Chile's Medical-Social Reality
This is the opening section of a book-length government report on health written by Allende in 1939 in his capacity as Minister of Health in the Popular Front government of President Pedro Aguirre Cerda. Its passionate tone and social content reflect Allende's medical background as a doctor and his concern for people's health in Chile, as witnessed by his introduction of the legislation that eventually became Chile's National Health Service (1952).
"To govern is to educate and provide health to the people."
Pedro Aguirre Cerda
Our country is going through a moment in its history in which it struggles to unshackle itself from the old economic methods, autocratic and based on free competition, channeling its social life into a course of cooperation and well-being covering all social strata. To His Excellency the President of the Republic, the Socialist Party and its ministers, this is the fundamental significance of the Popular Front government, established by the people only a year ago; to reclaim the social wealth and the economic potential of the nation, control it, direct it, foster it in the service of all the inhabitants of the republic, without privileges nor exclusions. Also, and as a consequence, restore for the people, for the working man, his physical vitality, his virility and health, which were once his outstanding qualities; to reacquire the physiological capacity of a strong people, recover its immunity against epidemics; all of which will allow a better performance in national production while also providing a better disposition and spirit to live and appreciate life. And finally, to conquer the right to develop our culture at all levels, regardless of social classes. A revitalized, healthy and educated people, this must be the slogan for all Chileans who have a fervent desire to serve the homeland, and who struggle without rest so that our people can overcome exploitation and ignorance.
Chile, like the majority of South American countries, has lived at the mercy of economic and cultural colonialism which has impeded its social progress and the development of its natural resources. Moreover, these factors have prevented its people from reaching living standards compatible with a civilized and relatively educated country. Some 120 years of independent political life have not been sufficient to incorporate the proletarian classes into civic life, within the standard concept of progress; they have barely been sufficient to enable a small percentage of the poor to enjoy minimal benefits of the economic, technical and cultural advances of humanity.
The formidable boom of industrialism, scientific progress, advances in hygiene and medicine, the benefits of cultural heritage, have all bypassed the great majority of Chileans, who, after all, are the ones who create public wealth. Until a few years ago, our national economy was dependent exclusively on two or three products for export, principally nitrates and copper, which became the primary sources of income for the state. The mining industries have not been exploited by Chilean capital and have always been in the hands of foreign companies and at the mercy of the interests of international economic imperialism. The agricultural and textile industries have suffered from the lack of foresight of past regimes, most of them of conservative background, with the result that technical advances have not been incorporated into farming or industry to any large degree. Our farmers continued growing the more easily marketable crops, as did the first colonizers, wasting a large quantity of land, exploiting man more than the soil, lacking an organic and methodic system of irrigation and communication, and using antiquated instruments and machinery. The light industries concentrated on those products with a secure and ready-made market, forcing us to become consumers of goods manufactured and produced by the large industrial countries. This is the reason why almost 35 percent of national income was from nitrate mining and, in lesser proportions, from copper mining, both of which had negotiated favorable tax rates.
The world economic crisis of 1929 brought a sudden decrease in the performance of our two main export industries, and the two pillars that sustained the Chilean economy were broken. The measures taken were barely able to ease the effects produced by the repercussion of the international crisis. The Chilean economy, a slave to the events, tried to find alternatives, and in the next 10 years has managed to develop some other aspects of our agriculture: new external markets have been found and, driven by small-scale national capital, the manufacturing industry has increased production which has in turn decreased imports. Despite the progress achieved, in historical terms we still remain a colonial and dependent country.
The progress obtained in national production levels has not meant a significant improvement in living standards for the poor because international capitalism — economic and financial owner of the large centers of production — is only interested in production to satisfy the market demand, and no more. The capitalist enterprises are not concerned that the working population lives in deplorable conditions, exposed to disease or condemned to obscurantism.
The motivation for production is profit, unlimited gain, with no concern that, as a result, people are perishing or suffering, not even discounting war in its obsession to conquer world markets. This has been the despicable destiny of semicolonial countries, of our South-American countries, which have been an inexhaustible emporium of riches and raw materials servicing the splendor of the great nations of the world.
This is why the action of our governments must not only be the preparatory task of guiding the people towards the future, but also to defend it from the alienation and exploitation of the economic imperialism that roams the world. This task is, without doubt, the first obligation of a popular government wishing to recover the nation's wealth and its fruits for the greater well-being.
We know that the development of our national economy is subject to the possibilities offered by world markets. The solution to our economic problems is not, as some believe, an automatic change in the ownership rights of certain export products, but rather in finding for them a secure and advantageous market. The nationalization of the production sources to satisfy nationalist sentiment resolves nothing nor does it add economic benefit. It is necessary to focus on the market and world competition. Naturally, the development of national production, by creating new jobs and incorporating great numbers of workers into remunerative activities, will increase the purchasing power of the nation as a whole. However, regardless of the modifications to our internal economic structure, its true expansion is linked, without a doubt, to the international economy. The current war, which has closed some of our habitual European markets, is irrefutable proof of this and proves that *he goodwill of statesmen has its limits in the relations that the laws of world economy have imposed on secondary and dependent countries.
The above considerations have led the Socialist Party and its ministers to adopt a new criteria when faced with the responsibilities of government. Our first task is to uncover and clearly show the authentic reality of the nation, its possibilities and the resources at hand. This way we can proceed objectively and we can measure the magnitude of the problems. We know that our desire to alleviate the anguish of the Chilean people is limited by an insurmountable barrier, but this barrier also indicates an area within which there is a lot of work to be done and many conquests to achieve.
Through these considerations, it is easy to realize the state of misery that the people have lived under, the lack of hygienic habits, the predisposition to epidemics and diseases of high social impact, the degree of cultural backwardness, all of which have prevented the recognition of its own interests as the working class. But the people grow and reach a maturity and it is then that they become restless and resolve to conquer the right to well-being, health and culture. The Chilean working classes acknowledged their destiny and the deplorable reality of life and that is why they resolved to break the trend of history to install a government able to deliver the fruits of economic, social, technical and cultural progress which has always been the patrimony of a minority. That is why October 25 is such a momentous date.
We know that the task facing the government of the Popular Front is enormous. His Excellency, the President of the Republic, has understood this from the first instant and has dedicated his initial efforts to learn and revise the urgent and acute problems which need to be tackled. His trips through the country enable him to prepare to lead the recovery of the nation and it is necessary for him to view in person and in contact with reality, what immediate needs must be satisfied in order to organize the adequate measures which will accelerate the pace of economic and social evolution of the country in an efficient and vigorous manner within a fair plan.
Consistent with this objective spirit, and conscious of the responsibility on his shoulders, the Minister of Health has begun his work with a serene, documented and realistic study on the conditions of health and hygiene in the country. A succinct and cold examination of our socio-medical reality is the best way to diagnose, and therefore, to apply the adequate remedies to reestablish health and vigor in our people. This is what has moved him to tell the nation about the true hygienic and sanitary conditions of the country; to examine what has been done, good or bad; note the deficiencies and errors and put forward solutions towards finding ways to rehabilitate our race.
We must loyally declare that all those medical measures taken will only produce benefits if they are accompanied by economic and financial resolutions that permit a rise in the standard of living of our citizens. It can be said that the fundamental bases that determine the welfare and progress of nations are precisely a good standard of living, adequate sanitary conditions and a widespread dissemination of culture. It's worth noting that the volume and consistency of these latter factors depend directly on economic growth without which it is not possible to build anything serious from the point of view of hygiene and medicine, nor with respect to culture, because it is not possible to provide health and knowledge to a malnourished people, dressed in rags and working under merciless exploitation.
PERSPECTIVES AND PLAN FOR IMMEDIATE ACTION
1. Consideration on human capital
The distressing demographic and sanitary outlook of the country requires a deep reflection from all Chileans, rich and poor, left and right, governors and governed. National health is one of those problems which has consequences for everyone. No social class, however prepared biologically, can feel immune from epidemics or safe from contagious diseases. The environmental conditions affect every being. It is true that those people with a well-developed immune system can better resist the pathological risks of an unhealthy environment but it is also true that bacillus, the infectious contact, the transmitting agent, waits and attacks all citizens without distinction.
It is possible that this concise picture of our sanitary reality may shock many of our compatriots; I doubt that anyone would be indifferent. It is possible that others may react and try to find scapegoats for this invisible tragedy of the people. Not a few will resign themselves with the consolation that other countries suffer similar ills.
We cannot lie back and lament the sad reality of our present. It is essential that we test the vitality of the national organizations and the capacity of the popular masses, and aim at regaining the qualities of our race and the right to live as a cultured people. It is necessary that the whole nation mobilizes towards a reparation of all these errors, ills and lack of foresight, so that all the economic, moral and spiritual forces and reserves of our people can join in a common goal to cleanse our country, to establish conditions which will allow Chilean men to function within a favorable environment, to begin a tenacious struggle against the calamities and vices, to take to the most remote corners the advances in sanitary engineering and social medicine.
The crudeness with which we have analyzed national reality is meant to uncover the problems in all their magnitude, weighing the legacy we have received, measure the projections and study the most convenient solutions.
I know that we are distant from those days when it was not considered politic and was even seen as unpatriotic for a minister to show his citizens the bare facts. This is the reason why we inform the Public, as there is no other way of learning and examining the biological realities of a people.
In matters like these there can be no subterfuges nor simulations. Social hygiene, public health, medicine do not allow compromises.
Sickness, malnutrition, alcoholism, endemic diseases, epidemics and ignorance act and erode from within and behind appearances and are inexorable in their effects. Our country has been a victim of this and that is the cause of the current alarming socio-medical reality.
Human capital, which is the fundamental base of economic prosperity of a country, has been underestimated and has been abandoned to its own fate. There lies the cause for the limited increase in our population, which must be improved and increased on the basis of numbers and in the quality of its native inhabitants. Its progressive growth is the primary condition for prosperity of a country and is a result of the state of health and culture of its components.
In historical terms, a country is valued by the quality of its inhabitants and by the size of its population rather than for its material resources. Any governmental plan requires a dense and healthy population, capable of working towards a thriving industrial and economic development. This is the mission of human capital.
All other forms of wealth: raw materials, instruments of work and the rest, lose their significance for the country that owns them, if it doesn't have at its disposal men who value and defend them, or, in summary, a robust and strong people to guide its destiny.
Our human capital has been seriously affected by abandonment and lack of social prevision. We have, of course, almost the highest mortality rate for children and adults, comparable only to the more backward countries. National health statistics are atrocious, with the state unable to significantly reduce the ravages of tuberculosis, syphilis and other contagious diseases. The population increase is below the norm which means that in 60 years, Chile's population has only increased from 2,075,871 habitants in 1876 to 4,200,000 in 1936. The average span of life of Chileans, according to statistics, is at most 24 years, while in Switzerland, Germany, Denmark and England it is above 50.
The enormous number of deaths and the high level of disease registered in our demographic records, apart from indicating the stagnation of the population, also influence the volumes of production and greatly affect the general economic possibilities, because the lost working hours and the decrease in consumption that follows, signify a considerable decline in national wealth.
Our social pathology shows that 20 percent of the active population is unable to work, reducing by a similar figure the value of national production. This is the same as if a fifth of the workers were on strike and, despite this, neither the employers, nor society are moved, nor are they interested in looking for causes and remedies. Add to this the temporary interruption to work of those who are sick or those whose organic inadequacies have not yet been expressed through an accident.
Let's add, finally, the enormous percentage of malnourished people who are easy prey for epidemics and other calamities; the lack of shelter and housing; the reduced level of urbanization existing in the country; the increasing occurrence of inbreeding among the population; the high number of illiterates and we have the true projections of the social reality of Chile.
Past governments considered the necessities of national salubriousness as deferrable and of secondary importance. They never moved to prevent, or stop to think that human capital, the basis of all wealth, constitutes the maximum responsibility of a modern state.
All progressive spirits will agree with the Minister of Health that we cannot waste any more time and that we must plan, organize and put into action a massive project aimed at restoring our nationality in its three fundamental aspects: effective economic improvement of the working classes; intensifying and extending the measures of prevention in national health programs; and an intense literacy campaign in the lower layers of the country. In order to carry out this immense task, the Popular Front was born.
The Medical Convention of Chile, held in 1936 in Valparaiso, had declared that "our socio-economic structure must undergo fundamental modifications to guarantee citizens optimal conditions of welfare through an equitable distribution of the fruits of work." It also declared that the state must regulate "production, distribution and price of articles of food and clothing." It affirmed that "housing, as property, is by essence a social function and the state must intervene in establishing norms and quality of housing." Finally, it also affirmed "that the problems related to work must constitute a medical concern due to the disastrous working conditions, the high number of accidents registered among the working class, and the deficient regulations covering the relations between capital and labor." With this, the convention stressed that the solution to the socio-medical problem of the country required precisely a solution to the economic problems affecting the proletarian classes.
With the honesty that has characterized his political action and perfectly committed to his present responsibility, the Minister of Health warns that the country must be considered to be in a state of emergency and points to the imperative necessity to use all means to deal with the dangers that threaten the existence of the country. It is necessary that the well-off contribute without haggling, for their own security. It is necessary that each and every one of our citizens support the gigantic task of lifting our country economically, health-wise and culturally, and thus bring the most dignified and effective benefit for the republic.
Let's help His Excellency the President with loyalty, in the task of rehabilitating our race, in his desire to return its creative capacity to the people.
Let's remember that Chile is, at present, a tense country, in pursuit of its rights; a country trying to mark its own destiny.