Starting in the 1920s, the first initiatives to organize the control of cancer in Argentina soon revealed the presence of different actors and interests, a specialized cancer institute, a women’s voluntary organization, state authorities, university departments, cancerologists, and gynecologists. Initially concentrated around the activities of the Institute of Experimental Medicine for the Study and Treatment of Cancer in Buenos Aires, cancer interventions expanded in the following decades through university departments and gynecology services, which outlined a decentralized approach for reining in the centralized efforts from the institute. While a therapeutic-based approach with substantial funding for research institutes characterized industrialized countries’ initiatives until the end of World War II, in Argentina it was within the field of cancer diagnosis where specialists sought to create the foundational structures of cancer organization. Early detection of tumors, it was argued, favored a good prognosis with surgical treatment, placing the burden of cancer control on public education, the availability of diagnostic services, and doctors’ knowledge of cancer identification. From the 1920s to the early 1980s, three distinct periods can be identified: first, an institutional approach, where the first cancer institute attempted to concentrate all the activities related to the control of cancer, that is, lay education, scientific research, diagnosis and treatment, patients’ support, and cancer statistics; second, a state approach, inaugurated by the arrival of Juan Domingo Perón to government, where the centralization of cancer initiatives became a state affair; and third, a long period characterized by the retirement of the state—marked by political unrest and a succession of military governments until the return of democracy in 1983—informed by decentralizing policies, the prominent role of civil society actors, such as voluntary organizations and medical societies, and the relative sway of the Pan American Health Organization. Throughout these three periods, all these actors played a role, and their ambivalent relationship and, often poor, interaction shaped the country’s efforts to control and prevent a disease that, since the 1940s, has steadily occupied the second cause of death. As the early detection strategy prevailed, responsibility for cancer control and prevention was constantly redistributed among the public, doctors, educators, and those who financed cancer services. The national state emerged as a feeble agent in cancer governance and, as discussed in the final section, this legacy is still felt today.
Giuseppe M. Messina
In Argentina, the provision of health care is divided into three components: a highly decentralized universal public sector, funded from general taxation; a constellation of compulsory collective insurance schemes, financed by contributions withdrawn from the salaries of workers in the formal labor market; and a system of private insurance companies used primarily by the middle and upper classes. Regarding the delivery of medical services, the configuration is mixed, as the weight of public and private providers is roughly equal. This complex structure, which derives from the historical development of particular institutions, produces high costs and unequal access to care according to a person’s geographical residence, occupational status, and purchasing power.
Carlos S. Dimas
Following independence in the early 19th century Argentina went through decades of internal political and social turmoil. During this time the sciences traversed a dormant period and operated at the amateur level, such as through collectors and hobbyists. Beginning in the 1850s and continuing through the 1860s, many of Argentina’s internal problems eroded. The newly consolidated state undertook a process of extending its influence throughout the nation and fostering a closer and collaborative association with the nation’s interior to foster national unity. Under the banner of ‘civilization, order, and progress’, ruling liberal elites looked for ways to herald social and economic development. The sciences, through practice and institutionalized places, played a critical role for the state. By the beginning of the 20th century, the state had invested in scientific ventures into Patagonia and other areas of the nation to collect and catalogue materials, such as fossils and plants, and had supported the construction of museums to display scientific collections to the public as a means to develop a national identity. Beyond museums and naturalists, the state financed the maturation of the medical sciences to respond to the waves of epidemic diseases that assaulted the nation and the numerous regional endemic diseases that elites presented as evidence of underdevelopment, such as malaria in the northwest and recurrent cholera and smallpox outbreaks throughout the nation. Fields such as meteorology and engineering provided the physical infrastructure to further integrate the nation, through railroads, the standardization of national time, and a space for local Argentine scientific actors to establish national and international careers. With the increased professionalization of numerous scientific fields, the bond between the state and scientists matured. Many used this as a platform to enter into politics, such as Eduardo Wilde, hygienist and Minister of the Interior. Others provided their services to the state to form public policy, as happened for example with the work of psychiatrists, criminologists, engineers, and hygienists. Collectively, these fields demonstrated that the sciences witnessed significant growth into the first quarter of the 20th century.