In Costa Rica, though, public health has been a priority for decades. Even in countries with robust universal health care, public health is usually an add-on the vast majority of spending goes to treat the ailments of individuals. People who have studied Costa Rica, including colleagues of mine at the research and innovation center Ariadne Labs, have identified what seems to be a key factor in its success: the country has made public health-measures to improve the health of the population as a whole-central to the delivery of medical care. The country’s average life expectancy was fifty-five years, thirteen years shorter than that in the United States at the time. Many youths and young adults died as well. In 1950, around ten per cent of children died before their first birthday, most often from diarrheal illnesses, respiratory infections, and birth complications. “At that time, Costa Rica was the most sad country, because the infant-mortality rate was very high,” he said. The images of the mourners are still with him. When someone died, a long procession of family members and neighbors trailed the coffin, passing in front of Salas’s home. On the cemetery road, however, there was another kind of traffic. Situated halfway between the capital, San José, and the Pacific port city of Puntarenas, Atenas was a stop for oxcarts travelling to the coast, and the store did good business. His father also had a store on the main road through town, where he sold various staples and local produce. His parents had a patch of land where they grew coffee, plantains, mangoes, and oranges, and they had three milk cows. Still, his family was among the better-off in Atenas, then a community of nine thousand people. He slept on a straw mattress, with a woodstove in the kitchen, and no plumbing. Salas grew up in a small, red-roofed farmhouse just down the road.
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