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> From: H-Net Staff via H-REVIEW <[email protected]>
> Date: August 31, 2020 at 3:57:15 PM EDT
> To: [email protected]
> Cc: H-Net Staff <[email protected]>
> Subject: H-Net Review [H-Environment]:  Gomez on Hochman, 'The Sanitation of 
> Brazil: Nation, State, and Public Health, 1889-1930'
> Reply-To: [email protected]
> 
> Gilberto Hochman.  The Sanitation of Brazil: Nation, State, and 
> Public Health, 1889-1930.  Translated by Diane Grosklaus Whitty. 
> Lemann Institute for Brazilian Studies Series. Urbana  University of 
> Illinois Press, 2016.  xiv + 216 pp.  $25.00 (paper), ISBN 
> 978-0-252-08211-5; $95.00 (cloth), ISBN 978-0-252-04061-0.
> 
> Reviewed by Rocio Gomez (Virginia Commonwealth University)
> Published on H-Environment (August, 2020)
> Commissioned by Daniella McCahey
> 
> In the opening lines of the conclusion, Gilberto Hochman writes: "It 
> is hard to adopt a strictly neutral scholarly perspective on 
> Brazilian public health policy, a topic that has us staring hard in 
> the face of human suffering and misery" (p. 149). Similarly, this 
> book review was written during the coronavirus summer and has thus 
> been influenced by human suffering, past and present. Ironically, 
> Hochman's scholarly tome has found a contemporary parallel in how 
> Brazil has approached the current crisis, making its contributions 
> echo into the present as much as in the past.
> 
> Originally published in 1998, stunningly translated by Diane 
> Grosklaus Whitty, and newly published for broader audiences by 
> University of Illinois Press in 2016, this book became an instant 
> classic in Brazil when it first came out. Focusing on the First 
> Republic (1889-1930), _The Sanitation of Brazil _examines how the 
> country developed its public health measures, the political hurdles 
> in building these reforms, and the cultural considerations to mutual 
> interdependence. Using archival documents, political treatises, and 
> legislation, the book dissects the growing awareness among Brazilian 
> elites that they are surrounded by a very sick country. With yellow 
> fever, Chagas disease, leprosy, and lurking parasite-borne 
> infirmities surrounding the metropoles, politicians and medical 
> doctors alike resigned themselves to the idea of creating a "vast 
> hospital" across the country, a term employed by physician Miguel 
> Pereira in an October 1916 speech to the National Academy of Medicine 
> (pp. 33-35). Public health, as Hochman notes, is not truly public and 
> exposes the social inequalities in a society, foreboding and timely 
> words. 
> 
> Evolving throughout the book is the idea of health, namely, the 
> question: to whom, when, and where is the government responsible? 
> Institutions, both scientific and medical, grew alongside this idea 
> and determined the approach to assuring the health of the public and 
> community. However, the riddle emerged with how to apply these 
> preventative and curative measures across such vast swaths of the 
> country. At its core, the book argues that the commitment to public 
> health remained intrinsically tied to the creation of public 
> authority. This slippery tightrope attempted to "collectivize" 
> healthcare while at the same time recognizing federal legislation. 
> Consequently, there exists two principal problems: the creation of a 
> "we" over "I" and a recognition of the federal government in a 
> country historically combative to any idea that dominated regional 
> sovereignty. 
> 
> The two salient themes of the book depict a country attempting to 
> balance its social inequalities and its vast territory while relating 
> the theme of interdependence. Hochman repeatedly points to government 
> efforts to structure itself in a way that facilitated the 
> implementation of public health policy throughout the country. These 
> efforts attempted to include state power and local support, which 
> proved uneven in the end. In this disparate application, Hochman 
> underscores interdependence. Interdependence emphasizes the idea that 
> the individual has a responsibility to society and vice versa. Using 
> Abram De Swaan's theory of "collectivization of [health]care" and 
> Norbert Elias's analysis of the state's roles, the author emphasizes 
> the reciprocal dependence between individuals, groups, and 
> institutions in order to avoid the perceived antagonism between 
> individual and society (p. 4). While tempting to read this section 
> solely as relevant to our current situation, Hochman reminds us of 
> the historical context of not only Brazil's size but also the 
> previous animosity between states and the federal government in the 
> nineteenth century. Ranging from regional bullheadedness or downright 
> military aggression toward any nationalist measures, this hurdle in 
> modern Brazil developed far before the First Republic was even a 
> dream. 
> 
> Using primarily federal health documents and sanitation policies from 
> 1919-30, the book is arranged chronologically and thematically to 
> accommodate the focus on public health policy, political structures, 
> and political maneuverings. Chapter 2 examines the 1916-20 campaign 
> for the sanitation of Brazil and its efforts to implement new reforms 
> to limit communicable disease. Chapter 3 examines the question of 
> responsibility and who should be responsible for communicable 
> diseases. It analyzes the political structure of public health 
> agencies and discussion among professionals on reforms and 
> legislation. Chapter 4 examines the success and failures of these 
> public health and sanitation measures in addition to how they 
> informed future interactions between state and federal officials. 
> Chapter 5 is the odd one, in particular because it focuses 
> exclusively on the state of São Paulo. It examines its perceived 
> exceptionalism and explores the state's public health measures as not 
> separate but rather very much central to federal efforts on public 
> health policy. 
> 
> While overall a fascinating and relevant read, the book does raise 
> some pertinent questions. Because the First Republic began just a 
> year after abolition in 1888, it seems fit to answer how this newly 
> freed population participated in or benefited from reforms (if any). 
> Unfortunately, this question remains a gaping hole in the 
> historiography due to lack of sources and the subsequent mass 
> migration that took place to urban centers. Furthermore, the book 
> primarily uses archives in Rio de Janeiro and São Paulo, which asks 
> what the political response to policy was in the states farthest from 
> the metropoles. 
> 
> Overall, the book proves to be integral to the discussion of early 
> public health and sanitation reform in Latin America. With its recent 
> translation, it will appeal to scholars in Latin American studies, 
> public health, and policy studies. While it may be used for first- or 
> second-year students, upper-level and graduate students may find it 
> most relevant in understanding the relationship between politics, 
> interdependence, and public health. A riddle that has yet to be 
> solved by Brazil, or the United States for that matter.
> 
> Citation: Rocio Gomez. Review of Hochman, Gilberto, _The Sanitation 
> of Brazil: Nation, State, and Public Health, 1889-1930_. 
> H-Environment, H-Net Reviews. August, 2020.
> URL: https://www.h-net.org/reviews/showrev.php?id=55453
> 
> This work is licensed under a Creative Commons 
> Attribution-Noncommercial-No Derivative Works 3.0 United States 
> License.
> 
> 

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