[Historical sketch of state medicine in Central America]

This essay sketches the fundamental characteristics of state medicine and public health in Central America, with an emphasis on the 20th century. The picture is variable, given the distinct configurations of political regime, ethnic division, and social conflict, some of them quite extreme. A high degree of historical continuity is noted in the way these factors have influenced the formation or deformation of public health and state medicine systems. Although external agents have had a strong presence in the health sector of most Central American countries, the paper argues that the historical forces that determine the nature of state medical systems in the isthmus are internal rather than external. Despite the historically weak development of state medicine in most countries, the question of public access to medicine has played an important and often highly charged role in the political life of most Central American countries.