Mexican national culture in the period from 1946 to 1982 can be understood by recognizing three overlapping transformations. The first was the consolidation of various national archetypes rooted in Mexican revolutionary and prerevolutionary mythologies of national identity and that were disseminated via state-sponsored cultural institutions as well as through global marketing campaigns related primarily to bolstering tourism. A second was the commodification of national popular culture through local cultural industries, namely radio, cinema, the recording industry, and television, and the competitive engagement of these industries with external cultural flows deriving, primarily though not exclusively, from the United States. The third was the invention of new forms of urban response to inflation and the cascading crises of political legitimacy that characterized the decade leading up to economic collapse in 1982. Across the body politic, one discerns a resilience of shared points of cultural reference—sonic, visual, culinary, and otherwise—derived, often in great measure, from governmental policies and discourse. At the same time, and increasingly over the course of this historical period, one finds movements characterized by an irreverent reappropriation of many of those same reference points, carried out by a diverse range of social actors in pursuit of individual and collective strategies of resistance to both state and patriarchal forms of authority. By the early 1980s Mexican national culture had become a rich and playful bricolage made up of iconic markers over which the state experienced a diminishing, though not yet exhausted, capacity to define.
The Conflict Textiles website is a digital resource that allows users to learn more about how individuals who have experienced or been impacted by political violence have used textiles to respond to and recount their experiences. Some of the textiles on the website were made in response to the wars and conflicts in South America in the 1970s and 1980s (including the Dirty War in Argentina, the Pinochet regime in Chile, and the conflict in Peru between the government and the Shining Path), while others have emerged as a response to the Troubles in Northern Ireland. The majority of the textiles were created by women, though in some instances, men have also contributed to their creation. Conflict Textiles is the name of both the digital resource and a physical collection of textiles. Originating from the Art of Survival International and Irish Quilts in 2009 in Derry, Northern Ireland, this collection and online repository highlights the prolific use of textiles as a medium through which individuals are able to express themselves and the overarching nature of this medium as a form of expression. These two entities, the website and the physical collection, coexist, with the Conflict Textiles website documenting the textiles present in the physical collection and events that occur, or have occurred, in association with the collection. In this way, the Conflict Textiles website serves as an online repository of the physical Conflict Textiles collection and allows users internationally to learn more about a collection that includes textiles from dozens of different countries including, but not limited to, Chile, Northern Ireland, and Argentina.
This research project investigates women’s involvement in the struggles to achieve political independence in Spanish America and Brazil during the first half of the 19th century. The project is hosted at the University of Nottingham, Department of Spanish, Portuguese, and Latin American Studies, School of Cultures, Languages, and Area Studies; it was funded by the University of Nottingham and the UK Arts and Humanities Research Council (AHRC) between 2001 and 2014. The online searchable database was a core output of the first of these AHRC-funded projects (2001–2006): “Gendering Latin American Independence: Women’s Political Culture and the Textual Construction of Gender 1790–1850.” It was enhanced in stages with an AHRC Pilot Dissemination Award (2006–2007) and Follow-on Funding (2012) for the crowd-sourcing project “
The aim of the follow-on-funding awards was to stimulate widespread public debate, preferably in collaboration with partners (national and international). This was of particular importance with respect to the involvement of Latin American women in the independence wars against Spain and Portugal, an aspect of women’s history that had been much neglected. Since 2006, a lively public debate has emerged about women’s involvement in the wars of independence, especially in Latin America. The debate has focused on women’s exclusion from mainstream nationalist historiography and their problematic position in postindependence politics and public culture. The unprecedented surge of interest in women’s history and the founding discourses of the Spanish American republics has been triggered by the bicentenary celebrations of Spanish American political independence, which began in 2010 and will continue into the 2020s, and the recent rise to political prominence of women in Latin America (women presidents in Brazil, Costa Rica, Chile, and Argentina).
The research project of 2001–2006 focused more specifically on the constructions of gender categories in the culture of the independence period and the impact of war and conflict on women’s lives, social relationships, and cultural production. The research emphasized the significance of women in the independence process and explored the reasons for their subsequent exclusion from political culture until recently. Independence was examined in terms of gender: (a) the study of women’s political culture, (b) women’s activities and writings, and (c) the textual construction of gender in political discourse. Questions were posed: Did the wars of independence change traditional ways of thinking about women, and change women’s views of themselves? How was the category “woman” produced historically and politically in Spanish America at the time? In what ways were those identified as women constructed ambiguously as subjects and objects in political discourse? What were women’s responses to the republican discourse of individual rights that equated individuality with masculinity? Why, after political independence, were political rights still denied to over half the population according to the criterion of sexual difference?
Anne Pérotin-Dumon and Manuel Gárate
Historizar el pasado vivo en América Latina (Historicizing the living past in Latin America) is an edited digital publication composed of thirty-four studies. Available online since 2006, it was the first extensive effort to examine the region’s new contemporary history after the return to democratic rule following dictatorships or internal armed conflicts. Historizar el pasado vivo en América Latina remains to this day the most systematic undertaking in Spanish and digital format to explore this historia reciente (or historia del tiempo presente)—“addressing recent events that remain in the memories of many, by historians that lived through them, in a time in which their dramatic character has made them an enduring moral problem for the national conscience.” More broadly, the publication aims to convey to professional historians and Latin Americanists in other disciplines the breadth and quality of this exciting intellectual development.
The editor’s substantial introduction, “Verdad y memoria: escribir la historia de nuestro tiempo,” analyzes the central issue of Latin America’s historia reciente (viz., to develop a historical critique close to events that have often affected historians themselves); its distinctively Latin American character (viz., as history written in an age framed by a culture of human rights); and how this work compares to European precedents (viz., as an interdisciplinary field drawing from the testimony of witnesses—oral history—but with more problematic access to archival collections).
This digital publication has a geographic focus on Argentina, Chile, and Peru but also presents various genres of history writing and retains a balance between case studies, more conceptual pieces, review essays, etc. A digital format is particularly apt for the publication’s most likely users—Latin American and Spanish faculty, teachers, and students drawn to the field of recent history or already working in it. A final section of the article assesses the contribution of Historizar el pasado vivo en América Latina to the field and surveys related online materials that have appeared since 2006.
Rosemary A. Joyce and Russell N. Sheptak
The Online Finding Aid for the Archivo General de Centro América will provide increased ways for researchers to identify documents of interest in a widely distributed microfilm copy of this primary resource for the history of Guatemala, Honduras, El Salvador, Nicaragua, Costa Rica, and Chiapas (Mexico). The original archive, located in Guatemala, houses approximately 147,000 registered document collections from the colonial period, ranging in date from the 16th century to independence from Spain in 1821. The microfilm copy, composed of almost 4,000 reels of microfilm, is organized according to basic keywords designating the original province in colonial Guatemala, a year, and a subject-matter keyword. Also associated in the basic records of the finding aid (which are already available online) are the reference number assigned each document in the original archive, and the specific reel(s) on which it is found. With funding from the National Endowment for the Humanities, enhanced records are being created for documents dating between 1700 and 1821 identified as associated with Guatemala, the administrative heart of the colony, for which there are no published indices. Enhanced records add names of people and places not recorded in the original record, opening up the microfilm collection, and through it, the original archive, to broader social history including studies of the roles of women, indigenous people, and African-descendant people.
Digital Resources: Power of Attorney, A Digital Spatial History of Indigenous Legal Culture in Colonial Oaxaca, Mexico
“Power of Attorney in Oaxaca, Mexico: Native People, Legal Culture, and Social Networks” is an ongoing digital research project that constructs a geography of indigenous legal culture through digital maps and visualizations. The
“Power of Attorney in Oaxaca, Mexico: Native People, Legal Culture, and Social Networks” is an ongoing digital research project that constructs a geography of indigenous legal culture through digital maps and visualizations. The Power of Attorney (
The multiscalar narrative of the Power of Attorney project speaks to multiple audiences, and the digital multimedia format allows visitors to further tailor their interactions with information. The site operates on many levels. It provides maps and visualizations based on original research, data culled from primary sources that can be used as a research tool, historical and geographical background information, information about how to read letters of attorney, and microhistorical narratives of power of attorney relationships. For undergraduates learning about the relationship between Spanish administration and pueblos de indios, the maps and visualizations provide an at-a-glance overview of the spatial and social connections among Indian towns, ecclesiastical and viceregal courts, and the court of the king in Madrid from the perspective of an indigenous region rather than a top-down perspective. Graduate students and scholars interested in the production of notarial records in native jurisdictions, social history and ethnohistorical methodology and the relationship between local and transatlantic processes can explore the maps, visualizations, and data in greater detail. An educated general audience interested in the history of Oaxaca’s native peoples can find a general introduction to the region, its history and geography, and the long-standing relationship between Mexico’s native people and the law.
Humanizing Deportation is a community archive of digital stories (testimonial video shorts) that recounts personal experiences related to deportation and deportability. The largest qualitative archive in the world on this topic, its bilingual (English/Spanish) open access website, as of March 2020, holds close to 300 digital stories by nearly 250 different community storytellers and continues to expand. All digital stories are created and directed by the community storytellers themselves. While the vast majority of the stories were created by Mexican migrants currently living in Mexico’s largest border cities (Tijuana, Ciudad Juárez), and other major urban metropolitan regions (Mexico City, Guadalajara, Monterrey), it also includes some stories of migrants living in the United States, as well as other migrants, many in transit, passing through Mexico from such countries as Honduras, El Salvador, Guatemala, Colombia, Peru, Cuba, and as far from North America as Cameroon. Launched in 2017, Humanizing Deportation’s teams of academic facilitators remain active, and the archive continues to grow.
Mexican History/Historia Mexicana (MH/HM) is a Facebook page dedicated to bringing together the world’s academic and popular masses in their interest of Mexican history. As of 2016, there are over 1300 members of the page, and posts garner one to three hundred views, though some posts or posted links have reached three to five thousand unique views.
The Facebook page grew out of the frustration of this author with the slow and censored listserv system that serves as the main forum for scholars of Mexican history. In addition, there was a desire to reach private scholars and members of the public who are generally excluded from the listserv systems. In December 2011, the author and another scholar joined together in creating a Facebook page that would, in the words of the page description, serve as “a forum for the free exchange of information on the history and related culture and events of Mexico.” In late 2012 a third scholar joined them as operators, managers, and editors of the page.
Material is selected in Spanish and English (and occasionally indigenous Mexican languages) related to Mexican history or events of historical importance. Generally, the goals of the page are to provide items of interest to the general public, resources to professional researchers that they may not know about, and well-known resources for new researchers. Information is provided on events or presentations related to the preservation of Mexican History, important new research works, and items of curiosity that simply pique theinterest of the operators. There is no systematic approach to content; instead, information is posted as a free-form collective, free of censorship. Members of the community are also welcome to post materials or queries and to comment and discuss topics on history and related items of culture and current events.
Regina Horta Duarte
Brazil’s environmental history is often told as a tale of irresponsible exploitation and societal indifference. However, a broader perspective must consider the country’s diverging traditions of environmental thought and practice. During the 19th century, several naturalists wrote about the need for the rational use of natural resources, founding a conservationist cultural tradition. In the 1920s and 1930s, a group of naturalists from the National Museum produced various initiatives related to biological research and conservationism. In the 1950s, another group of scientists, agronomists, and journalists founded the National Foundation for the Protection of Nature, active until the 1980s. Although none of these initiatives led to a continuous environmental mobilization, they shaped public policies and cultural sensibilities toward the environment. Beginning in the 1970s, a new wave of environmentalism emerged in several cities—with protests against pollution, nuclear energy, and deforestation—but also in rural areas and forests, with demands from traditional peoples. Over the years, several conservation units and federal institutions were founded to implement environmental policies. Finally, the 1992 Earth Summit gave a special boost to these movements in an era of growing NGO activism. All of these fueled the feeling that environmental activism in Brazil had entered a golden age of dialogue and negotiation.
Contrary to this view, some activists claimed that major political advances were still needed. Through the lens of socio-environmentalism and environmental justice, they denounced the displacement of communities by mining companies and the construction of hydroelectric plants, as well as the unhealthy and violent conditions faced by inhabitants of urban peripheries and areas where agribusiness was expanding.
Skepticism toward gradual advances was warranted following the election of Jair Bolsonaro, whose administration threatened environmental legislation and institutions and prior achievements. To confront these perils, environmental activism must become a political, scientific, and cultural movement.
Alexandra Minna Stern
Eugenics emerged in Latin America in the early 20th century on the intellectual foundations of 19th-century social Darwinism and positivism, and expanded in contexts influenced by Catholicism, nationalism, and transnational scientific exchange. Although the extent and objectives of eugenic policies, practices, and organizations varied across the region, Latin American eugenicists tended to subscribe to neo-Lamarckian principles of environmental modification, foreground puericulture or infant and maternal care, and support new techniques of human measurement associated with biotypology. Overall, eugenics in Latin America was less extreme than in Anglo and Nordic countries, rarely resulting in sanctioned policies of compulsory sterilization or euthanasia. It was an integral component of programs designed to combat infectious ailments, especially sexually transmitted diseases, and to ameliorate national health indicators. This overlap meant that eugenics sometimes was less visible as a stand-alone movement, and that its tenets were absorbed with little friction into public health and social welfare infrastructures and campaigns. At the same time, eugenic racism was expressed in calls for immigration restriction that reverberated across Latin America, most notably in the 1910s and 1920s. In retrospect, eugenics in Latin America contributed both to exclusionary policies that stigmatized certain social groups and to overarching campaigns for health and wellness that were backed by a diverse political spectrum that could include feminists, Socialists, and military leaders.
The 1960s in Argentina was a time convulsed by profound social, cultural, and political changes. Reflecting on the effect these processes had on the everyday, conceived as the spaces and routines involved in the reproduction of life that vary according to social class, generation, and gender, provides a valuable perspective for studying historical phenomena. It gives substance to and evidences the social nature of personal experience. Through that prism, the study of everyday life will be the gateway to understanding the turbulence produced by cultural effervescence, growing consumerism, the expansion of the media, the problems triggered by economic instability and escalating inflation, and the ruptures caused by political and social radicalization and the rise of repressive violence.
In the 1850s, Juana Catarina Romero, known popularly as Juana Cata, peddled her cigarettes on the streets of Tehuantepec in the state of Oaxaca, Mexico, an activity that enabled her to serve as a spy for the liberals under the command of Captain Porfirio Díaz during the War of the Reform (1858–1860). By 1890, Romero (1837–1915) had emerged as an international merchant, sugar cane producer and refiner, philanthropist, and “modernizing” cacica of the city of Tehuantepec. As powerful women rarely receive credit for their achievements, popular myth attributes her success to the men in her life, a supposed youthful love affair with Díaz or a later lover, Colonel Remigio Toledo. In contrast, a study of her career helps to shed light on how women could attain and exercise power in the 19th century and the ways in which they participated in the construction of the nation-state and a capitalist economy. Her trajectory shows that when allied with these forces of modernization, women could take on a more public role in society. It also reveals that it is through the lens of local and regional history that women’s contributions and accomplishments, so often erased in national histories, can be made visible.
Jadwiga E. Pieper Mooney
The official histories of family planning and reproductive rights in Chile started in the 1960s, with initiatives by Chilean doctors to reduce maternal mortality due to self-induced abortions; Chilean women’s mobilization for rights surged in the 1970s, and the concept of reproductive rights became the focus within health policy debates only by the 1990s. Specific Chilean political developments shaped these trajectories, as did global paradigm changes, including the politicization of fertility regulation as a subject of the Cold War. These same trajectories also generated new understandings of reproductive rights and women’s rights. The goals of preventing abortions and maternal mortality, of controlling population size, and of protecting families all contributed to the public endorsement of family planning programs in the 1960s. Medical doctors and health officials in Chile collaborated with the International Planned Parenthood Federation (IPPF) and founded the first Chilean family planning institution, the Association for the Protection of the Family (APROFA). Since 1965, APROFA, affiliated with the IPPF, has remained the primary institution that makes family planning available to Chilean women and couples.
The concept of “reproductive rights” is relatively new, globally, and in its specific national representation in Chile; questions of women’s rights gained unprecedented international prominence after the United Nation’s designation of the International Women’s Year (IWY) in 1975. International conferences, and the extension of IWY to a Decade for Women between 1975 and 1985, stimulated debates about policy norms that linked human rights, women’s rights, and the right to health to nascent definitions of reproductive rights. Just as international gatherings provided platforms for debates about rights, unparalleled human rights violations under military rule (1973–1990) interrupted the lives of Chilean citizens. Women in Chile protested the dictatorship, mobilized for democracy in their country and their homes, and added reproductive rights to the list of demands for democratic restructuring after the end of dictatorship. While family planning programs largely survived the changes of political leadership in Chile, the dictatorship dealt a lasting blow to quests for reproductive rights. The military’s re-drafted Constitution of 1980 not only compromised effective political re-democratization, but also imposed such changes as the end of therapeutic abortions, which have remained at the center of political activism against reproductive rights violations in the 21st century.
Juan Alberto Salazar Rebolledo
The Festival de Rock y Ruedas took place in Avándaro, in the suburbs of Valle de Bravo, a small town in Estado de México, on September 11 and 12, 1971. Among the organizers were transnational corporations such as Coca-Cola and the national mass media monopoly Telesistema Mexicano. Avándaro was the culmination of the process of creating a youth culture of consumption that started in the early 1960s and went through several transformations during the next decade.
As part of the project to commercialize youth culture, the mass media tried to impose stereotypes that were reappropriated and resignified by groups of young people, such as “onderos.” Their actions became an obstacle for corporate business plans and turned Avándaro into one of the milestones of the Mexican countercultural movement in the second half of the 20th century.
At the beginning of the 19th century, Colombian physicians thought of food as an essential factor in shaping human character and corporeality. Framed in a neo-Hippocratic system, health and racial differences were related not only to climate but also to the connection between food qualities and humoral fluids. For example, it was believed that the tendency to eat cold and moist food, as well as greasy substances, was one of the reasons why people in warm regions of Colombia were choleric, phlegmatic, and indolent. By midcentury, it was further argued that each regional type—a local racialized categorization based on geographic determinism—had certain diet habits and physiological characteristics that explained its character (sober, obedient, lazy, industrious, etc.), and that made this type “naturally” suitable for different kinds of work. During this period, the working population’s diet was not perceived to be a social problem requiring regulation, at least not by the government. In the midst of liberal reforms, the political elites were more focused on the economic and genetic integration (“whitening”) of highland Indians, and to a lesser extent blacks, than on producing a supposed “better race” through nourishment.
But by the late 19th and the early 20th centuries, however, a new cultural framework that crossed the boundaries of thermodynamics, political economy, experimental physiology, and eugenics had begun to emerge in Colombia, converging in the social problem of nutrition. Centered on the analogy of the human body as a heat engine that transforms energy, local scientists began to conduct surveys of the eating habits of the “working classes,” analyses of the chemical and caloric composition of their foods, and studies on the metabolic characteristics of different regional populations. The results of these investigations were used to push the government to “restore the energies” of an impoverished population that was consistently thought to be weak and racially inferior, but capable of physiological and hereditable improvement. The cry of conservative elites for political and moral “regeneration” at the turn of the century also had a biological component—the optimization of the human motor. In the 1920s and 1930s, several campaigns and institutions were created for this social engineering, aimed at producing a modern, healthy, and industrious citizen. These campaigns gained special political force after the Liberal Party returned to power in 1930.
Maira Mayola Benítez Carrillo
Gabriel Vargas Bernal created one of the greatest examples of Mexican comic strips, The Burrón Family. He had a remarkable career as a prolific cartoonist, screenwriter, historian, and journalist, with many titles published throughout decades of work. His predominant topic is social criticism and his narrative style is that of journalistic humor. Self-taught, he worked for the country’s most important–newspapers. Over the years, he wrote pieces on sports and the most popular festivals in Mexico, completed comic strips to support literacy campaigns, and designed many types of comics: historical, religious, war, detective, ecological, didactic, humor, and adventure. In 1948, he created the comic La familia Burrón, a series that tells of a poor family’s daily life in a working-class neighborhood. The author’s sense of criticism was the key to allowing readers to identify with the almost one hundred characters who appeared on its pages. Many of them came from real life and were recreated on the pages of this comic, which was published for six decades.
Vargas had a clear critical view of Mexican society. He incorporated costumbrist scenes and knew how to use idioms and popular expressions through his characters, adapting them to each decade in which the comic strip was published. His stories are full of humor and absurd situations, a mix of reality and fiction. The strip had a half-million printings per week and has been published in compilation books that are among the most sold at Mexico’s main book fairs. Vargas’s work is a necessary reference to learn and understand the idiosyncrasies of Mexicans—their customs, traditions, conflicts, and short-comings—in the urban environment.
On March 12, 1956, Basque National and Columbia University lecturer Jesús María de Galíndez Suarez disappeared from New York City never to be seen again. While no conclusive evidence was ever uncovered, it has been widely accepted that he was taken by functionaries of the regime of Rafael Trujillo in the Dominican Republic, flown to the island, tortured, and killed. Galíndez, who had worked for the Trujillo regime after fleeing Spain in 1939 and subsequently immigrated to the United States in 1946, had just completed a dissertation on the Trujillato at Columbia. The regime did not look kindly on his chosen perspective and set in motion a plan to have him disappeared. Following his abduction, many U.S. solidarity activists joined forces with Dominican exile groups to push for greater attention to the atrocities of the Trujillo regime as well as for a closer investigation into Galíndez’s disappearance. While Trujillo had similarly disappeared a number of individuals in the United States and other Latin American countries, the Galíndez case is unique for several reasons. First, Galíndez’s life offers a prime example of a transnational identity, of someone who juggled multiple identities and causes, crossed physical and ideological borders, and operated daily with conflicting alliances and allegiances. Second, the murder of the Basque national mobilized a significant collective of solidarity activists in the United States, garnered considerable national press, and built a foundation for future activism. Moreover, as Galíndez had been working as a U.S. intelligence operative since before his arrival in the United States, his story complicates the traditional nexus of solidarity work. Finally, the case offers a unique window onto the geopolitics of the early Cold War (prior to the Cuban Revolution) and the intricacies of the second half of the Trujillo regime.
Sueann Caulfield and Cristiana Schettini
Over the past forty years, increasing attention to gender and sexuality in Brazilian historiography has given us a nuanced understanding of diverse ways in which women and men in Brazil’s past experienced patriarchy, racism, and other forms of oppression. As gender historians have shed light on how racialized and patriarchal gender and sexual roles have been reconstituted in different historical contexts, empirical studies in the field of social history have focused primarily on the historical agency of women, particularly non-elite women, who lived within or pushed against the confines of prescribed gender roles. Pioneering histories of sexual minorities have accompanied this trajectory since the 1980s, although this subfield has grown more slowly.
A few nodal themes help to explain transformations in gender relations during each of the major periods of Brazil’s social and political history. Under the empire (1822–1889), honor is the entryway for analysis of gender and sexuality. Gendered standards of honor were critical tools used to mark class and racial boundaries, and to traverse them. Historians of the imperial period also stress the centrality of gender to the social, cultural, and economic networks built by members of various occupational, familial, and kinship groups. During the First Republic (1889–1930), the focus shifts to state vigilance and social control, together with debates over modernization of sexual and gender norms, particularly regarding urban space and prostitution. In the Vargas era (1930–1945), patriarchy and racialized sexuality formed the core of intellectual constructions of the nation’s history and identity, at the same time that homosexuality and women’s and worker’s rights generated intense debate. A new emphasis on domesticity emerged in the context of developmentalism in the 1950s, helping to spur a reaction in the form of the counterculture and sexual revolution of the 1960s and 1970s. The dictatorship (1964–1985) went to great lengths to suppress challenges to gender and sexual norms as part of its broader strategy to demobilize society and repress oppositional political movements. These challenges reemerged in the 1970s, when feminists and sexual minorities gained much greater visibility within a new wave of social movements.
The 1988 constitution articulated these movements’ aspirations for social justice and equality through its foundational principal of human dignity. Significant legal changes followed over subsequent decades, including recognition of equal labor rights for domestic and sex workers, affirmative-action policies, and the legalization of same-sex marriage, in 2011. Despite notable setbacks, the momentum toward gender and sexual equality at the start of the 21st century was remarkable. This momentum was halted by the political coup that ousted the first woman president in 2016. The anti-feminist mood that accompanied the impeachment process underscored an overarching theme that runs through the historiography of gender and sexuality in Brazil: the centrality of gender to the major legal and political shifts that mark the nation’s history.
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.