Community Health Groups and the
Changing Terms of Health Care in Mexico
By Suzanne D. Schneider
Unequal access to and rising costs of health care are among the most pressing global problems of the 21 st century. As the cost of treatment soars, millions of people throughout the world are denied access to basic medical care, not to mention advanced medical technology. While the clamor for biomedicine increases, particularly among those who have little access, a growing critique of modern medicine and the institutions that deliver it has propelled a global movement for medical alternatives and new modes of health care delivery.
One local expression of this global movement can be seen in central Mexico where grassroots health organizations are sprouting up throughout the region. Local community groups, searching for new ways of “doing” and delivering health care, have organized around the study and diffusion of alternative medicine. The health groups I observed in the state of Morelos share the following similar set of characteristics. They all express a critique of the dominance of biomedicine; they advocate a counterpoint to biomedicine’s curative approach by embracing holistic health practices with roots in both Eastern and Western traditions; they run community clinics, natural pharmacies, and training programs in order to make the alternatives they propose accessible and affordable for all residents; and finally they advocate community service as a means to distribute their resources. The discourses they advocate and the work they do help shed light on the shifting terms of health care in Mexico.
Such community health groups emerge in the context of persistent health disparities, the rising cost of medical treatment, and the deterioration of an underfunded national health system. Neoliberal health reforms implemented by the Mexican government over the last two decades have emphasized less government intervention in public health, which in return has accelerated the decrease in health care protection. As a result of neoliberal reforms patients are now expected to pay fees for public services that historically were available free of charge. Meanwhile the private sector’s participation in health care expands. As the divide between the retracting state and the inaccessible market grows, citizens and local communities are increasingly expected to step in and fill in the gaps of a declining public health system.
The health groups I studied attempt to bridge this divide by making their health services and education accessible and affordable for all residents. Members are largely low-income women who share an interest in health care and alternative medicine. These women seek education and professional options in a country that grants poor women few opportunities for either. In programs that last eight months to three years, health group members train in Chinese medical philosophy, nutrition, acupuncture, herbalism, and naturopathy, among other diagnostic and healing modalities. Students may apprentice or shadow more advanced practitioners in community clinics where a range of therapeutic services including nutrition therapy, massage, acupuncture, Reiki, polarity therapy, homeopathy, and traditional Mexican herbalism are offered on a sliding scale. Patients that utilize clinics services are sometimes invited to become students; joining the training program is viewed by members as an extension of the healing process. Work offered by health group members is mostly voluntary and the majority of the groups’ operating budget is largely generated through clinical consultations, natural remedy sales, and donations.
These clinics draw a demographically diverse group of patients including poor farmers who come from the rural countryside, middle-class women who come from the cities, and the working poor who live in the towns in which these clinics operate. The most common problems that patients present are those that “traditional” biomedicine can not easily remedy—chronic aches and pains largely resulting from occupational stress and chronic illnesses that have no known biomedical “cure.” Sometimes “alternative” medicine can help with problems that traditional biomedicine cannot easily resolve. Moreover, alternative medicine is arguably better suited for certain problems: for example, herbal remedies can mitigate intestinal and respiratory problems and holistic therapies often more adequately address emotional or psychological problems.
While health groups incorporate an array of global health practices with roots as far away as China, India, and Europe, they also emphasize the goal of “rescuing” traditional Mexican medicine as a central component of their practice. Participants are mestizo Mexicans (people of mixed Spanish and Indian descent) who share a concern that as a result of the influence of Westernization their native traditions and values are rapidly disappearing. Traditional medicine (particularly herbalism) is viewed as one aspect of culture that can and should be rescued and diffused particularly in light of the expense of synthetic medicines and their potential side effects. The emergence of these health groups therefore relates as much to social critiques of Westernization as to local critiques of biomedicine and government health care delivery.
As health care increasingly becomes a commodity to be bought and sold, health groups also articulate a concern regarding the decline of health care as a social right. Their work is therefore conceived of in communitarian terms—helping the poor and empowering the community in health matters. To achieve those ends, groups charge for their services on a sliding scale, seek to attend to the poor members of society, and offer “scholarships” and affordable membership for those who join the health training program. While offering a communitarian approach to health service delivery members sometimes also participate in the commodification of health care. For example, after volunteering their time and labor in the community clinics members may hold private consultations either in their homes or in the community and charge a relatively considerable fee for their services. Moreover, health groups are increasingly involved in developing herbal medicine cooperatives with the goal of generating income. The most successful groups market their products on the internet to an international clientele. Paradoxically, although market-based approaches to health care are contrary to health groups’ mission of community service, capitalizing on the economic benefits of alternative medicine may provide the only option for such groups to remain viable. In fact, health groups largely choose to work independent of government funding since such funding is notoriously linked to “a lot of work for a little money.” On an individual level, charging a fee for private consultations and selling herbal products offer some women a unique opportunity to gain a semblance of economic independence from their husbands. Indeed, such conflicting interests create tensions both within and between groups. For example, I documented numerous occasions in which either individual members or those groups experiencing entrepreneurial success were perceived by others as “robbing” the community since they were not adhering to communitarian values.
Not unlike the domain of formal health care, the tension between capitalist and communitarian values marks the work of community health groups. Like any other service or commodity, to remain competitive and viable alternative medicine (and its providers) must adapt to the market in order. In becoming too market oriented however, health groups risk contributing to what Baer (2001) calls “a marketed social movement.” Many argue that movements in the United States such as holistic health and organic agriculture exemplify this pitfall and run the risk of representing a consumer lifestyle rather than a civic responsibility (DeLind 2000). Health groups in Mexico thus confront certain of the same dilemmas that they themselves critique in formal medicine. Rather than existing outside of those social forces that are changing the terms of health care, they appear instead to be bound within them.
Immersed within these social forces, health groups struggle to fulfill their mission of community service and while simultaneously maintaining authenticity in practice. These members attempt to bridge the health care divide by attending to the poor, the aged, and to those who feel marginalized in public clinics. They utilize global and local resources to contribute to and redefine the health care process as one that centers on the patient as participant.
The members I interviewed view their work as urgent, particularly as biomedicine becomes increasingly costly, impersonal, and technologically-oriented. They strive to revive some of the “humanity” they feel has been lost in modern medicine. In essence, their work reflects the spirit of the modern Hippocratic Oath that reminds health practitioners that “there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.” 1 While contributing to the dialogue concerning what constitutes just and compassionate care, these groups provide health services to individuals who would otherwise not receive treatment, offer health education to those with little access, and empower patients to participate in their health.
Although they play an active role in providing community health care intended to be complementary to available biomedical options, the groups I studied are largely ignored by the local government and health officials. In fact, health group participants are often viewed as “women practicing what they have always practiced—traditional medicine” to quote one health official I interviewed. This assumption not only stereotypes the participants, but it also overlooks the diversity of the groups’ global and pluralistic health care approaches. Additionally, officials’ inattention to the local health system reinforces a message that has been communicated in public health efforts for decades—that there is only one avenue to improve community health and that route is through biomedicine.
As health groups are overlooked, public officials and health administrators speak of their growing concern regarding chronic health resource shortages, increasing population demands on public clinics, and the strain that chronic illnesses are having on the local health system. The irony here is that while community groups offer creative solutions to address the limitations of curative-based health care, their efforts are viewed pejoratively as “traditional” (that is, backwards) and thus ineffective. Moreover, the strategies they advocate—prevention and participation—are hailed as the panacea by global health reformers to address the inefficiencies and inadequacies of Mexico’s health system. Yet on the ground, those strategies are viewed as irrelevant by those in charge of instituting health reforms.
As local groups and their medical alternatives are rendered invisible by adherents to the dominant medical paradigm, this case raises important questions regarding the role of civil society in the context of state decline. For example, who controls a health care process that requires the participation of multiple sectors of society? Who deter- mines which groups are equipped to deliver health care services? What is the role of the market in determining the value and viability of community health services? Immersed in many complex and contradictory social forces, health groups in Morelos appear to be both products and producers of social change. They express the many challenges inherent in health care today and the possibilities for health care tomorrow.
Notes
1. Retrieved from http://www.pbs.org/wgbh/nova/doctors/oath_modern.html, June 21, 2006.
References
Baer, Hans A. 2001. Biomedicine and Alternative Healing Systems in America: Issues of Class, Race, Ethnicity, and Gender. Madison, WI: The University of Wisconsin Press.
DeLind, Laura. 2000. Transforming Organic Agriculture into Industrial Organic Products: Reconsidering National Organic Standards. Human Organization 59(2) 198-208.