A social disease/a social response: lessons in tuberculosis from early 20th century Chile.

摘要

During the 1930s, Chile reported the world's highest mortality rate due to tuberculosis. In this pre-antibiotic era, the attention of the biomedical community frequently turned to the underlying social inequalities and deficiencies that created conditions of heightened risk for Chile's rapidly expanding working class. With the recognition that crowded housing, chronic malnutrition and substandard working conditions fostered an environment in which the disease developed and spread with virulent rapidity, physicians frequently became vocal advocates for widespread and significant social reform. However, by the time of the introduction of efficacious pharmaceutical agents in the 1940s and with the overall rapid development of biomedicine in the mid-20th century, the larger medical discourse became more rigidly defined and characterized by the promotion of the new antibiotics and treatments. These factors increased the depth of the self-defined medical territory but substantially reduced its breadth. Accompanying this shift was an increasing focus on individual behaviors that were seen as deficient and were both socially censored and used as explanations for increased susceptibility. In the midst of the current worldwide epidemic of tuberculosis, this disease and its epidemiological pattern heightens our awareness of the significance and consequences of global inequalities. It also draws our attention to the importance of intervention within the social conditions from which these patterns emerge.