Dismantling Health by Design: Social Medicine, US-Led Interventions, and the Political Neoliberal Economy of Care in Latin America.

Abstract

Recent US policy decisions affecting domestic and global health funding have renewed debate on the United States' disproportionate influence over global health governance, institutions, and priorities. Although some scholars call for defending existing frameworks and others advocate reimagining global health beyond US-centric paradigms, these discussions often remain focused on immediate geopolitical developments. We place these debates in a broader historical context by examining Latin America, where US-led political and economic interventions interacted with domestic elites to shape health policy trajectories. Drawing on the traditions of Latin American social medicine and collective health, we analyze how global and national political-economic forces reshaped health systems in Chile and Brazil. Neoliberal reforms emerged through the convergence of international financial pressures, domestic elite coalitions, and policy diffusion. These reforms occurred through 3 interconnected processes: the depletion of public health capacity, the marketization and fragmentation of services, and the weakening of community-based care models. Latin America's experience demonstrates how neoliberal governance commodified health while also fostering enduring traditions of resistance and rights-based care, offering lessons for reimagining social medicine and global health today. (<i>Am J Public Health</i>. Published online ahead of print July 23, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308564).