular, the bishops of the Northeast.

Health constituted an integral part of the development project and was integrated into Brazil’s international health and international relations policies. In the Juscelino Kubitschek Administration (1956–1961) a national program to control endemic rural diseases was created as part of a broader project development, including national integration efforts and the construction of a new federal capital in central Brazil (Brasilia). The country waged its malaria control campaign in conjunction with the Global Malaria Eradication Program of the World Health Organization (WHO) and, to receive financial resources, it signed an agreement with the International Cooperation Agency (ICA). From 1957 malaria eradication had become part of U.S. foreign policy that sought the containment of communism.

The Malaria Eradication Campaign (CEM, 1958-1970) marked the largest endeavor undertaken by Brazilian public health in this period and can be considered as constituting synthesis of this linkage between development and health. Given its centralized, vertical, and technobureaucratic model, this project failed to take into account the structural obstacles to development, a fact denounced by progressive doctors and intellectuals, particularly those affiliated with the Brazilian Communist Party (PCB). They affirmed that disease, illiteracy, and hunger stemmed from inequality in land ownership and of the “latifúndio” system. These were the real obstacles to development in the countryside and needed to be removed by an agrarian reform or by a socialist revolution. This debate became radicalized in the early 1960s and constituted one of the factors that led civilian and military elements to launch the coup d’état in March 1964.