Allende, Salvador. La realidad médico-social chilena [Chilean social-medical reality], Santiago de Chile: Ministerio de Salubridad, Previsión y Asistencia Social, 1939.
Second Edition, 1999. Edited by TADECH.
Objectives: To present an explanatory model of medical problems in the context of underdevelopment. To analyze demographic and social statistics to show the relationship between social context and health problems. To demonstrate that social change is the only potentially effective therapeutic approach for many health problems.
Methods: Epidemiological methods permit one to understand the relationships among social structure, disease, and suffering. Illness is defined as a disturbance of the individual that may be fostered by deprived social conditions. Demographic and geographic data place health problems in context. This model emphasizes social structural characteristics that are amenable to reform at the level of social policy. The author analyzes differential wages by sex and social class, the impact of inflation, and laws aiming to ensure subsistence-level income.
Results: Allende emphasizes the social conditions of underdevelopment, international dependency, and - anticipating future concerns - the impacts of foreign debt and the work process. He argues that economic development is a prerequisite for meaningful interventions in medicine and public health. He suggests that incremental reforms within the health care system would remain ineffective unless accompanied by broad, structural changes in the society.
For the central part of La Realidad, Allende focuses in greater depth on several specific health problems, including maternal and infant mortality, tuberculosis, sexually transmitted and other communicable diseases, occupational illnesses, and emotional disturbances. Within these chapters, Allende provides clinical and epidemiologic accounts of living conditions, and how these conditions lead to adverse health outcomes. In several instances, Allende also calls attention to issues that had not been studied previously. He elucidates, for instance, the complications of illegal abortion among working class women and the psychosocial conditions that motivate abortion, the relationship between reduced incidence of tuberculosis and economic advances rather than technical innovations in pharmacologic treatment, the importance of housing density in infectious diseases, and differences between generic and brand name pricing in the pharmaceutical industry.
Conclusions: These expository chapters lead to the conclusions of La Realidad, which takes a unique direction by advocating social rather than medical solutions to health problems. Allende proposes income redistribution, state regulation of food and clothing supplies, a national housing program, and industrial reforms to address occupational health problems.
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