Juan César García and the Latin American social medicine movement: notes on a life trajectory

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                                                                                                                                   SALUD COLECTIVA, Buenos Aires, 7(3):285-315, September - December, 2011
                                  Juan César García and the Latin American social
                                  medicine movement: notes on a life trajectory

                                  Juan César García y el movimiento latinoamericano
                                  de medicina social: notas sobre una trayectoria de
                                  vida

                                  Galeano, Diego1; Trotta, Lucía2; Spinelli, Hugo3

1
  Professor and resarcher,        ABSTRACT This article analyzes the trajectory of Juan César García, one of the referential
Institute of Collective Health,
Universidad Nacional de           figures of the latin american social medicine movement. The question that inspired this
Lanús (UNLa), Argentina.          work sought to uncover in what moment and in what circumstances García incorpora-
dgaleano.ufrj@gmail.com
                                  ted a Marxist framework into his way of thinking about health problems. Following the
2
  Professor and researcher,       methodological guidelines proposed by Pierre Bourdieu, we used the concept of “life tra-
Institute of Collective Health,   jectories” to reconstruct a life path that divides in various directions: from his birthplace
Universidad Nacional de
Lanús (UNLa), Argentina.          in necochea to the city of la plata, from there to Santiago de Chile and, finally, his nu-
luciatrotta.2@gmail.com           merous trips from Washington DC to a large part of latin america. in order to trace these
                                  paths, we carried out semi-structured interviews with key informants: family members,
3
  Director, Institute
of Collective Health,             friends, and colleagues from argentina, Brazil, ecuador and Cuba. We also analyzed the
Universidad Nacional de           books included in his personal library, donated after his death to the international foun-
Lanús (UNLa), Argentina.
hugospinelli09@gmail.com          dation that carries his name, and documents from different personal archives.
                                  KEY WORDS History; Social Medicine; Public Health; Social Sciences; Pan American Health
                                  organization.

                                  RESUMEN Este artículo analiza la trayectoria de Juan César García, uno de los referentes
                                  del movimiento latinoamericano de medicina social. la pregunta que desencadenó
                                  este trabajo buscó indagar el momento y las circunstancias en que García incorporó
                                  para sí la matriz del marxismo para pensar los problemas de salud. De esta manera,
                                  siguiendo los lineamientos metodológicos propuestos por pierre Bourdieu, utilizamos
                                  la noción de “trayectoria de vida” para reconstruir un recorrido vital que se bifurca en
                                  varias rutas: de su Necochea natal a la ciudad de La Plata, desde allí hasta Santiago
                                  de Chile y, finalmente, sus innumerables viajes desde Washington hacia gran parte de
                                  américa latina. para ello, realizamos entrevistas semiestructuradas con informantes
                                  clave: familiares, amigos y colegas de argentina, Brasil, ecuador y Cuba. asimismo,
                                  analizamos los títulos de su biblioteca personal, donada a la fundación internacional que
                                  lleva su nombre, y documentos de distintos archivos particulares.
                                  PALABRAS CLAVES Historia; Medicina Social; Salud pública; Ciencias Sociales; organización
                                  panamericana de la Salud.

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                                                                                          INTRODUCTION                                                  of health and disease, disregarding the
                                                                                                                                                        qualitative difference between these states.
                                                                                                                                                        Therefore, social medicine emerged as a
                                                                                                Juan César García (1932-1984) is known in               “modern” conception, adapted to the new
                                                                                          many parts of Latin America as one of the leaders             modes of production that were developing in
                                                                                          of “social medicine,” a school of thought that in             Europe. (3 p.22) [Own translation]
                                                                                          the second half of the twentieth century began
                                                                                          to change the way health-disease-care processes               Latin American hygienism, developed as a
                                                                                          (HDCP) were studied. In fact, social medicine was        political rationality starting in the mid-nineteenth
                                                                                          something more than a school of thought, as it           century, implied an institutionalization of social
                                                                                          had many elements of a real political movement.          medicine and its more ambitious intervention
                                                                                          There was a certain consensus about what the             projects, often limited by liberalist resistance. By
                                                                                          concept of “social medicine” meant, although it          contrast, during the postwar period of the following
                                                                                          coexisted with the ideas of “public health,” “sani-      century, the “preventive medicine” paradigm pro-
                                                                                          tarism” [sanitarismo], “preventive medicine” and         moted by the United States provided a new idea of
                                                                                          “community medicine.” Each of these notions              health care that articulated private medicine with
                                                                                          has a specific and relatively autonomous gene-           public health through specific mechanisms such as
                                                                                          alogy. The public health paradigm emerged in the         “community medicine” or “family medicine” (1).
                                                                                          modern European States, particularly in France                The Latin American social medicine movement
                                                                                          and Germany during the eighteenth century,               emerged from a critical view of this inherited
                                                                                          through historical processes that – as countless         knowledge, emphasizing the necessity of paying at-
                                                                                          scholars have studied (1,2) – were closely related       tention to the “social determinants” of the HDCP as
                                                                                          to social moral reform projects and hygienist            well as to inequalities in the distribution of health
                                                                                          codes for population control.                            care services. This change was closely related
                                                                                                However, the Latin American thinkers iden-         to a growing dialogue between the medical and
                                                                                          tified with the social medicine movement ac-             social sciences, particularly sociology and history.
                                                                                          knowledged this lineage quite late; during the           This path from the medical sciences to the social
                                                                                          1960s and 1970s they tended to regard “social            sciences was precisely the intellectual trajectory
                                                                                          medicine” as a counter-hegemonic movement,               of Juan César García, who studied medicine at
                                                                                          opposed to the medicine provided by the indi-            the Universidad de La Plata (UNLP) (Province
                                                                                          vidualistic, liberalist and capitalist market. In the    of Buenos Aires, Argentina) and later decided to
                                                                                          last text García wrote before his death, a sort of       continue his academic education at the Santiago
                                                                                          self-interview he was able to outline – although         de Chile branch of the Latin American School of
                                                                                          not finish – when he was seriously ill, he acknowl-      Social Sciences (FLACSO, from the Spanish Fac-
                                                                                          edged that long history. He asked himself: “What         ultad Latinoamericana de Ciencias Sociales).
                                                                                          is the history and the meaning of the term social             Both the choice to study sociology and the
                                                                                          medicine?” and answered:                                 scholarship provided for graduate education
                                                                                                                                                   abroad were paths marked by particular university
                                                                                               Eighteen forty-eight (1848) is the year the         policies related to developmentalism [desarro-
                                                                                               concept of social medicine was born. It is also     llismo]. Nevertheless, García’s decision was also
                                                                                               the year of great European revolutionary move-      influenced by his individual trajectory shaped by
                                                                                               ments. Like the revolutions, the concept of         his social and political activism. This is the least
                                                                                               social medicine emerged in various European         known aspect of García’s biography, which may
                                                                                               countries at the same time. [...] The concept,      be connected to the little attention he has received
                                                                                               although ambiguously used, attempted to             in his own country (Argentina), as compared to the
                                                                                               highlight that diseases were related to “social     influence he has had and still has in others such as
                                                                                               problems” and that the State should actively        Brazil, Ecuador, Mexico and many parts of Central
                                                                                               intervene to solve health problems. Simi-           America and the Caribbean.
                                                                                               larly, the term “social medicine” was interre-
                                                                                               lated with the new quantitative conceptions

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SOME METHODOLOGICAL                                      and making the material produced during the re-
CONSIDERATIONS                                           search process available to the general public.
                                                               The task of reconstructing a life trajectory
                                                         enters into some amount of tension with the legacy
      In order to reconstruct the life and profes-       of Juan César García and the social medicine
sional trajectory of Juan César García, we utilized      movement. Any historiographical reconstruction
different types of sources. First, we reviewed his       of the life of a physician has as a backdrop the
own writings and the existing literature about him,      model of the traditional history of medicine, made
as well as literature regarding the social medicine      up of a collection of biographies of illustrious
and collective health movement. Secondly, thanks         doctors. This paradigm was highly criticized by
to the generosity of his family, friends and col-        the school of thought called the “new history of
leagues, throughout the research process we had          medicine,” which, using various theoretical ap-
access to different documentary sources: pho-            proaches, prioritized the study of healthcare
tographs and letters from his youth; copies of a         systems and large processes and structures. Conse-
newspaper in which he participated while he was          quently, life stories were left aside in order to give
studying in La Plata; writings, newspaper clippings      way to the analysis of healthcare institutions and
and correspondence from his years in the Pan             to the criticism of knowledge-power mechanisms.
American Health Organization (PAHO). During              To what extent, then, would a research study of
this documentary search we also had access to            this nature imply a return to the traditional history
material about García’s years as a student activist,     of medicine, even when this study is based on the
kept in the Intelligence Office of the Buenos Aires      life of a physician who was paradoxically against
Police Force (DIPBA, from the Spanish Dirección          traditional approaches?
de Inteligencia de la Policía de la Provincia de               This question leads to an utterly current
Buenos Aires) and now under the custody of the           debate; some Latin American historians of HDCP
Provincial Commission for Memory (Comisión               are discussing the necessity and importance of “a
Provincial por la Memoria).                              return to life stories” as a new and fresh impetus
      We also conducted interviews with family           in an increasingly saturated field of study. This
members, friends, fellow students from UNLP,             impetus has already proved fruitful, as shown
and peers from FLACSO and from García’s first ex-        in the publication of works that have achieved
periences organizing Latin American social med-          a more or less successful synthesis of the critical
icine networks. The link with the Brazilian “saúde       corpus produced by the new history of medicine
coletiva” movement was fundamental, for which            and the use of biographical analysis as a method-
reason we interviewed representatives of this            ological tool (4).
movement, in addition to analyzing interviews                  In this work, the concept of “life story” was
from the oral archive at the Osvaldo Cruz Foun-          replaced by the notion of “trajectory,” following
dation and from the project on Sergio Arouca’s           Pierre Bourdieu’s suggestions about the risks
trajectory carried out by Universidade Federal do        of using life history methodology, very much in
Estado do Rio de Janeiro. Finally, we interviewed        vogue within the social sciences (5). This French
colleagues from other countries who were closely         sociologist made a suggestive criticism of what he
connected to the leftist thought being developed         calls “biographical illusion,” that is to say, the ten-
surreptitiously within the PAHO, in particular the       dency to regard a whole life as if it were a coherent
Ecuadorian Miguel Márquez.                               story. Instead, Bourdieu proposes analyzing life as
      Many of these interviews became part of            a trajectory, the way in which an actor takes posi-
archive of the Thinking about Health Documen-            tions in a social field, using resources and means
tation Center (CEDOPS, from the Spanish Centro           that are always limited, negotiating and competing
de Documentación “Pensar en Salud”) at the In-           against others for the control of economic and
stitute of Collective Health (ISCo, from the Spanish     symbolic capital.
Instituto de Salud Colectiva) of the Universidad               This trajectory, like any other, not only con-
Nacional de Lanús, with the aim of enriching the         sists in a movement through time, but also a series
oral memory of Latin American social medicine            of displacements through space. The first path is

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                                                                                          traced by García’s arrival in the city of La Plata in    UNIVERSITY, STUDENT ACTIVISM AND
                                                                                          1950 from his hometown (Necochea, Province of            SOCIAL SCIENCIES
                                                                                          Buenos Aires, Argentina) to his departure for San-
                                                                                          tiago de Chile halfway through the next decade.
                                                                                          His most well-known facet in Latin America draws               Juan César García was born on June 7, 1932,
                                                                                          a second path that goes from Chile to the United         in Necochea, an Argentine town located in the
                                                                                          States, where he first joined a research team at         coastal area of the Province of Buenos Aires, where
                                                                                          Harvard University and then started work at the          he spent his childhood and adolescence. There, in
                                                                                          PAHO. And, based in this organization, García            his seaside hometown, many of García’s school-
                                                                                          coordinated the creation of various social med-          mates who we interviewed remember him to this
                                                                                          icine networks in Latin America, an activity he          day as a lively student, a sensitive person who
                                                                                          conducted quite anonymously, since its political         was always ready to listen to others (7,8). García
                                                                                          content was incompatible with the hegemonic              came from a humble household; his father was a
                                                                                          ideas within the PAHO.                                   farmworker and his mother did the housework, so
                                                                                                This article is therefore structured in two        the possibilities of intergenerational upward social
                                                                                          parts. The first part comprises García’s education       mobility depended on what his academic edu-
                                                                                          at UNLP and his participation in university pol-         cation was able to provide him.
                                                                                          itics; his specialization in pediatrics at the same            In secondary school, García experienced a
                                                                                          institution; his first medical work at the Medical       very particular climate of the time in which politics
                                                                                          Student Association (Sociedad de Estudiantes de          began to permeate the educational sphere: in fact,
                                                                                          Medicina); and his role in the creation of a Nec-        the Head of Necochea National School (Colegio
                                                                                          ochea Student Union (Centro de Estudiantes Nec-          Nacional de Necochea), where he studied, was a
                                                                                          ochenses) and of a team of physicians that traveled      socialist leader of the area and a promoter of novel
                                                                                          through the Province of Buenos Aires. The expe-          pedagogical methods and tools (a). According to
                                                                                          rience of this physician traveling to Santiago de        some of the interviewees (9,10), the political in-
                                                                                          Chile in order to study at FLACSO, the context of        fluence from García’s uncle Julio Laborde, his
                                                                                          that decision and its implications are also explored     mother’s brother, was also important for him. The
                                                                                          in this part. In summary, this section looks into a      Laborde family came from Basque immigrants who
                                                                                          decade and a half of academic and political ex-          arrived in Argentina in the nineteenth century and
                                                                                          perience to detect many of the problems García           settled in the area of Quequén as agricultural land
                                                                                          would attempt to analyze with new intellectual           tenants. García’s uncle came be a leader in the Mar
                                                                                          tools during the following years.                        del Plata Communist Party and later Secretary of
                                                                                                The second part is focused on García’s expe-       the Central Committee of the party in Avellaneda
                                                                                          rience in the PAHO’s Human Resources and Re-             as well as the director of the newspaper Nuestra
                                                                                          search areas, that is, the almost two decades of his     Palabra and the journal Nueva Era. During the in-
                                                                                          life he spent in Washington. During this period,         terview, Miguel Márquez recalls conversations in
                                                                                          the first research study carried out by García under     which Juan César told him that it was this uncle
                                                                                          the sponsorship of the PAHO proved to be key;            who introduced him to readings related to so-
                                                                                          it was carried out from the time he joined the or-       cialism, such as the works of José Ingenieros (11).
                                                                                          ganization in 1967 until 1972, when the results                Once García had finished secondary school,
                                                                                          were published in the book La Educación Médica           his family decided to sell the house in Necochea
                                                                                          en America Latina (6). This research was signif-         and move to the city of La Plata so that Juan César
                                                                                          icant because it made it possible for him to dis-        could continue his studies and attend the uni-
                                                                                          cover in depth the teaching of social medicine in        versity. He settled there with his mother, sister
                                                                                          various Latin American countries and to start to         and brother. His decision to study medicine – ac-
                                                                                          build a network of contacts, accumulating an im-         cording to a schoolmate from Necochea – was
                                                                                          portant social and political capital that helped him     framed by the climate of the time, when opting
                                                                                          maintain certain lines of work inside the PAHO,          for a traditional and professional course of study
                                                                                          even under the suspicious eye of many directors          in the university meant attempting to achieve
                                                                                          who were not sympathetic to these activities.            upward social mobility (7).

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      This possibility of accessing higher edu-           María Ludovica Children’s Hospital in La Plata
cation arose within a historical context in which         and then to a health clinic in Berisso, a locality
a university degree would be the key to the labor         contiguous to La Plata, where he would take his
market and a better social position. Having studied       first steps in professional and community medical
in the town’s National School would enable many           practice. As a result of these experiences and the
students, who like García came from humble                close contact with the social problems that they
backgrounds, to get a good education and think            provided him, at the end of 1958 García and other
about the possibility of continuing their studies.        colleagues decided to travel around the Province
The value that a professional degree had in Ar-           of Buenos Aires in order to collect information
gentina led people to attend educational institu-         about health conditions in the towns and cities
tions, and in particular universities, which for the      within the province. They thus traveled to Tandil,
middle class was the avenue for social mobility           Balcarce and their own hometown, Necochea,
par excellence. In this type of societies, where          among other places (Figure 1).
the production (and educational) structure is little             Another important moment at the beginning
diversified and the professional fields are only          of his trajectory was his relationship with the
slightly specialized, obtaining a university degree       School of Journalism. Once his studies at the
becomes of utmost importance to the composition           Medical Sciences School were advanced, he
of the social classes (12,13).                            looked for other areas in the university where he
      During the nine years he lived in La Plata          could channel interests and questions outside the
(1950-1959), García passed through not only               reach of medical knowledge. According to the
university classrooms, but also several collective        interview with one of his fellow students at that
spaces where he built social networks that were           time, García formally enrolled in the School of
undoubtedly central to his trajectory, and in             Journalism, although he did not finish this course
which he left his own mark. During his first years        of study (14). However, while studying in this re-
in La Plata, he worked as a medical assistant in          cently created school, he was one of the advocates
the periphery of the city, a position provided by         of the Student Union statute and of the library, and
the Medical Student Association that helped him           had considerable influence in the proposals which
alleviate the economic difficulties his family was        would result in the transfer of this school to the
experiencing at that time.                                jurisdiction of the UNLP. García’s enterprising
      At the same time, García was an advocate            nature, as well as his interest in cultural debates,
of the Necochea Student Union, which brought              was also reflected in the creation of the newspaper
together the university students from Necochea            Edición (Figure 2), which was produced with other
that were studying in La Plata, the capital city of       fellow students from the School of Journalism and
the province. Their lives as university students          in 1955 published two issues. Far from focusing
and the concerns they shared as students coming           on one specific area of culture, the newspaper in-
from a small outlying city brought together these         cluded articles about science and art as well as
young people with different courses of study and          various essays and interviews. This social network
different ideological backgrounds. Among them             also facilitated book exchanges among students;
were two well-differentiated groups: one con-             authors as diverse as Borges, Sábato, Estrada,
sisting of García, his sister and other students, all     Macedonio Fernández, Sartre and the French
of more humble origins; and the other consisting          existentialists provided Juan César with readings
of students from the Faculty of Agronomy – future         that fascinated him and which he would often rec-
agronomical engineers – connected to nationalist          ommend to those around him.
Peronism, who came from a higher socioeco-                        Juan César García started his studies at the
nomic status (9).                                         UNLP at a particular moment in the history of
      After his graduation, García would once             higher education in Argentina. The university
again become involved in the types of tasks that          reform of 1918 had created a series of tensions that
had steered him toward the study medicine. His            would persist throughout time, with core debates
decision to specialize in pediatrics led him to           regarding different “university models”: the primary
complete his residency in the third ward of Sor           dilemma at stake was the creation of an institution

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                                                                                Figure 1. Juan César García (on the left) and the group of physicians from La Plata touring the
                                                                                Province of Buenos Aires (Tandil, December 8, 1958).

                                                                                Source: Photograph provided by García’s family.

                                                                                           more concerned with scientific production versus         the period prior to the university reform (including
                                                                                           an institution concerned with issuing degrees for        suspension of institutional autonomy; derogation of
                                                                                           professional practice. What was so particular about      the tripartite government [among faculty, students,
                                                                                           the configuration of the Argentine university after      and graduates]; absence of academic freedom and
                                                                                           the reform was how it maintained a highly profes-        of a public, competitive faculty selection process),
                                                                                           sional structure, in relation to the relative weight     by means of political overhauls, purges and an in-
                                                                                           of the studies of liberal professions, while at the      creasing regulation of the political activity at the
                                                                                           same time containing modernizing and democratic          university. This regulation became tighter over time
                                                                                           elements such as student participation in university     and, during the first years of the 1950s, students
                                                                                           government (15-17). Undoubtedly, the reform              became the most fervent opponents of State inter-
                                                                                           made it possible to conceptualize a university           vention, forming one of the main fronts of resistance
                                                                                           with open doors, thereby democratizing access to         against the national government. In this respect, it
                                                                                           higher studies; but also, by removing the conser-        should be clarified that the dynamic of this student
                                                                                           vative elites from the university government, the        opposition did not represent a rupture with the past,
                                                                                           reform allowed for a strong connection with pro-         but rather a deepening of the defense of university
                                                                                           fessional organizations (18 p.137-143).                  autonomy and of reformist principles that had been
                                                                                                Perón’s first administration (1946-1955), which     carried out since the 1930s. It also brought together
                                                                                           coincided with García’s years as a student, was a        an amalgam of different sectors within the student
                                                                                           time of changes in the classrooms, and universities      federations, joined not only by their defense of the
                                                                                           began to be increasingly politicized. Party politics     university reforms but also their anti-Peronist stance
                                                                                           burst onto the academic scene with regressions to        (19 p.79, 20 p.150).

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     On the other hand, these years were marked                The Medical Student Union (CEM, from the
by a world context of a growing tendency toward          Spanish Centro de Estudiantes de Medicina),
the massification of higher education studies and        of which García was an activist, had a strong
increased student enrollment. In Argentina, this         presence among the student federations organized
process had particular characteristics, not only be-     against the national government. The tension
cause it was a country with one of the highest rates     which permeated the university sphere during the
of secondary school attendance in all Latin America      first Peronist administrations took on particular
(that is to say, it had larger potential enrollment      characteristics within each academic department.
pool for higher education), but also because the         One example was the implementation of Act
Peronist government introduced policies that fa-         13.031 in 1947, which established student rep-
vored access to the university for students from         resentation in the Governing Council through a
working class sectors. Although the real scope of        student elected by the university authorities from
these policies is controversial, what stands out is      among those students with the highest grade point
the amplification of access implied in the system        averages; this representative had the right to voice
of scholarships in effect during the late 1940s, the     an opinion but not the right to vote.
elimination of student fees in the 1950s as well               At the UNLP the student representatives at-
as the abolition of the entrance examination in          tempted on one occasion to voice reformist posi-
1953. At the same time, a model centered on pro-         tions of the student assembly before the governing
fessional development was strengthened, as was
reflected in the composition of the enrollment: at
the beginning of the 1950s, 30% of the university         Figure 2. First page of the newspaper Edición. 1955.
student enrollment of the entire country was con-
centrated in medical studies (18 p.160).
     The amplification of university access within
the Faculty of Medical Sciences in La Plata serves
as a case study of these national and international
transformations. Unlike the rest of the medical
schools in the country, not only did the Faculty
have an entrance examination, but also an en-
rollment quota policy. The abolition of these re-
quirements together with the establishment of
free university education had a bearing on the
substantial increase in the number of students en-
rolled: in 1945, there were 128 students enrolled
in the Faculty; this number had more than doubled
by 1952 (288 students), and in 1953 it jumped ex-
ponentially with 630 new enrolled students (21).
     García spent his years as a medical student
in La Plata immersed in this context of university
access amplification and politicization. Moreover,
he actively experienced these tensions in the
education field, positioned within the pro-reform
forces, where he was an activist against the na-
tional government. For that reason, security forces
burst into his house on two different occasions to
arrest him. On the first occasion García remained
in custody for several days, while on the second
his family prevented the arrest by showing the se-
curity forces a photo of Perón that by chance they
                                                          Source: Original provided by María Luisa Gainza.
had in the house (9).

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                                                                                               council; in response, the General University Con-        Peronism. The student unions called for a resto-
                                                                                               federation (CGU, from the Spanish Confederación          ration of democratic values and the principles of
                                                                                               General Universitaria) sought to generate parallel       the reform, positioning themselves against what
                                                                                               channels of dialogue with the authorities. The           they called the “totalitarian advance,” the “dic-
                                                                                               members of this confederation, aligned with the          tatorship” that “tried to control them with hired
                                                                                               Peronist government, developed a regulation to           thugs and political overhauls in the universities”
                                                                                               allow all students the possibility to petition the au-   (22) (b). This confrontation increased with certain
                                                                                               thorities and, thus, also submit their own demands.      measures taken by the university authorities in
                                                                                               During the first years of the 1950s, the confronta-      favor of the national government. Such was the
                                                                                               tions between students in favor of Perón’s gov-          case of the commotion caused by a formal speech
                                                                                               ernment and students of the reformist wing were          by the UNLP rector and professor of the Faculty of
                                                                                               increasingly intense. All the positions in the Faculty   Medical Sciences that urged the university com-
                                                                                               tended to become more polarized; the authorities         munity to vote for Perón’s presidential reelection,
                                                                                               were sympathetic toward the national government,         or by those proposals of the CGU to rename the
                                                                                               while the student federations were opposed to it.        faculty after Perón and to give the main lecture
                                                                                                    Thus, the atmosphere of the time among              hall the name of “Evita Perón” (21 p.73).
                                                                                               the student representation was tinged with anti-               Several fights were therefore carried out by
                                                                                                                                                        the La Plata University Federation (FULP, from
                                                                                                                                                        the Spanish Federación Universitaria de La Plata)
                                                                          Figure 3. Pamphlet of the University Federation of La                         (Figure 3). These included fights in favor of a
                                                                          Plata (FULP). 1952.                                                           student cafeteria; against the Act of Residence
                                                                                                                                                        [that allowed the government to deport immi-
                                                                                                                                                        grants without previous trial] and against the il-
                                                                                                                                                        legal pressure exerted upon students who carried
                                                                                                                                                        out political activities; against the political over-
                                                                                                                                                        hauls, the presence of the CGU inside the uni-
                                                                                                                                                        versity, arbitrary professional appointments,
                                                                                                                                                        budget cuts, the image of the university as an
                                                                                                                                                        “unidad básica” [a name given to basic electoral
                                                                                                                                                        district organizations of the Peronist Party, in
                                                                                                                                                        charge of disseminating its ideas, qualifying its
                                                                                                                                                        members and promoting affiliation to the party,
                                                                                                                                                        among other tasks], the promotion of courses re-
                                                                                                                                                        lated to the “National Justicialist [Peronist] Doc-
                                                                                                                                                        trine” and, in the Faculty of Medical Sciences,
                                                                                                                                                        a specific struggle to eliminate the premedical
                                                                                                                                                        entrance course (22).
                                                                                                                                                               In 1954, García participated in the Pro-
                                                                                                                                                        Reform Student Organization (ADER, from the
                                                                                                                                                        Spanish Agrupación de Estudiantes Reformistas)
                                                                                                                                                        (23,24). This organization created a candidate list
                                                                                                                                                        in order to contest the leadership of the Medical
                                                                                                                                                        Student Union, in which García is listed as can-
                                                                                                                                                        didate for substitute representative of the FULP
                                                                                                                                                        for the period 1954-1955 (Figure 4). The ADER
                                                                                                                                                        list competed against the list of the Unitary Or-
                                                                                                                                                        ganization of Medicine (“Agrupación Unitaria
                                                                                                                                                        Medicina”) and another presented by Freedom
                                                                                                                                                        and Reform (“Libertad y Reforma”) according to
                                                                          Source: DIPBA archives. Table A, student factor, File No. 1 (FULP).
                                                                                                                                                        a DIPBA report (c).

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      ADER had a deep pro-reform bent; it was asso-
                                                           Figure 4. Ballot paper of the Reformist Stu-
ciated with the Radical Party, and its members were        dent Organization (ADER), of the Medical
working class students, while “Libertad y Reforma”         Student Union of Universidad Nacional de
shared the reformist ideals from a more libertarian        La Plata. 1954.
perspective, but most of its members came from the
middle and upper classes. This suggests that, like
many university students of that time, García’s in-
sertion into student politics was not only influenced
by his political ideas, but also by the people who
were close to him and the social capital he had ac-
cumulated, which reflected some distance from the
local elite families that historically produced the
most distinguished medical professionals.
      During the beginning of the following decade
(1955-1966), known as the “golden age” of the
Argentinean university, García actively took part
in the debates going on behind the scenes in the
university. From the start, the Argentine University
Federation played an essential role in recovering
autonomy and also in appointing rectors and
deans within the political overhaul (in La Plata, the
overhaul dean of the Faculty of Medical Sciences
was proposed by the reformist students). The Exec-
utive Order No. 6403/55 of the administration of
the so called “Liberating Revolution” (Revolución
Libertadora) determined the direction of the uni-
versity reorganization, by reestablishing not only
the principle of autonomy, but also the policy of
                                                           Source: DIPBA archives. Table A, student factor, File No. 39 (CEM).
a competitive and public faculty selection process
in order to reinstate those who had been dismissed
throughout the previous decade and to discrim-
inate against those who had connections with the          a contentious and unresolved issue in the history
overthrown government. This executive order also          of the school. At that time, the dean, a number of
established – in Article 28 – the authorization to        professors and the graduates of the Advisory Board
create “universidades libres” [private universities       fought for the creation of some kind of mechanism
free from State control], one of the sources of           that would partially limit admission to the school,
tension that would later undermine the harmony            on the grounds that the scarcity of material and
that prevailed during this university renaissance.        human resources was further complicated by the
      In 1956, an Advisory Board was created at           massive influx of new students.
the UNLP Faculty of Medical Sciences made up                   In representation of the students, García de-
of professors, graduates and student representa-          manded issues more central to the Argentine edu-
tives, of which García was one. There were two            cational system be addressed, related to the quality
central debates during the existence of this board:       of secondary school education and the budget
the competitive faculty selection process and the         deficit, as well as proposing a non-eliminatory
entrance examination. With regards to the se-             entrance examination. This debate clearly placed
lection process, despite the rebuttals presented          into evidence a new antinomy between the old re-
by graduates and students, the dean approved a            formists and the younger ones, who had become
rather limited quantity of faculty members. The           reformists in the heat of the fight against the Per-
debate over entry requirements to the medical             onist government, but had also mostly been able to
school continued for years, and is still to this date     gain access to the university thanks to its policies.

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                                                                                          Restrictions on the access to higher education           stay at FLACSO-Chile proved to be fundamental to
                                                                                          were no longer imaginable to them, generating a          his career. The prevailing climate in the institution
                                                                                          mixture of reformist ideas with advances achieved        during that time was one of great effervescence,
                                                                                          during Perón’s administration (25 p. 17-18).             creativity, and commitment to knowledge and to
                                                                                               Major historical processes therefore allow          the development of local human resources. This,
                                                                                          us to understand the political positions taken by        at least, is how García explained his experience:
                                                                                          García during his years as a student activist. The
                                                                                          cultural and social changes experienced in the                It should be kept it mind that the Latin
                                                                                          postwar world serve as the framework within                   American School of Social Sciences, sponsored
                                                                                          which these events took place, and, in Argentina,             by UNESCO to raise the standard of social sci-
                                                                                          these changes took on singular characteristics of             ences education, was created at the end of the
                                                                                          a clearly political nature, starting with the over-           1950s. At the same time, scholarships were
                                                                                          throw of the Peronist government (26 p.54). In a              awarded to foreigners with the aim of gener-
                                                                                          context in which Peronism was synonymous with                 ating, through this and other mechanisms, a
                                                                                          an archaic past to be left behind, the diagnosis              “critical mass” of social scientists. Of course,
                                                                                          made was one critical of a university that had been           for how could it have been otherwise, the edu-
                                                                                          emptied. Breaking with the immediate past went                cation provided was under the hegemony of
                                                                                          hand in hand with the restoration of the reforms              sociological positivism, which does not mean
                                                                                          and the uplifting of democratic values (27).                  that other schools of thought did not flourish
                                                                                               This de-Peronization of the university oc-               and that students did not react against the pre-
                                                                                          curred in a context in which the prevailing de-               vailing education. (3 p.XX) [Own translation]
                                                                                          velopmentalist ideas were promoted in most of
                                                                                          Latin America. Science and technology were the                García studied at FLACSO between 1960 and
                                                                                          two privileged areas upon which all economic             1962. Later, at the suggestion of Peter Heintz, dean
                                                                                          and social development programs were based,              of the ELAS during those years, García became a
                                                                                          and the State was considered the privileged agent        member of the teaching staff as professor of Social
                                                                                          for making those changes viable. Within this             Theory until the end of 1963. Heintz himself then
                                                                                          framework, several innovative practices of cultural      recommended García to work with Alex Inkeles,
                                                                                          modernization were adopted and the university            sociologist of the institution, although this job did
                                                                                          became a legitimate space for knowledge pro-             not work out and was one of the incentives for him
                                                                                          duction and creation. This was accompanied by            to accept the scholarship that would take him to
                                                                                          an accelerated academic institutionalization and         Harvard the following year (28). García came into
                                                                                          the strengthening of disciplinary fields that, as was    contact with this US university as a result of an
                                                                                          the case with the scientific sociology promoted by       international research study carried out in seven
                                                                                          Gino Germani, would contribute new theoretical           countries regarding “The influence of the working
                                                                                          elements such as American structural function-           environment on the behaviors of individuals,” in
                                                                                          alism as well as a local view of the development         which García participated along with other col-
                                                                                          processes of peripheral societies.                       leagues. This research, based at FLACSO, required
                                                                                               It was within this panorama that García, en-        a group of students to systematize information col-
                                                                                          couraged by a friend from the School of Journalism,      lected by means of 1,500 surveys conducted in
                                                                                          decided to dedicate himself to social studies, and       Chile, which gave them important methodological
                                                                                          applied to study at the FLACSO branch in Chile.          experience and led to the consequent invitation
                                                                                          By means of a scholarship, he was able enroll in         from Harvard University.
                                                                                          the Latin American School of Sociology (ELAS,                 The possibility of participating in fieldwork was
                                                                                          from the Spanish Escuela Latinoamericana de              part of a pedagogical strategy promoted by Heintz
                                                                                          Sociología), which was dependent on FLACSO.              within the institution, where education was based
                                                                                          Thus, in 1960, García travelled to Santiago de           on teaching content related to sociological theory,
                                                                                          Chile with the intention deepening his search for        methodology, research methods and empirical as-
                                                                                          answers to his questions and finding a more in-          pects of economic and social development. Such
                                                                                          tegrated approach to the study of the HDCP. His          a course of studies implied the participation of

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students in concrete research studies seeking to           on the role of social sciences in the medical cur-
combine theory, methodology and empirical re-              ricula: this main object of study in his 1965-1972
search in a single process. According to several           writings will be analyzed in the following section.
interviews and the work of García during those                  Hence, the training of health professionals at
years, the education had an eminently structural-          higher education institutions would be decisive in
functionalist approach combined with some ele-             the construction of a new paradigm. For García,
ments of Germani’s sociological approach that              universities were historically determined and in-
came from Argentina. A student from the third              tegrated the production, transmission, and social-
cohort describes it as follows:                            ization of knowledge according to the concrete
                                                           social formation in which they operated. In this
     I found that FLACSO had an extremely con-             way, the role of medical education became central
     servative climate. The dean at that time was          to the reproduction of healthcare services. At the
     Peter Heintz, a Swiss man heavy influenced            same time, García ascribed these institutions
     by US trends – Parsons, Merton – and also by          certain autonomy and ability to create spaces for
     the powerful influence of Gino Germani from           change and innovation (33,34).
     Argentina. There were no courses in Marxism,               García’s first experiences as a university actor
     everything was structural functionalism, with         in that context of student politicization and in the
     a slight anthropological orientation (29 p.73)        disputes over the definition of the university model
     [Own translation]                                     may have been the elements that, in the following
                                                           years, served as the foundation from which to ask
      As the archives at FLACSO-Chile’s library            questions about the relationship between social
show, García graduated with a thesis entitled “Vari-       structure and the prevailing mode of production
ación en el grado de anomia en la relación médico-         of health professionals.  
paciente en un hospital” (Variation in the level of
anomie in the doctor-patient relationship at a hos-
pital) (30). This was the first of a series of studies     SOCIAL MEDICINE AND LATIN
with topics centering on the medical elite, the            AMERICAN COOPERARION NETWORKS
doctor-patient relationship and authoritarianism,
considered by García to be a defining element in
the doctor-patient relationship. These first works               In March 1966, Juan César García joined
showed an incipient dialog between the social sci-         the Human Resources Department of the PAHO,
ences and medicine, a horizon he would never               with headquarters in Washington DC, where he
abandon. Also written by García during this period         worked until his death. It was a time of great po-
(1961-1964) were the articles “Sociología y me-            litical upheaval; the backdrop was marked by the
dicina: bases sociológicas de la relación médico-          Vietnam War, the escalation of anti-imperialism,
paciente” (Sociology and medicine: sociological            the May of 1968 in France and the revolutionary
bases of the doctor-patient relationship) and “Com-        movements in Latin America, with the Cuban
portamiento de las elites médicas en una situación         Revolution as their symbol. When García joined
de subdesarrollo“ (Behavior of the medical elite in        the PAHO, he was 33 years old; he had a degree
a context of underdevelopment) (31,32).                    in Sociology from FLACSO-Chile and experience
      In these works from the early 1960s, García          as research assistant at Harvard University.
used categories from American medical sociology,                 In the 1960s, a sector of the PAHO led
but also a critical analysis of the practical “problem     projects to reformulate public health courses from
solving” approach in medicine. As a result of his          a perspective critical of the biologicist paradigm of
investigation and his critical interpretation of this      the natural history of disease. It was fundamental
literature, he organized a collection in 1971 with         in this process to incorporate knowledge from the
the aim of informally circulating a series of works by     social sciences which permitted awareness of the
Talcott Parsons, John Simmons, Edward Suchman              multi-causality of health problems, knowledge
and Joan Hoff Wilson. This interest led him to grad-       originating from both the US preventive model as
ually focus on the medical education processes and         well as from the historical-structural perspectives

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                                                                                          that were emerging in Latin America as a new                   One such colleague, the Ecuadorian phy-
                                                                                          approach (35,36). From Harvard, García was in-           sician Miguel Márquez, summarizes what many
                                                                                          corporated into the PAHO through an ambitious            highlight regarding García’s work style, displayed
                                                                                          research project sponsored by the Milbank Foun-          all over Latin America with medical colleagues
                                                                                          dation, whose aim was to map the advances made           and other health professionals: “he had a great
                                                                                          by the preventive and social medicine disciplines        ability to bring people together” (11). García
                                                                                          in the education of health professionals in Latin        put Márquez in charge of the data collection
                                                                                          America; this project would then extend to a cur-        in Ecuador and six Central American countries.
                                                                                          ricular analysis of medical education in general.        Márquez explains that he met García in Cuenca
                                                                                               The fieldwork for this research study gave          before the fieldwork began, when García took a
                                                                                          García the opportunity to visit a large number of        trip through the countries to be included in the
                                                                                          countries, to see first-hand hundreds of schools of      study. According to this interviewee, great effort
                                                                                          medicine, to engage in dialogues with numerous           was required on García’s part to convince many
                                                                                          colleagues and to being to weave social networks         colleagues to take part in the study; those who
                                                                                          that would later give way to the first meetings on       belonged to university federations aligned with
                                                                                          “social sciences applied to health,” according to        communist ideals were at first suspicious of a
                                                                                          the name that was in use in the 1970s. Once more,        research study based out of Washington and fi-
                                                                                          as had happened during his years of activism at          nanced by a US foundation.
                                                                                          the UNLP Medical Sciences School, the question                 When García arrived in Ecuador to visit
                                                                                          of curriculum design became an area of dispute           schools of medicine, Márquez was advisor to the
                                                                                          and the site of an array of possibilities for change.    Medical Student Federation in Cuenca. Garcia’s
                                                                                          García explained that this interest in drawing a         first step was to talk to the students and explain
                                                                                          map of the medical education processes in Latin          to them the objectives of the project. The students
                                                                                          America had some precedents at the PAHO,                 (some Maoists, others more pro-soviet) then went
                                                                                          which had previously organized two seminars:             to their advisor to express their suspicions: they
                                                                                          one held in Chile in 1955 and the other in Mexico        thought García was a CIA secret agent. Márquez
                                                                                          in 1956, “both attended by representatives of            asked them to allow him to speak with García per-
                                                                                          almost every school of medicine in the continent”        sonally. They had an extremely long conversation,
                                                                                          (6 p.2). Meeting participants recommended that           one that lasted the whole day. “I encountered a
                                                                                          the PAHO take on the task of assessing the actual        man of few words, and I learned where he came
                                                                                          reach of social sciences knowledge within the cur-       from,” said Márquez in regard to García’s socialist
                                                                                          riculum design of these schools.                         origins and sociological education (35). That
                                                                                               Following this suggestion, the PAHO decided         day a long-standing friendship began, one full of
                                                                                          to gather a team of experts in Washington, who           collaborations.
                                                                                          discussed (between 1964 and 1967) the possibility              In 1972, the same year that García published
                                                                                          of developing a research study that would serve          La educación médica en América Latina (Medical
                                                                                          as “frame of reference” for the recommendation           education in Latin America), he managed to bring
                                                                                          of policies whose aim was to homogenize criteria         together a number of these colleagues in the city
                                                                                          for medical education. García was hired as one of        of Cuenca, Ecuador, where for the first time the
                                                                                          the coordinators of the fieldwork, carried out be-       incipient group took an explicitly critical position
                                                                                          tween the end of 1967 and the beginning of 1968.         regarding the functionalist theoretical framework
                                                                                          Altogether, the work took more than four years           that prevailed in the sociological analyses of health
                                                                                          and local professionals from 18 countries collabo-       at that time. Just before his death, García assessed
                                                                                          rated in the data collection; they were in charge of     the results of this meeting whose aim was, at that
                                                                                          administering questionnaires previously designed         moment, “to define more clearly the field” of social
                                                                                          by PAHO’s Human Resources Development De-                sciences in health; that is, he acknowledged that it
                                                                                          partment. Among them were several colleagues             implied a search for the theoretical and method-
                                                                                          with whom García would later strengthen his con-         ological foundations that could support this field of
                                                                                          nections in the organization of the movement of          study in the making. The group was growing but,
                                                                                          santitarists related to social medicine (d).             in García’s own words, “it was lacking the ideo-

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logical cement needed to go beyond these friendly         Berlmartino, the Latin American Social Medicine
relationships, differentiating social medicine from       Association (ALAMES, from the Spanish Asoci-
public health and separating it from preventive           ación Latinoamericana de Medicina Social) was
medicine” (3 p.XX).                                       established. In the endnotes of its founding doc-
      In order to understand the context in which         ument, the signatories decided to make “a special
the Cuenca discussions took place, it is necessary        mention” of Juan César García, in recognition of
to recall what “social sciences applied to health”        “his pioneering work in social medical thought in
meant in Latin America at the beginning of the            Latin America, his substantial theoretical contri-
1970s. Firstly, the institutional insertion of this       bution to this thought and his leadership in our As-
knowledge did not extend beyond a handful of              sociation” (39). Paradoxically, what was probably
courses on preventive and social medicine. Within         García’s greatest aspiration came to pass the same
the bibliography the most abundant references             year as his death.
were to the “behavioral sciences” approach, which               Although functionalism had contributed to the
was developed in the US after the Second World            incorporation of social sciences in the analysis such
War. García, critical of this approach, questioned        problems as the doctor-patient relationship and the
its positivist methodology and the use of a term          link between social structure and health, the crisis
(behavior) which made invisible the historical root       of the developmentalist project and the emergence
of human actions. In that sense, the group gathered       of other approaches, such as dependency theory,
in Cuenca jointly expressed that the “application         strengthened resistance to the prevailing function-
of the functionalist analysis to health issues,” as       alist paradigm. The “ideological cement” García
well as the reductionist view of works based on           referred to was Marxism and, as Hugo Mercer well
the natural history of disease paradigm and on the        described, the transition from functionalism to his-
studies of the determinants of individual behavior,       torical materialism was a process of “substitution of
all contributed to a “static conception” and to a         one structuralism for another,” since the Marxism
“formalist description” of health processes (37           that took hold in Latin America was in line with
p.XIX).                                                   Althusserian thought (40).
      According to the opinion of several of our                Consequently, García’s work (not only his
interviewees (11,38,50,71), García was the main           written and published works but also the more
advocate of that first seminar and of the internal        silent work of organizing the Latin American
consolidation of this group that remained in close        social medicine movement), showed, at the be-
contact during the following years. They planned          ginning of the 1970s, what might be called a
to hold another meeting similar to the one held in        “Marxist turn.” Glimpses of this shift can be ob-
1972, which was finally held in 1983 once again           served in previous years, when García traveled
in Cuenca. Everardo Nunes, one of the attendees           to Harvard with his colleague Carlota Ríos, an at-
at both meetings, stated during his interview that        torney who had also studied at FLACSO and was
García, who was already quite ill, commissioned           trained in Chilean socialist thought. Their schol-
him to compile the works submitted to that second         arships at Harvard were to work with George
seminar (38). That request was fulfilled and resulted     Rosen and Milton Roemer, both of whom had
in the release of the book entitled Las ciencias so-      studied under Henry Sigerist (11).
ciales en salud en América Latina: tendencias y                 Sigerist (1891-1957), known as one of the
perspectivas (Social Sciences and Health in Latin         most important historians of medicine, was head
America: Trends and Perspectives), published              of the Institute of the History of Medicine at John
both in Spanish and Portuguese (37).                      Hopkins University in Baltimore from 1932 until
      Not long after the second meeting in Cuenca,        the mid-1940s, and was one of the pioneers in
García died. Several of the attendees – Saúl Franco       using a historical and sociological analysis to think
Agudelo, Asa Cristina Laurell, Hesio Corderio,            about medicine. He was able to understand the
Jaime Breilh, Sergio Arouca and Everardo Nunes,           limitations that the social structure imposed on
among others – met again at the end of that               health phenomena, incorporating into his scien-
year in the Brazilian city of Ouro Preto. At that         tific processes a Marxist perspective which would
meeting, attended also by Mario Testa and Susana          lead him to consider socialism a superior way of

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                                                                                          life for the human being (41). The presence of this            García’s library makes it possible to map
                                                                                          author in García’s work can be observed in the           not only his readings, but also his contacts, since
                                                                                          bibliography he used within a number of writings         many of the volumes stemmed from trips and
                                                                                          after this period, such as in the work entitled “Las     networks with other colleagues. In this sense, al-
                                                                                          ciencias sociales en medicina” (Social sciences in       though García was living in Washington, there are
                                                                                          medicine), which was presented in the 23rd World         numerous books in Spanish and Portuguese: half
                                                                                          Congress of Sociology held in Caracas, Venezuela,        of his books (approximately 1,170) are written in
                                                                                          in November 20-25, 1972 (42). Undoubtedly, this          Spanish, one-third are in English and the rest are in
                                                                                          change of direction was related to a particular en-      other languages, especially in Portuguese. During
                                                                                          vironment of readings and theoretical discussions,       his successive trips to Brazil, he collected close
                                                                                          but there was also a leaning toward the Cuban and        to a hundred titles from a great variety of fields,
                                                                                          Nicaraguan experiences, where Marxism went               which suggests that his library was not only made
                                                                                          beyond a reality drawn by books. Miguel Márquez,         up by gifts from his Brazilian colleagues of the san-
                                                                                          a colleague of García’s very close to the Cuban Rev-     itarist movement. In fact, there are very few books
                                                                                          olution, remembered that during the 1960s, before        on health topics, as compared to the number of
                                                                                          García’s turn towards Marxism, they had met along        publications by sociologists such as Caio Prado
                                                                                          the path of social medicine, to which they had ar-       Junior, Octavio Ianni or Gilberto Freyre; econo-
                                                                                          rived with very different ideological backgrounds:       mists and political scientists of dependency theory
                                                                                          García with socialism and Márquez with Liberation        such as Celso Furtado; as well as numerous works
                                                                                          Theology. The 1970s, however, only consolidated          on Brazilian history and a considerable amount
                                                                                          this structuralist Marxist point of view, incorpo-       of books on the labor movement, anarchism and
                                                                                          rating different texts.                                  Marxism.
                                                                                                An inside look at his personal library, donated          Although in his library a trace of Anglo-Saxon
                                                                                          after his death to the International Social Sciences     functionalist literature (of which he amassed
                                                                                          and Health Foundation of Ecuador (e), allows at least    many books) remains, the number and diversity
                                                                                          an approximate reconstruction of these readings.         of books on Marxist theory, anti-imperialism and
                                                                                          Several sources indicate that García was not only        Latin American history is noteworthy. Shortly after
                                                                                          an avid reader but also a regular buyer of books. His    the first meeting in Cuenca, García presented his
                                                                                          library consists of approximately 3,700 volumes;         programmatic work “Las ciencias sociales en me-
                                                                                          half of these are periodical scientific journals,        dicina” (Social sciences in medicine), in which
                                                                                          conference proceedings and institutional reports,        Marxist thinking already fully permeated his reflec-
                                                                                          while the other half consists of books of individual     tions. In this work, García proposed the study of
                                                                                          and collective authorship. Among the scientific          the social structure to understand the production of
                                                                                          journals, a series of US journals on sociology stand     diseases and of healthcare services; he also stated
                                                                                          out (American Sociological Review, Theory and            that the “position taken by a physician” as a social
                                                                                          Society, The American Journal of Sociology, etc.);       actor was “determined by the mode of production,”
                                                                                          journals of sociology of science and education (So-      be it slavery, feudalism or capitalism (42 p.21).
                                                                                          ciology of Education, Science in Society, Harvard              However, this search for “ideological cement”
                                                                                          Education Review); and several publications on the       and for a new “frame of reference” different from
                                                                                          social sciences and health fields, some in English       that of US functionalism was far from an abstract
                                                                                          (Social Science and Medicine, Journal of Health          and meta-theoretical task. Based in the PAHO,
                                                                                          & Human Behavior), but most of them in Spanish           García supported two complementary processes
                                                                                          and in Portuguese: Revista Panamericana de Salud         developed during the 1970s: a remarkable impetus
                                                                                          Pública, Gaceta Médica de México, Revista Cubana         toward empirical research and the institutional
                                                                                          de Salud Pública, Revista Ecuatoriana de Higiene y       design of graduate courses in social medicine.
                                                                                          Medicina Tropical, the Chilean Cuadernos Médico-         An anecdote told by Miguel Márquez clearly
                                                                                          Sociales, and the Brazilian Cadernos de Saúde            illustrates this interest in quickly turning theoretical
                                                                                          Pública. PAHO bulletins and various publications of      discussions into tangible results. At a meeting
                                                                                          the World Health Organization (WHO) constituted          held in 1978, it occurred to García to address his
                                                                                          a great number of the publications he received.          colleagues with a parable he called “the beast

                                                                                          Universidad Nacional de Lanús | Salud Colectiva | English Edition ISSN 2250-5334
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