As in education, Venezuela had, by Latin American standards, an enviable record in health and social welfare and one that had shown tremendous progress. In 1940 the overall life expectancy at birth was forty-three years. By 1990, that figure was over seventy years: seventy-one years for males and seventy-seven for females, both among the highest in Latin America. The death rate was only 4 per 1,000 population and the average caloric intake was 107 percent of the minimum level established by the United Nations (UN) Food and Agriculture Organization. These indices reflected generally improving health conditions, especially since the end of World War II, and the increase in preventive public health measures undertaken by the government. For example, successful inoculation programs had lessened the incidence of a number of contagious diseases. On the other hand, a comparison between the causes of death in 1973 and 1981 shows that Venezuela, a rapidly industrializing country, was also becoming more prone to causes of death--heart disease, accidents, and cancer--often associated with urban and industrialized countries and a faster pace of life (see table 6, Appendix). Acquired immune deficiency syndrome (AIDS) was also a growing problem, particularly for the major cities, such as Caracas and Maracaibo, and for tourist centers, such as La Guaira and its environs. In 1990 information on the actual incidence of AIDS in Venezuela was unreliable.

Infant mortality, pegged at a relatively low 27 deaths per 1,000 live births in 1990, has also been steadily declining, especially in the years following World War II. The major causes of these improvements were better public health measures, prenatal care, and national immunization campaigns. Overall, health care facilities had grown in number and in quality at the same time, the population had become more urban and better educated. There was also a marked increase in the number of medical facilities and personnel offering health care (see table 7, Appendix). The rise in the number of nurses reflected government incentives in this field as well as the selection of this vocation by a greater number of professionally inclined Venezuelan women.

Medicine has traditionally been a highly respected profession, and Venezuelan medical schools turned out adequate numbers of well-trained doctors. At the same time, however, relatively few nurses received proper training, so that doctors often lacked the necessary support system. The availability of care in rural areas represented another gap in the health care delivery system. Doctors tended to concentrate in the large cities, especially Caracas, leaving many smaller provincial towns without adequate medical personnel. The government has attempted to meet these shortcomings, with some success, by providing basic medical services through a system of paramedics. On the other hand, shrinking budgets could take a toll on health services. In the summer of 1990, President Carlos Andrés Pérez him 1d0e mself showed deep concern over the fact that, by goverÍÍÍÍÍÍÍnment estimates, nearly 46 percent of state-supported hospital buildings were in need of repair.

Private medical facilities, operated for profit, enjoyed greater prestige than public institutions. Charitable organizations, especially the Roman Catholic Church, operated some health facilities. The bulk of the population, however, relied on the Venezuelan Social Security Institute (Instituto Venezolano de Seguro Social--IVSS), which operated its own hospitals, covering its costs out of social security funds. At public hospitals, small fees were charged to those patients able to meet them, but indigents were treated without cost. Services were furnished without charge at public outpatient facilities, with a nominal charge for prescription drugs. Overall, the medical assistance received by most Venezuelans far exceeded that available to the great majority of Latin Americans.

The Ministry of Health and Social Welfare operated hospitals and lesser clinical medical facilities nationwide and coordinated the planning of medical services by the states and the Federal District. Although attempts have been made to provide a unified health system, as of 1990 such plans had not been implemented.

Government campaigns for the prevention, elimination, and control of major health hazards have been generally successful. Venezuela has largely rid itself of malaria, yaws and the plague have been brought under control, and Chagas' disease, carried by a beetle that attaches itself to straw thatch roofing, has been nearly eliminated. Immunization campaigns have systematically improved children's health, and regular campaigns to destroy disease-bearing insects and to improve water and sanitary facilities have all boosted Venezuela's health indicators to some of the highest levels in Latin America.

In addition to providing public health care, the IVSS also administered the country's public welfare program. Launched in 1966, the IVSS provided old-age and survivor pensions. In addition, it sponsored maternity care and medical care for illness, accidents, and occupational diseases for workers in both the public and private sectors. Participation in the program was mandatory for all wage earners with the exception of temporary and seasonal or part-time workers, the self-employed, and members of the armed forces (who were covered under a separate system). The availability of benefits has been extended progressively to all regions of the country so that even farm workers and farmers associated with the agrarian reform program were eligible.

Private charitable and social welfare organizations, which were exempt from the income tax, played an important role in supporting and maintaining charity hospitals and organizations, assisting persons of limited income, and funding scholarships. Among the most active of these organizations was the Voluntary Dividend for the Community, founded in 1964 and supported by contributions from the business community. It subsidized welfare programs, private education, and community development projects. In this instance, as in others, Venezuela benefited from the efforts of community-minded leaders of the private sector, who bolstered government programs and provided further assistance for those in greatest need.

Thus, in the 1990s, Venezuela did not lack for public and private leaders who were deeply concerned about the needs of their fellow countrymen. Rather, the looming problem appeared to be one that Venezuela had not known for decades, that of scarcity. Throughout the 1980s, the state had fewer resources with which to respond to the demands of an expanding young population that had become accustomed to relying on the public sector for employment and social services. For a time, the public was willing to blame the new problems of scarcity on the ineptness and, to some extent, the corruption of politicians. By the end of the 1980s, however, most Venezuelans realized that even a well-intentioned, honest, and capable government would have to adjust to the economic reality of reduced export income and a large external debt. The apparent upward trend in oil prices heralded by the Iraqi invasion of Kuwait in August 1990 represented the one bright spot on the economic horizon. Even that, however, was obscured by concerns over the general health of the domestic economy, the availability of refining capacity for Venezuela's heavy crudes, and other considerations.

Despite these economic setbacks, the legitimacy and the viability of the Venezuelan democratic society did not seem threatened. Racial tension did not divide this largely mestizo society as it did some other Latin American societies. Although poor Venezuelans sometimes demonstrated violently, as in the case of the February 1989 riots against economic austerity, there was no sentiment outside of small extremist groups for a return to an authoritarian government of the right or the establishment of a Cuban-style government of the left. The events of the 1980s, however, shocked Venezuelan society after decades of increasing prosperity and improving health, education, and economic indices, Venezuelans suddenly found themselves vulnerable to the shifting fortunes of a world economy that had always proved beneficent in the past. This "crisis," although more economic than social, should nonetheless provide the sternest test yet of Venezuelan commitment to a free, tolerant, and socially conscious system.

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A major, comprehensive study of Venezuelan society is still to be written. Although the literature in English is not voluminous, good, but narrow, perspectives can be found in Robert F. Arnove's Student Alienation: A Venezuelan Study, G.E.R. Burroughs's Education in Venezuela, Lisa Redfield Peattie's The View from the Barrio, and John Duncan Powell's Political Mobilization of the Venezuelan Peasant.

In Spanish, the offerings are much more promising. Among the best are Federico Brito Figueroa's La estructura económica de Venezuela colonial, Sergio Aranda's Las clases sociales y el estado en Venezuela, Maritza Montero's Ideología, alienación e identidad nacional, Rafapel Carías's Quiénes somos los venezolanos, and excellent chapters in Antonio Frances's Venezuela possible. (For further information and complete citations, see Bibliography.)

Data as of December 1990