Consensus and Coercion: Primary Health Care and the Guatemalan State

Abstract

During the 1970s international and bilateral development agencies actively began promoting and financing comprehensive primary health care (PHC) programs in underdeveloped countries. The stated goal of these activities was to provide rural peoples with a modicum of basic health services, and access to health care did increase as a consequence of the PHC effort. However, this article examines the relationship between capitalist development processes, the state, and the peasantry in Guatemala in order to demonstrate another consequence of PHC interventions: that they ultimately operated as an inherent part of this relationship and bolstered legitimacy for the existing social and economic order. Although the delicate balance between the state's need to garner consensus and its potential for resorting to coercion to establish its legitimacy is clearly highlighted in an extreme example like Guatemala, the same relationship between processes of capitalist accumulation and social legitimation pertains to other settings.

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