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Venezuela Health and Social Security
As in education, Venezuela had, by Latin American
standards,
an enviable record in health and social welfare and one
that had
shown tremendous progress. In 1940 the overall life
expectancy at
birth was forty-three years. By 1990, that figure was over
seventy years: seventy-one years for males and
seventy-seven for
females, both among the highest in Latin America. The
death rate
was only 4 per 1,000 population and the average caloric
intake
was 107 percent of the minimum level established by the
United
Nations (UN) Food and Agriculture Organization. These
indices
reflected generally improving health conditions,
especially since
the end of World War II, and the increase in preventive
public
health measures undertaken by the government. For example,
successful inoculation programs had lessened the incidence
of a
number of contagious diseases. On the other hand, a
comparison
between the causes of death in 1973 and 1981 shows that
Venezuela, a rapidly industrializing country, was also
becoming
more prone to causes of death--heart disease, accidents,
and
cancer--often associated with urban and industrialized
countries
and a faster pace of life (see
table 6, Appendix).
Acquired
immune deficiency syndrome (AIDS) was also a growing
problem,
particularly for the major cities, such as Caracas and
Maracaibo,
and for tourist centers, such as La Guaira and its
environs. In
1990 information on the actual incidence of AIDS in
Venezuela was
unreliable.
Infant mortality, pegged at a relatively low 27 deaths
per
1,000 live births in 1990, has also been steadily
declining,
especially in the years following World War II. The major
causes
of these improvements were better public health measures,
prenatal care, and national immunization campaigns.
Overall,
health care facilities had grown in number and in quality;
at the
same time, the population had become more urban and better
educated. There was also a marked increase in the number
of
medical facilities and personnel offering health care (see
table 7, Appendix). The rise in the number of nurses reflected
government incentives in this field as well as the
selection of
this vocation by a greater number of professionally
inclined
Venezuelan women.
Medicine has traditionally been a highly respected
profession, and Venezuelan medical schools turned out
adequate
numbers of well-trained doctors. At the same time,
however,
relatively few nurses received proper training, so that
doctors
often lacked the necessary support system. The
availability of
care in rural areas represented another gap in the health
care
delivery system. Doctors tended to concentrate in the
large
cities, especially Caracas, leaving many smaller
provincial towns
without adequate medical personnel. The government has
attempted
to meet these shortcomings, with some success, by
providing basic
medical services through a system of paramedics. On the
other
hand, shrinking budgets could take a toll on health
services. In
the summer of 1990, President Carlos Andrés Pérez himself
showed
deep concern over the fact that, by government estimates,
nearly
46 percent of state-supported hospital buildings were in
need of
repair.
Private medical facilities, operated for profit,
enjoyed
greater prestige than public institutions. Charitable
organizations, especially the Roman Catholic Church,
operated
some health facilities. The bulk of the population,
however,
relied on the Venezuelan Social Security Institute
(Instituto
Venezolano de Seguro Social--IVSS), which operated its own
hospitals, covering its costs out of social security
funds. At
public hospitals, small fees were charged to those
patients able
to meet them, but indigents were treated without cost.
Services
were furnished without charge at public outpatient
facilities,
with a nominal charge for prescription drugs. Overall, the
medical assistance received by most Venezuelans far
exceeded that
available to the great majority of Latin Americans.
The Ministry of Health and Social Welfare operated
hospitals
and lesser clinical medical facilities nationwide and
coordinated
the planning of medical services by the states and the
Federal
District. Although attempts have been made to provide a
unified
health system, as of 1990 such plans had not been
implemented.
Government campaigns for the prevention, elimination,
and
control of major health hazards have been generally
successful.
Venezuela has largely rid itself of malaria, yaws and the
plague
have been brought under control, and Chagas' disease,
carried by
a beetle that attaches itself to straw thatch roofing, has
been
nearly eliminated. Immunization campaigns have
systematically
improved children's health, and regular campaigns to
destroy
disease-bearing insects and to improve water and sanitary
facilities have all boosted Venezuela's health indicators
to some
of the highest levels in Latin America.
In addition to providing public health care, the IVSS
also
administered the country's public welfare program.
Launched in
1966, the IVSS provided old-age and survivor pensions. In
addition, it sponsored maternity care and medical care for
illness, accidents, and occupational diseases for workers
in both
the public and private sectors. Participation in the
program was
mandatory for all wage earners with the exception of
temporary
and seasonal or part-time workers, the self-employed, and
members
of the armed forces (who were covered under a separate
system).
The availability of benefits has been extended
progressively to
all regions of the country so that even farm workers and
farmers
associated with the agrarian reform program were eligible.
Private charitable and social welfare organizations,
which
were exempt from the income tax, played an important role
in
supporting and maintaining charity hospitals and
organizations,
assisting persons of limited income, and funding
scholarships.
Among the most active of these organizations was the
Voluntary
Dividend for the Community, founded in 1964 and supported
by
contributions from the business community. It subsidized
welfare
programs, private education, and community development
projects.
In this instance, as in others, Venezuela benefited from
the
efforts of community-minded leaders of the private sector,
who
bolstered government programs and provided further
assistance for
those in greatest need.
Thus, in the 1990s, Venezuela did not lack for public
and
private leaders who were deeply concerned about the needs
of
their fellow countrymen. Rather, the looming problem
appeared to
be one that Venezuela had not known for decades, that of
scarcity. Throughout the 1980s, the state had fewer
resources
with which to respond to the demands of an expanding young
population that had become accustomed to relying on the
public
sector for employment and social services. For a time, the
public
was willing to blame the new problems of scarcity on the
ineptness and, to some extent, the corruption of
politicians. By
the end of the 1980s, however, most Venezuelans realized
that
even a well-intentioned, honest, and capable government
would
have to adjust to the economic reality of reduced export
income
and a large external debt. The apparent upward trend in
oil
prices heralded by the Iraqi invasion of Kuwait in August
1990
represented the one bright spot on the economic horizon.
Even
that, however, was obscured by concerns over the general
health
of the domestic economy, the availability of refining
capacity
for Venezuela's heavy crudes, and other considerations.
Despite these economic setbacks, the legitimacy and the
viability of the Venezuelan democratic society did not
seem
threatened. Racial tension did not divide this largely
mestizo
society as it did some other Latin American societies.
Although
poor Venezuelans sometimes demonstrated violently, as in
the case
of the February 1989 riots against economic austerity,
there was
no sentiment outside of small extremist groups for a
return to an
authoritarian government of the right or the establishment
of a
Cuban-style government of the left. The events of the
1980s,
however, shocked Venezuelan society; after decades of
increasing
prosperity and improving health, education, and economic
indices,
Venezuelans suddenly found themselves vulnerable to the
shifting
fortunes of a world economy that had always proved
beneficent in
the past. This "crisis," although more economic than
social,
should nonetheless provide the sternest test yet of
Venezuelan
commitment to a free, tolerant, and socially conscious
system.
* * *
A major, comprehensive study of Venezuelan society is
still
to be written. Although the literature in English is not
voluminous, good, but narrow, perspectives can be found in
Robert
F. Arnove's Student Alienation: A Venezuelan Study,
G.E.R.
Burroughs's Education in Venezuela, Lisa Redfield
Peattie's The View from the Barrio, and John Duncan
Powell's Political Mobilization of the Venezuelan
Peasant.
In Spanish, the offerings are much more promising.
Among the
best are Federico Brito Figueroa's La estructura
económica de
Venezuela colonial, Sergio Aranda's Las clases
sociales y
el estado en Venezuela, Maritza Montero's
Ideología,
alienación e identidad nacional, Rafapel Carías's
Quiénes
somos los venezolanos, and excellent chapters in
Antonio
Frances's Venezuela possible. (For further
information and
complete citations,
see
Bibliography.)
Data as of December 1990
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