HEALTH POLICY AND SOCIAL CHANGE: A COMPARATIVE

Chile and Cuba took different roads toward socialism, and their histories have much to teach about policy, strategy, and the nature of reform. When the Unidad Popular (UP, or "Popular Unity") government headed by Salvador Allende took office in Chile in November 1970, it began introducing socialism gradually and nonviolently. The military coup d'etat in 1973 abruptly terminated Chile's so-called "peaceful road." On the other hand, Cuba's revolution in 1959 was rapid and violent, and it thoroughly consolidated state power. Events in both countries clarified the links between medicine and social change. These links need careful consideration in health policy and strategic planning. The experiences of Chile and Cuba illustrate the limitations of major health-care reforms in the context of unresolved social contradictions, and the advantages of health policies tied to broad, social structural change. This paper compares the social history of health policy in Chile and Cuba. The analysis is based on my observations as a medical practitioner and consultant in Chile between 1971 and 1973 and in Cuba during 1979; selective interviews with public health officials, health workers, community and labor representatives, and patients in both countries; documents about health services, morbidity, and mortality which I received from sources in the two countries and from international health organizations; and other secondary accounts. In the first part of the paper, I discuss the rationale of comparing Chile and Cuba; I also emphasize the theoretical problems of mass mobilization, state power, and incremental reform, which are crucial issues in understanding the links between medicine and social change. Second, I describe the pre-socialist healthcare systems which existed in the two countries. After discussing the contrasting revolutions in Chile and Cuba, I then analyze the modifications that occurred in their health-care systems. In conclusion, I speculate on the strategic implications of the Chilean and Cuban experiences for progressive change in medicine and society.