In nations with large Indigenous populations like Guatemala and Ecuador, overlapping narratives of nationalism, public health, and race signal the complexity of modernizing health care. Various variables—race, gender, class, geography, the role of the state, divisions within the ruling class—impinged on people’s health care decisions. To analyze how racial thought and public health influenced each other during Guatemala’s predominantly dictatorial rule and Ecuador’s authoritarian but more participatory government at a time when the most significant international public health organization—the Rockefeller Foundation (RF)—sought to improve public health in both countries, I combine transnational and comparative historical analyses of the first half of the twentieth century. Triangulating Guatemalan, Ecuadorian, and RF archives and focusing on the primacy of Indigenous voices reveals an interactive matrix of different types of racism in Guatemala, Ecuador, and RF that shaped indígenas’ (Indigenous people’s) engagement with, exclusion from, or rejection of public health initiatives and scientific medicine. The politics of indigeneity was as consequential for public health as scientific developments. Many state agents and RF representatives used public health contexts to mobilize social constructions of race and ethnicity that advanced their agendas and marginalized indígenas. In turn, indígenas often determined the extent to which authorities’ aspirations matched their accomplishments.

中文翻译：

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“最不文明地区”的医疗卫生

在危地马拉和厄瓜多尔等原住民人口众多的国家，民族主义、公共卫生和种族的重叠叙述表明医疗保健现代化的复杂性。各种变量——种族、性别、阶级、地理、国家的作用、统治阶级内部的分歧——影响着人们的医疗保健决定。分析种族思想和公共卫生如何在危地马拉的独裁统治和厄瓜多尔的专制但更具参与性的政府期间相互影响，当时最重要的国际公共卫生组织——洛克菲勒基金会 (RF)——寻求改善两国的公共卫生，我结合了二十世纪上半叶的跨国和比较历史分析。三角测量危地马拉、厄瓜多尔、和 RF 档案并关注土著声音的首要地位揭示了危地马拉、厄瓜多尔和 RF 不同类型种族主义的互动矩阵，它塑造了 indígenas（土著人民）参与、排斥或拒绝公共卫生倡议和科学医学. 土著政治对公共卫生的影响与科学发展一样重要。许多国家代理人和 RF 代表利用公共卫生背景来动员种族和族裔的社会建构，以推进他们的议程并边缘化原住民。反过来，原住民通常决定当局的愿望与他们的成就相匹配的程度。以及影响 indígenas（土著人民）参与、排斥或拒绝公共卫生倡议和科学医学的 RF。土著政治对公共卫生的影响与科学发展一样重要。许多国家代理人和 RF 代表利用公共卫生背景来动员种族和族裔的社会建构，以推进他们的议程并边缘化原住民。反过来，原住民通常决定当局的愿望与他们的成就相匹配的程度。以及影响 indígenas（土著人民）参与、排斥或拒绝公共卫生倡议和科学医学的 RF。土著政治对公共卫生的影响与科学发展一样重要。许多国家代理人和 RF 代表利用公共卫生背景来动员种族和族裔的社会建构，以推进他们的议程并边缘化原住民。反过来，原住民通常决定当局的愿望与他们的成就相匹配的程度。许多国家代理人和 RF 代表利用公共卫生背景来动员种族和族裔的社会建构，以推进他们的议程并边缘化原住民。反过来，原住民通常决定当局的愿望与他们的成就相匹配的程度。许多国家代理人和 RF 代表利用公共卫生背景来动员种族和族裔的社会建构，以推进他们的议程并边缘化原住民。反过来，原住民通常决定当局的愿望与他们的成就相匹配的程度。