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The Sick Republic: Tuberculosis, Public Health, and Politics in Cuba, 1925-1965

Urban, Kelly (2017) The Sick Republic: Tuberculosis, Public Health, and Politics in Cuba, 1925-1965. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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This dissertation explores the politics of disease control in Cuba during the mid-twentieth century, and uses tuberculosis as a lens to understand citizenship, state-building, and populism. By analyzing the popular press, health reports, medical journals, and official correspondence in U.S. and Cuban archives, it argues that ordinary citizens, public intellectuals, and civic actors in the interwar era—not the revolutionary government of 1959—introduced the concept of a “right to health” and invoked it to demand an efficient state healthcare sector. In response to these claims and in his quest to strengthen the state, Fulgencio Batista created the Consejo Nacional de Tuberculosis in 1936.

The heightened visibility of tuberculosis, achieved in part by the claims-making of citizens, channeled state attention towards a disease of the poor, but it also distorted the design of health projects, making them inefficient and openly political. Thus, although increased state attention to tuberculosis improved mortality rates and access to health services by the 1950s, the state proved unable to depoliticize the tuberculosis campaign and to uniformly implement the right to health care on the ground. The gap between the expectations of citizens and the performance of republican administrations influenced the growing de-legitimation of the state, the overthrow of Batista’s government, and the new regime’s priorities in health policy. Nonetheless, despite the revolutionary rhetoric of radical change, there were clear continuities in tuberculosis control policy before and after 1959, such as the new government’s reliance upon the resources and institutions developed by republican administrations.

By complementing health outcomes and statistics with a social and political history of tuberculosis, and by balancing attention between state health efforts and grassroots definitions of medical success, this dissertation shifts the frame of a decades-long debate in Cuban historiography that has sought to establish the objective quality of state health care before and after the 1959 revolution. Furthermore, it challenges the assumption of a weak Cuban state and insists that health projects constituted a fundamental arm of state formation. Finally, “The Sick Republic” points to the agency of citizens as they became health activists, shaped state-building efforts, and defined citizenship rights.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee CoChairde la Fuente,
Committee CoChairAndrews, George
Committee MemberPutnam,
Committee MemberTroesken,
Committee MemberWebel,
Date: 2 July 2017
Date Type: Publication
Defense Date: 16 March 2017
Approval Date: 2 July 2017
Submission Date: 3 May 2017
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 310
Institution: University of Pittsburgh
Schools and Programs: Dietrich School of Arts and Sciences > History
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: tuberculosis, Cuba, populism, Batista, state-building, citizenship, medical citizenship, right to health
Date Deposited: 02 Jul 2017 19:33
Last Modified: 02 Jul 2020 05:15


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