Brief Update on

The Politics of Health in Mexico’s Sierra Madre

Prepared for a forthcoming booklet by the International People's Health Council

David Werner, November, 2002

Increasing poverty, crime, and violence in rural and urban Mexico

The Ajoya Massacre. For the last 37 years the village of Ajoya in the foothills of Mexico's Sierra Madre Occidental, has been the nucleus of the groundbreaking community-based health and rehabilitation innitiatives, projects Piaxtla and PROJIMO. These programs have been the source of the widely used handbooks Where There Is No Doctor, Helping Health Workers Learn, Disabled Village Children, and Nothing About Us Without Us. But over the last several years the combination of drugs, violence, robberies, and kidnappings have plagued the village. At a festival and dance for Mothers’ Day last May (2002), a massacre resulted in the death of 12 person including 2 “Protection Police,” a 7 year old boy, and a grandmother in her 60s.

Tragically, the village of Ajoya is fast becoming a "pueblo fantasma," a ghost town. The same is true for many of villages of the Sierra Madre, and throughout rural Mexico. Since 1994 when the North American Free Trade Agreement was launched, over 2 million destitute campesinos (peasants) have left the rural area for the mushrooming city slums.

But in the cities, the situation is in some ways worse than in the countryside. Within the last few years crime and kidnapping have escalated, as have delinquency, drug trafficking, organized crime, and police brutality. Mexico City has kidnappings nearly every day. According to the New York Times (June 7, 2002) often the Police are themselves involved in the kidnappings. The promises of the new President, Vicente Fox, to clean up crime and corruption have proved as empty as his promises to combat poverty.

Situational Analysis

From NAFTA to kidnapping. Many analysts tie the growing subculture of crime and violence in Mexico to the widening gap between rich and poor. This, in turn, they trace at least in part to NAFTA: the North American Free Trade Agreement. (I have written about this in HealthWrights’ Newsletters from the Sierra Madre, and in the book by David Sanders and myself, "Questioning the Solution: The Politics of Primary Health Care and Child Survival."

In brief, NAFTA to a large extent has benefited big business and foreign investors at the expense of the poor. First, as a condition for Mexico's entry into NAFTA, the Mexican government was required to change its Constitution and annul its agrarian reform laws. When the legislation that safeguarded the land holdings of small farmers was rolled back, millions of hectors of the best farmland concentrated again into giant plantations, much of it now controlled by giant US agribusiness. Second, NAFTA's lifting of tariffs on export to Mexico of US government subsidized grain and cattle has driven countless small farmers and herders in Mexico into bankruptcy. Both these events have spurred unrest and crime in rural areas, and turned “urban drift” into a mass exodus.

In turn, in the cities, the huge influx of destitute job-hunters has pushed real wages down by 40%. This was followed by the crash of the peso in 1995. Triggered by the sudden pullout by foreign speculative investors, it caused the closure of one third of Mexico's businesses (the smaller ones) with subsequent massive unemployment. Further aggravating the situation, austerity measures and "structural adjustments" imposed to correct the crisis included cutbacks in public assistance increase in sales taxes, and other measures that meant further hardships for the poor. The result was the current pandemic of street children, drug trafficking, petty crime, and then kidnappings and assaults, precipitating a backlash of police brutality, corruption, and unsolved human rights violations.

This deteriorating situation for the poor (and middle class) majority in Mexico led, in 2000, to the ousting of the powerful PRI (Institutionalized Revolution Party), the elite, corrupt oligarchy that wielded heavy-handed, single-party control for nearly 70 years. But the new PAN coalition party under Vicente Fox, though it promised to fight corruption and reduce crime, has not been effective at either. In terms of crime and kidnappings, the situation has worsened.

The physical violence in Mexico is the fruit of structural violence: namely the entrenched socioeconomic situation that allows the rich to get richer at the expense of the poor. Since the onset of NAFTA, both the numbers of people living in poverty and the percentage of malnourished children have increased. While millions of destitute people struggle to find jobs and feed their children, Mexico today has more billionaires per capita than any other nation! Although President Fox (he is well named), talks smoothly about lifting the poor out of poverty, this former chief of Coca-Cola Mexico is in essence a Harvard-trained corporate executive and a great pal of George Bush. (That fact that Fox kicked Fidel Castro out of the recent Monterrey Economic Summit as favor to Bush reveals his stars and stripes).

Despite Fox's pro-poor rhetoric, his social policies are regressive. He has pushed to up the sales tax and extend it to cover basic foods and medicines. He has proposed a "user fees" for rural health centers, which have historically been free. (Introduction of this kind of cost-recovery "health reform package," previously widely promoted by the World Bank, has caused worsened heath status in a number of poor countries, as documented in "Questioning the Solution" by Werner and Sanders ). Fox has also wanted to privatize part of Mexico national oil industry, giving exploration rights to US transnationals. But so far, even his own Congress has resisted.

A way forward?

If Mexico wants to reduce the pandemic of crime, kidnappings and violence now wracking the country, it will not do so through investing in more in police and military force/. Nor will it to so by yielding its oil rights to the control of US transnational corporations.

Rather, it advance toward a healthier society by working toward a socioeconomic balance which helps reduce poverty, polarization, and despair, by providing fair wages and fair distribution of land. It will do so by increasing the accessibility of health care and other services in a way that effectively reaches the most vulnerable. And it will do so by encouraging (or at least permitting) a participatory democratic process where the poor and disadvantaged gain an effective voice in the decisions that determine their lives and their deaths.

Participatory democracy – if it is ever to function fully – will require an educational system that encourages critical analysis and collective self-determination rather than blind obedience, and which deals more honestly with history.

But the people of Mexico – or any other of the less powerful nations -- even if they somehow manage to unite in struggle for a fairer, more representative national government – will have a hard time achieving and sustaining such a just society in today's top-heavy market-driven world. Today most countries, rich as well as poor, are experiencing similar polarization of society, cut backs in assistance to the poor, and undermining of democratic process by under the influence of Big Money. This is all part of the globalized development paradigm that puts the growth of the rich before the well being of the many. As history demonstrates with increasing virulence, the dominant power structure has little tolerance for any “less developed” country that steps out of line.

Given the state of the world, Mexico has little chance of correcting the current trend of structural and societal violence. The global forces are too great. Only the a grassroots movement for change within Mexico joins in solidarity with similar mobilizations in other countries, is the critical mass likely to be achieved that may be sufficient to turn the tide.

To bring about such democratic transformation within today's top-heavy market-driven world, concerned and forward-looking people of the planet must mobilize a ground swell of awareness for change. This is, of course, the intent of the International People's Health Council, the People's Health Movement, the International Forum on Globalization and other coalitions working to build a fairer, healthier, more sustainable global society.

In last analysis, the answers to violence and terrorism lie not in retaliation and punishment but in understanding and equity. Not in more and stronger soldiers but in more, more caring teachers. Not in more authoritarian controls but in more welcoming of difference. Not in hate and vengeance but in caring and sharing.