and redistribution of large land holdings
After gaining greater confidence, organizational
skills, and unity through combating other problems,
finally the poor farmers were ready to tackle the
most basic problem contributing to hunger and poor
health: the inequitable distribution of the fertile,
river valley farmland. They began to systematically
invade and cultivate some of the large holdings of
rich families--land to which they knew they had a
constitutional right. They divided up the land fairly
and then demanded ejidal land titles from
the government. When the authorities at the state
level ignored their demands, the poor farmers sent
a committee to the Ministry of Agrarian Reform in
Mexico City. The villagers persisted until the officials
finally relented, and ordered the state authority
to grant title to the poor farmers' land claims.
To date, the peasant farmers have reclaimed, won
legal title to, and parceled out nearly half of the
local riverside farmland. To increase food production,
they purchased water pumps and began to irrigate the
land during the dry season. This enabled them to harvest
two crops a year instead of one. As a result, their
families were able to eat better, to earn income by
selling some of their produce, and to save some money
for medical emergencies and other needs.
The impact of these various actions toward greater
fairness--between rich and poor and between men and
women--has had a significant impact on health, especially
that of children. When the villager-run health program
began in 1965, the Under Five Mortality Rate for this
remote mountainous area was around 340 per thousand.
Today it is down to between 50 to 70 per thousand.
Equally important, there are now far fewer malnourished,
sickly, and stunted children. More youngsters are
healthy, growing well, and bursting with energy and
Undoubtedly a number of factors have contributed
to the impressive drop in child death rate. Most families
agree that the Piaxtla health program has played a
key role in reducing child death and improving health.
But if you ask "What actions brought the biggest improvements?"
few people will say curative or preventive medicine.
Many will mention organized action to reclaim their
rights and their land. Most families realize that
the main reason why so many of their children used
to get sick and die is that often they didn't get
enough to eat. With their collective efforts to set
up a peasant-controlled maize bank and cooperative
fencing program, to combat excessive use of alcohol,
and above all, to more fairly distribute the best
farmland, the families of the village have been able
to increase their economic base and to put more food
on the table. All in all, they have gained more control
over their health and their lives through cooperative
Since the early years of the health program, there
has been a visible shift in power at the local level.
In the first years, village council meetings had been
strongly controlled by a few forceful land barons
and cattle owners, but as the poor gained strength
and unity, the few wealthy men who previously dominated
decisions were so disempowered that they seldom attended
ejido meetings. Outnumbered, they could no
longer swing votes by threatening to evict sharecroppers
or refuse them loans. In this way, the local struggle
for health, which had turned into a struggle
for land and liberty, also led to a more democratic
and equitable community with greater accountability
However, the process remained local and incomplete.
The campesinos realized that if improvements
in health were to be sustained, more good riverside
land needed to be invaded and redistributed: not only
in the Piaxtla valley but throughout the country.
Of course, this struggle for land, liberty,
and health in the Sierra Madre was not an isolated
event. In many parts of Mexico, grassroots groups
were beginning to organize and demand their rights.
As these groups gained in numbers and strength, high
level attempts to silence them became more frequent
and repressive. On occasion, Piaxtla health workers
were jailed. And in a program which the Piaxtla team
had helped to start in the neighboring state of Durango,
two health workers were killed by the state police
for organizing local residents to stand up for their
timber rights. (An American plywood company was paying
the corrupt leaders of the local ejido for
the timber they removed. When the health workers organized
their local ejido to demand fair disbursement
of this money among all the families, the lead health
workers were assassinated by the State Police.)
In response to this and other misfortunes, grassroots
groups felt the need to unite in mutual self defense.
To stabilize their tenuous gains, the health team
joined with other grassroots programs to organize
educational interchanges. This eventually led to both
a national and a regional network of community-based
health programs, covering Mexico and Central America.
These grassroots networks share the conviction that
the struggle for health is a struggle for liberation
from hunger, poverty and unfair social structures.