H-Diplo Article Review 729 on “Stimulating a Cooperative Spirit? Public Health and U.S.-Bolivia Relations in the 1950s.”

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Article Review
No. 729
6 December 2017

Article Review Editors: Thomas Maddux and Diane Labrosse
Web and Production Editor: George Fujii

H-Diplo Article Review of Nicole Pacino.  “Stimulating a Cooperative Spirit?  Public Health and U.S.-Bolivia Relations in the 1950s.”  Diplomatic History 41:2 (April 2017):  305-335.  DOI:  https://doi.org/10.1093/dh/dhw054.

URL: http://tiny.cc/AR729

Review by Kevin A. Young, University of Massachusetts Amherst

U.S.-Bolivia relations in the mid-twentieth century present an apparent paradox: why did a government that has so often opposed revolutions with savage violence decide to support the government that took power in the 1952 revolution? Bolivia was the leading per-capita recipient of U.S. aid in Latin America in the 1950s. Most historians have concluded that while the strategy the United States adopted in Bolivia was different, U.S. goals were not. U.S. officials saw the moderate middle-class leadership of the Movimiento Nacionalista Revolucionario (MNR) as a bulwark against a more radical revolution. In Bolivia, as elsewhere, the major goal was to maintain an “economy based on private enterprise and improve the atmosphere for private foreign capital.”[1] The U.S. strategy achieved considerable success, although the revolution went somewhat farther than the United States would have liked.

Nicole Pacino’s study of U.S.-funded public health programs qualifies this picture. Pacino argues “that not all U.S. aid to Bolivia during the 1950s deepened Bolivian subservience to the United States or stalled a social revolution in progress, as is often seen as the objective behind U.S. aid programs” (306). She ultimately seems to agree with prior historiography on the intent of U.S. aid but disputes the outcome, contending that the results were not what U.S. officials had hoped. The MNR itself was the biggest beneficiary of the health programs, which it used to project and consolidate its power throughout the country.

The Servicio Cooperativo Interamericano de Salud Pública (Inter-American Cooperative Public Health Service, SCISP) operated in Bolivia between 1942 and 1963, greatly expanding after 1952. By 1959 it had established eighteen health centers, providing a wide range of preventive and curative care including immunizations, disease treatments, maternal and infant health services, and health education. SCISP also funded scholarships for 200 health professionals. In the 1950s most of the SCISP funding came from the United States, with lesser amounts provided by the Bolivian government. U.S. health aid totaled a modest $3.1 million over the life of the program, but SCISP initiatives reportedly reached one-fifth of Bolivians.

The most interesting part of Pacino’s argument is her analysis of how the MNR used SCISP funding to its own advantage. Party leaders took credit for the health centers, which they touted as examples of their efforts to transform the country. This “discursive nationalization of foreign aid” benefitted both the MNR and U.S. governments by simultaneously mitigating anti-imperialist sentiment among the public, enhancing the MNR’s political legitimacy, and solidifying an important regional alliance for Washington (314). The MNR further benefitted by taking over the SCISP program when U.S. health officials left in the early 1960s.

As the article makes clear, public health efforts were central to the MNR’s own development agenda in the countryside. One of SCISP’s explicit objectives was to “preserv[e] manpower important to the economical [sic] development of Bolivia,” a goal fully shared by the MNR (quoted, 315). Health outreach prioritized regions deemed to hold the most productive potential, particularly the tropical lowlands. In 1956 President Víctor Paz Estenssoro stressed the importance of health reforms in the quest to “dominate nature, which in our case, is a difficult, threatening, and hostile nature but one that is pregnant with riches” (quoted, 318). For the paternalistic mestizo leaders of the MNR, subduing nature also required “disinfecting and integrating” the rural indigenous population (319). Like their predecessors, most MNR leaders saw rural Indians as culturally inferior and in need of uplift, including in the realm of personal hygiene and sanitation.[2] Ironically, those same leaders often faced similar condescension from U.S. officials, and the resultant tensions contributed to the Bolivian Health Minister’s 1959 decision to end the SCISP program.

Pacino’s analysis of MNR agency adds to a growing body of scholarship on the ways that subordinate governments maneuver within the confines of imperial relationships, acting on their own motives and sometimes exercising significant power.[3] Her conclusion is partly a product of her methodology: the source base includes a rich mix of U.S. and Bolivian sources, drawing from the two countries’ national archives as well as smaller collections.

The argument is convincing, if not quite as new as the author implies. Many prior accounts have noted the ways that the MNR regime benefitted from U.S. support. They stress how, unlike many other Bolivians, the MNR’s top leaders never intended to launch a radical social revolution. Their main goal was economic ‘modernization’ along capitalist lines. They only embraced redistribution out of political expediency and did not hesitate to repress the left.[4] MNR goals were not all that different from those of U.S. liberals, who wanted to promote “middle-class revolution” in Latin America in order to avert an anticapitalist “‘workers-and-peasants’ revolution.”[5]

Pacino presents her argument as a challenge to prior historiography:

Despite claims that U.S. aid to Bolivia helped “tame” or “defuse” the MNR’s revolution, this study demonstrates that bilateral public health programs benefitted the MNR regime. It shows that two nations that were economically, politically, and militarily unequal could create a cooperative aid program from which both could benefit. (335)

While the history of public health projects indeed adds an interesting new dimension to the story, I question whether this argument is actually incompatible with studies emphasizing the conservative impact of U.S. policy. The fact that the MNR benefitted from the SCISP presence (as did some Bolivian patients) does not negate the conservative U.S. rationale in aiding the MNR. Nor does it negate the overall impact of U.S. aid in taming the Bolivian Revolution. One can stress the reactionary power of the U.S. government while also recognizing the MNR’s own motives, the ways the MNR benefitted from the relationship, and the incidental benefits that accrued to some of the Bolivian public as a result of U.S. policy. These arguments are entirely compatible with one another – especially when we consider that U.S. aid itself was a response to the threat of radical mobilization from below, without which neither the MNR nor Bolivian patients would have benefitted to nearly the same degree. 

Part of my disagreement here may stem from the subtle conflation of the MNR and the rest of Bolivia that is present, for example, in the quote above. The 1952 revolution was not really ‘the MNR’s revolution,’ but, as Pacino hints elsewhere in the article, a mass mobilization of Bolivians whose agendas were often much more revolutionary than those of the MNR leadership. MNR officials participated in the effort to tame this radical energy. They benefitted from U.S. aid, at least in the short term. But the overall impact of U.S. intervention on the Bolivian nation is much more mixed, to say the least. If we understand the MNR itself as the primary Bolivian beneficiary of U.S. health aid, it becomes easier to reconcile Pacino’s argument with the other scholarship on U.S. policy toward the Bolivian Revolution.

This quibble notwithstanding, Pacino’s account is an important contribution to the historiography. Her analysis of the MNR’s use of U.S.-funded health programs offers suggestive insights that could inform the study of foreign aid programs elsewhere. The article also fills a gap in studies of public health in midcentury Bolivia, a long-neglected facet of the U.S.-MNR relationship and the MNR period more generally.


Kevin A. Young is Assistant Professor of History at the University of Massachusetts Amherst. He is the author of Blood of the Earth: Resource Nationalism, Revolution, and Empire in Bolivia (University of Texas Press, 2017), and is currently compiling an edited volume on the history of the Latin American left.

© 2017 The Authors | Creative Commons Attribution-NonCommercial-NoDerivs 3.0 United States License


[1] Assistant Secretary of State Henry Holland to Under Secretary of State Herbert Hoover, Jr., June 1, 1955, in U.S. National Archives, Record Group 59, Entry 1132, Box 1. Studies of U.S.-MNR relations include Kenneth D. Lehman, Bolivia and the United States: A Limited Partnership (Athens: University of Georgia Press, 1999); James F. Siekmeier, The Bolivian Revolution and the United States, 1952 to the Present (University Park: Pennsylvania State University Press, 2011); Thomas C. Field, Jr., From Development to Dictatorship: Bolivia and the Alliance for Progress in the Kennedy Era (Ithaca: Cornell University Press, 2014); Kevin A. Young, Blood of the Earth: Resource Nationalism, Revolution, and Empire in Bolivia (Austin: University of Texas Press, 2017).

[2] On public health and racial ideologies prior to 1952 see Brooke Larson, “Capturing Indian Bodies, Hearths, and Minds: The Gendered Politics of Rural School Reform in Bolivia, 1920s-1940s,” in Natives Making Nation: Indigeneity, Gender and Class in the Andes, ed. Andrew Canessa (Tucson: University of Arizona Press, 2005), 32-59; Ann Zulawski, Unequal Cures: Public Health and Political Change in Bolivia, 19001950 (Durham: Duke University Press, 2007).

[3] See sources cited in Max Paul Friedman, “Retiring the Puppets, Bringing Latin America Back In,” Diplomatic History 27:5 (2003): 621-636, plus Siekmeier, The Bolivian Revolution and the United States. Calls to understand Latin American elites as more than just ‘puppets’ are worthwhile, though these critiques sometimes target straw persons: most anti-imperialists are quite aware of the importance of Latin Americans’ actions, too.

[4] For instance James M. Malloy, Bolivia: The Uncompleted Revolution (Pittsburgh: University of Pittsburgh Press, 1970); Laura Gotkowitz, A Revolution for Our Rights: Indigenous Struggles for Land and Justice in Bolivia, 1880–1952 (Durham: Duke University Press, 2007); Kevin Young, “Restoring Discipline in the Ranks: The United States and the Restructuring of the Bolivian Mining Industry, 1960-1970,” Latin American Perspectives 38:6 (2011): 6-24; Mario Murillo, La bala no mata sino el destino: Una crónica de la insurrección popular de 1952 en Bolivia (La Paz: Plural, 2012); Kevin Young, “Purging the Forces of Darkness: The United States, Monetary Stabilization, and the Containment of the Bolivian Revolution,” Diplomatic History 37:3 (2013): 509-537; Field, From Development to Dictatorship; Young, Blood of the Earth.

[5] Arthur Schlesinger, Jr. “Report to the President on Latin American Mission, February 12-March 3, 1961,” in Foreign Relations of the United States, 19611963, vol. 12 (Washington, D.C.: USGPO, 1996), 12.