The 1980s have seen an explosion in the number of publications dealing with the Nicaraguan Revolution reminiscent in many ways of the flood of printed materials that followed the Cuban Revolution. A good portion of the literature has tried to document the purported socioeconomic advances made by both revolutionary societies. This genre, broadly speaking, can be divided into two types. The first one comprises a largely ideological and uncritical literature adding little to reasoned understanding. A second type consists of more careful assessments helpful in appreciating complex social realities. To a great extent, the book under review falls into the latter category. The Nicaraguan Revolution in Health, while highly partisan, provides judgments based on a systematic evaluation of evidence from a country in which dispassionate analysis is the exception rather than the norm. Donahue does not always succeed, however, as in the elaboration of some of his premises and conclusions he is carried away by revolutionary fervor.
Donahue’s main purpose is to examine how changes in the political economy of Nicaragua contribute to the transformation of the national approach to health care, and in particular to health delivery systems. In doing so, he discusses how the internal debate attendant on changes in the political economy have helped mold the Nicaraguan approach to health care. He also discusses the nature of health care before the Sandinista victory and the programs, mainly in primary health care, instituted by the revolutionary government. Central to the author’s analysis is the role of popular education in health and how health educators in Nicaragua “attempted to combine in a culturally relevant manner the social and biological components of primary health care and preventive medicine” (p. 63). Donahue’s methodology consists of subjecting to content analysis popular health pamphlets and documents issued between 1981 and 1982.
Donahue concludes that changes initiated by the Sandinista government have been beneficial. The political leaders chose to follow a proven path to improved health by embracing primary health care and preventive medicine, with special attention given to rural areas. Except for a number of details, what the Sandinistas have done in Nicaragua largely fits the model most developing socialist states, and many nonsocialist countries as well, have followed. Sandinista Nicaragua, as Donahue shows, has borrowed heavily from many other countries—particularly Cuba—and has even followed through on recommendations made by U. S. technical teams that visited Nicaragua before the revolution. International cooperation in health matters is an encouraging development too often mediated, unfortunately, by political considerations. Progress in health, too often as well, is slowed down by uncaring governments and by unjust power structures as was the case in Nicaragua under the Somozas.
To jump from these facts to the conclusion that to bring about better health it is essential to have a health education program, one of whose purposes is to modify political attitudes, constitutes a major leap of faith. The examples of Costa Rica, Panama, Mexico, Colombia, and many other countries, including prerevolutionary Cuba, seriously undermine such a conclusion. Many factors affect the health status of a population—among the most important is a government’s commitment to address the issue of health needs. Governments of many different political stripes have successfully done so. Further, while the contents of the health education materials Donahue analyzed are acceptable and necessary to him, they are certain to raise many eyebrows: some of these materials would be objectionable to others not ideologically committed to what the Sandinistas wish to accomplish in Nicaragua. Finally, Donahue seems to be far too credulous in accepting what obviously are inflated claims made by the Sandinistas. Many of these claims appear to be politically motivated; at this time there is not sufficient evidence to either refute or verify them.
