Front Cover
 Front Matter
 Table of Contents
 Physical and cultural environm...
 Herbert C.S. Thom: Some aspects...
 Donald R. Hanson: Some housing...
 Leonard J. Currie: Housing and...
 Felipe García Sánchez and Gilberto...
 Arthur W. Peterson: Man-land relations...
 Food and nutrition
 Hugh C. Miller: Food production...
 C. Richard Arena: Food marketing...
 Carlos J. Hilburg: water and sewage...
 Paul L. Rice: Control of insects...
 Frances E. Williamson: Educational...
 Ruth R. Puffer: Morbidity and mortality...
 Werner Ascoli: Nutritional diseases...
 Federico Hernández-Morales: Intestinal...
 Health administration
 Antonio Rìos Vargas: Status and...
 Robert L. King: Health facilities...
 Harold W. Brown: Government and...
 Nilo Vallejo: Health education...
 Aida B. Lizardi: Some nursing problems...
 Agencies engaged in health...
 E. Ross Jenney: The Pan American...
 Fred W. Devine: C A R E in the...
 Bibliography and reference...
 Janeiro B. Schmid: Bibliography...


The Caribbean : its health problems
Full Citation
Permanent Link: http://ufdc.ufl.edu/UF00100574/00001
 Material Information
Title: The Caribbean : its health problems
Series Title: Caribbean conference series
Physical Description: xx, 273 p. : ill. ; 25 cm.
Language: English
Creator: Wilgus, A. Curtis ( Alva Curtis ), 1897-1981
Conference: Conference on the Caribbean, 1964
Publisher: University of Florida Press
Place of Publication: Gainesville, FL
Publication Date: 1965
Copyright Date: 1965
Subjects / Keywords: Public health -- Caribbean Area   ( lcsh )
Social conditions -- Caribbean Area   ( lcsh )
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
Bibliography: Includes bibliographical references and index.
General Note: "A Publication of the Center for Latin American Studies"
General Note: "Papers delivered at the fifteenth conference on the Caribbean held at the University of Florida, December 2, 3, 4, and 5, 1964."
Statement of Responsibility: edited by A. Curtis Wilgus.
 Record Information
Source Institution: University of Florida
Holding Location: University Press of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 26639227
System ID: UF00100574:00001

Table of Contents
    Front Cover
        Page i
        Page ii
    Front Matter
        Page iii
        Page iv
        Page v
        Page vi
        Page vii
        Page viii
    Table of Contents
        Page ix
        Page x
        Page xi
        Page xii
        Page xiii
        Page xiv
        Page xv
        Page xvi
        Page xvii
        Page xviii
        Page xix
        Page xx
    Physical and cultural environment
        Page 1
        Page 2
    Herbert C.S. Thom: Some aspects of the Caribbean area climate
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
    Donald R. Hanson: Some housing problems in the Caribbean
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
    Leonard J. Currie: Housing and health in the Caribbean
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
    Felipe García Sánchez and Gilberto Balám: Some consideration of rural and urban change in Mexico
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
    Arthur W. Peterson: Man-land relations in the Caribbean region
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
        Page 62
        Page 63
        Page 64
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
        Page 73
        Page 74
    Food and nutrition
        Page 75
        Page 76
    Hugh C. Miller: Food production in countires of the Caribbean area
        Page 77
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
        Page 86
        Page 87
    C. Richard Arena: Food marketing and health problems in the Caribbean: Some historical observations
        Page 88
        Page 89
        Page 90
        Page 91
        Page 92
        Page 93
        Page 94
        Page 95
        Page 96
    Carlos J. Hilburg: water and sewage problems in the Caribbean
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
        Page 102
        Page 103
        Page 104
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
    Paul L. Rice: Control of insects of public health importance in the caribbean
        Page 110
        Page 111
        Page 112
        Page 113
        Page 114
        Page 115
        Page 116
        Page 117
        Page 118
        Page 119
        Page 120
        Page 121
        Page 122
        Page 123
    Frances E. Williamson: Educational campaigns in St. Lucia
        Page 124
        Page 125
        Page 126
        Page 127
        Page 128
        Page 129
        Page 130
        Page 131
        Page 132
    Ruth R. Puffer: Morbidity and mortality in the Caribbean
        Page 133
        Page 134
        Page 135
        Page 136
        Page 137
        Page 138
        Page 139
        Page 140
        Page 141
        Page 142
        Page 143
        Page 144
        Page 145
        Page 146
    Werner Ascoli: Nutritional diseases in the Caribbean
        Page 147
        Page 148
        Page 149
        Page 150
        Page 151
    Federico Hernández-Morales: Intestinal disorders in the Caribbean
        Page 152
        Page 153
        Page 154
        Page 155
        Page 156
        Page 157
        Page 158
        Page 159
        Page 160
    Health administration
        Page 161
        Page 162
    Antonio Rìos Vargas: Status and need of medical care facilities in the Caribbean
        Page 163
        Page 164
        Page 165
        Page 166
        Page 167
        Page 168
        Page 169
        Page 170
        Page 171
        Page 172
        Page 173
        Page 174
        Page 175
    Robert L. King: Health facilities contrustion in the Caribbean
        Page 176
        Page 177
        Page 178
        Page 179
        Page 180
        Page 181
        Page 182
        Page 183
        Page 184
        Page 185
        Page 186
        Page 187
        Page 188
        Page 189
        Page 190
    Harold W. Brown: Government and medicine in the Caribbean
        Page 191
        Page 192
        Page 193
        Page 194
        Page 195
        Page 196
        Page 197
        Page 198
        Page 199
    Nilo Vallejo: Health education in the Caribbean
        Page 200
        Page 201
        Page 202
        Page 203
        Page 204
        Page 205
        Page 206
        Page 207
        Page 208
        Page 209
        Page 210
        Page 211
        Page 212
    Aida B. Lizardi: Some nursing problems in the Caribbean
        Page 213
        Page 214
        Page 215
        Page 216
        Page 217
        Page 218
        Page 219
        Page 220
        Page 221
        Page 222
        Page 223
        Page 224
    Agencies engaged in health activities
        Page 225
        Page 226
    E. Ross Jenney: The Pan American health organization in W H O and the Caribbean
        Page 227
        Page 228
        Page 229
        Page 230
        Page 231
        Page 232
    Fred W. Devine: C A R E in the Caribbean
        Page 233
        Page 234
        Page 235
        Page 236
        Page 237
        Page 238
        Page 239
        Page 240
        Page 241
        Page 242
        Page 243
        Page 244
        Page 245
        Page 246
    Bibliography and reference sources
        Page 247
        Page 248
    Janeiro B. Schmid: Bibliography and reference sources in the Caribbean
        Page 249
        Page 250
        Page 251
        Page 252
        Page 253
        Page 254
        Page 255
        Page 256
        Page 257
        Page 258
        Page 259
        Page 260
        Page 261
        Page 262
        Page 263
        Page 264
        Page 265
        Page 266
        Page 267
        Page 268
        Page 269
        Page 270
        Page 271
        Page 272
        Page 273
Full Text






A publication of the
which contains the papers delivered at the fifteenth conference on the Carib-
bean held at the University of Florida, December 2, 3, 4, and 5, 1964

1 1 5 1 to 103 too 90 so 75 70 63 60

b --~ MA



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0 100 200 300 400 5?0 600 MILES 1'
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110 105 100 95 90 aos so 7 *.o 70oor5


edited by A. Curtis Wilgus



A University of Florida Press Book





C. RICHARD ARENA, Associate Professor of History, Saint Joseph's College,
WERNER ASCOLI, Chief, Epidemiology Service, Institute of Nutrition of
Central America and Panama (INCAP), Guatemala
GILBERTO BALAM, Consultant to the Director General of Nutrition Pro-
grams, Mexico City
HAROLD W. BROWN, Professor of Parasitology, School of Public Health
and Administrative Medicine, Columbia Univer-
sity, New York City
LEONARD J. CURRIE, Dean, College of Architecture and Art, University
of Chicago
FRED W. DEVINE, Deputy Executive Director, CARE, Inc., New York
FELIPE GARCIA SANCHEZ, Director General of Nutrition Programs,
Mexico City
DONALD R. HANSON, Officer-in-Charge, Housing, Building and Planning
Branch, Bureau of Social Affairs, United Na-
tions, New York
FEDERICO HERNANDEZ-MORALES, Professor of Clinical Medicine, Univer-
sity of Puerto Rico School of Medi-
cine, Santurce
CARLOS J. HILBURG, Zone Engineer, Pan American Sanitary Bureau, Ca-
racas, Venezuela
E. Ross JENNEY, Chief, Zone III, Pan American Health Organization,
World Health Organization, Guatemala
ROBERT L. KING, Hospital and Planning Consultant, Austin, Texas
AIDA B. LIZARDI, Special Assistant in Nursing to General Administrator,
Puerto Rico Medical Center, San Juan
HUGH C. MILLER, Development Officer, Natural Resources Division,
Caribbean Organization, Hato Rey, Puerto Rico
ARTHUR W. PETERSON, Agricultural Extension Service, Washington State
University, Pullman
RUTH R. PUFFER, Chief, Health Statistics Branch, Pan American Health
Organization, Washington, D. C.
J. WAYNE REITZ, President, University of Florida, Gainesville
PAUL L. RICE, Chief, Special Projects Unit, Vector-Borne Disease Section,
Training Branch, Communicable Disease Center, At-
lanta, Georgia

vi The Caribbean: Its Health Problems
ANTONIO RIos VARGAS, Executive Director, Curso en Administraci6n de
Hospitales para Graduados, Mexico, D.F.
JANEIRO B. SCHMID, Chief Librarian, Pan American Health Organization,
Washington, D.C.
HERBERT C. S. THOM, Washington, D.C.
NILO VALLEJO, WHO/PAHO Professor in Health Education, School of
Public Health, Central University of Venezuela, Caracas
A. CURTIS WILGUS, Director, Caribbean Conferences, University of Flor-
ida, Gainesville
FRANCES E. WILLIAMSON, Training Officer, Division of Administration,
Ohio Department of Health, Columbus


OVER THE PAST fourteen years, the University of Florida's Annual
Caribbean Conference has been devoted primarily to the political, social,
economic, cultural, and educational aspects of the contemporary Carib-
bean. In view of the nature and the magnitude of health and sanitation
problems in the Caribbean. it seemed appropriate this year for the
Center for Latin American Studies and the J. Hillis Miller Health Center
to organize jointly the Fifteenth Conference with health as its central
This decision proved to be a fruitful one. Dr. Samuel Martin, Provost
of the Health Center, and Dr. A. Curtis Wilgus, Director, Caribbean
Conferences, procured the services of a most distinguished group of ex-
perts from the United States and the Caribbean as speakers and par-
ticipants. As a consequence, the papers and addresses presented were not
only of outstanding individual quality, but. together, constitute a com-
prehensive and well-integrated view of problems and accomplishments
in the field of health in the Caribbean area.
I should like to express my deep appreciation to all the persons on
the faculty and staff of the University who worked so effectively to make
the meeting a success and to Smith, Kline and French Laboratories of
Philadelphia who, as co-sponsors, provided invaluable assistance.
As in past years, the University of Florida Press has published the
proceedings of the conference in a most attractive format. I am sure that
the present volume will be a valuable reference work not only to health
experts but also to all serious students of the Caribbean region.
J. WAYNE REITZ, President
University of Florida


The Caribbean Conference Series

Volume I (1951): The Caribbean at Mid-Century

Volume II (1952): The Caribbean: Peoples, Problems, and Prospects

Volume III (1953): The Caribbean: Contemporary Trends

Volume IV (1954): The Caribbean: Its Economy

Volume V (1955): The Caribbean: Its Culture

Volume VI (1956): The Caribbean: Its Political Problems

Volume VII (1957): The Caribbean: Contemporary International

Volume VIII (1958): The Caribbean: British, Dutch, French,
United States

Volume IX (1959): The Caribbean: Natural Resources

Volume X (1960): The Caribbean: Contemporary Education

Volume XI (1961): The Caribbean. The Central American Area

Volume XII (1962): The Caribbean. Contemporary Colombia

Volume XIII (1963): The Caribbean: Venezuelan Development,
A Case History

Volume XIV (1964): The Caribbean: Mexico Today

Volume XV (1965): The Caribbean: Its Health Problems


Map of Caribbean Area . ....Frontispiece
List of Contributors ...... ..... v
Foreword-J. WAYNE REITZ. ..... ..... .ii

CARIBBEAN . . . .. 9
4. Felipe Garcia Sanchez and Gilberto Balam: SOME CONSID-
5. Arthur W. Peterson: MAN-LAND RELATIONS IN THE

CARIBBEAN AREA . . . . . 77

CARIBBEAN . . . . .. . .. 97
10. Frances E. Williamson: EDUCATIONAL CAMPAIGNS IN ST. LUCIA 124



x The Caribbean: Its Health Problems
13. Federico Hernandez-Morales: INTESTINAL DISORDERS IN THE
CARIBBEAN . . . .. 152

CARIBBEAN ...............176
CARIBBEAN ......... ...... 191

W H O AND THE CARIBBEAN .. . ..... .227
20. Fred W. Devine: C A R E IN THE CARIBBEAN .. .... 233

IN THE CARIBBEAN . . . . 249
Index... . ..... ..............265



with health problems in the Caribbean. Everyone, to some degree, is
interested in health problems, especially his own, although somehow
problems of health in remote areas of the world seem to be less im-
portant and perhaps even less serious than those nearby. But the Carib-
bean is at our front door, and all aspects of health in that area should
be of interest to people in the United States. As a matter of fact, the
United States has concerned itself for decades with helping to solve
health problems in the Caribbean. Especially has the United States been
concerned with problems in the area since the Spanish-American War
in 1898. With the acquisition of Puerto Rico, the forcing of the Platt
Amendment upon Cuba, and the purchase of the Virgin Islands, we
have become actively concerned with improving standards of living,
concentrating largely upon problems of health. Therefore, a conference
of this nature attracted wide attention, and a number of experts from
the Caribbean and from the United States with specialized and extensive
experience assembled to discuss this significant topic. In previous Carib-
bean Conferences, questions of health and related topics have been
discussed, but no conference until this one was devoted entirely to the
subject. It is hoped that this volume may serve as a reference, not only
for experts, but also for the general public who wish to learn more about
the Caribbean area and who, incidentally, may wish to travel in that
area and perhaps even retire there someday.


xii The Caribbean: Its Health Problems

The successful practice of medicine in the Caribbean was advanced im-
measurably by the School of Tropical Medicine of the University of
Puerto Rico. It therefore seems relevant to the general theme of this
Conference to describe briefly the founding of this remarkable institu-
tion as an introduction to the general subject of "Health Problems" in
the area.
Some thirty-five years ago, on my first visit to Puerto Rico, I had the
good fortune to walk by the School of Tropical Medicine of the Univer-
sity of Puerto Rico and the good sense to go in and visit it. The School
had been opened in September, 1926, and although there were schools of
tropical medicine in England, France, Germany, and the United States,
this was the first one to be established in the tropics where conditions
could be studied firsthand in their environment.
The School stems from the former Institute of Tropical Medicine and
Hygiene organized in 1912 in Puerto Rico. In 1923 the President of the
Senate of Puerto Rico, Antonio R. Barcel6, became personally interested
in the establishment of a School of Tropical Medicine and he proposed
to the Corporation of Columbia University in New York City that it join
with the University of Puerto Rico in founding a School of Tropical
Medicine. This, however, was not the first suggestion to form such a
school. Mr. Barcel6 consulted Dr. A. L. Goodman and Dr. J. Antonio
L6pez Antongiorgi, and plans were formulated whereby mutual coopera-
tion between Columbia University and the University of Puerto Rico
could be worked out. The plan which they drew up was presented to
and endorsed by Horace Mann Towner, Governor of Puerto Rico. It was
then presented to the Legislature.
This body moved rather rapidly and the next year, in 1924, a joint
resolution was agreed upon creating a School of Tropical Medicine of
the University of Puerto Rico under the auspices of Columbia Univer-
sity, and the sum of $100,000 was provided through the Building Fund
of the University for the construction of a building containing offices
and laboratories. At the same time this resolution provided that the old
Institute of Tropical Medicine and Hygiene should cease to exist and
that its property should be transferred to the new school.
The next year, in July, 1925, another act of the Legislative Assem-
bly, with the Governor's approval, authorized a reorganization of the
University of Puerto Rico and provided for a special Board of Trustees
for the School of Tropical Medicine which would succeed the temporary
provisional board.

In May, 1926, the building for the School was completed and the
equipment from the old Institute was transferred to the new School.

The new School opened its first term October 1, 1926. An announce-
ment stated that its primary aim was "to give the opportunity for the
study in a tropical environment of that large, ill-defined group of dis-
orders known as tropical diseases, and at the same time to observe the
influence of exotic conditions on diseases in general."
The first official course announcement was as follows:

Under the Auspices of Columbia University
San Juan, Porto Rico
REGULAR TERM COURSES beginning October 1, and February 1,
each lasting sixteen weeks, are given in tropical pathology, bacteriology,
parasitology, chemistry, clinical medicine, public health and communi-
cable diseases.
A certificate in Tropical Medicine is granted upon the completion of
an approved program of study.
A SHORT INTENSIVE COURSE planned especially for physicians
and health officers is offered January 10 to February 1. In this course
the commoner diseases of the American tropics will be considered in
their pathological, clinical, and public health aspects. Correlation of
laboratory, clinical, and field studies is made possible by a close affilia-
tion of the School with the Insular Department of Health.
In both the regular and the short courses the number of students is
limited. A medical degree or equivalent preparation, is a prerequisite
in all cases.
Opportunities for research in laboratory and field are open to quali-
fied investigators during the entire year.
For further information, apply to
School of Tropical Medicine,
San Juan, Porto Rico

The first laboratories were established for the study of bacteriology,
chemistry, mycology, pathology, and parasitology, each of which was to
accommodate fifteen students and investigators. An excellent library,
open to students and investigators alike, was on the second floor of the
building. Seventy-five journals covering various branches of tropical


The Caribbean: Its Health Problems

medicine and related fields were received as well as a number of public
health reports. At least 500 volumes of textbooks and reference works
were at the disposal of students. Thus a rare opportunity was provided
to qualified investigators wishing to pursue independent research or to
collaborate with local staff on problems of mutual interest. Materials
needed by these research workers were to be provided at cost. Field
work could be carried out in any part of the island through the coopera-
tion of the Department of Health, and classes from the School were to
spend one to three weeks in Puerto Rican districts where intensive cam-
paigns against diseases were organized. One attack made was upon
malaria, which was a very serious problem throughout the Caribbean.
Adequate clinical facilities were arranged through the courtesy of
various public and private hospitals in the island. During the first year,
clinical instruction was given in the Quarantine Hospital for Trans-
missible Diseases, the Leper Hospital, the Presbyterian Hospital, the
Municipal Hospital of San Juan, and the Anti-Tuberculosis Sanitarium.
Plans for a small hospital of forty beds and a dispensary to be directed
by the Insular Government were proposed for the School. This hospital
was to be operated by the Department of Health in close cooperation
with the School, providing special facilities for teaching and investigation.
From the inception of the School, courses of study offered a wide
scope and included several principal subjects: bacteriology, mycology,
pathology, chemistry, medical zoology, public health and transmissible
diseases, tropical medicine, and surgery. There were nine professors on
the faculty, fourteen instructors, six resident lecturers, four visiting lec-
turers, and two consultants. Colonel Bailey K. Ashford, connected with
the former Institute of Tropical Medicine and Hygiene, agreed to col-
laborate in the work of the School. The first administrative officers were
Dr. Thomas E. Benner, Chancellor of the University of Puerto Rico, Dr.
Nicholas Murray Butler, President of Columbia University, and Dr.
Robert A. Lambert, Director of the School of Tropical Medicine.


Although the first courses at the School did not begin until October 1,
the School was inaugurated on September 22. At that time a number
of addresses were delivered, among them being that of Dr. William
Darrach, Dean of the College of Physicians and Surgeons, Columbia
University. Some excerpts from his address will prove interesting.
"The School of Tropical Medicine is essentially a place for study, and
so there have already been assembled a staff of men who are essentially

students-twenty-eight in all, twenty-five from Puerto Rico and three
from the United States; men whose interests and desires are not only
to teach what is known today of this field but to continue their studies
in order to ever broaden and deepen the knowledge of these conditions.
This spirit of research, this desire for the truth is the great overwhelm-
ing essential quality for the staff of a modern school. A great deal already
has been learned concerning the symptoms and course of tropical dis-
eases: much has been brought to light as to the causes of these conditions
and how to cure and prevent them. Yet we feel that a far greater amount
remains yet to be done in alleviating the suffering, lengthening the life
and increasing the producing powers of the people in the tropics.
"Among the reasons for the establishment of such a School in tropical
America are, first, the wealth of opportunity for study. Not only is there
a wide variety of pathological conditions for investigation and for teach-
ing material, but the fact that through the efforts of the Department of
Health and the medical men of Puerto Rico, great strides have been
made in the control, cure and prevention of these conditions. It is well
for a student to see not only the dark side of these conditions, their
distressing effect on mankind, but also to see the brighter side and what
is already being done to combat them.
"Secondly, it must be confessed that the doctor who graduates from a
medical school in the states has learned but little of the conditions as
they occur in the tropics. It is necessary, therefore, for one who is to
practice in the tropics to take a postgraduate course in such subjects. To
meet this need a definite comprehensive course has been planned out so
that such men can, within one academic year, become familiar with the
essentials of tropical disease.
"A third reason is that most of the schools of tropical medicine
throughout the world are situated in northern climates. Some of the
men who have done the most to broaden our knowledge of these condi-
tions have had to do their work away from the tropics. It is hoped that
many such advanced workers will be tempted to come to Puerto Rico to
continue their studies under such ideal conditions.
"What share has Columbia University in this project?
"At the invitation of your representatives, Columbia has been asked
to assume a definite responsibility. It was felt that because of its experi-
ence in similar undertakings, and perhaps its prestige, it could be of
service in guiding the educational work in the selection of the scientific
personnel and in criticizing the projects of the laboratories. This respon-
sibility the University has willingly accepted and will sincerely carry
out to the best of its ability. .



xvi The Caribbean: Its Health Problems
"The financial contribution that Columbia is now making is pitifully
small. No one realizes that as much as we ourselves do. But this does
not mean that it will remain so. We have every intention and every
expectation of increasing the contribution as times goes on and we are
able to interest people with money to spend it in that way."


In May, 1927, the Director of the School of Tropical Medicine, Dr.
Robert A. Lambert, sent a special report to the Board of Trustees of the
School summarizing briefly the activities during its first year. The
following is an excerpt of this report with some significant quotations.
During the first year 14 courses were offered in the following sub-
jects: pathology-2 courses; chemistry-2 courses; bacteriology and
mycology, immunology, clinical pathology-2 courses; public health
administration-2 courses; parasitology, transmissible diseases, malaria,
rural sanitation, public health engineering, and bedside instruction. In
addition there were given weekly clinics on Saturday mornings and
scientific meetings or seminars, on Thursday evenings, to both of which
the medical public was invited without registration or other formality.
Twenty-nine students, a number considerably larger than had been
expected, registered during the first year. Twenty-three had the degree
of Medical Doctor; the remaining six, had degrees or certificates indi-
cating adequate preparation for the courses taken. No undergraduate
instruction was offered. Most of the students, as anticipated, were Puerto
Rican physicians who took this opportunity for graduate study.
Fifteen public lectures were given during the year on subjects of
general interest, seven by resident lecturers and eight by visiting scien-
tists. "Probably never before has Puerto Rico had the opportunity of
seeing and hearing so many distinguished scientific visitors at a single
season." Wide interest was shown in these lectures and on one occasion
the auditorium, which seated 60 people, was filled to overflowing by 120.
It was decided at the beginning that the School should not make
routine tests but physicians were invited to send for examination
"patients suffering from diseases of special interest, and those of possible
value in research. Furthermore, we offered to examine histologically,
autopsy and surgical specimens, such a service not being provided by
the Department of Health or by any other agency on the island. This
offer met with the prompt response from the physicians of Puerto Rico
and has increased to such an extent that our space and budget are being
taxed to maintain it. Fifty-five autopsies have been performed, some of

them in towns some distance from San Juan, and over 70 surgical speci-
mens have been sent to the school for examination by seventy-six physi-
cians representing seventeen municipalities. No charge was made to
either patient or physician for any examination.
Teaching the first year was on a bilingual basis. "While it is gener-
ally not practicable to give the same courses in two languages at the
same time, it has been found feasible to give the same course alternately
in English and in Spanish, thus meeting the needs of students who speak
only one language." During the year six public lectures were given in
Spanish and nine in English. A majority of the Saturday clinics were
given in Spanish while a majority of the seminars were given in English.
The School offered an exceptional opportunity to students who knew a
second language slightly to increase their proficiency in it.
Because of the complete cooperation of the Department of Health,
there was no lack of interesting cases for the School's clinics, and fre-
quent demonstrations were held. "On the other hand the hospitals here,
as in other medical centers, have recognized that cooperation with the
teaching institution is of mutual benefit. Though the special hospital will
solve our greatest need. we shall expect not only to continue but to
broaden the School's affiliations with other hospitals, both in San Juan
and other cities of the island.
"The School has two functions: teaching and research. While the
value to Puerto Rico of the teaching function will be the more quickly
seen, the results being indeed already evident, it will be the research
done here that will eventually show not only the largest results locally,
but that will carry the name of the School all over the world. I do not
expect that any great number of students will ever come here for study.
Specialized graduate schools never attract large numbers, but thousands
of physicians and scientists working in other tropical fields will read our
publications and profit by the results of investigations made here.
"The energy of our staff this first year has been largely consumed in
details of organization, collection of material for teaching, classes, etc.
But already several papers have been finished and various others will
be completed during the summer when there will be less teaching and
consequently more time for research.
"Research requires not only laboratory equipment, but most im-
portant of all, trained men with time for work and contemplation. Very
little by way of investigation can be expected from busy clinicians or
public health workers, whose time is generally filled with routine duties.
The School will need a large number of trained workers with time free
for investigations....



xviii The Caribbean: Its Health Problems
"The most important topic has been left to the last. Since a full finan-
cial statement cannot be made before the end of the year, I wish at this
time only to point out some pertinent facts. The budget for 1926-27,
approved by you on June 23, 1926, amounted to $43,480 exclusive of
Columbia's contribution for the Director's salary. Since the university
allotment to the School was only $30,500, there was an anticipated
deficit of $12,980 (the income from tuition fees has been estimated at
"On November 1, 1926, Columbia assumed for the current year the
salaries of two other professors who had come from the mainland, con-
tributing $5,000 to this end. This addition to our assets, together with
several economies made possible by private donations, have reduced the
deficit to about $5,000.
"In addition to Columbia's own contribution, there have been received
through the Columbia affiliation, donations in material and in money
for specific expenditures by the Director, amounting to more than
$3,000. To Columbia's credit may be added also, the services of two of
her professors, Dr. McKinley and Dr. Phelps, who each spent several
weeks here in giving lectures and in organizing of our departments.
"It is clear therefore that while the greatest value of Columbia's
affiliation comes from counsel, guidance and prestige, the material assist-
ance rendered amounting directly or indirectly to nearly $20,000 during
this first year, is of the greatest importance."
In conclusion, Dr. Lambert said, "This brief survey of the School's
activities in its first year, I trust will give you some idea of the excellent
beginning that has been made. Toward this result the splendid work of
the faculty, the valuable assistance of the Department of Health, the
cooperation of the medical profession, the interest of the public, have
all contributed."


The October, 1928, issue of the Porto Rico Review of Public Health
and Tropical Medicine contained in its brief news notes the announce-
ment that Dr. Robert A. Lambert, who had been Director of the School
of Tropical Medicine for the last two-and-one-half years, was resigning
to accept a position with the Rockefeller Foundation in New York as
Associate Director of the Division of Medical Education. On this occa-
sion the staff of the School and the medical profession at large through-
out the Island expressed their appreciation of the splendid constructive
services which Dr. Lambert had rendered the School and to the medical

profession during his regime. He had demonstrated a rare combination
of high executive ability as well as an exceptional professional attain-
ment. "His sympathetic understanding of the medical and social prob-
lems of the Island has in many instances been a subject of general
Dr. Lambert made another contribution in editing the above-named
review, which received wide praise everywhere.
As a token of their appreciation and esteem, the faculty of the School
presented Dr. Lambert with a certificate signed by the faculty members
and with a beautiful gold watch on the back of which was engraved the
seal of Puerto Rico. The announcement concluded: "With him go the
best wishes of his many friends here for continued success and opportu-
nity for service in this new field of activity."
The successor to Dr. Lambert was Dr. Earl D. McKinley, born in
Kansas in 1894, who assumed office in September, 1928. Dr. McKinley
remained as Director of the School until he resigned in September,
1931, to accept the headship of the Medical School at The George
Washington University in Washington, D.C. It was here at this institu-
tion that I first came to know Dr. McKinley as a friend and a colleague.
The School was again in excellent hands, for Dr. McKinley had had
a most interesting background. He had served as instructor in bacteri-
ology and physiological chemistry at the University of Michigan Medical
School, 1919-22; as assistant professor of pathology, bacteriology, and
hygiene at Baylor University, 1922-23; as professor of bacteriology and
hygiene and chairman of the department at Baylor University College
of Medicine, 1923-24; as Fellow National Research Council, Bordet's
Laboratory of the Pasteur Institute, University of Brussels, 1924-25; as
assistant professor of bacteriology in the College of Physicians and
Surgeons of Columbia University, 1925-26; as associate professor of
bacteriology in the College of Physicians and Surgeons of Columbia
University, 1926-27; and as state director, International Health Divi-
sion, Rockefeller Foundation, stationed at the Bureau of Sciences in
Manila, Philippine Islands, 1926-28. At the same time he had served as
professional lecturer in the School of Hygiene and Public Health in the
University of the Philippines. It was from these two latter positions that
Dr. McKinley came to assume the directorship of the School of Tropical
Medicine at the University of Puerto Rico.
Under such admirable directorship the School was bound to prosper
and to develop a much wider field of activity and influence. However,
we are concerned here only with the establishment of the School, and
while Dr. McKinley's activities are most interesting, an account of his




The Caribbean: Its Health Problems

regime in San Juan must be left to others. At The George Washington
University, Dr. McKinley maintained his contacts with the Philippine
Islands and it was on a flight over the Pacific, July 28, 1938, that his
plane disappeared without a trace.
In concluding, one significant date should be mentioned. In June,
1948, Columbia University withdrew its sponsorship of the School and
it then became much more closely attached to the School of Medicine
of the University of Puerto Rico as an autonomous unit of that university.

Caribbean Conferences

Bibliographical note: The above account is based on personal knowledge, cor-
respondence, and the following publications:
Porto Rico Health Review (Official Bulletin of the Department of Health, pub-
lished by the Department of Health), San Juan. II, 2 (August, 1926); II, 4
(October, 1926) ; II, 11 (May, 1927).
Porto Rico Review of Public Health and Tropical Medicine (Official Bulletin of
the Department of Health of Porto Rico and the School of Tropical Medicine
of the University of Porto Rico under the auspices of Columbia University),
San Juan. IV, 4 (October, 1928).
The American Journal of Tropical Medicine, XIX (1939), 97-101.
For valuable suggestions and assistance I am indebted to Mrs. Janeiro B.
Schmid, Chief Librarian, and to Miss Mary E. Bedwell, Assistant Reference
Librarian, Pan American Health Organization, Washington, D.C.

Part I




I. Introduction

CLIMATE is the statistical population of weather events. It is described
by statistics estimated from sample series of meteorological data con-
stituting the observational records of weather conditions from individual
meteorological stations or networks of such stations. Although meteoro-
logical observations are the most satisfactory means of describing cli-
mate, other means may be employed either as aids to the meteorological
description or as independent parameters. The most common aid is the
landscape. Since the pedology and geomorphology of an area are partial-
ly related and the botanical development almost entirely related to
climate, the landscape has been used extensively as a depiction of climate
as an aid to meteorological data as well as independently. There are
other factors which are determined by climate and therefore are also
indicators of climate. The medical geography of a region may be an
indication of climate; although here one must be careful that the factor
depicted is causally related to weather conditions. Many have been mis-
led in this area by apparent relations which are nothing more than
geographical coincidences or related only by reason of a relation to a
common factor. For example, the Caribbean area has a tropical climate
and also a high mortality from a number of diseases. Only a part of this
can be laid to climate, for if the economic level of the population is
raised, this mortality will immediately go down. Climate to a great extent
is only as much of a determiner of economic level as man wishes it to be.
It cannot be emphasized too strongly that outdoor climate cannot be

4 The Caribbean: Its Health Problems
changed. Under certain special conditions local weather conditions might
be modified, but the possibility of modifying climate is extremely remote
and should not be thought of as a potential solution to climatically related
problems. Indoor climate and environment can, of course, be modified.
Climate must be thought of generally as having both resource factors
and liability factors. Man is at his best when he takes full advantage of
its resources and ameliorates as many of its liabilities as he can.
In keeping with the theme of this Conference emphasis will be given
to climatic factors related to comfort or well-being. These are tempera-
ture, humidity, wind, and solar radiation.

II. Temperature

The most general description of the climate often given to the Carib-
bean area is that it is tropical. This implies broadly that the temperature
is warm and varies little throughout the year. Part of the seasonal stabil-
ity is due to the latitude position but a part is also due to the Caribbean
Sea. It has been said that the temperature of the islands and of the
coastal areas is that of the Sea. This, of course, is a generalization.
Mean monthly temperature near sea level is generally in the 70's
during November through March or April and in the 80's from April
through October. In more tropical areas in the western parts of the area,
the temperature averages in the 80's over the entire year. Average maxi-
mum temperatures are generally in the middle or high 80's in summer
and in the high 70's or low 80's in winter. Average minimum tempera-
tures are generally in the low to middle 70's in summer and mostly in
the 60's in winter. Extreme temperatures above the 90's and below the
70's are not frequent.
The Caribbean land area is one of widely varied topography. Eleva-
tion above sea level, of course, greatly reduces temperature. A reduction
of 10F for each 300-foot increase in elevation appears to be a good
average for the area.

III. Humidity

Relative humidity is remarkably constant through the year at most
locations varying only a small per cent partly in relation to the precip-
itation. Precipitation, however, is much more variable both between
seasons and over the area due to variation in elevation and exposure.
Relative humidity appears to be controlled largely by the temperature



of the Caribbean Sea and the annual variation in temperature, the two
varying together in such a way as to result in little seasonal variation
in relative humidity.
Mean relative humidity over the area varies from 65 to 80 per cent
with most stations having values between 70 and 80 per cent with 70
per cent being a fairly representative value during the warm hours.
Both vapor pressure and saturated vapor pressure (temperature) de-
crease with elevation at rates which leave the relative humidity constant
or cause it to increase slightly with height. When the skies are mostly
clear the relative humidity will rise about 10 per cent above the daily
average during the cool hours of the night and fall 10 per cent below
the daily average during the warm hours of the afternoon.

IV. Wind

The circulation over the Caribbean area is controlled almost entirely
by the very persistent northeast trade winds. Thus at most locations the
wind is preponderantly in the easterly quadrants with a substantial per-
centage from the northeast and east. Mean wind speeds vary from 7 to
12 miles per hour (700-1,000 feet per minute). Speeds are higher dur-
ing the warmest hours of the day averaging from 12 to 15 miles per
hour (1,000-1,300 feet per minute).
During the night they average 5 to 10 miles per hour (400-900 feet
per minute). The percentage of winds less than 3 miles per hour (calm,
260 feet per minute) is small during the warmest hours of the day.
Wind conditions can, of course, vary widely according to exposure but
the Caribbean area is generally a breezy region at all times. During the
warm hours the sea breeze reinforces the prevailing wind in windward
exposures and, of course, does the reverse in leeward exposures.

V. Radiation

There is not a great deal of radiation data available in the Caribbean
area, but short periods of observation at San Juan and Swan Island give
an indication of general conditions. Mean daily radiation varies from
400 to 650 langleys, with the months from February through September
having above 500 and the months from March through August generally
above 600 langleys.
Percentage of possible sunshine varies generally from 60 to 80 per
cent with the values in the 60's from May through September.


The Caribbean: Its Health Problems

VI. Climate and People

Panama has as tropical a climate as any area in the Caribbean. Ken-
drew in his Climates of the Continents says: "The Canal Zone had an
extremely bad medical reputation in former times, which seems to have
been justified by the high disease and mortality rates during the early
attempts to dig a canal. But rigorous and extensive application of sani-
tary, especially anti-mosquito, measures by the American engineers of
the present canal worked a wonderful improvement, and the zone is now
notably healthy, and even pleasant in winter for a region so near the
equator." This is only one piece of evidence supporting the proposition
that climates are not unhealthy and that only environments which may
be changed are unhealthy. To be sure, some climates may be unhealthy
for unhealthy people, but for the healthy person in a healthy environ-
ment climate only affects his comfort.
Certainly there are important problems of climate in respect to the
unhealthy. These are problems for the physician. When he can specify
the climate required for a particular state of ill-health, and progress
has already been made in some areas, the optimum climate could be
established artificially indoors, the patient could seek a prescribed cli-
mate, or he might be taught to minimize the bad effects of the climate
in which he resides. We shall concern ourselves only with the normally
healthy who are subject to the ordinary climatic conditions of the area.

VII. Climate and Comfort

Studies of comfort in relation to measurements of the condition of
the air have been made. Some have taken the comfort approach; i.e.,
experiments are run under different conditions and the subjects are asked
to register their feelings of comfort or discomfort. Others have taken the
physiological approach where comfort is evaluated by measurements on
the human body and little attention is paid to the feelings of the subject.
Most studies seem to give roughly comparable results at the more ex-
treme conditions of discomfort and have their greatest disagreement at
the more moderate conditions where physiological measurements are
not as sensitive and it is difficult for subjects to express their state of
comfort. A great deal, of course, depends on the state of activity of the
subjects, and this has also led to varying results.
Recent studies for persons at rest seem to show that at moderately
uncomfortable conditions the dry bulb temperature is a more important
component and the humidity a less important component of comfort

than was originally thought. This has been amply demonstrated in south-
ern Florida which in recent years has become as important a summer
resort as it has long been a winter resort. To be sure, structures there are
now commonly air-conditioned, but this only modifies the indoor climate
which is almost always much worse than the outdoor climate, especially
in the poorly designed structure. The answer appears to be that southern
Florida, which has a climate like much of the Caribbean, has a limit
placed on the dry bulb temperature by the humidity and has good winds
with steady speed which exert a favorable effect on the outdoor comfort
especially of people who are engaging in vacation activities.
Although the effective temperature is not a completely satisfactory
parameter of comfort at fairly high temperatures and humidities, it
gives a fairly good indication of comfort especially when including the
effect of wind speed. At a commonly encountered condition of 70 per
cent relative humidity and 850F with no wind speed, the effective tem-
perature would be about 80 which would make people who are nor-
mally clothed and at rest outdoors in the shade somewhat uncomfortable.
Increasing the wind speed to 9 miles per hour, a common value in the
Caribbean area, would decrease the effective temperature to about 750,
a quite comfortable value. On the beach with 900 and 75 per cent rela-
tive humidity a person dressed in a swim suit sitting in the shade with
the same breeze would not feel uncomfortable. It is seen that the steady
winds of the Caribbean area play a strong role in outdoor comfort.
Indoors the situation is ordinarily quite different; here radiation
tends to play a strong role and ventilation air speeds tend to be much
lower than outdoors. Here, therefore, every effort must be made to pro-
tect against radiation which can greatly increase the dry bulb tempera-
ture effect and to insure that maximum advantage is taken of natural
ventilation. Radiation, however, is the factor which seems to have the
greatest susceptibility to control and its control ensures comfort more
than any other component of the climate.
Air conditioning is, of course, the ultimate answer to indoor comfort.
There is hardly a place in the populated world where air conditioning
is not desirable, mainly because of the important effect of radiation on
indoor temperature. How widespread air conditioning becomes will de-
pend on economics and on provision of power and other means.

VIII. Climate and Work

For people doing office work the conditions for comfort are roughly
the same as for people at rest; i.e., an effective temperature 750 or less

8 The Caribbean: Its Health Problems
is desirable. In uncomfortable conditions mental work becomes difficult
and, although little conclusive evidence on the effect of increased com-
fort on efficiency is available, marked improvements have been noted.
Most companies feel that to air condition or to increase comfort is good
When man is doing physical work a measure of efficiency is more
readily available. At the American Society of Heating and Refrigerating
Engineers Research Laboratory it was found that men doing physical
labor at 90,000 foot-pounds per hour were able to accomplish the same
amount of work at 600 and 70 effective temperature. When the effective
temperature was increased to 80 the work accomplished was lowered to
93 per cent of that at 700. At 85' it was 84 per cent of that at 70; and
at 90 effective temperature the percentage dropped to 68. For higher
effective temperatures the percentages dropped rapidly. Again the effect
of ventilation was marked. When the air speeds were increased to 350
feet per minute the above percentages were raised about 8 per cent.
At this rate of work the pulse of the worker rose 17 at 850 effective
temperature, 31 at 90', and thereafter the increase doubled for each 50
rise in effective temperature. Up to 900 the rise in body temperature
was not dangerous; beyond 900, however, it was.
Experiments have shown that the healthy can stand very adverse cli-
matic conditions without suffering permanent effects. Adverse climatic
conditions below the danger level, 950 effective temperature, are never
attained except under strong radiation and in confined spaces in the
Caribbean area. Comfort and work efficiency are reduced at much lower
effective temperatures.



THE WORLD HOUSING SITUATION appears to be deteriorating
rather than improving. Statistics support that impression. Statistics are
also painful; they are difficult reading even while they are revealing.
Relying on your ability to withstand pain, the following data are

I. Population Explosion
Consider the world's population. A person born in 1930 will see the
population double in 1980 when he is 50 years of age and redoubled
again by 2000 when he is 70. When you consider that it required 190
years-from 1650 to 1840-to double the population, the term "popula-
tion explosion" becomes meaningful.
Latin America, and the Caribbean area especially, has the biggest
explosion of all; a rate of 3.1 per cent versus the world rate of 1.8
per cent.1
The world populations are also "shifting" (while they are exploding)
to the urban areas. Latin American cities and towns increased their
inhabitants from 39 per cent of the total population in 1950 to 46 per
cent in 1960.

II. Housing Needs
The United Nations estimates "that over 1,000 million people in
Africa, Asia and Latin America-about half the total population of

10 The Caribbean: Its Health Problems
these continents-live in housing which is a health hazard and an affront
to human dignity."2 Furthermore, over 200 million new inhabitants are
expected to crowd into the cities of those areas during the period 1960-
1970. To meet these challenges, the United Nations suggests that the
targets for this period should include the construction of a total of
19-24 million dwellings in these areas, to be allocated as follows:
(1) To house the increase in population: construction by 1965 of 4
million dwellings and ancillary facilities annually in urban areas, and 4.6
million in rural areas.
(2) To eliminate shortages in thirty years: construction by 1970 of
about 6 million dwellings annually.
(3) To meet current obsolescence: construction by 1970 from 4 to 9
million dwellings annually.3
In more comprehensible terms this means that the world must build
about 10 units per 1,000 population per year to solve the housing
A different way of expressing the problem has been given by Dr.
Doxiades.4 Estimating in terms of rooms, because "dwelling is a concept
which can cover widely varying conditions," a total of 1,425 million
rooms will be needed between 1960 and 1975. This is about 11-12
dwellings per 1,000 inhabitants.
The United Nations estimates for 1960-1975 are more conservative,
but still add up to a staggering need for an annual housing program of
8-10 dwellings per 1,000 inhabitants.

III. Housing Accomplishments in the World
The inevitable question comes next. Can these needs be met? Before
even trying to answer this question, it would be worthwhile to analyze
accomplishments in a number of other countries. Taking those countries
which appear to have successfully met or are meeting their current
housing needs, only ten can be listed, and their output is seven or more
dwelling units per 1,000 inhabitants.5
Finland 7.1 Sweden 9.1
France 7.0 Switzerland 9.3
Netherlands 7.4 USSR 14.0
Norway 7.4 Germany 10.3
Romania 7.3 US 7.1
On the other hand, in the developing countries the output is usually low,
even falling to two and fewer per 1,000 population (e.g., India and

In virtually all developing countries, the portion of housing allocations
as a share of gross domestic fixed investment ranges from 12 to 30 per
cent. As a per cent of gross national product, the range is usually not
more than 3.3 per cent. However, to meet the needs given by the United
Nations and using current construction costs, 10 per cent of gross
national product, or in many cases, the entire investment resources
available in less developed countries would be required!
In other words, most developing countries would need to double
and triple their present allocations to even reach 7 units per 1.000
population, which they will not do without great thought on the subject.
In 1952 the United Nations' study on "Housing in the Tropics"
stated ". . it must be recognized that, even under the most favour-
able conditions, it may be a very long time before sufficient progress has
been made to permit the use of adequate economic resources for such
social goals as better housing and improved community facilities. Mean-
while, with few exceptions, families in the tropics simply cannot afford
to buy or rent houses built for them on a commercial basis. It is also
obvious that neither Governments nor private agencies can provide
housing on a subsidized basis to all in need. In addition, in most
countries, the technically retarded state of the building industry is one
of the factors raising the cost of house construction beyond the reach
of most of the population. The physical improvement of houses and
communities and the important construction work to be done in connec-
tion with transport, power and industry will be possible only by first
developing an adequate building industry and related manufactures in
line with each country's resources. But to accept that nothing can be
done amounts to a gospel of despair. Although resources and technicians
are in short supply, the aspirations of man are not. Practical solutions
to the crushing problem of tropical housing must be arrived at in the
near future. They should combine the initiative and resourcefulness of
the people, the rational application of local materials and skills, the
social advantages of group work, and the best use of resources and
technical knowledge available."6
After more than a decade, the situation appears to be alarmingly
similar today. The question then becomes, why has the world been so
slow in cleaning up this mess of a housing situation? If one were to
sum up the situation in a few words, the answer might be "backward-
ness, old-fashionedness, statics." Conversely, the solution might be "bold-
ness, new methods, dynamics." Of course, change, whether good or even
bad, causes new problems, but if this is what it takes, it seems that now
is the time, before an alarming problem becomes a catastrophe.

12 The Caribbean: Its Health Problems
IV. Major Causes of Housing Shortages

Before attempting to describe what a dynamic housing program might
be, it may be useful to summarize the major causes of housing shortages
in most of the developing countries. The following list is not necessarily
given in the order of magnitude since the items would vary from country
to country.
a. The absence of a clearly defined housing policy or even of any
housing policy.
b. The rapid increase of population.
c. The influx of rural and semiurban population into towns.
d. The preference for large luxury houses, rather than for basic
e. The rising cost and speculation of buildable land.
f. The increasing cost of building materials which are often imported.
g. The lack of basic services and facilities in buildable areas.
h. Inadequate incentives and inducements for housing building.
i. Insufficient credit facilities.
j. The slow return to investors in housing in comparison to other
investments, especially in low and low-middle income housing where the
need is the greatest.
k. The inability of governments alone to finance the nation's entire
housing requirements.
1. The lack of development of the building and the local building-
materials industries.
m. The inability of building trades to reorganize for modern building
n. The scarcity of skilled labor and of local contractors who can or-
ganize large building operations.
o. The disorganization of self-help families who may build 50 per cent
or more of a nation's annual housing program.
p. Poor and costly structural standards resulting in rapid deteriora-
tion, especially in shanty-town and rural housing.
q. The slow replacement of obsolete and dilapidated houses.
r. The operation of obsolete and unsuitable building laws.
s. The use of high taxation on land and new houses.
t. A feeble and unimaginative policy on slum clearance or on pro-
gressive slum upgrading to acceptable standards.
u. Inadequately organized cooperative housing developments.
v. The lack of research in design, construction, use of local materials,
social standards.
w. The lack of communicating this research to builders, investors, and
x. The lack of technical assistance to self-help families.

y. The sudden strike of natural disasters and of wars.
z. Last, and perhaps it should be first, the lack of coordination be-
tween over-all economic plans, community development, and housing
For the convenience of this paper, the list can be simplified into these
a. Housing in the national economy
b. Industry and industrialization
c. Self-help housing and cooperatives
d. Urbanization
e. Training and dissemination of information
f. Standards and research
g. Land
h. Disasters.

A few of these subjects are discussed below.

V. Housing in the National Economy

Decent housing has been recognized for some time as not merely the
need but even the right of every family. This satisfies the socially
oriented person. But strong objections to this philosophy are most often
heard from the economists, who contend that housing, while making
claims on investment resources, is unproductive in that it does not lead
to a flow of tangible goods and is also not creative of permanent, as
against constructional, employment. But the arguments one way or an-
other are not that simple. Perhaps the late Prime Minister of Ceylon,
the Honorable S. W. R. O. Bandaranaike, stated the case very well.
In one sense, perhaps, the case for housing in the context of develop-
ment strategy is less strong. Since the rate of growth of the economy
depends largely on the availability of capital goods, investment in fields
which help increase the latter, e.g., export earning or import saving
activities, may claim greater priority. But even here the issues are not
at all straightforward. For instance, in conditions of an acute housing
shortage rents will tend to rise, leading to higher living costs and in-
creased wage demands. These factors may themselves undermine the en-
tire development effort. On the other hand, even an effective control of
rents, assuming this were possible, may only result in a diversion of
purchasing power to other consumer needs and to a raising of consumer
imports. The objective of import savings may thus be frustrated. Above
all, inadequate housing will have such deleterious effects on the health
and the morale of the population as to destroy the very basis of a suc-
cessful development effort. Such an effort requires the maximum of

14 The Caribbean: Its Health Problems
popular enthusiasm and support and a background of political stabiltiy.
These cannot be sustained for long in a democracy if the fruits of
development are too late in coming.
Some interesting conclusions have been developed by the Economic
Commission for Africa7 on this subject. They conclude that "housing
construction seems to be the most decisive factor in economic develop-
ment at the moment of the transition of an agrarian society into an
industrial one," and is therefore a motive force of progress. It is also a
factor of productivity not only for new industries in remote areas but
also for reducing urban workers' absences through illness and for im-
proving labor productivity through high morale. Its importance in the
building industry, where, relatively speaking, labor is more important
than capital and where the proportion of unskilled labor is relatively
high, is significant because this is the sector where rural migrants often
first find work. Also, housing is a prime mover in encouraging thrift
and savings. Finally, family expenditures on housing could reduce, and
even prevent, the purchase of imported consumer goods, thereby con-
tributing to improvement of the trade balance.
On the other hand, to say that housing should be granted high prior-
ity, is also not correct. It has a rightful part in development, especially
if it is first directed towards economic projects such as agricultural and
industrial developments; towards the development of secondary towns,
which could slow down the rural exodus to the largest cities; towards
dwellings that meet the greater need rather than luxury buildings for
the few; and finally towards providing basic infrastructure services for
that large body of families who build their houses by self-help.
To summarize, a realistic housing program should:
a. represent 3-6 per cent of the gross national product (at 5 per cent
annual rate of growth).
b. utilize 121/2 per cent-about 25 per cent national capital formation.
c. create 8-10 units per 1,000 population per year.
d. redistribute housing allocations so that low-cost housing is included
with emphasis on units that cost not more than $1,000 for urban houses
and $200 for rural houses (including utilities) making maximum use
of self-help, local materials, and industrialization.
e. be coordinated with new economic development projects.

VI. Industry and Industrialization
Industrialization of the building industry has been offered at times as
the panacea for the rapid building of houses. It has failed to date in
the developing countries probably because its advocates have thought

only in terms of prefabrication. While methods similar to Buckminster
Fuller's Dimaxion structures (which reduce construction costs by as
much as 90 per cent) and similar to prefabricated concrete panels (used
extensively in Europe) should be encouraged, it can be said that more
flexible and adaptable methods are needed in the developing countries
for the next 10 years.
These new methods should come from science and technology centers
but they have not played a major role in housing solutions to date.
Most of the current methods of house building are centuries old, are still
being used in the developed countries, and are slavishly being copied in
the developing countries. What is needed, for example, are battery or
solar power electronics to harden mud bricks. Or use of foam plastics
with low-cost equipment and throw-away type spray guns to create en-
tire houses in 3-4 hours. The foam could be sprayed on framework of
sticks, bamboo, or thatch and could cost less than $300 for a 400-square-
foot house.
These new methods could ideally be financed through foreign aid and
would create new local industries and jobs.

VII. Self-Help

Another panacea offered to developing countries has been self-help.
Unfortunately it is another process whose full potential has not yet been
realized. Its use, however, has never been in greater need than today.
Self-help housing can make better use of existing funds, for two rooms
in a self-help house can be built for the price of one; or, about two
houses could be built (and twice as many building materials needed)
with the same funds. Banks, so timid about entering the low-cost hous-
ing field, should find the difference between the value of the house and
its actual cost a desirable investment factor.
But if governments do not support and help to organize self-help
housing, the people will usually undertake it in any event, although often
creating slums in the process. An example given for a Latin American
country is equally applicable to Africa and Asia. "In a seven-year
period, 1949 to 1956, the government built 5,476 houses which was less
than 1 per cent of the housing deficit during those years, and at a unit
cost that made repayment by the average urban family impossible. And
this was an exceptionally active period in government building work.
During the same period no less than 50,000 families took matters into
their own hands and solved at least part of their housing and com-
munity development problems on their own initiative and outside the

16 The Caribbean: Its Health Problems
established legal, administrative, and financial superstructure."8 From
this typical case, it would appear more logical for a government to place
more of the proper tools, techniques, and knowledge in the hands of
these families if the housing problem is to be solved at all.
For greater detail on this subject, the Conference should refer to the
United Nations Manual on Self-help Housing. The Manual provides
principles and practical techniques for developing successful self-help

VIII. Urbanization

Everywhere, in both developed and developing countries, urban popu-
lations are increasing at faster rates than the general population. The
developing countries are more fortunate, however, in that they can
analyze the overcrowded "developed" cities of the world and can plan
for the prevention of similar ills.
Dr. Barbara Ward, in The Process of World Urbanization, has singled
out a few of the major considerations all governments should analyze.
The family motor car, a status symbol of all parts of the world, versus
mass public transport is a major consideration. The two approaches call
for entirely different town plans. The tendency for the world's urban
population to be concentrated in growing urban agglomerations requires
a decision as to whether it is better to decentralize the population or to
develop existing ones. There is no clear-cut evidence as to which method
is better; yet, it does seem, according to-Dr. Ward, that "large num-
bers of citizens would rather not have urban sprawl if there were genu-
ine alternatives." In either case, the need for administrators in the
broadest sense of urban development and planning is great. Only they,
and time, can provide the knowledge to determine the best solutions.
So-called "squatters" and urbanization seem to be partners. Charles
Abrams has stated that "one of the main factors that will control the
city's future pattern will not be what is put into the blueprint as much
as what will be imposed by squatter settlement movements. If influxes
are anticipated and planned for, the planning can be substantially pre-
served. This calls for a designation of sites on which settlement will be
permitted and those on which it will be proscribed. It calls for firmness
with understanding. It entails a policy of land layout that will permit
settlement according to plan, help with materials where essential, and
even undertake some inspirational building by the government to influ-
ence the character and course of growth. Squatters will settle where they
can if they are not told where they may. They will build what they can

afford if they are not helped to build what they should. The houses will
improve with time and with better economic conditions if the squatters
are given a stake."

IX. Disasters

Natural disasters can be both a horror and a blessing in disguise. The
hardships and deaths can never be compensated for, yet the funds and
technical assistance that come from world organizations and sympathetic
nations following the wake of hurricanes, earthquakes, and other dis-
asters can rebuild entire regions in a way that governments never seem
able to organize. Therefore, it would be not only farsighted but even
extremely beneficial to the people, if each government would prepare
emergency plans for rehousing and resettling victims. Disasters happen
often enough to make this a worthwhile project in the development plans
of every country.

X. Conclusion

The above suggestions are but a few of the more important approaches
to solving the housing problem. There certainly is no one panacea, but
a giant step will have been taken if developing countries recognize that
urbanization and natural disasters are inevitable and must be planned
for, that greater use must be made by housing people of the "brains" in
science and technology, and that the industrialization of housing is
essential. If these actions are then coupled with the creativity and ener-
gies of the people who need housing the most, through their self-help
efforts, perhaps in 10 years time we will begin to see the tide turn, and
realize that the housing problem can be solved.

1. Based on medium variant of statistics in the Demographic Yearbook 1962,
United Nations, New York.
2. The United Nations Development Decade Proposals for Action (United
Nations publication, Sales No. 62, II, B. 2) p. 59.
3. Ibid., pp. 61-62.
4. The International Programme in Housing, Building and Planning, a Report
to the United Nations Committee on Housing, Building and Planning, 27 January
5. Annual Bulletin of Housing and Building Statistics for Europe 1960, United
Nations publication, Sales No.: 61, II, E. 5, table 5.
6. United Nations Bulletin 6, "Housing and Town and Country Planning,"
ST/SOA/SER.C/6, Sales No.: 1952, IV, 2, p. 2.
7. Housing in Development Planning, August 31, 1964.
8. John C. Turner, Catherine S. Turner, Patrick Crooke, "Dwelling Resources
in South America," Architectural Design (London, The Standard Catalogue Co.,
August, 1963), p. 389.



I. Introduction

U NDER SOME SYSTEMS of geographic classification, the Caribbean
countries and peoples comprise the island nations of the area. From a
perusal of the themes of prior conferences of this series, our Conference
is considering the Caribbean as all of those countries or places whose
shores are washed by the Caribbean. This certainly has validity, and is
a necessary assumption if we are to include Florida, and hence our Con-
ference site, in the Caribbean area. Yet, just as Florida has multiple
affinities-it is at once part of the Caribbean, part of the United States,
and an Atlantic seaboard state-so Colombia may be regarded as a
Caribbean country, an Andean country, part of South America, etc. In
like manner, Costa Rica is an integral part of Central America, and of
Latin America, and is oriented toward the Pacific as well as toward the
Caribbean. Hence the references I shall make and the examples I shall
show will for the most part deal with Caribbean countries in the broad
sense of the Conference-especially Venezuela, Colombia, Panama, Costa
Rica, and Mexico, all peripheral to the Caribbean, and Puerto Rico
which is Caribbean by any definition. However, housing problems have
a certain commonality and relatedness throughout the world, so we may
occasionally range over Latin America and even make reference to other
world areas.
As this audience is varied in its interests, my remarks may at times
be directed primarily to the students of architecture, at times to students
who are potential Peace Corps candidates, and at still other times to

those most interested in the healthful aspects of housing. I hope this is
not too ambitious for one brief session, but I suggest that we attempt to
consider simultaneously the subject of housing under three broad cate-
gories: housing in its relation to health, housing as a factor in socio-
economic development, and housing as an aspect of international techni-
cal assistance.

II. Awakening of a World Region

I propose to sketch briefly what is happening in and around the
Caribbean, outlining the tremendous social and economic changes which
are occurring, the basic problems that underlie the changes, and the new
problems created by this upheaval. Within this milieu, the nature of the
housing problem can be considered along with the constructive steps
taken to resolve it, and with the principal shortcomings of present hous-
ing problems. Realizing such an exposition would properly require an
entire semester course, I shall quite shamelessly attempt to summarize
it in a few minutes.
It is really difficult to generalize about an area so vast and varied as
the countries surrounding the Caribbean. In size, the countries vary from
the smallest ones: Haiti, with only 10,700 square miles, and Costa Rica,
with only 1.4 million inhabitants (and the world's highest rate of demo-
graphic growth), to Mexico with over 760,000 square miles of terri-
tory and more than 35 million people. Geographically, the region
encompasses mountain ranges with snowcapped crests, great deserts,
rain-forest areas popularly known as jungles, bleak, windswept moun-
tain plateaus, great plains, fertile valleys, and numerous tropical islands.
While presenting a greater unity of tradition, culture, and language
than the population around other comparable bodies of water, such as
the Mediterranean, the Caribbean peoples vary greatly from one coun-
try to another and even within countries. Except in the United States,
along the northern shores of the Caribbean basin, Spanish is the pre-
dominant language of the region, with French in Haiti and Martinique,
Dutch in Curacao, and various native Indian dialects in several of the
South and Central American countries. In some areas, people of pure
Spanish descent are in the majority, in others they form the small upper
class. Many of the Indians of the Andes and in Guatemala, as well as
the wild tribes in the jungle interior of Venezuela, have preserved their
traditions, language, and ethnic purity, seemingly unaffected by Euro-
pean colonization. However, more typically, the Spanish populations
have blended to a greater or lesser degree with the various indigenous

20 The Caribbean: Its Health Problems
groups to form mixed cultures. Relatively recent immigrations of Ger-
mans, Italians, and British in some places have markedly affected the
commerce and the political institutions, and have somewhat modified
certain local cultural patterns.
Considering the greatly varied natural resources, the general potential
of the Caribbean region appears to be virtually unlimited. In addition
to fertile agricultural lands suited to cultivation of all types of fruits,
sugar, coffee, cereals, truck farming, cotton, and grazing, the region has
a variety of forests, tremendous water-power potential, and great min-
eral resources, including some of the world's richest deposits of iron ore
and petroleum.
One might well ask why this area of the world, and indeed all of
Latin America, with its magnificent possibilities, remained for so many
centuries after the Spanish conquest as a decidedly underdeveloped area
and only very recently has begun a rapid and uneven economic develop-
ment. The great hindering factors have been both natural and human
in their origins, and remain to be considered in any present and future
In order to develop the basic essential transportation and communica-
tions systems, it has been constantly necessary to fight against rugged
mountainous terrain, thick jungles, torrential rainy seasons, and numer-
ous debilitating tropical diseases. However, when we consider that before
the arrival of the Spanish, the Inca civilization had achieved an astonish-
ing road-net, erosion control through extensive agricultural terracing,
and irrigation projects in the extremely rough Andean region, we must
recognize the existence of many man-made obstacles to progress. It
should be noted that the deterring human factors apply more to some
countries than others, and that they are now being overcome in many
places. They include: widespread illiteracy and superstition, marked
class distinction with very little middle class, a tradition that manual
work is degrading, and undue emphasis on externals, wars between
countries, and countless revolutions.
In recent years a new problem has arisen as the most serious obstacle
to development and to the attainment of a decent standard of living-
a problem that stems from the success of the health programs. I refer
of course to the population explosion which more than cancels out the
growth in the gross national product of the various Latin American
countries. The birth rate in Latin America has not gone up; rather, the
death rate has gone down markedly, due to sanitation programs, in-
creased food supply, malaria control, and other public health measures.
This points up the kinds of imbalances caused by uneven development.



For years the various international agencies and the foundations have
focused their technical assistance on the health and nutritional programs
of Latin America, but little attention has been paid to education, housing
and planning, community development, and the manifold social and
cultural problems of life in large metropolitan centers.

III. Focus on a Local Subculture

Having painted the picture of Caribbean problems with a broad brush,
I should now like to illustrate how we must focus in our housing studies
on the specifics of a local area, and from them develop some principles
and guidelines for action.
The anthropologist Professor Gerardo Reichel-Dolmatoff, of German
origin but a long-time resident of Colombia, tells us something about the
attitudes and aspirations of the people of the rural Magdalena valley and
Atlantic coastal regions of Colombia and how the cultural patterns
influence the design and construction of houses. Professor Reichel-
Dolmatoff is careful to qualify his observations as applicable only to
the northern Colombia area which he has studied for many years, but
his study area includes the campesinos on the slopes of the Sierra
Nevada de Santa Marta, which lie near the Venezuelan border, so ob-
servations might be extrapolated (with caution) to other areas of
Colombia and Venezuela. The rural people, who migrate each year to
Caracas, Bogota, Medellini, and Cali and build their squatters huts
around the cities, come from such areas as the Magdalena valley, the
Atlantic coast, and the Santa Marta mountain range. They bring with
them their deeply ingrained attitudes and values as regards clothes, food,
manual labor, the house, alcohol, sex, illness, family life, neighbors, etc.
Indeed, many who read Reichel-Dolmatoff's little report, El marco cul-
tural en el studio de la vivienda, published in 1953 by the Interamerican
Housing Center (CINVA) in Bogota, find that much of what is described
might be useful in explaining attitudes and habits that recur throughout
Latin America.
The "prestige complex" and the resulting behavior pattern of the
Magdalena campesino, and probably the rural peoples of most of Latin
America, is not derived from the Spanish or Indian cultures, but appears
to be uniquely mestizo or Criollo or what Reichel-Dolmatoff prefers to
consider as a "culture in transition." Unlike the developments in the
Andean countries to the south, the biological and cultural mixing occur-
red very rapidly in Colombia and Venezuela during the Colonial period.
The Spanish cultural forms, language, clothes, religion, and beliefs were

22 The Caribbean: Its Health Problems
quickly adopted as being civilized, desirable, and ideal. All those forms
stemming from the Indian were rejected as "uncivilized, despicable, and
inferior, even though many of the Indian attitudes and beliefs continued
beneath the veneer of a culture that strove to be Spanish. The term
"Indian" came to mean-and still does-the lowest social state; it is not
an ethnic description but rather a term of social degradation.
Time does not permit our elaboration on this theme. But, briefly, in
Colonial days the Spaniard did not work with his hands, and especially
he did not till the soil. The Indian, the inferior being, did work with his
hands and did till the soil. In a mestizo culture no one wants to be in-
ferior; each person wants to adopt the ideal of the superior, or Spanish,
model, and hence assiduously avoids physical labor; if work such as
tilling the soil must be done, it is performed, not with pride, but with a
great sense of shame and humiliation. If a man is forced by necessity
to work for someone else as a farm laborer, he will frequently go to a
nearby village or rural district where he is not known, thus avoiding
the ignominy of facing degradation in his own community.
Prestige is the most important of motivations, and the top status sym-
bol in the Magdalena valley is clothing. Laborers digging a trench for
an oil line will often wear silk shirts imported from the United States.
On certain feast days everyone is expected to appear on the streets with
a complete set of new clothes, much like an exaggeration of our Easter
bonnet tradition. Those who simply cannot secure the cash or credit for
the new clothes-especially girls-will remain in their shacks all day
behind closed shutters rather than appear in public with used clothes.
To shift our focus to another country, Costa Rica, with quite a different
ethnic and cultural background, I recall from a housing study that I
made there some years ago that Costa Ricans spent as much as 90 per
cent of their income on clothes and yet many spent nothing on housing.
Sickness conveys status, as do also modern and expensive remedies
such as penicillin. To have injections is much more prestigious than to
take oral remedies. The maids and cooks in all Colombian and Vene-
zuelan cities are, by and large, country girls, and I have noted that they
preserve these same attitudes and values.
Food, housing, and education for the children are ascribed little or
no prestige value, so are readily sacrificed for the gratification that
comes with expenditures for status symbols-especially clothing-but
also liquor and medicine.
In the rural Atlantic coastal regions, the family structure is rather
complex and unorthodox from our point of view. Legal marriages are
costly and overly restrictive, and hence not common. More usual are

common-law relationships, with the men tending to wander off and
work, to return only at unpredictable intervals; often the man will have
several women at different locations, with each woman maintaining a
house and family. To establish more or less permanent relationships
with a woman, a man is obliged to build her a house which then be-
comes her property. This is of considerable importance in any study of
housing problems and programs, as the views and desires of the woman
are thus of even greater importance than is the case in North America.
The man is the owner of the fields and this ownership is passed on from
father to son, while the house is passed from mother to daughter. In one
typical village studied, three-fourths of the houses were owned by women.
While housing conveys very little status-being something primarily
for the women, or mujeres-some houses have more prestige value than
others. Traditional houses, including original Spanish Colonial houses
several centuries old, are considered ugly. Everything old is ugly or
feo; everything new is pretty or bonito. Houses with thatch or tile roofs
that can be seen from the street are far less prestigious than those with
pretentious false fronts of cement stucco. In Cali and in Bogota, I have
heard such added facades referred to proudly as fachadas de prestigio
(prestige facades).
Again to quickly shift to another place, Puerto Rico, I recall discussing
with the head of a government agency the small single-family houses
being built by that agency. I expressed some concern about the flat con-
crete slab roofs-the houses being little concrete boxes under the tropical
sun-and the insufferable radiant-heat, cooking the inhabitants as in
an oven. The agency head gave me the standard, official answer, that
Puerto Rico has no lumber and no other building materials except con-
crete (which is really not true). I suggested that some sticks and thatch,
which seemed readily available for huts in the rural areas, might be
built over the concrete roofs to shade them. He then got down to the
real reason and said, "The grass roofs are a symbol of poverty; our
people are most anxious to eliminate such a symbol; they will put up
with anything to avoid having a grass roof."
In Panama, about a dozen years ago when air conditioning was still
uncommon, I attended an elegant cocktail party at the Peruvian Em-
bassy, a large, pretentious residence in the neo-classic-Mediterranean-
Spanish-California-cement-stucco-style set on a generous lot in the swanki-
est area of Panama City. The party was well attended and we were
packed in like sardines, with all of our white linen suits and the ladies'
white dresses soaking wet with perspiration and all of us nearly suffo-
cating. Any sensibly designed house in such a climate would have been

24 The Caribbean: Its Health Problems
completely open to the breeze. Lacking that, the party could have been
out of doors, but that would not have been as prestigious and formal. I
noticed that this house, and each of its neighbors as well, had a sort of
tea-house in the garden, an open shelter with four corner posts support-
ing a wood and thatch roof-just like those seen in the countryside. On
less formal occasions, with only the family present, they could sit out
under the shade of the thatch roof and be served with food and drink
in great comfort. If anyone were to suggest that the Panamanian govern-
ment (or any Latin American government) might use thatch paja for
roofs of public housing projects for low-income groups, the idea would
be immediately rejected because of the fire hazard and because such
roofs tend to harbor vermin and snakes and insects. Yet in all of the
hot regions in Latin America the wealthy people have garden shelters
with thatch roofs and they go on vacations for weeks at a time living in
ancient houses with thatch roofs-and loving it.
To return to the subject of the houses in the Magdalena community,
they are much like those I have seen in many other regions of Colombia.
The house is rectangular with a gable roof of thatch or palm leaves, walls
of bahareque (a form of mud-and-wattles), and the floor is of dirt. In
plan there are two rooms side by side, one being the sala, or parlor, with
a window and with doors front and back. The sala has a mirror, the
image of a saint, seats, and any other objects of prestige the family
might own. This is the formal room, strictly for show and to receive
visitors, much like your grandmother's parlor. Next to the sala is the
aposento (sleeping room), without windows and with an access door
only from the sala. This is the intimate room of the house, with the ham-
mocks or cots, trunks or boxes filled with clothes. It is hot, dark, dirty,
and infested with insects.
Going through the sala to the back of the house, one finds a fenced
patio where most of the real living takes place. Here is the kitchen-
generally four posts with a bit of roof over it; at times the kitchen has
walls about it, but it stands free of the main house. The patio is where
the woman, the children, the pigs, chickens, and dogs, spend most of
their time. This is where the corn is ground, a pile of wood for cooking
is stored, where one finds a few potted plants growing in old tin cans.
One factor that influences the orientation as well as the design of the
house is the popular belief that winds bring sickness (which may have
had some basis in fact when malaria and yellow fever were more com-
mon). Often whole communities have all the houses oriented so that the
prevalent northeast wind will not blow into the doors. The windward
side of the houses always has blank walls without windows. The bed-



room has a small air vent about the size of a brick. However, it is be-
lieved that the wind, or fresh air in general, can be fatal for sick
people, pregnant women, and babies. So when any of these are present,
the vent hole is stuffed with cloth and the room becomes completely
dark and free from any movement of air. The belief in witches and
spirits is also a consideration in this matter.
The attitudes and habits we have been discussing are centuries old.
When these people migrate to the city and build their squatters shacks
on public lands or on the banks of the streams, they generally build a
smaller and more miserable facsimile of their original farm home. What
does this suggest in the planning and design of new housing for these
people? What would be their reaction to bedrooms with large windows?
There seem to be two alternatives: one is to design and build in com-
plete accord with the established traditions; the second is to educate and
persuade and thus modify the behavior patterns. In practice, some com-
bination of these two approaches seems indicated. But in any event, it
is first necessary to become familiar with the traditions, beliefs, and
habits of any particular group, and it is also well to remember that it
will take considerable time and effort to educate the campesino, to
change his pattern of living and his values, and for him to accept and
maintain a different kind of home.
The widespread belief that bad odors carry disease makes it difficult
to persuade the campesinos to use outhouses, called letrinas. They may
wish to have a letrina if it has some worth as a status symbol, but as it
inevitably smells bad, it is hence dangerous, and they prefer to relieve
themselves in the fields as they have always done. In some regions,
ownership of a water closet carries sufficient prestige that a few houses
will have them, but not necessarily installed so that they can function. A
water closet is something to possess, but not to use!
In many rural areas of Colombia and Venezuela, concrete floors are a
sign of prestige and they are often appreciated because they feel cooler
to bare feet. The greater hygienic value of concrete floors as compared
with dirt floors is not understood and hence not given any consideration.
Often only part of the house will have a concrete floor, and that part
will be the sala, of course.
It has been wisely observed that the rural peoples in underdeveloped
countries throughout the world, in India, Africa, and Latin America,
have much more in common with each other than with the upper classes
in their own countries. Among many of the professionals and intellec-
tuals in Latin America, there is a tendency to insist upon unrealistically
high standards. While our students at the Housing Center were hearing

26 The Caribbean: Its Health Problems
lectures and studying examples such as I have been citing, one of my
staff, an intelligent and capable Latin American architect, educated in
the United States, was working on a model set of housing standards, to
be adopted (hopefully) by various Latin American National Housing
Agencies. He was following the "Standards of Healthful Housing," a
bulletin promulgated in the United States, with its minimum room sizes,
and not more than two children of the same sex per bedroom, and other
specifications. If I had been so indiscreet as to suggest that the typical
Latin American laborer or peasant would not know what to do with a
house built to such standards, I might have triggered a suspicion that I
regarded the Latin Americans as inferiors and not good enough for
United States standards.
To cite a specific case related to customs and standards, the Rocke-
feller Foundation and the Colombian Ministry of Agriculture coopera-
tively operate an experimental agricultural station called Tibitata in
the high plains, or Sabana, about twenty miles from Bogota. At the
station they do such things as develop new strains or varieties of wheat
suited to the local climate. For a time their few, regular, farm workers
came daily from a nearby village. It was then decided, in order to
protect the experimental crops, to build several houses for these farm
workers at scattered locations around the periphery of the farm. The
Rockefeller Foundation agronomists, not having given much thought to
housing standards, secured plans from the United States of typical mod-
ern farmhouses, not unlike FHA-financed, suburban 5-room houses.
Shortly after completion and occupancy of the dwellings, the United
States agronomist directing the experiment station noted a surprising
number of people coming and going from one of the houses, so one day
he asked the tenant employee, "Who is that going into your house?"
"Oh, that is my Aunt Maria." "And who is that who just came out?"
"Oh, that is my cousin Juan." And so it went! It turned out that there
were the equivalent of four or five families living in this one house.
The tenant's income was steady and probably double that of his fellow
villagers, but since his family had always lived in one room, or possibly
one room plus a sala, what could they do now with a 5-room house?
Family ties are strong in Latin America. If one member of a family
does well, which is clearly a matter of good luck or "fate," his cou-
sins and second cousins are apt to arrive for an endless visit to share his
good fortune with him. When Pedro moved into his new house on the
experiment station, the very effective grapevine communication system
doubtless transmitted the message rapidly to all members of the clan,
many possibly living in Boyaca or Valle. There was undoubtedly much

exclamation and elaboration in describing this "house of luxury" with
water and electricity and "five rooms, can you imagine?"

IV. The Housing Situation and Housing Education

During my years at the Interamerican Housing Center, or CINVA, as
it is called in an adaptation of the Spanish title. Centro Interamericano
de Vivienda, the eager young students came to us from all over the
hemisphere searching, as for the holy grail, for the miraculous "housing
penicillin." It took us a year of dedicated work with the graduate stu-
dents to bring them to realize that housing penicillin does not exist and
is never likely to exist. In this process we succeeded in making "housing
experts" out of them, and in them lies the only real hope for housing
progress in Latin America. A housing expert is a person who knows
how little he knows about the remarkably subtle and complex and diffuse
subject which is characterized as housing-which, incidentally, is a most
inadequate term to describe the physical environment of humankind. As
many of these CINVA graduates are now in influential technical or policy-
making positions in their national housing agencies, and on the faculties
of universities, they are beginning to shape national housing policies and
programs along realistic lines, to counter the tendency toward simplistic
improvisation, and to educate more Latin American youth in the under-
standing of the manner in which environmental problems are inextri-
cably interwoven with traditions, superstitions, public health, mental
health, delinquency, productivity, economic development, and almost
every other aspect of human life.
The more that we study housing, the more it becomes evident that
housing is not a problem of walls and roofs, but rather a problem of
people. It is a problem of people and their attitudes, their aspirations,
their motivations, their cultural level, and how they live and interact
together in families and in communities. Housing improvement must
come, step by step, as part of an even development, as part of the
gradual educational, social, and economic advancement of a people. If
environmental conditions lag behind general development, they serve as
a brake to that development; if an attempt is made to advance too far
and too fast in environmental terms-ahead of the aspirations and the
cultural developments of the people-the results will be disastrous as
well as economically wasteful, as I have noted where nutritional and
public health programs have gotten ahead of general socioeconomic
development. There is considerable evidence that when families move
from slums into new and improved housing, rates of crime, disease,

28 The Caribbean: Its Health Problems
infant mortality, etc., tend to decrease, if the change is not too abrupt,
if the families are able to adapt to their improved surroundings, and if
the change is accompanied by programs of social service and basic edu-
cation. However, slum mentalities breed slums; if people living in a
pigsty are moved into a palace, they will soon turn the palace into a
pigsty. Unless the people change in their attitude and habits, the slums
will accompany them wherever they go.
To cite the wide range of climates throughout the region is to give
only a hint of the essentially local nature of the housing problem and
the essentially local nature of its solution. The people and their habits
and culture and economic resources vary even more markedly than do
the climate and terrain.
While it should be evident that the housing problems and housing
programs in Haiti-with its barter economy, voodooism, and universal
illiteracy-has little in common with the problems and programs of
advanced cities like Caracas or Mexico City, it is often overlooked that
within a very large country like Mexico one can find a wide range of
climates and almost infinite economic and cultural variations. Even
within a country as tiny as Costa Rica, about the size of New Jersey
and with one of the most homogenous populations in the hemisphere,
the factors of climate, tradition, local materials, and the local economy
suggest a great number of differing solutions to the local housing
The Latin American housing problem is just one sector of a world
problem, and rather typical of that problem. We now have three billion
people in the world and an alarming rate of population growth. About
two-thirds of the world population, or two billion people, are inade-
quately housed. Just for argument, let us assume that by means of some
remarkable technological break-through we could produce an adequate
minimum house, ship it to its site, and erect it for $1,000 per family-
or $200 per capital. This is a manifestly farfetched assumption, as it
generally costs more than this to acquire and develop the land and pro-
vide water and sewer service before we spend anything on the house
itself. However, even with such hopeful estimates, it would thus cost
$400 billion to meet the immediate housing needs, and the needs are
growing every day. It seems evident that such funds will not become
available, and a more realistic assessment of costs within our technologi-
cal capabilities would raise the figure to several thousand billions of
dollars. It is clear that such sums simply are not available.
The great masses of people who have the most severe housing needs
have more time than money, and they have traditionally built their



houses with their own hands and with locally available materials-some-
times with stone or wood or bamboo, but mostly with earth, or with
earth and wood in some combination. The walls of most of the houses
in the world are of adobe, rammed earth, sod, or mud-and-wattles. Roofs
are framed with wood or bamboo, and covered with cane, thatch, mud,
or locally produced tile. Even brick, which is used so widely in the
technologically advanced countries (as well as by the Assyrians 5,000
years ago) is merely a baked adobe block.
Therefore, I submit that if a solution can be found to the housing
problem of Latin America and of the other poor areas of the world, it
will involve a large measure of self-help-people building their own
houses-with locally available materials-"found" materials that cost
nothing or very cheap materials involving little or no transportation-
and the materials will be principally earth and wood. I am now referring
only to the shelter-the walls and roof-which I consider as a minor
segment of the housing problem, especially in warm or moderate
As the urbanization of the population continues as the campesino
moves to the cities and to the peripheral slums that ring virtually all
Latin American cities, the problems of community living loom larger
than those of simple shelter. Unused to crowded urban life, unlettered,
unemployed or underemployed, blessed with virtually no economic re-
sources, the poor campesino tries to feed his family and maintain a
semblance of the only life he knows by keeping a few pigs and chickens
along with the children in the shack or in the mud of the tiny patio,
cultivating postage-stamp-sized gardens, defecating in the patio or the
path that serves as a street, and dipping water from the nearest filthy
river or drainage ditch. The priority needs for these people, in terms
of physical facilities, are: water supply, sewage disposal, access streets,
electricity, play areas, schools, community centers for meetings and
adult training, churches, and clinics or dispensaries. They desperately
need social service and training programs, guidance in organizing and
carrying out community improvement programs and in developing group
leaders. All of this implies planning-physical planning, social planning,
and economic planning.
You will note that I have put no priority on the house itself-the
basic shelter-the item on which most of the Latin American govern-
ments have spent all of their scarce and precious appropriations for
housing. And the results of housing efforts have been really insignificant
in relation to the problem-like a drop of water falling on desert sands.
There is a marked tendency to build houses to excessively high standards


The Caribbean: Its Health Problems

with government funds, yet streets have not even been leveled by bull-
dozer, and no provision made for water and electricity, to say nothing of
the essential community facilities.
In relation to the urban housing problem, which must be considered
quite apart from the rural one, I would urge that available resources for
housing be used to prepare realistic comprehensive plans, to zone and
subdivide the land, to establish a street pattern and land-use pattern
which would anticipate long-range requirements, to preserve land for
community facilities, and to provide water mains and sewers. Initially
the water would be available only at occasional water points, but the
system would be planned for eventual service to each dwelling unit. The
qualified families would acquire a lot through nominal purchase, or
through paying ground rent, and would be allowed to build their shacks
much as they do now, but the subsequent progressive improvements
would be within a favorably disposed framework of land-use and land
This is not a new idea-in fact, nothing I propose is new; these are
just simple, common-sense concepts that need to be understood by more
people in policy-making positions. What I have just described is the
basic idea used in Puerto Rico and elsewhere, often referred to as "land-
and-utility" schemes. Well known as it is, why was this technique not
used for the large working class residential areas of the two great new
cities built in recent years-Chandigarh and Brasilia? Both India and
Brazil were desperately short of capital for housing and city building,
so the inherent economy of such a scheme should have been appealing.
In the case of Brasilia, it would have directed the energies and materials
and the substantial capital investment that has gone into the free city-
the shanty town city of the workers adjacent to the glittering official
city-the living city-the city of the people-the city that is supposed
to be wiped out when Brasilia is completed, but which will not be.
Another technique that has much promise, aided self-help, is often
advocated but seldom used. This form of technical assistance at the
village or neighborhood or barrio level can be used in several ways-
in the progressive upgrading or replacement of the first shacks of a
land-and-utility scheme, in fomenting community improvement projects,
and in village and rural housing improvement. Aided self-help is not
easy to organize and administer; it involves more of education and
group social work than of construction techniques. The resulting benefits
in building people-developing leadership, skills, pride, personal con-
fidence-through such projects, are of greater long-term benefit than the
building of houses.



For those who are inclined to think that everything can be done better
by private industry, I would suggest that the profit incentive must always
be present for business to operate, and there is a very limited prospect
for profits in ministering to the housing needs of the low economic
groups in the underdeveloped areas of the world, at least in the first
stage of their development. The work that I describe-the most urgent
problem which involves education and social work-must be undertaken
by governments, international agencies, and eleemosynary institutions.
Private enterprise has a role, of course, in indirect ways, mostly in
the area of power development to serve new industry as well as domestic
needs, in steel and cement plants, production of cement-asbestos for roof-
ing, and development of the lumber industries in the various countries.
Tree farming, forest management, scientific cutting, standardizing of
lumber sizes, drying and treating lumber could improve quality, reduce
lumber costs, and greatly stimulate the use of wood for housing and
other purposes in the urban areas.

V. References

Before leaving the subject of the rural areas where the prevalent Latin
American mores and attitudes are incubated, I should like to refer you
to several items of essential reading which time does not permit me to
summarize. One is the recent special supplement on Mexico in the
March, 1964, copy of The Atlantic Monthly Magazine, and especially
the article entitled, "Love and Authority," by the North American
psychologist Michael Maccoby, who reports on his work and observa-
tions in a Mexican village which he calls "Las Cuevas." The village could
equally well be anywhere in the Caribbean area. Maccoby brings special
insight and perception to the manner in which the feudal heritage and
the patron system of authority has weakened the peasant's self-reliance
and undermined the moral supports of reliability and cooperation; this
will help explain to you why the local people often work to please the
foreign expert or the Peace Corpsmen assigned to their village, but not
for their own satisfaction.
Another book, available in paperback edition, is The Silent Language,
by the anthropologist Edward T. Hall. This book, a brief and practical
commentary on comparative cultures, enables you to realize how and
why other peoples have quite different concepts of such things as time
and bargaining patterns than you have. It points out how your physical
proximity to persons of another culture under specific circumstances can
put them at their ease or so disturb them as to hinder your communica-

32 The Caribbean: Its Health Problems
tion. Much of this material was prepared by Dr. Hall when he was
giving an orientation course for United States specialists on Point-4
missions, so it is most pertinent for all who are concerned with technical
assistance programs.
A third is the brief CINVA report that I referred to, by the anthropol-
ogist Reichel-Dolmatoff. It is called, "El marco cultural en la studio de
la vivienda." If it is not out of print, you can get it by writing the
Interamerican Housing and Planning Center in Bogota. The address is
Apartado Aereo #6209.

VI. Conclusion

The most common housing misconception in Latin America is the
idea that masonry housing is eternal, that when a family acquires a
newly built house their housing problems are solved for all time. The
concept of housing as a replaceable and replenishable item is rarely
understood in Latin America or elsewhere. When a hungry person has
a good meal, it is not expected that it will sustain him forever. It is
generally understood that a suit of clothes will wear out and must be
replaced. The cycle of housing replacement is longer than that of cloth-
ing or food, but housing is every bit as cyclical as are our other basic
human needs. Ruskin to the contrary, when we build we do not build
forever. Housing is not a problem that can ever be solved and then
forgotten. Houses are built; they depreciate, become obsolete, decay,
and are demolished. For various reasons all this takes place more rapidly
in Latin America than in the United States. Hence, the housing problem
will never be really solved in Latin America or anywhere else on earth.
Housing and rehousing is a basic and never-ending and ever-challenging
human activity.
We in North America have several reasons to be vitally concerned
with the economic development and the raising of living standards in
Latin America: first, we realize that such development is important in
our hemispheric defense; second, it is essential to stop the spread of
Communism in the Americas; third, it is useful in the growth of our
international trade. However, there is another more basic reason, a rea-
son that would impel us to do our utmost to raise living standards
throughout Latin America even if there were no Communist threat in
the world, and that is our inherent American sense of fair play-our
unabashed idealism-our recognition of the great Judeo-Christian phil-
osophy of the essential brotherhood of man. Fortunately, poverty is not
endemic and need not be the eternal lot of any people.


Felipe Garcia Sanchez and Gilberto Balaim: SOME

I. Introduction

PRIOR TO THE CONQUEST, the indigenous communities depended
upon a ceremonial epicenter which was later changed by the European
conqueror to an urban mestizo epicenter. This destroyed the base of the
ceremonially centered culture and organized a feudal economy which
imposed obligations and taxes.
The native woman progressively assimilated elements of the occidental
culture, thereby changing her traditional ideas and practices. She often
learned a small amount of the national language as well.
During colonization, culturization was bound to the interests of the
dominant group; it was a culturization induced by the Spanish and was
limited to religious aspects and political organization. It resulted in the
regional integration of aboriginal communities and a mestizo center.
Upon achievement of Independence, the mestizo culture and the seculari-
zation of institutions became more consolidated.
The Reform movement prepared the way for the restructuring of
Mexican society under the patrons of liberalism without achieving
national integration of the indigenous people. Ecclesiastical property
disappeared and private property characteristic of haciendas with peons
appeared, thus leading the way to the democratic Revolution of 1910.
Since then, the communal farms and rural schools have been useful in-
struments in the transformation of Indian and mestizo towns, although
several isolated groups, in forests, deserts, and tropical marshes, have

34 The Caribbean: Its Health Problems
progressively incorporated themselves into occidental culture. Communi-
cation, assisted by technical advances, such as roads, radio, press, is
contributing to the integration of the indigenous communities and en-
couraging racial rapprochement, cultural fusion, language unification,
and the economic equilibrium of the groups (1).*

II. Demography
According to accounts in the year 1521, Mexico had 7,264,059 in-
habitants; after 300 years of Spanish domination, that is, in 1820, the
population was only 6,204,000 due to a very high mortality rate caused
by massacres, subhuman living conditions, exploitations, and epidemics.
From 1821 to 1921-after 100 years of independent life-the popula-
tion doubled; in 1921 there were 14,334,780 inhabitants, notwithstand-
ing the fact that the country had had important social movements:
liquidation of the Independence movement, Centralism against Federal-
ism, the Reform, and the Mexican Revolution.
In 1930 the population registered a figure of 16,552,722 and in 1960
it was 34,923,129. The aforementioned figures indicate an increase of
209.8 per cent, which means that the population doubled in 30 years.
As in all small industrialized countries, the rural population of Mexico
still predominates over the urban; in 1930, the rural population ac-
counted for 66.5 per cent; in 1940, 64.9 per cent; and in 1950, 57.4
per cent. In 1960 it was estimated at 50 per cent (2).

III. Ecology
The great climatic contrasts of Mexico allow a vast diversification of
products and establish the basis for regional specialties and social and
cultural division of groups. The physiographical environment in which
the Mexican population lives is characterized by broken terrain which
is a consequence of mountainous areas. Two mountain ranges cross the
country, forming the so-called Mexican Plateau, which comprises ap-
proximately one-third of the national territory and has an average alti-
tude of 1,700 meters with extreme altitudes of 2,600 meters.
The high ranges and plateaus with steep, rugged slopes create a
scarcity of deep river beds, and explain why the majority of the rivers
are not navigable. The pluviometric conditions are characterized by
very short periods of rain. It is estimated that in 53 per cent of the
territorial area it rains less than 60 days of the year, in 28 per cent from
*Italicized numbers in parentheses refer to the numbered items in References on
page 41.

61 to 90 days, and in the remaining 19 per cent more than 90 days. The
average annual temperature range is 150 C. Approximately 52 per cent
of the ground is arid with 104 million hectares, 41 per cent semiarid
with 82 million hectares, and 7 per cent humid with 14 million hectares.
For this reason, Mexico has very few favorable conditions for its devel-
opment. However, application of modern and scientific techniques have
permitted adequate exploiting of natural resources-renewable and non-
renewable-which exist apparently in great quantities but are anti-
economic in actuality.

IV. Housing

According to the 1950 census there were 5,259,208 dwellings, of which
only 19 per cent were in adequate condition, with water service and a
minimum of comfort; 62 per cent barely reached normal conditions;
and the remainder lacked the most elementary necessities of habitation.
It is actually estimated that 25 per cent were in good condition and 55
per cent in semihabitable condition (2).
In 1960, of the 34.9 million inhabitants. 12.5 million (36 per cent)
had public services-potable water-and 22.4 million (64 per cent)
lacked these services, or had them very rudimentarily. Of the 12.5 mil-
lion who had potable water, 4.5 million lived in the Federal District (6).
During the last few years, several official agencies-the Mexican
Social Security Institute, the Institute of Security and Social Services
for State Workers (ISSSTE), National Housing Institute-and several
private banks, such as the Banco de Credito Hipotecario, have been
sponsoring programs for the construction of dwellings, principally in
cities for the labor sectors and in this way efficiently contributing to the
solution of popular housing problems in Mexico.

V. Economy

The Spanish domination did not produce grave disorders in the in-
digenous communities since the intensive cultivation of the land per-
mitted the introduction of the plow and the innovation of Western-type
harvests. Prior to 1910, the material base of the economy was formed
by the hacienda, which included agricultural land, water, pastures,
forests, quarries, mines, limestone, and other riches, thereby making it
self-sufficient and bringing about the monopolization of land to obtain
large numbers of cheap and unskilled laborers. It included the tienda de
raya, a form of company store run by the land owners, a regulation

36 The Caribbean: Its Health Problems
agency for the payment of the peon, a church and a cemetery, a jail, and
sometimes a school. Close to the wall which surrounded the hacendario
nucleus were the dwellings or huts of the peons.
The redistribution of lands and the institution of the communal farms,
initiated with the Revolution, gave way to an incipient industrialization.
However, a cultural change has not been produced with the same rapid-
ity as the advanced social transformation. These cultural aspects explain
some incongruities which today are displayed in regional ecological
integration. In some zones the cooperative farmers and indigenous In-
dians persist in primitive means of agriculture, leaving unused the
arable lands or simply employing them as pastures (1).

VI. Trends of the National Economy

During the last 20 years the gross national product has tripled, but in
the same period the national per capital production has increased less
because of the accelerated demographic growth (Table 1).


YEAR (Millions of Pesos) (Millions of Inhabitants) (Pesos)
1940 20,721 19,791 1,609
1960 67,000 34,923 1,918
Source: Bank of Mexico, S.A.

The participation of diverse economic activities within national pro-
duction from 1940 to 1957 did not register any fundamental changes, as
may be seen in Table 2. It is important to note that in the last few years
mining has lost importance and the petroleum industry has increased;
farming activities are represented by only 22 per cent of the national
product although they absorb 53 per cent of the work force; and lastly,
the manufacturing industry has increased its share in the total produc-
tion of goods and services (6).

VII. Education
Eleven-Year Plan
The Mexican government has established a plan whose fundamental
goal is to diminish to a great extent illiteracy within a period of eleven
years; to give all rural and suburban communities prefabricated school


1940 1957
Agriculture 20.5 65.4 22.9 53.6
Mining 4.4 1.5 2.4 0.8
Petroleum 1.7 0.3 3.7 0.4
Manufacturing 16.4 9.0 22.2 12.1
Electric Power 0.6 0.1 1.2 0.3
Construction 1.8 1.8 5.0 3.2
Commerce 25.1 9.3 19.5 8.7
Transportation and
Communications 5.8 2.5 4.9 3.5
Banks and Securities 1.3 0.2 0.8 0.4
Private Services 15.4 6.6 14.1 13.6
Government 7.0 3.3 3.3 3.5
Totals 100.0 100.0 100.0 100.0
Source: Ifigenia M. de Navarrete, The Distribution of Income and the Economic
Development of Mexico.

buildings for primary instruction; to provide free books and notebooks;
to increase the number of openings for teachers; and to raise the level
of technical and university teaching by the creation of specialized centers
in the most important populated areas of the country.

Illiteracy and Language
In 1930 illiteracy in the population six years of age or over was 67
per cent; in 1940, 59 per cent; in 1950, 44 per cent; and in 1964 it was
estimated at 27 per cent.
Not taking into consideration persons under five years of age, 88 per
cent speak Spanish; 7 per cent Spanish and indigenous tongues; and 3
per cent indigenous dialects only. In comparing this last percentage
with that of 1940 it is noted that the monolinguistic population of
Indian dialects has decreased to almost half (2).

Free Textbooks Distributed
In 1960, 15,492,198 free books and workbooks were distributed; in
1964, the number was 24,754,090. The total number distributed in the
period 1960-64 was 107,155,755 (5).

Elementary Teaching
The number of elementary schools and the percentage of school-age
children attending compared to 20 years ago is shown in Table 3.


The Caribbean: Its Health Problems


1940 4,684 16,953 45
1960 7,284 25,611 63

General Culture (4).
Some significant facts concerning general cultural trends are shown
in Tables 4, 5, and 6.

VIII. Health and Welfare
Specific campaigns have been carried out, the most important ones
dealing with malaria, typhus, diarrhea, tuberculosis, leprosy, oncocer-
cosis, pintodisease, poliomyelitis, goiter, venereal diseases, vaccination
against smallpox, whooping cough, diphtheria, and tetanus, as well as
campaigns relating to hygienic education and, just recently, regarding
nutritional education concerning supplementary diets for preschool chil-
dren and pregnant women.
There are more than 2,000 sanitary offices and health centers, and
more than 3,000 hospital centers (official and private) which serve large


PROFESSION 1948 1961
Humanities 1 31
Technical professions 566 1,680
Social professions 265 604
Administrative professions 2,957 10,911
Medical auxiliary professions 1,054 1,893
General instruction 989 2,457


1953 1960
Daily 131 197
Weekly 296 378
Biweekly 94 545
Monthly 545 856
Others 184 234



1953 1961
Commercial radio stations 240 399
Cultural radio stations 6 16
Television transmitters 6 22

areas of the cities and which are penetrating rural regions. Although
facilities are still insufficient, they are on an acceptable scale as can be
seen in Table 7.
In recent years efforts in sanitation have emphasized the realization
of integral programs coordinating sanitary action with assistance and
field personnel who at any moment may undertake both functions, with-
out neglecting the training of highly skilled and specialized personnel.
Until recently, the integral programs were basically concerned with
coordination of preventive and curative medicine, and rehabilitation and
As this action penetrated, in an organized manner, the rural environ-
ment by means of the institutional structure, the need was observed for
considering within the sanitary programs action for socioeconomic bet-
terment, chiefly in the rural areas, so that it can now be stated that the
sanitary districts' integral programs include plans for rural socio-
economic betterment, whose principal objective is to organize the com-
munities and prepare voluntary auxiliaries. The main objective of the
cooperative and national programs of rural community development is
to use the unoccupied and semioccupied work force in the rural areas,
thus converting these people into productive human beings, giving them
buying power to free themselves from their misery and thereby making
them free men. Up to the present, this program has organized more than
1,000 projects of various types in the country; sanitation, recreation,
education, and agriculture and livestock promotion.

SERVICES 1930 1960
Hospital centers 496 3,384
Hospital beds 7,214 69,250
Number of doctors 4,317 24,600
Assistance to interns 90,525 532,407
Assistance to nonresidents 4,700,000 47,235,619
Immunizations 870,000 11,629,584
Clinical examinations 65,287 1,007,568


The Caribbean: Its Health Problems

The response has been so great that after one year of working with
this type of program, the Ministry of Health and Welfare has used the
experience gained to organize a National Program of Rural Community
Development, which was begun in September of 1964. This program
functions under the Ministry of Health, and 150 million pesos has been
allocated for the distribution of national products.
Table 8 presents a resume of the results obtained by the program;
and Table 9 lists the projects terminated or in process up to July 31,


(August 1, 1963, to July 31, 1964)


Work terminated and in process 1,218
Total cost of projects $50,417,780
Rations authorized 2,579,181
Rations distributed 1,111,959
Economic allocations authorized 922,923
Voluntary workers 44,356


Environmental sanitation 263
Agriculture and livestock promotion 143
Education, recreation facilities, village beautification 452
Communications 241
Small industry and commerce 6
Miscellaneous public services 113
Total 1,218

Finally, Table 10 presents comparative data on public health to illus-
trate the influence of the sanitary organizations in matters relating to
health (6).


1930 26.5 131.6 26.6
1962 62.0 67.4 10.4


1. Aguirre Beltran, Gonzalo, "El process de aculturaci6n," General Direction of
Publications. Edition of the National University of Mexico, 1957.
2. Flores Talavera, Rodolfo, "Recursos humanss" Typed copy of the work pre-
sented by the author to the Plenary Session of the Second Congress on Public
Health with reference to the Economic and Social Development of Latin
America, Mexico, D.F., April, 1963.
3. De la Riva, Javier, and Garcia Sanchez, Felipe, "Planeaci6n, administraci6n y
evaluaci6n de los programs de salud public en Mexico" (Planning, Adminis-
tration and Evaluation of the Public Health Programs in Mexico). Ministry of
Health and Welfare. Edition for the Second Mexican Congress on Public
Health, April, 1963.
4. "Anuarios estadisticos de los Estados Unidos Mexicanos" (Statistical Annual
of the United States of Mexico). Ministry of Commerce and Industry. General
Direction of Statistics.
5. Comunicacion personal de la Comisi6n Nacional del Libro de texto gratuito.
Ministry of Public Education. 1964.
6. Bustamente, Miguel E., et al., "Salud public y desarrollo economic y social
con referencia a Latinoamerica" (Public Health and Economic and Social
Development with reference to Latin America). Work presented by the authors
at the Second Mexican Congress on Public Health, April, 1963.
7. "Manual del program cooperative para el desarrollo de la comunidad rural"
(Manual of the Cooperative Program for the Development of Rural Communi-
ties). General Direction of Nutrition Programs. Ministry of Health, Mexico,



M Y PERSONAL EXPERIENCES in the study and observation of
land and land use in the Caribbean region are limited to four countries
during the period 1950-1953: Costa Rica, El Salvador, Cuba, and Haiti.
In El Salvador and Costa Rica I helped make Agricultural Region maps
and became familiar with general relationships of land to people. In
Costa Rica, I cooperated with Ralph Loomis of the Food and Agricul-
tural Organization of the United Nations in a study of the management
of individual farms and the land use of the Reventaz6n River water-
shed.* Later, in this paper, I shall use data from the Costa Rican studies
to illustrate land and people relationships.
The Artibonite Valley of Haiti was studied intensively by representa-
tives of various international agencies in the early 1950's. A rural soci-
ologist of Michigan State University and I spent a short time reviewing
engineering, agricultural, and sociological studies of the proposed project
for this fertile valley. We concluded, in a report to the Inter-American
Institute of Agricultural Sciences, that the most limiting factors in the
possible success of this project were cultural. The land and water re-
sources appeared good to excellent. I have not visited the project since
1952 and did not find specific references to it in the literature.
Cuba, where I spent about six months in 1953, has the best over-all
agricultural resources of any country in the Caribbean region. My per-
*From July, 1950, to September, 1953, I was Land Use Economist, Inter-
American Institute of Agricultural Sciences, Organization of American States,
Turrialba, Costa Rica. I was stationed at Turrialba for one year; at San Jose,
Costa Rica, for about one and one-half years; and in Havana, Cuba, for six

sonal experience was in a demonstration area of a regional training proj-
ect of the Technical Cooperation Program of the Organization of the
American States. This demonstration area was about 50 miles east of
Havana and bordered a large sugar cane region. Most of the farms were
family-operated and grew sugar cane, tobacco, and miscellaneous crops.
One area we classified as a dairy region. The data gathered in a farm
management study and by personal observation indicated that the eco-
nomic development of that part of Cuba was the highest I had seen in
Latin America. A few families had already installed TV sets by 1953.*

I. General Land Use Characteristics and Agricultural Production Trends
The following quotation describing agricultural land use in Mexico,
Central America, and the Caribbean Islands comes from a publication of
the United States Department of Agriculture.

Mexico has an immense territory in the northern part of the country
that is arid, and without adequate irrigation it is unproductive. In fact,
about 33 per cent of Mexico's land is considered unproductive. The
mountains in northern Mexico are rugged; some are of relatively recent
volcanic origin, and sufficient soil has not formed to support vegetation
even if there was adequate rainfall.
About 34 per cent of Mexico's land is considered to have sufficient
soil and precipitation for pasturage of some kind; 20 per cent is for-
ested; 9 per cent is cultivated; and only 4 per cent is reported as poten-
tial productive land. The land in Mexico having the greatest productive
capacity for commercial agricultural commodities lies in the great Cen-
tral Plateau, where the soil is fertile and the altitude is suitable for
temperate climate crops and comfortable human habitation.
Central America
The productive agricultural area of Central America lies in the high-
lands near the west coast, except for the extensive banana plantation in
the coastal area on the Gulf of Mexico. As in Mexico, about 9 per cent
of the total area of Central America is in cultivation. In some individual
countries, however, the percentage is much higher. Central America has
sufficient annual rainfall for crop production, but the uneven seasonal
distribution is a great disadvantage in many areas.
About 52 per cent of the land in Central America is forested, and
from it comes a great variety of forest products. Some of the finest
mahogany comes from Honduras, for example. About 10 per cent of the
*During the three years I made official visits for the Inter-American Institute
of Agricultural Sciences to all countries in Latin America except Paraguay and

44 The Caribbean: Its Health Problems
land of Central America is in pasture; 15 per cent is potential produc-
tive land; and about 14 per cent is unproductive.
Central America, with its variation in physical features, can qualify
as both a temperate and tropical area. Its high plateaus provide pleas-
ant habitation for man and vegetation, and its lowlands are suitable for
tropical products.
The Caribbean Islands
The land in the densely populated Caribbean Islands is utilized for
the production of agricultural commodities to a much greater extent
than is that in continental Latin America. About 17 per cent of the land
of the Caribbean is cultivated; 26 per cent is in pasture land; 27 per
cent, forested; 5 per cent, potentially productive; and 25 per cent,
Sugar production occupies the largest part of the cultivated land.
However, the islands produce a wide variety of tropical products in
their relatively small area, for their elevation ranges all the way from
5,000 feet to a few feet above sea level. Most of the islands lie in the
path of the hurricanes and suffer periodically from severe damage to
the crops.1
There are wide variations in the land characteristics of the Caribbean.
With the exception of Cuba, the percentage of land that can be cultivated
or pastured is low, relative to most areas of the world. Some of the
characteristics of the land that limit its intensity of use are:
1. Steepness of slope or shallowness of soil mantle.
2. Poor drainage of many areas at low elevations.
3. Low productivity because of leaching and rapid decomposition of
organic matter in humid, subtropical areas.
4. Low rainfall.
5. Small size of countries and small size of regions with similar phys-
ical land features. The development of efficient agricultural services and
processing and marketing industries is difficult because of the small
volume of production available in one place. For example, the develop-
ment of a seed industry to provide hybrid corn requires a relatively
large corn region with similar climatic characteristics.
It seems probable that the author of Man, Land and Food is correct
when he writes:
Thus far, efforts have been concentrated in correcting minor defects
to render the existing land supply productive. Some land has such seri-
ous defects as to make efforts to make it productive too costly to con-
sider. Much of the earth's land surface falls into this category. It is too
cold, too steep, lacking in the basic nutrients, or too dry and too far
from an adequate water source to permit irrigation. As capital becomes

more plentiful, as cheaper sources of energy are developed, and as more
effective, efficient means of converting sea water to fresh water become
available, considerable land may be added to that currently under culti-
vation. At this time, it seems that little additional land, by nature well
suited for cultivation, is available. Any substantial additions to the cur-
rently cultivated area must await the investment of human effort and
capital, in irrigation, drainage, or other land improvement.2

Income and Arable Land Per Person
A figure prepared by the Economic Research Service of the U.S.
Department of Agriculture and published in their recent publication,
How The United States Improved Its Agriculture (page 26), allows us
to compare the relative position of most of the countries in which we
are interested with the other countries of the world, on the basis of
income and arable land per person. Three countries, Haiti, Jamaica,
and Puerto Rico, included in our study area, have less than one-half
an acre of arable land per person. Of these three countries, Haiti is the
only one which also has an income of less than $200 per person annu-
ally. Little relationship between the income per person and the arable
land per person is indicated.

Trends in Agricultural and Food Production
Indices of total agricultural and food production by countries and per
capital are published in the Regional and World Agricultural Situation
Reports of the U.S. Department of Agriculture, Tables 1, 2, 3, and 4.3
The base years for this comparison are the crop years 1952-53 to
1954-55, inclusive. I am impressed by the difference in rates of growth
of the total agricultural production among countries of the Caribbean
region. Haiti is the only country that did not show an increase in total
agricultural production from the base period of 1960, although Jamaica
made relatively slow progress. Cuba kept pace with the other countries
until 1961-62, but from that time forward, total agricultural production
in Cuba has decreased rapidly. Three countries-El Salvador, Guate-
mala, and Nicaragua-have almost doubled their total agricultural pro-
duction since the base period and Mexico has increased production by
over two-thirds. The rates of growth per capital, however, are much
lower because of the rapid increase in population growth.
Population growth rates in Latin America, as reported in the publica-
tion, Man, Land and Food, have been consistently higher than any other
geographic region of the world. The total population of Latin America
has increased threefold since 1900 and projections forecast a ninefold
increase during this century.4

46 The Caribbean: Its Health Problems
(1952/53 -1954/55 = 100)

COUNTRY 1958/59 1959/60 1960/61 1961/62 1962/63 1963/64
Caribbean Countries:
Cuba 122 123 133 101 84 77
Dominican Republic 136 135 138 142 137 141
Haiti 94 109 93 108 105 94
Jamaica 104 114 116 116 126 125
Trinidad and Tobago 104 120 131 112 125 126
Average 112 120 122 115 115 112
Central American Countries:
Panama 123 126 112 124 124 130
Costa Rica 118 117 131 129 134 137
Honduras 125 125 128 138 143 147
El Salvador 134 127 136 167 180 198
Guatemala 125 131 135 151 175 189
Nicaragua 140 121 134 165 186 193
Average 127 124 129 145 157 165
Mexico 147 145 150 156 166 171
1. Adapted from Table 1, The 1964 Western Hemisphere Agricultural Situation.

The Caribbean area has kept pace in population with the rest of Latin
America. When I was in Costa Rica, a little over ten years ago, the
annual rate of population increase was over 3 per cent. It is now esti-
mated to be near 4 per cent.5
It is not surprising, therefore, that agricultural production per capital
has a much slower rate of increase than total agricultural production
(Table 1 compared with Table 2). Several countries actually show a
decline below the base period. Cuba, with an index one-half that of
1960-61, shows the largest decrease, followed by Haiti. Trinidad and
Tobago, Panama, Costa Rica, Honduras, the Dominican Republic, and
Jamaica, are all approximately the same as the base period. The four
countries-El Salvador, Guatemala, Nicaragua, and Mexico-show im-
portant increases in their agricultural production per capital *
*Farming is a biological industry that requires great flexibility in management
when bad weather, insects, and diseases strike. Usually, also a farm operation
requires a relatively large area per worker and supervision of several workers per
manager is difficult. Monoculture (one crop farming) lends itself to large-scale
farming better than areas where several crops are grown on the same farm
simultaneously or in rotation. The family-operated, but not necessarily family-owned
farms, usually are more efficient in countries with educated farm operators. Com-
munal and large state-owned farms have been notable for their failures, not their



(1952/53- 1954/55 = 100)

COUNTRY 1958/59 1959/60 1960/61 1961/62 1962/63 1963/64
Caribbean Countries:
Cuba 110 109 115 86 69 63
Dominican Republic 114 110 109 108 101 100
Haiti 85 96 80 92 87 76
Jamaica 98 106 106 105 112 111
Trinidad and Tobago 90 101 107 88 95 94
Average 99 104 103 95 92 88
Central American Countries:
Panama 106 106 91 98 95 97
Costa Rica 98 93 100 95 95 93
Honduras 108 104 103 109 109 109
El Salvador 117 108 112 135 141 151
Guatemala 108 110 110 119 135 141
Nicaragua 119 99 106 126 137 138
Average 109 103 103 113 118 121
Mexico 127 121 121 123 127 127
1. Adapted from Table 2, The 1964 Western Hemisphere Agricultural Situation.

Why these differences in rate of growth of agricultural production per
capital? In some cases, like Cuba, the answer seems simple. But why has
Haiti had such an alarming decrease in its agricultural production per
person? Why have several other countries barely held their own?
The charts showing indices of food production in total and per capital
are similar to those showing total agricultural production.6 It seems
significant, however, that most of the increased agricultural production
for the Dominican Republic, Haiti, Jamaica, Trinidad and Tobago,
Panama, Costa Rica, and Honduras was due to an increase in food
production. The countries of El Salvador, Guatemala, and Nicaragua,
on the other hand, reflect a slower growth in food production than in
the over-all index of agricultural production. In El Salvador, food pro-
duction has not kept pace with population. This suggests that the agri-
cultural growth rate per capital in these countries is a result of growth
in production of nonfood commodities. It appears from the data that
Mexico has had a parallel growth in total agricultural production and
food production per capital.
Table 5 shows the population growth in the countries under study
and the per capital food availability for the period of 1956-58 and
1959-61.7 Haiti and the Dominican Republic show the poorest food

48 The Caribbean: Its Health Problems
1963/641 (1952/53 -1954/55 100)

COUNTRY 1958/59 1959/60 1960/61 1961/62 1962/63 1963/64
Caribbean Countries:
Cuba 122 123 133 100 83 76
Dominican Republic 142 139 142 143 138 142
Haiti 100 106 114 107 108 89
Jamaica 104 115 118 117 126 126
Trinidad and Tobago 103 120 131 111 123 124
Average 114 120 127 115 115 111
Central American Countries:
Panama 125 129 114 125 127 132
Costa Rica 107 105 113 138 142 148
Honduras 125 126 133 138 142 148
El Salvador 95 98 101 99 117 117
Guatemala 116 119 122 127 133 135
Nicaragua 130 135 141 150 156 154
Average 116 118 120 125 132 135
Mexico 146 156 153 162 168 186
1. Adapted from Table 3, The 1964 Western Hemisphere Agricultural Situation.
situation per capital, followed closely by Guatemala and El Salvador.
Panama, Trinidad and Tobago, and Jamaica fall in the middle group
with Cuba, Mexico, and Costa Rica at a relatively high level. It is proba-
ble that the per capital food availability in Cuba has fallen drastically
since 1958.
Before discussing the characteristics of land that influence its use, let
me turn your attention to an additional piece of historical evidence
about agricultural development in the Caribbean region.
Indices of the economic development of agriculture in the Caribbean
region from before World War II to about ten years after its close are
shown in Table 6.8 The base years, 1935-39, represent a depression
period in the economic life of the Western Hemisphere. The years 1955-
56 and 1956-57 are at the end of an inflationary period caused by World
War II and the Korean War. Because most countries of the region under
study export agricultural products as raw materials, or at the most as
semiprocessed products, the agricultural price level fluctuates widely and
follows the world level of raw material prices.
Purchased items of farm and family living costs, on the other hand,
respond more slowly to world price levels, and may continue to move in
an opposite direction from raw material prices for a considerable period
of time, as they have done since the end of the Korean War. This is

THROUGH 1963/641 (1952/53- 1954/55 = 100)

COUNTRY 1958/59 1959/60 1960/61 1961/62 1962/63 1963/64
Caribbean Countries:
Cuba 110 109 115 85 69 62
Dominican Republic 119 113 112 108 101 101
Haiti 90 93 98 91 89 72
Jamaica 98 106 108 105 112 112
Trinidad and Tobago 89 101 107 87 94 93
Average 101 104 108 95 93 88
Central American Countries:
Panama 108 108 93 99 98 99
Costa Rica 88 83 86 82 87 86
Honduras 108 105 107 109 108 110
El Salvador 83 83 83 80 91 89
Guatemala 100 100 99 100 102 101
Nicaragua 110 111 111 115 115 110
Average 99 98 96 97 100 99
Mexico 126 130 123 128 128 138
1. Adapted from Table 4, The 1964 Western Hemisphere Agricultural Situation.
because the products which represent cash costs to farmers of the Carib-
bean, as well as the United States, are influenced greatly by "prices" of
taxes, depreciation, interest, and urban wage rates of the industrialized
sectors of their own or other countries.
Commercial agricultural production in the Caribbean was stimulated
by the period of inflation during World War II and the Korean War
just as it had been depressed by the unfavorable price relationships of
the 1930's. Table 6 shows the influence of a favorable price period on
commercial agriculture in the Caribbean Region. In contrast, Tables
1, 2, 3, and 4 represent a period of relatively unfavorable prices for
raw materials when compared with "farm costs." Agricultural develop-
ment in total and per capital occurred at a rapid pace in Cuba, Costa
Rica, El Salvador, Nicaragua, and Mexico during the 20-year period
from 1935-39 to 1955-57 (Table 6). In Honduras, Haiti, and the
Dominican Republic, the total volume of agricultural production in-
creased about 50 per cent, apparently at about the same rate as the
increase in population.
Let me summarize:
1. The countries of the Caribbean produce mostly raw materials for
world trade.
2. Prices received by farmers in commercial agriculture are greatly
influenced by world price trends of raw materials.


The Caribbean: Its Health Problems


COUNTRY Average Average Average Average
1956-58 1959-61 1962 1963 1956-58 1959-61
Caribbean Countries: (1,000) (1,000) (1,000) (1,000) calories calories
Cuba 6,389 6,797 7,086 7,242 2,910 2,730
Dominican Republic 2,719 3,015 3,228 3,341 1,960 1,930
Haiti 3,904 4,161 4,340 4,433 1,870 1,780
Jamaica 1,559 1,619 1,661 1,682 2,190 2,260
Trinidad and Tobago 778 850 902 929 2,390 2,470
Central American Countries:
Costa Rica 1,048 1,176 1,269 1,319 2,570 2,480
Honduras 1,690 1,849 1,963 2,023 2,190 2,330
El Salvador 2,245 2,435 2,570 2,641 2,190 2,000
Guatemala 3,448 3,768 3,980 4,103 2,080 2,010
Nicaragua 1,333 1,476 1,578 1,631 2,330 2,190
Panama 983 1,073 1,138 1,172 2,380 2,370
Mexico 31,893 34,934 37,108 38,251 2,480 2,580
1. Adapted from Table 5, The 1964 Western Hemisphere Agricultural Situation.

(1935-39 100)

COUNTRY 1955-56 1956-57 1955-56 1956-57

Caribbean Countries:
Cuba 172 197 115 129
Dominican Republic 150 169 96 107
Haiti 150 124 116 95
Central American Countries:
Costa Rica 208 233 128 137
El Salvador 180 198 133 144
Guatemala 158 168 108 112
Honduras 158 147 92 83
Nicaragua 334 365 234 248
Panama 189 192 121 120
Mexico 258 250 157 148
1. Agricultural Geography of Latin America, p. 3, para. 8, Table 1.



3. Prices paid by commercial farmers are greatly influenced by the
fixed costs of manufacturing, transportation and government.
4. Periods of "worldwide" inflation are generally favorable for
raw material producers, like farmers, and periods of deflation are
5. Most farmers in the Caribbean region, especially producers of com-
mercial crops, enjoyed a favorable price relationship from the begin-
ning of World War II until the end of the Korean War.*
6. Since 1953, raw material prices, including agricultural prices, have
been stable or have decreased while prices paid by farmers have risen.
Net incomes of most farmers in the Caribbean area and the United
States have decreased since 1953 unless farmers have been able to offset
the unfavorable price relationships by increased volume of production
per person.
7. Economic growth has been relatively slow since about 1954 in
countries where the economy has an agricultural base, as in the Carib-
bean region.
8. The future agricultural development of the Caribbean region will
be greatly influenced by those external forces which determine the direc-
tion of the world price level for raw materials and its relationship with
prices of finished goods which farmers buy.

II. Characteristics of Land That Influence Its Use and
Agricultural Development

The characteristics of land and man have been classified in many
different ways in attempts to understand land use and its relationship to
the well-being of people. Four broad groupings have been helpful to me.
Two of these, cultural and institutional, are related to the human re-
source side of the equation and two to the land side. Let me illustrate the
first approach I have found useful in an economic classification system
of the land resources.

Characteristics of Land

It is possible to interpret and classify the physical features of land
from two viewpoints that have social and economic implications. These

*The Wholesale Price Index, which is usually used to indicate changes in the
value of money, is no longer a satisfactory measure of inflation or deflation of
the value of the "farmers' dollar." This is because wholesale prices reflect a
larger and larger percentage of fixed costs like depreciation, taxes, interest, and
industrial wage rates in their structure.

52 The Caribbean: Its Health Problems
1. How many people are supported per unit of land? This involves
outlining broad geographic areas within the same country and cultural
setting into agricultural regions. An agricultural region is defined as a
geographic area of land with similar population density patterns of the
rural population.
2. How well are people supported? This involves identifying smaller
geographic areas within the same agricultural region which are similar
in their productive capacity per acre. It follows, therefore, that these
"economic land classes" differ from each other within an agricultural
region in their capacity to profitably repay expenses per acre, including
management and risk.
The production curve per acre as it responds to increasing inputs of
expense units per acre differs from one economic land class to another
in much the same way that the production curves differ for dairy cows
with variations in inherent capacity to produce milk.
The available net income per farm family for family labor and man-
agement varies by economic land class. Economic land classes are, there-
fore, related to those economic and social results which are caused by
differences in income per family.
Figure 1 diagrams the relationships between physical land character-
istics to land use and the welfare of rural people, that have been found
in many studies in the United States and Canada. Dr. A. B. Lewis, who
did the original research work at Cornell University in the early 1930's
has made similar studies in mainland China, Puerto Rico, Guatemala,
and other countries.9 I have helped conduct studies of this type in Costa
Rica, Cuba, and Taiwan, and in the states of Nebraska and Washington.
Professor Isowo Iwakata of Kyushu University, Japan, and his stu-
dents have made several studies in southern Japan using basically this
method of land classification.10 Dr. Shison C. Lee and his students have
continued the work started in Taichung Hsien and City, in 1960.11 They
have classified about one-third of the Province of Taiwan and made
over 2,000 farm family business interviews as a part of these studies.
This method of classifying land is described in Studying Land Use in
Costa Rica: Applicability of the Method to Other Regions, which was
published by the Inter-American Institute of Agricultural Sciences, Turr-
ialba, Costa Rica, in January, 1953.12 In this publication, agricultural
regions are defined as follows: "In order to make useful recommenda-
tions regarding adjustment in land use, it is necessary to study and
evaluate the relationships between physical land factors, land use, and
the welfare of people. Some land factors, such as climate, geological soil
factors, and distance to market, tend to be regional in their influence.
These land characteristics which usually determine the general land-use

Differences which usually cause Agricultural Regions

Casual (physical)




Distance from
bodies of water
Availability of
irrigation water

Distance from and accessibility
to market



Micro-climatic factors

Association with other
areas of land that must
be cultivated with it
to make economic and
social units

Intermediate (land use)

Kinds of crops
(major differences)

Kinds of livestock
livestock products

Final results (economic and social)

Value of land per hectare

Number of hectares per farm

Number of rural people per
square kilometer

Marketing costs

Differences which usually cause Economic Land Classes
Crop yields Farming returns per family
Kinds of crops
(minor differences)
Production per animal unit Farming returns per worker

Quality of products

Number of livestock per
Quality of livestock

Value of land per farm

Value of other capital

Amount and condition of electric
service, roads, schools, and other
public services

Cost of local government per farm

Number of farmsteads or villages
per square kilometer

Amount and condition of capital
per farm family
Safety of mortgage loans
Safety of insurance policies

Land tenure
Taxes paid per farm
Incidence of tax delinquency
Attitude toward risk
Level of living

The fundamental factors of soil, climate, topography, distance from markets and relation to other areas of land influence every
economic feature of the life of an agricultural area. Changes in climate and distance from markets usually cause differences in Agri-
cultural Regions; changes in soils or topography usually cause differences in Economic Land Classes.

Figure 1. Factors Related to the Intensity of Use to which an Area of Land is Adapted








The Caribbean: Its Health Problems

pattern of a broad region, also are associated with the capacity of land
to support people per unit of area. Usually differences in land-use pat-
terns between regions are accompanied by differences in the area of
land a farm family can operate. The most important regional differences
in land characteristics, therefore, affect not only the land-use pattern but
also the number of manzanas (area) per person or per rural family.
Using this concept, agricultural regions can be defined as broad areas
of land which have similar land-use patterns and densities of rural
Economic land use classes are defined as follows: "Within agricultural
regions land varies by areas in its capacity to pay the expenses of oper-
ating a farm unit and to provide an acceptable level of living for the
farm family relative to the standard of the culture. These land areas, of
differing economic productivity within agricultural regions, are called
economic land use classes. Usually five or more different economic land
use classes can be identified and mapped within a single agricultural
Dr. Quentin West and I prepared an agricultural region map of Costa
Rica using the method of land classification previously described.13 We
adjusted the "natural" boundaries to the 1950 census segment bound-
aries so that the census data could be summarized by agricultural re-
gions. The Department of Statistics and Census in the Ministry of
Economics summarized the 1950 census by regions as well as by prov-
inces. Table 7 indicates the wide variation in manzanas (a manzana is
about 1.7 acres of land) per person and per family by agricultural
regions of Costa Rica. Tables 8 and 9 reflect the land use patterns by
agricultural regions as summarized from 1950 census data.
As indicated earlier, Ralph Loomis and I, assisted by Carlos M.
Castillo, P6nfilo Rodriguez, and others, prepared an economic land use
class map of the Reventaz6n River Watershed near Cartago, Costa Rica.
Table 10 shows income, expense and capital investment differences for
family farms by economic land use classes within the dairy and coffee-
cane regions of the Upper Reventaz6n River Watershed.14 As the eco-
nomic productivity increased from low to very good (measured by
economic land class) the man equivalents, gross and net earnings per
farm, farm expenses, and capital investment per farm increased from
3 to 4 times. The farm earnings and expenses tended to be a little higher
in the coffee-cane region than in the dairy region but the capital per
farm, as estimated by farmers, was about the same in the two regions.
Similar studies in Taiwan in 1960-61 reflected relationships between
land and people similar to those found in Costa Rica ten years earlier.




Coffee 0.8 5.9 4.7 2.7
Cane 1.5 5.9 8.8 2.1
Coffee-General 1.8 5.7 10.3 1.9
Coffee-Cane 2.2 6.0 13.2 3.6
North Dairy 2.3 6.0 13.8 2.5
Banana 2.9 5.2 15.1 5.6
Cacao-Banana 4.0 4.6 18.4 4.3
Grain 3.7 6.0 22.2 2.2
South Dairy 4.6 6.0 27.6 2.6
Grain-Livestock 5.8 5.6 32.5 1.5
Livestock-Grain 7.9 6.1 48.2 1.6
Intensive Livestock 8.5 6.5 55.2 1.9
General Farming 10.7 5.4 57.8 1.8
Extensive Livestock 59.4 6.7 398.0 1.2
1. Regions are listed in order of intensity of use as determined by the number
of manzanas per family in each region. 2. Average of cantons in each region.
Taiwan is more densely populated than Costa Rica and is about ten
degrees farther north. There are, however, many similarities in the
natural flora of these two parts of the world, and in their commercial
agricultural crops. Tables 11, 12. and 13 show relationships of farm
receipts, farm expenses, and the calculated amount available for invest-
ment or debt retirement per family farm by economic land class and
size of farm in the rice region. In the rice region of Taiwan even the
"large farms" are "small in area, usually less than five acres per farm
family. Most Chinese farmers and their families make an acceptable
level of living (based upon their standards of living), pay their farm
expenses, and accumulate capital. Farms in land of marginal productiv-
ity, or of small size (11/3 acres or less), are usually exceptions to this
general rule of "adequate income," and family workers on these farms
seek off-farm jobs.
The approximately 70,000 farms in Taichung Hsien and City were
estimated to have accumulated about $5 million U.S., which was availa-
ble for investment or debt retirement. This estimate is based upon 1960
production data gathered by a farm management survey taken in 1961
stratified by economic land classes. This favorable economic situation
for most Taiwanese farmers is reflected in the rapid agricultural growth
rates of Taiwan since World War II.15



First Second Third Fourth Fifth First Second Third Fourth Fifth TOTAL


North Dairy


South Dairy


Coffee Corn Cane Beans Tobacco
Cane Coffee Corn Beans Tobacco
Coffee Corn Beans Cane Rice
Coffee Cane Cut Beans Corn
Coffee Corn Cane Cut Potatoes

Bananas Rice Corn
Cacao Bananas Corn

Corn Rice
Coffee Corn

Cacao Plantains
Coconuts Yuca

Beans Plantains Coffee
Cut Beans Cane

Corn Beans Rice Cane
Bananas Corn Beans Rice

Intensive Livestock Corn
General Farming Corn
Extensive Livestock Corn

Rice Beans Plantains Bananas
Bananas Rice Beans Cane
Beans Rice Plantains Bananas

74.7 8.1 8.0 5.9 1.9 98.6
37.7 26.8 15.0 14.4 2.2 96.1
27.8 24.4 17.0 6.9 3.6 79.7
52.3 21.0 6.1 3.4 3.1 85.9
25.6 22.0 12.3 8.1 6.7 74.7

61.2 7.4 6.1 3.3 3.8 81.8
42.6 14.7 6.7 2.4 0.8 67.2

22.2 16.1 11.8
20.7 16.9 9.1

Bananas 24.1 13.1 9.7
Cacao 14.9 12.6 10.6

20.9 10.1 4.7
19.6 10.4 8.1
8.5 6.5 5.3

Corn Coffee Beans Bananas Rice 16.0 13.7 7.7

4.0 3.6 57.7 c
7.7 1.9 56.3

4.4 4.1 55.4
8.5 8.0 54.6

3.3 1.3 40.3
4.0 3.8 45.9
2.0 1.3 23.6

7.6 6.6 51.6






Coffee 2.8 0.7 3.3 0.4 0.7 0.07 16.7
Cane 3.4 1.2 3.6 0.7 0.8 0.03 20.7
Coffee-General 3.8 0.8 3.4 0.7 1.6 0.01 22.1
Coffee-Cane 6.9 1.8 7.2 1.5 0.8 0.01 14.0
North Dairy 8.6 1.2 9.4 0.9 0.7 0.08 16.1
Banana 7.9 0.1 6.5 4.7 4.3 ...... 24.8
Cacao-Banana 10.1 0.5 7.2 2.0 1.9 0.03 16.2
Grain 14.4 1.2 10.2 2.4 3.9 0.07 27.7
South Dairy 12.4 1.4 14.0 0.9 1.0 0.20 18.0
Grain-Livestock 7.0 0.6 6.6 1.5 3.3 ...... 25.9
Livestock-Grain 18.7 0.8 9.9 2.3 4.7 0.03 18.6
Intensive Livestock 31.0 1.4 18.6 5.5 6.9 0.09 23.8
General Farming 11.4 0.6 7.8 2.1 8.1 0.08 24.8
Extensive Livestock 58.9 1.3 35.3 10.3 6.1 0.04 20.0
Total 12.6 1.0 9.4 2.0 3.3 0.05 21.5
1. Per farm having any cattle.
2. Per farm; total in region.
3. Per farm having milk cows.
4. Per farm having livestock (except poultry).

III. Characteristics of Man That Influence Land Use and
Agricultural Development

Having looked at some characteristics of land that influence land use
and agricultural development, I now turn to cultural characteristics of
man and his institutions that seem to be important factors.

Cultural Characteristics
After my experiences in Latin America, and again in Taiwan ten
years later, I am convinced that cultural factors are among the most
basic influences on man-land relationships. In a memorandum of June
24, 1963, to the Director of Agricultural Experiment Stations, Washing-
ton State University, I expressed it this way: "My hypothesis is that
economic development is basically dependent on the values and beliefs
of a social group of people. I would suggest that we try to design a
study of values and beliefs held by rural people, and then explore the
possibility of relationships with economic development. In order to do
this, we would have to make comparisons among countries, cultures....
It would be necessary to decide on a set of beliefs, or values that we

58 The Caribbean: Its Health Problems

Dairy Region

Low 8 1.4 3,507 1,788 1,719 8,500
Fair 10 1.7 5,383 2,700 2,683 22,800
Average 10 1.9 5,818 2,450 3,368 30,600
Good 17 3.1 12,100 6,182 5,918 47,724
Very good 20 2.7 14,441 6,480 7,961 69,190
Coffee-Cane Region
Low 8 2.2 5,126 2,588 2,538 14,012
Fair 15 2.5 7,636 4,012 3,624 21,456
Average 19 2.5 8,147 3,426 4,721 29,268
Good 11 3.1 13,428 5,366 8,062 40,464
Very good 13 3.3 16,776 7,215 9,561 62,223
1. A family farm was defined as having the equivalent in family and hired
labor of not less than 0.7 and not more than 8.0 man "years" equivalent. The
monetary unit is a col6n, equal to about 15 cents U.S. in 1951-52.
2. Includes the estimated value of products produced on the farm and con-
sumed by the farm family and hired workers.
3. Includes a charge for all labor except the operator.
4. Returns to operator for labor, management, and capital.

hypothesize might be important, both those that might encourage and
those that might inhibit economic development. It would then be neces-
sary to try to state these in such a way that rural people could indicate
whether they held such beliefs or not."
Members of other social science disciplines, particularly anthropolo-
gists, have made many studies of the influence of culture of land-man
relations. Nevertheless, Arthur Niehoff and J. Charnel Anderson made
the following observation:
In Human Behavior Studies the area of the dynamics of culture
change has been largely neglected. Social scientists in the past, particu-
larly anthropologists, have tended to study human groups from a static
point of view. That is, specific changes were identified and described
but the process by which they had taken place was not known to the
researchers. It is our contention that if enough data, based on actual
field studies, can be collected and analyzed, the specific characteristics
of this process can be isolated and evaluated. Even more important, a


(N. T. $) (N. T. $) (N. T. $) (N. T.$)
Land Class 1
Very large 59,085 71,092 69,475 66,551
Large 42,956 36,228 32,548 37,244
Medium 27,302 26,739 25,278 26,440
Small 15,578 13,718 12,751 14,016
Land Class 2
Very large 51,237 52,699 45,495 49,510
Large 28,348 29,148 25,988 27,828
Medium 19,748 22,057 22,125 21,310
Small 9,843 10,430 6,902 9,058
Land Class 3
Very large 37,872 41,474 35,122 38,156
Large 21,265 22,516 22,786 22,189
Medium 16,688 14,905 11,686 14,426
Small 11,617 7,340 8,611 9,189
1. Land Class 1 is very good land for rice production in Taiwan. The economic
productivity of the land decreases from Land Class 1 to 3.
Farms were classified as to size as follows:
Very large 1.35 hectares (about 31/3 acres) and larger.
Large -0.95 hectares (about 21/% acres) to 1.34 hectares.
Medium 0.55 hectares (about 11/% acres) to 0.94 hectares.
Small 0.54 hectares (about 11/3 acres) and smaller.
The New Taiwan Dollar was officially exchanged at 40 N. T. to 1 W. S.
The black market rate was about 45 to 1.

recurring pattern of the most important characteristics should emerge
and a general theory of the change process could be formulated.'"
In the Caribbean area there are important differences in land use
caused by the influences of culture; for example, the African culture in
Haiti versus the Spanish culture in Costa Rica, and the Spanish versus
the Indian cultures in Central America.
East and West Pakistan have a common religion and national govern-
ment but different cultural backgrounds. The influence of differences in
culture on land use was apparent when I visited Pakistan earlier this
One of the best examples of the influence of culture that I have seen
was in Malaysia. The Malaysian government is sponsoring new village


The Caribbean: Its Health Problems

settlements in the rubber regions. For political reasons the government
finds it necessary to settle families of three different cultural groups
(Polynesian, Chinese, and Indian) in each village. The commercial crop
of the village is rubber but each family has its own house and plot of
land. The houses reflect the cultural differences as do the crops and live-
stock raised on the individual plots. A farm management study showed


(N. T. $) (N. T. $) (N. T. $) (N. T. $)
Land Class 1
Very large 29,920 45,027 42,988 39,312
Large 23,595 24,304 19,808 22,569
Medium 17,830 17,553 18,760 18,048
Small 9,284 10,329 8,245 9,286
Land Class 2
Very large 29,915 30,190 26,585 28,897
Large 17,253 19,261 20,992 19,169
Medium 13,168 13,509 15,110 13,929
Small 7,571 8,709 6,392 7,557
Land Class 3
Very large 21,683 26,845 26,387 24,972
Large 18,687 16,532 16,680 17,300
Medium 10,292 10,523 8,233 9,683
Small 8,871 6,858 7,022 7,584

Chinese families making more money than their neighbors, partially be-
cause a small hog enterprise for home consumption and sale is tradi-
tional in the Chinese culture, but forbidden, or at least not traditional,
in the other cultures represented.
Different cultures have developed different formal and informal insti-
tutions which reflect the culture. "Institutions" also vary within the same
cultural group. Many people have observed the relationship between
land use and institutional factors. Some students of land-man relation-
ships have concluded that changing legal institutions such as rights of
ownership and use of land is the most important method of improving
land use.


(N.T. $) (N.T.$) (N.T. $) (N.T.$)
Land Class 1
Very large 23,842 11,690 24,916 20,149
Large 10,707 2,427 6,116 6,417
Medium 225 2,170 9,387 3,927
Small 1,291 136 447 625
Land Class 2
Very large 14,099 15,202 6,854 12,052
Large 9,844 5,048 -1,467 4,475
Medium 1,418 2,397 357 1,153
Small -1,955 -1,971 -2,075 -2,000
Land Class 3
Very large 4,881 12,494 -2,842 4,844
Large 1,146 769 -1,804 37
Medium 1,353 -1,677 229 184
Small 1,428 -5,063 2 -1,211

Institutional Factors
Agriculture must operate within the framework of legal, commercial,
and social institutions, which in turn influence agricultural development.
Some of these institutional factors are:
1. Form of government, especially strength of local government units
2. Stability of government
3. Religious institutions
4. Educational institutions
5. Marketing and supplying systems (Cooperative versus other forms
of organization)
6. Communication and transportation systems
7. Credit systems
8. Land tenure and inheritance.

Let us now examine these institutional factors:

1. Form of government: Cuba illustrates a basic change in philosophy
and form of government, and its influence on agricultural development.

62 The Caribbean: Its Health Problems
Many people were critical of the Cuban government under Batista.
Whatever the merits of that criticism, Tables 1 through 4 reflect the seri-
ous decline in total and per person production of agriculture in Cuba
since 1961. Although other factors were operative, it seems probable
that organizing farm production, marketing and supplying businesses
into large, government-controlled organizations is conducive to lower
agricultural production.
Experience in the USSR with state and collective farms versus pro-
duction on private plots provides additional evidence that farm families
respond to the incentives of individual operation (not necessarily owner-
ship). Data from the United States Department of Agriculture show that
about 3.3 per cent of the sown area in Russia is on about 25 million
privately-operated plots. This area of 3.3 per cent produces approxi-
mately one-third of the total agricultural output in Russia. Further
evidence of the influence of this form and philosophy of government on
agricultural production can be found in comparing the recent advances
in agricultural production in Taiwan versus the mainland of China. In
Taiwan, the agricultural production increased about 58 per cent from
1952 to 1962.17
Comparable statistics for the mainland are difficult to find and more
difficult to verify, but Hoang Van Chi, writing in the China Quarterly,
reports as follows regarding the use of communes in Mainland China:
"The Chinese Communist Party admitted, on December 28, 1960, to a
vertical drop in food production since 1959, that is to say just one year
after the implementation of the commune system. The blame for this
was assigned to bad weather and natural calamities, but the remedy
prescribed by Mao suggests that this may not have been the truth, or at
least not the whole truth."'8
"Local self government," says A. B. Lewis, ". is the key to national
economic advancement and political stability." He goes on to say:
"Economic development depends mainly on the education of the people
and on transportation, that is, on schools and roads. For economic
development like that of the advanced countries, good elementary schools
for all the rural village children are necessary, and there must be roads
from the farms to the market towns. In the economically developed
countries the structure of government is such that the villages and rural
districts can tax their own citizens and provide these services for them-
selves. On the other hand, in the underdeveloped countries, without ex-
ception, the powers of taxation are highly centralized, and villages and
rural districts have little or no governmental income of their own. They
must always beg for schools and roads from the central authorities, and

the central authorities never have enough money to supply these needs.
Rural schools and roads are always few and poor when they are supplied
and controlled by the central government. The people of the economically
advanced countries were not highly educated nor wealthy when they
installed their systems of local self-government. They had no large uni-
versities and no scientists. They had no steel mills and no big irrigation
dams. Local self-government enabled them to begin to have schools,
roads, and canals. It enabled them to understand and use freedom as an
instrument of national progress."19
Costa Rica had one of the more stable governments of Latin America
but in 1950 to 1953 it did not have strong local rural government units
with the power of taxation. As far as I know, local governments are still
weak in Costa Rica, in other Central American countries and in the
Caribbean Islands. In contrast, Taiwan (Formosa) has strong county
(Hsien) and township governments with the power to levy taxes for
roads and schools. These local governments provide a help in developing
local leaders. A related factor in developing local leaders in Taiwan is
the presence of county and township farmers' associations operated by
elected boards of directors who hire managers to operate these coopera-
tives. A corps of educated, experienced local leaders exists throughout
The "basic democracies" of Pakistan are another example of local
government units that seem to be developing into viable instruments for
economic and agricultural development. The statistics regarding the
building and improvement of schools, rural roads, dikes, drainage, and
irrigation works at the local level are impressive. In meetings with sev-
eral of these locally elected "basic democracy" groups of West and East
Pakistan, I saw local leadership in action. These leaders had pride in
their accomplishments.

2. Stability of Government: Agricultural development is associated
with capital accumulation and investment of this capital in productive
enterprises. It seems to be almost a truism that stable government is
essential to economic and agricultural development. Some countries of
the Caribbean are seriously handicapped in economic and agricultural
development because of a history of unstable central governments.

3. Religious Institutions: Religious beliefs and institutions are among
the most important influences in agricultural development in my opinion.
What a man believes to be true influences his creative capacity and his
acceptance of change. Unfortunately, there is little systematic research
to support or contradict the opinion I have just stated. As indicated

64 The Caribbean: Its Health Problems
earlier in this paper, I think it is a serious gap in our knowledge of
man-land relationships.
Dr. A. T. Mosher, Director of the Agricultural Development Council,
had this to say: "Agricultural development does not depend on farmers
and agricultural technicians alone; it is a function of the whole culture,
the whole way of life of a people. . The group of topics for research
mentioned most frequently by correspondents consulted in preparation
of this paper consists of questions about the value systems, aspirations,
dominant motives of rural people, and of the urban elite of each low-
income country. Questions with respect to the attitudes and values of
rural people include the following:

(1) Attitudes toward nature in general, and with respect to man's
place in the world.
(2) What are the dominant aspirations of farmers? Of rural people
generally ?
(3) Attitudes with respect to social interaction. Are they individ-
ualists? Cooperative? Do they feel that cooperative aid should be limited
to kinfolk? Extended to close neighbors? To all members of the village?
(4) Attitudes with respect to family obligation. Do farmers feel free
to keep the fruits of increased production for expenditure or for invest-
ment, or must they share these with relatives or others in the community?
(5) Attitudes with respect to the proper functions and responsibili-
ties of government.
(6) Attitudes with respect to land and livestock.
(7) How strong is the attachment of rural peoples to particular staple
foods in their diet? Does this have realistic significance?"20

4. Education: The importance of all kinds of education for rural
people as a factor in agricultural development has been recognized by
most leaders in both developed and underdeveloped countries. One could
raise the question, however, "Has improving education or local govern-
ment received as much emphasis as land reform by political and intellec-
tual leaders?" Farm management studies have consistently shown a
positive relationship between increasing formal education, the acceptance
of improved farming practices and crop yields.
Education is also related to the rate of population increase. A recent
study in Taiwan showed that education is related to family size. Women
between the ages of 35 and 39 who had senior high school education
said they had wanted about 3.2 children on the average compared with
over 4 children wanted by women without any formal education. The
women with a senior high school education had borne about 3.5 children
compared with over 5.5 for those women with no formal education. The



levels of education in between the two extremes showed a consistent rela-
tionship with both number of children wanted and borne per family.
The lower the level of formal schooling, the more children per family.
The use of contraceptives was also positively correlated with education.21

5. Marketing and Supplying System: My personal observation is that
it is important to encourage private enterprise and to attract foreign
capital into this part of the agricultural industry. Too often, the primary
emphasis in the use of scarce capital has been placed upon building up
heavy industry subsidized by the central government rather than on
encouraging private agricultural production, marketing, and supplying
services. The granting of monopolies to government-owned and -operated
businesses as so-called cooperatives has been a deterrent rather than a
help to agricultural development, in my opinion. Dr. Mosher, in the
paper previously quoted, suggests that among the areas of research
needed are, "Studies of experience with cooperative societies as agencies
for marketing and credit. 'Cooperation' has stood very close to 'land
reform' as a slogan and as a panacea for rural ills. Enthusiasm for co-
operatives has persisted in many parts of the world despite repeated
failures of cooperative enterprises. The magic of the slogan is so strong
that the name cooperative is applied to types of organization making
no recognizable application of the classical principles of the Rochdale
society of weavers from which the modern Cooperative Movement
sprang. Meanwhile, the problems which cooperative societies are ex-
pected to solve are real, and they are of major importance to agricultural
development. It is obvious that some type or types of effective organiza-
tion through which the marketable produce of millions of small farms
can move to market and through which production credit and requisites
can be made available to these many small farmers is essential. And
there are examples of successful cooperative societies on a wide scale,
notably in Japan and Taiwan, keeping the hope alive that such societies
may serve these functions elsewhere. What is needed is careful multi-
country studies of various types of organizations called 'cooperatives,' of
the conditions under which they have arisen, of the problems they have
encountered, of the- modifications which have been introduced in efforts
to solve these problems, of their actual administrative costs (sometimes
hidden in general governmental administrative and auditing budgets as
well as in public subsidies), and of the ethical and other cultural ele-
ments necessary to their success or responsible for their difficulties."22

6. Communication and Transportation: These two institutional factors
are related to other factors previously discussed, especially the market-


The Caribbean: Its Health Problems

ing and supplying system. They may be covered in other papers, but I
want to recognize in passing that good communications and transporta-
tion systems are vital to modern agriculture and that they should be
developed in relation to agricultural regions and economic land class
7. Credit System: The need for a government-supported agricultural
credit system, as a prerequisite to agricultural development, has been
overrated, in my opinion. In a developing country where most of the
people live in rural areas, agriculture will have to generate most of the
investment capital, and unless capital is forcefully siphoned off into non-
agricultural industries through taxation, the agricultural industry prob-
ably will be serviced better than other industries because rural people
will control the "surplus" capital. Rural people are better informed
about agriculture than about other industries and should know the
risks involved. If interest rates are high in rural areas, you are likely to
find comparably high risks.
8. Land Tenure: Among agricultural economists and many other
social scientists the key to agricultural development has often been
sought through land tenure reform. The term "land reform" needs to
be distinguished from "agrarian reform." The latter is used when a
broad group of institutional changes are considered versus land reform
which refers to the narrower field of land tenure.23
I will limit the discussion in this section of the paper to a considera-
tion of land reform. In reading the literature, I find many hypotheses
and theories advanced about the influence of land tenure institutions on
agricultural and economic development but few factual studies. Most
relationships of land tenure to agricultural development and production
have been accepted as true, without testing the hypotheses. The report
of the Latin American UsoM's Seminar on Agrarian Reforms, held in
Santiago, Chile, February, 1961, is an example of this tendency.24
In general, I hold similar values, especially about family farms, to
those expressed by the participants at this seminar. I am concerned,
however, by the lack of research to support the conclusions on which
land reform programs are promoted. Perhaps I have not searched the
literature carefully enough, but I find scientific studies to support the
validity of the following assumptions. Sometimes the available evidence
suggests a conclusion which is the reverse of the assumption. Let's look
at a few of these assumptions.
1. Ownership of land by individual families is the primary value of
rural people in the Caribbean and other underdeveloped regions of the



world. Most of us accept this assumption as true. We believe "land re-
form" revolutions to be caused by the landless peasant. Our reasoning
sounds logical from our cultural viewpoint and it seems to be accepted
by what Dr. Mosher calls the "urban elite" in the underdeveloped coun-
tries. But I would like to see this hypothesis tested in relation to other
values held by rural people with an indication of priorities.
2. Land use is better and yields are higher on land that is owned by
farmers than it is on land rented by farmers. The trouble with this
hypothesis is that the research evidence available does not support it.
Most studies show no statistical differences among tenure groups in crop
yields on the same class of land. Moreover, part-owner farms are usually
larger than either fully-owned or fully-rented farms and reflect higher
production per person. This seems to indicate that renting additional
land is an effective way to gain management control over additional
3. Family farms have better land uses and higher yields than multi-
family farms. The only opportunity I've had to test this hypothesis was
in the Meseta Central of Costa Rica in 1950-51. Ralph Loomis and I
found no consistent pattern of yield difference between family-sized (0.7
to 8.0 man equivalents) versus multi-family farms (8.0 man equivalents
and larger). Loomis reported to the Food and Agricultural Organization,
United Nations, as follows: "With the exception of corn yields on family
farms in the Dairy Region as compared with multi-family farms, where
the yields were higher on the multi-family farms, there was no signifi-
cant difference in yields of the various crops between the family and
multi-family farms."25
4. Small farms are more intensively used than large farms in the
same agricultural region and economic land class. Studies indicate that
this is not true for commercial crops where the yields can be measured.
The unused land on large farms may not have the capacity for intensive
use, but most researchers do not take time to check variations in land
5. Rents are usually too high because the landlords have a better bar-
gaining position than the tenants. What do you use as a standard to
establish that a rental rate is too high?
6. It is beneficial in underdeveloped countries to allow capital to flow
out of agriculture, but it is not beneficial to have nonfarmers' invest in
land and fixed capital improvements like irrigation or drainage unless
they become owner-operators. (One could ask, "Why not place restric-
tions on nonfarm industrial firms and insist that they be family-owned
and -operated, also?")
7. Interest rates are too high and should be lowered (to approximately
what farmers pay in developed countries). Where do we find studies

68 The Caribbean: Its Health Problems
that have measured risks and customs against which the local members
of a culture have established their rates of capital cost?
To me it seems that land reform as a method of agricultural develop-
ment has been overemphasized relative to other alternatives, including
more research. Even the land reform in Taiwan, which has been so
widely heralded, has not been subjected to objective, scientific investiga-
tion. Yet, it is often held up as a model.
A year ago, when I was in Taiwan for the Lutheran World Relief, I
visited several rural Presbyterian churches. Presbyterian church leaders
told me that many of their rural congregations had suffered because the
land reform had seriously affected the community leadership and sup-
port of the rural church. This aspect of the land reform is not widely
publicized but, if true, is an important aspect of the result of land re-
form in Taiwan. Closely related to it and detrimental to agriculture, in
my opinion, was the forced flow of capital from agriculture to non-
agricultural industries and other investments in Taiwan as a result of
land reform. The land reform law provided that land ex-appropriated
from landlords should be paid for in rice at the rate of 37.5 per cent of
the rice crops over a ten-year period. Previous to land reform, a land-
lord receiving rent (then usually 50 per cent) would be obligated to pay
the real estate taxes and maintain or improve the land and fixed capital
attached to it. (By custom, he also had other social obligations in the
community, as previously mentioned.) But as a result of the land re-
form, capital flowed out of agriculture with no compensating inflow.
Although agricultural development occurred during this period, it was
at a much slower rate than industrial development.

IV. Implications and Conclusion
Cultural and institutional factors may inhibit agricultural develop-
ment, but they need not prevent it. At least this is the opinion of several
agricultural economists who have had wide experience in both the
United States and foreign cultures. Recently, in a conversation, Dr.
F. F. Hill of the Ford Foundation reminded me of the fact that the
recent rapid rate of growth in agricultural production per person in the
United States was associated with "big" technological improvements like
hybrid corn. He pointed out that prior to 1935, agricultural development
in the United States had proceeded at a relatively slow rate. In the late
1930's, a number of revolutionary discoveries changed the curve of
production per acre and per animal sharply upward. A table in the
publication, How The United States Improved Its Agriculture, published

in March, 1964, supports the observations made by Dr. Hill and others.
Dr. Mosher gives Dr. Carl C. Taylor credit for the following state-
ment: ". . that so-called tradition ridden peasants will not be inhibited
by their sanctions and taboos (value systems) if they are approached
with alternative ways of doing things which they are already doing, and
the doing of which yields them immediate, obvious results."
The classification of land and land use from an economic viewpoint,
as previously described in this paper, provides a basis for further re-
search in farm management and the adaption of farm practices. Dr.
W. I. Myers of Cornell University makes this comment: "Another fre-
quent cause of unsatisfactory results from 'improved' practices obtained
by research in developing countries is due to the failure to try out the
new practices in different regions before they are recommended to
farmers. A new practice may appear very promising under conditions
prevailing in the experimental plots but fails or is less effective in other
areas because of differences in soil and climatic conditions. No recom-
mendation of an improved practice can safely be made until it has been
thoroughly tested on farms in the principal environmental areas of the
country concerned.26
For implications of "research needed" let me refer you again to the
report by Dr. Mosher. The following is a quotation from his paper to
which I have previously referred.27

Rural Development and American Culture
The Taylor Hypothesis, in addition to being intrinsically important,
provides an easy transition to what may be the most important topic for
research considered in this section, if not in all of rural developmental
assistance, namely, What is the Relevance to Rural Development of
Specific Attitudes and Values Prominent in American Culture?
It may be that, in becoming aware of cultural differences among
peoples, and of the multiform influences of aspects of these cultures on
rural development, we are in danger of concluding that to get along in
their cultures we must master their ways almost to the point of adopt-
ing them ourselves.
If attitudes and values are such important determinants of rates of
development, why, positively, did rapid rural development begin so much
earlier and accelerate so much more rapidly in the United States than in
many other places? Americans now going abroad in developmental
assistance are the inheritors of those attitudes and values which accele-
rated this development, and, to greater or lesser degree, they embody
them. What is it they have to contribute that is of greatest value? Is it
their tractors, their centrifuges, their scientific concepts, the dollars in

70 The Caribbean: Its Health Problems
their pockets? Or is it their attitude toward nature? Their willingness
to risk ridicule in order to try a new method? Their ways of dealing
with peers, "superiors," "subordinates" within an organization? Their
sense of time as a valuable asset? Their propensity to want to measure
with precision? Their literal use of language? Their readiness to classify
and generalize? The value they place on formal schooling? Their pref-
erence for local over national government? Their willingness to delegate
responsibility coupled with distrust of concentrations of power? Their
preference for pragmatism instead of for dogma? Their acceptance of
some right to equal consideration of all persons? Their concern for the
underdog? Their preference of the new to the old?28
Obviously, in any such studies, due consideration must be given to
other factors. Certainly America was blessed with abundant natural
resources. It could create a new civilization in a new, largely empty
land. It did not have to transform an established feudal culture in a
crowded land into something different. It was effectively separated from
foreign tyrannies. Nevertheless, why was it that thousands left an un-
crowded (by any other than American standards) East to line up to
dash in to settle Oklahoma, without roads, schools, hospitals, seeds, or
credit supplied by "the government," whereas elaborate subsidies seem
necessary to get settlers into Mindanao, South Sumatra, eastern Bolivia,
southern Venezuela? What was it about the "climate of investment" that
brought European capital in large amounts into nineteenth-century
America without the guarantees implicit in colonialism? What is it
about American culture that impels voluntary private philanthropy into
"distressed areas" long before governmental action is even considered?
Perhaps there are two sides to this question of "attitudes and values"
in developmental assistance. We have been forced by our experience in
low-income countries to recognize that non-economic aspects of culture
are powerful forces affecting the rate of development there. Is it not
time we really studied the extent to which the non-economic aspects of
our own culture have affected our own development? We are in a posi-
tion now as we have never been before to make such studies, by bringing
to them an increasing knowledge of contrasting cultural components in
many different settings of resource endowment, population density, and
institutional history, around the world. Only when such studies have
been made will we be able to answer with assurance the question: What
really does America have to contribute via developmental assistance?
In conclusion, man-land relations in the Caribbean region have been
and will be influenced by a complex of factors that are not easy to un-
ravel. This paper emphasizes these points:
1. Important breakthroughs in the production of agricultural com-
modities per acre and per worker are of relatively recent date, even in
the United States. Recent studies show that discoveries of improved agri-



cultural practices in the magnitude of hybrid corn may find cultural
barriers of adoption much less formidable than previously thought. The
basic problem may be to discover agricultural practices which, when
used on farms in the less developed countries actually do increase rates
of production per acre or per person at a percentage rate similar to
recent agricultural practice improvements in the United States.

2. A related problem is to understand the physical and economic
characteristics of land in relation to people well enough so that the exten-
sion of practices can be specific as to agricultural regions and economic
land class areas. This requires also that research results be tested under
field conditions in areas selected because of significant differences in
physical and economic characteristics.

3. Nevertheless, more thorough studies of the cultural and institu-
tional characteristics and their relationship with land use need to be
made to test the validity of political solutions which have been used to
reform cultural institutions such as the land tenure systems. These
studies may require a multi-country approach.

4. Finally, a more careful analysis of the attributes of our own cul-
ture, where agricultural development has been rapid, compared with the
characteristics of cultures, where agricultural development has been slow,
should be made. Such studies should increase our understanding of
man-land relationships.


Agriculture's Role in Economic Development, by Walt W. Rostow, Counselor
and Chairman, Policy Planning Council, U.S. Department of State, A/D/C Re-
print, No. 1, November, 1963.
British Guiana, Its Agriculture and Trade, United States Department of Agri-
culture, Economic Research Service, Regional Analysis Division, ERS-Foreign-45.
Caribbean Land Tenure Symposium, Washington, D.C. 1946 Caribbean Com-
mission, Committee on Agriculture, Nutrition, Fisheries, and Forestry of the
Caribbean Research Council.
Economic Land Use Classification of Jayuya Municipio, Puerto Rico, by A. B.
Lewis, December, 1963, Commonwealth of Puerto Rico, Department of Agriculture
and Commerce, Division of Agricultural Economics, Land Use Planning Section.
El Salvador, Its Agriculture and Trade, U.S. Department of Agriculture, Eco-
nomic Research Service, Regional Analysis Division, ERS-Foreign-49.
FAO-Latin American Seminar on Land Problems; Document: 1-3, Campinas
(San Paulo) Brazil, May 25 to June 26, 1953; "Some Economic Relations of
Land Use," by Arthur W. Peterson, Land Use Economist, Inter-American Institute
of Agricultural Sciences, Technical Cooperation Program of the Organization of
the American States, Project 39. This paper was prepared with the help of Dr.
A. B. Lewis, Director of the program. The material as presented, however, is the
responsibility of the author.
Food Balances for 24 Countries of the Western Hemisphere, 1959-61; ERS-
Foreign 86, Foreign Regional Analysis Division, Economic Research Service; U.S.
Department of Agriculture; August, 1964.

72 The Caribbean: Its Health Problems
Foundation and Fashions in Farm Management Teaching, by A. B. Lewis.
A Graphic Summary of World Agriculture, Miscellaneous Publication, No. 705,
U.S. Department of Agriculture, Economic Research Service, Regional Analysis
Division, September, 1964, Revised.
Indices of Agricultural Production for the 20 Latin American Countries (Plus
country tables for Jamaica and Trinidad) Revised 1958-59 through 1961-62; Pre-
liminary 1962-63; Forecast 1963-64; Western Hemisphere Branch, Regional Analysis
Division, Economic Research Service, U.S. Department of Agriculture, December,
1963; ERS-Foreign 44 (Revised 1963).
Sampling Plan for the February 1962 Economic Land Use Farm Management
Survey Changwha and Nantou Hsien, Taiwan, China, by C. F. Sarle, February 6,
Selected Community Development and Social Service Projects in Taiwan, Re-
public of China, Recommended for Church Support to Lutheran World Relief,
by Arthur W. Peterson, January, 1964.
The 1964 World Agricultural Situation, Foreign Agricultural Economic Report
No. 14, U.S. Department of Agriculture, Economic Research Service, Foreign
Agricultural Service, Washington, D.C., for release January 2, 1964.
The World Food Budget, 1970; Foreign Agricultural Economic Report No. 19,
U.S. Department of Agriculture, Economic Research Service, Foreign Regional
Analysis Division.

1. Agricultural Geography of Latin America, May, 1958, Misc. Publication No.
743, U.S.D.A., p. 31, para. 8-12.
2. Man, Land and Food, by Lester R. Brown, Foreign Agricultural Economic
Report No. 11, U.S.D.A., Economic Research Service, Regional Analysis Division,
Nov. 1963, pp. 16-17.
3. The 1964 Western Hemisphere Agricultural Situation, Supplement No. 1, to
the 1964 World Agricultural Situation, ERS-Foreign #71, U.S.D.A., Economic
Research Service, Washington, D.C., pp. 51, 52, 53, and 54.
4. P. 8, Fig. 2.
5. The 1964 Western Hemisphere Agricultural Situation, p. 83.
6. Ibid., Tables 2 and 4.
7. Ibid., Table 5, p. 55.
8. Agricultural Geography of Latin America, p. 3, para. 8, Table 1.
9. Dr. A. B. Lewis is Associate in Agricultural Economics, The Agricultural
Development Council, Inc., 630 Fifth Avenue, New York, N.Y.
10. For example, see, A Study of Economic Land Classification in the Saga
Plain Area, Saga Prefecture, Japan, by Shigeyoshi Ueno; English Bulletin #1,
Department of Agricultural Economics, Kyushu University, Fukuoka, Japan.
11. For example, see, An Economic Study of Land Use in Changhwa and Nan-
tou Hsien, 1961, by Shison C. Lee, Director, Research Institute of Agricultural
Economics, Provincial Chung Hsing University, Taichung, Taiwan.
12. Studying Land Use in Costa Rica: Applicability of the Method to Other
Regions, by Arthur W. Peterson, Land Use Economist, Northern Zone, and A. B.
Lewis, Director, Technical Cooperation Program. A contribution of the Technical
Cooperation Program of the Organization of the American States, Project 39,
Technical Training for the Improvement of Agriculture and Rural Life, No. 30,
January, 1953, p. 11, para 2.
13. Agricultural Regions of Costa Rica, by Arthur W. Peterson, Land Use
Economist, Northern Zone, and Quentin M. West, Land Use Economist, Andean
Zone, Turrialba, Inter-American Institute of Agricultural Sciences, 1953, Misc.
Pub. No. 4, p. 1.



14. A report and map were published by the Inter-American Institute of Agri-
cultural Sciences, Turrialba, Costa Rica. Mr. Loomis made a report to the FAO of
the United Nations which summarized the Farm Management Survey.
15. For more detail, see, An Economic Study of Land Use in Taichung Hsien
and City, 1960, by Arthur W. Peterson, Visiting Professor, Research Institute of
Agricultural Economics, Provincial Chung Hsing University, Taichung, Taiwan.
16. The Process of Cross-Cultural Innovation, by Arthur Niehoff and J. Charnel
Anderson, Human Resource Research Office, The George Washington University,
A/D/C Reprint, No. 2, September, 1964.
17. Taiwan Statistical Data Book, 1963.
18. "Collectivization and Rice Production," by Hoang Van Chi. China Quarterly,
First Quarter, 1962, p. 95, para. 3.
19. Excerpts from mimeographed paper, "Local Self-Government: The Key to
National Economic Advancement and Political Stability," by A. B. Lewis, Asso-
ciate Director for Agricultural Economics, The Council on Economic and Cultural
Affairs, Inc., March 15, 1956.
20. "Research Needed to Improve Developmental Assistance with Respect to
Special Rural Problems," prepared for Brookings Research Conference, May 25-27,
1961, by A. T. Mosher, Director, Agricultural Development Council, New York
City (preliminary draft, mimeographed April 15, 1961).
21. "A Study in Fertility Control," by Bernard Berleson and Ronald Freedman,
Scientific American, Vol. 210, No. 5, May, 1964.
22. See Note 20.
23. Agrarian Reform and Economic Growth in Developing Countries, Farm
Economics Division, Economic Research Service, U.S.D.A., Washington, D.C.,
March, 1962. See especially definitions by Philip M. Raup, p. 52.
24. Latin American USOM's Seminar on Agrarian Reforms, International Co-
operation Administration, Washington, D.C., February 21-24, 1961. Santiago, Chile.
25. "Factors Affecting Income on Farms in the Upper Reventaz6n River Water-
shed, Cartago Province, Costa Rica, 1950-51," Ralph A. Loomis. Unpublished
report to the FAO of the United Nations, June, 1953, p. 42.
26. The Role of Education in Agricultural Development, by William I. Myers,
Professor of Farm Finance, Cornell University, January, 1963.
27. See Note 20.
28. "This listing is illustrative only; it is in no sense a list of considered hy-
potheses. It contains items that come easily to the writer's mind to try to make a
point: the point that we need to search our own cultural background to try to
determine what is pertinent to rate 'development,' and what is not."

Part II





I. Introduction

THIS PAPER deals only with a section of the Caribbean area-that
section which is served by the Caribbean Organization and includes the
three Guianas in South America. the Netherlands Antilles. Jamaica,
Puerto Rico, the Virgin Islands of the United States and of Great
Britian, and the arc of islands stretching southerly from Anguilla to
Tobago and Trinidad a few miles off the coast of Venezuela.
It must be emphasized that the area defined above is one of extreme
diversity, showing marked differences in political as well as economic
development, with differing social and ethnic patterns, separated by
language differences and differing metropolitan associations and reflect-
ing in varying degrees the effects of rapid changes which have been
taking place in the region over the last 20 years.
Thus, while Jamaica and Trinidad and Tobago have recently achieved
the status of full-fledged sovereign states, and Puerto Rico enjoys a rela-
tionship with the United States which is unique in international relation-
ships, eight of the islands of the Eastern Caribbean, the Virgin Islands
of the United States and of Great Britain, and British Guiana are still
colonies, the Netherlands Antilles and Surinam are overseas partners of
the Kingdom of the Netherlands, and the French Antilles and French
Guiana are integral parts of France itself.
National incomes per capital range from less than U.S.$150 in Mont-
serrat, Grenada, and St. Lucia (1959) to over U.S.$900 in the United
States Virgin Islands and in the Netherlands Antilles (1962). Contribu-

78 The Caribbean: Its Health Problems
tions made by agriculture to the G.D.P. range from 40 per cent in
Guadeloupe (1960) to almost nil in the case of the United States Virgin
Islands and the Netherlands Antilles, while population intensities range
from a density of 1,416 persons per square mile in Barbados to less than
one in French Guiana in 1963.
Table 1 indicates the wide range of variation which the data on
population densities and national incomes exhibit.

II. General Features of Caribbean Development

Despite these obvious differences, however, the countries of the area
all share a limited range of latitude, and are closely linked by geography
and a common pattern of historical development and changing fortunes.
Their agricultural development began in earnest with their partition
amongst the British, French, and Dutch colonizers, and their fortunes
and importance have fluctuated in similar response to the growth and
decline of the sugar industry which has dominated the economy of the
region over the last 300 years.
During the eighteenth century, the Caribbean islands attained the
zenith of their importance as the sugar bowl for Europe; in comparison,
the mainland colonies of Middle and North America were important
mainly as sources of food supplies for the Caribbean area, and it was
the sugar produced in the Caribbean which was largely responsible not
only for financing the industrial revolution in Britain but also for pro-
viding a basis for the early prosperity of the farmers of the American
However, a prosperous sugar industry demanded the establishment
of large plantations and cheap, abundant labour such as was provided
by the slave trade. The nineteenth century saw the abolition of slavery
and the development of competitive sugar production in the East where
labour was cheaper and more abundant and where new lands assured
heavier yields. As a result, Caribbean income from sugar declined
rapidly but, though many of the once wealthy Caribbean planters were
ruined, the plantation system remained and the sugar industry, bolstered
by occasional periods of high prices brought about by international wars
or disasters of one kind or another in rival sugar-producing countries,
has continued to dominate Caribbean agriculture.
It is true that some attempts at diversification have been made in the
area but the production of these new crops was also based on the now
accepted plantation system. Moreover, the coffee, cacao, spices and, to
a lesser extent, the banana and other enterprises which have subse-




1. French Guiana 1 300 1963
2. Surinam 5 349 1962
3. British Guiana 7 280 1960
4. The Netherlands Antilles 517 912 1963
5. Jamaica 387 367 1962
6. Puerto Rico 734 736 1962-63
7. The U.S. Virgin Islands 275 1,761 1963
8. British Virgin Islands 136
9. St. Kitts-Nevis-Anguilla 387 215 1961
10. Montserrat 368 175 1961
11. Antigua 345 237 1961
12. Guadeloupe 432 420 1963
13. Dominica 207 233 1964 (estd.)
14. Martinique 706 420 1963
15. St. Lucia 383 179 1961
16. St. Vincent 568 180 1961
17. Grenada 672 189 1961
18. Barbados 1,416 293 1961
19. Trinidad and Tobago 449 580 1961
Source: Caribbean Plan, Annual Report 1964, Caribbean Organization.
Note: About 88 per cent of the population of the region is concentrated in the
mountainous island territories which constitute only 7 per cent of the total land
mass in the area.

quently challenged the dominance of the sugar estate have all perpetu-
ated the pattern of using the best available land and other facilities for
crops intended for export, forcing the rapidly increasing population in
the area to depend on marginal lands, fragmented holdings of uneco-
nomic size, unskilled and part-time local farmers, and especially on
imports for supply of their food requirements.
Thus, while traditional export crops have been assured the best lands,
the best facilities for financing and marketing and the best available
production expertise, very little effort has been made until within recent
years to provide any service other than lip service to encourage the
production and distribution of food for local use.
While the Caribbean countries were able to maintain a position in
which they could dictate the prices for their products and be assured of
cheap supplies of food, adherence to such a pattern of production and
trade could be justified. However, this period was of relatively short
duration. The War of American Independence and the application of

80 The Caribbean: Its Health Problems
the terms of the British Navigation Act to the new nation served to cut
off cheap food supplies from the mainland, and with the development
of cane sugar production in other tropical areas and beet sugar in
temperate countries the terms of trade for Caribbean countries became
steadily more unfavourable.
A similar fate has befallen efforts at developing alternative cash crops
such as coffee, cacao, and bananas; and the steady impoverishment of
the Caribbean countries which followed was only prevented from caus-
ing absolute ruin by the intervention of the metropolitan countries with
which they were associated. This took the form of subsidies to the vari-
ous unit countries and the provision of varying degrees of protection in
the markets of Britain, France, the Netherlands, and more recently the
United States for products of their respective dependencies.
Similarity of production policies and perpetuation of trading chan-
nels between metropolitan countries and their Caribbean dependencies
had the effect of isolating individual countries from their neighbours,
reducing intra-Caribbean trade to negligible proportions and develop-
ing within the area a marked lack of cooperation which was shared not
only between countries under different sovereignty but even between
countries under the same flag. Even today it is not forgotten that the
development of sugar production in Jamaica brought many sugar
planters in Barbados to ruin and that later the French Caribbean pos-
sessions created similar problems for all the British territories together.
Thus the outbreak of World War II found the Caribbean area a col-
lection of small units, depending heavily on agriculture for their in-
comes, utilising their resources mainly for the production of export
crops, competitive one with the other, and with economies deteriorating
steadily as a result of unfavourable terms of trade. Many of the countries
had recently experienced grave rioting by sections of their population
which had suffered most from the depression, strong national aspirations
had been aroused and a militant labour movement had been born.
With the war came recognition of the need for cooperation between
the metropolitan countries in promoting the economic improvement of
the area, the beginnings of regional and individual country development
planning, and keen appreciation that there was urgent need to reduce
dependence on outside sources of food. For the first time the Caribbean
countries themselves became aware of the advantages to be gained by
working closely with their neighbours, by exchanges of experiences and
knowledge with other countries in the area, and the possibility of im-
proving their own economic development through projects undertaken
on a regional basis.