Costa Rica and the Cost of Living Well

In late August The New Yorker featured a fascinating, slightly awestruck examination of “the Costa Rica Model” of “health care that understands its community,” by American surgeon and professor of public health Atul Gawande. Gawande, nominated by President Biden to serve as assistant administrator of the US Aid and

Development Agency’s Bureau for Global Health, opened by asking: “The country’s life expectancy outstrips ours. How did they do it?”

Costa Rica’s five million people, after all, earn barely $12,000 per capita in an economy ranked 79th globally for its Gross Domestic Product (GDP) of around $60 billion, compared to 332 million Americans earning $65,000 per capita in the world’s biggest economy, producing more than one-fifth ($20+ trillion) of global GDP ). No wonder, in the course of his research, Gawande often felt humbled, as when a doctor “asked me how things worked where I was from,” and “I could only sigh.”

Gawande found many of the right answers to the conundrum: a strong emphasis on integrating community and individual — as well as physical and mental –- health; free and easy access to a wide range of medicines, treatments, check-ups, and advice; a full-lifespan focus on disease-prevention and healthy living (one dazzling sign of which, Gawande marveled, was “some of the best teeth I’d seen anywhere”); and a premium on sustaining a healthy natural and social environment. But he inexplicably missed one of the biggest clues of all. As politely pointed out by New Yorker reader Joan Sturmthal:

One additional reason that Costa Ricans have been able to devote so much time and so many resources to developing their public-health system is that the country abolished its military in 1948. The end of the armed services allowed for a greater financial and cultural focus on health and education, resulting in a well-educated and long-lived population. There’s a lesson in this for politicians everywhere…

 

Perhaps no country has more spectacularly failed to learn this lesson than the United States, now managing to spend over $80 million an hour (!) – over three quarters of a trillion dollars a year – on its conventional and nuclear forces. Americans waste comfortably more wealth on the war machine each year than Costa Rica generates in a decade, while also paying incredibly dearly – enriching vast and callous corporations – for far poorer healthcare outcomes than any Costa Rican would expect or accept.

As of December 20, for example, the Coronavirus pandemic had killed 243 per 100,000 Americans, and almost a hundred fewer – 145 – per 100,000 Costa Ricans, with slightly more Costa Ricans (67%) than Americans (61%) double-vaccinated  (In Canada, with nearly 80% of the population double-vaccinated, the death rate is 80 per 100,000.) A more telling indicator of the toll, however, is widely considered to be ‘excess deaths’: mortality surpassing projections based on pre-COVID trends. Although compiling reliable comparative data is challenging, a major study published this summer  showed that the US had experienced (by June 6) a 22% jump in such deaths, and Costa Rica (by the end of 2020) just a 4% increase. (The Canadian increase, by March 2021, was 5%.)

Less healthy and resilient societies tend to be less equal and more violent, and under acute shock and strain those ‘pre-existing conditions’ can translate into wildly disproportionate impacts, falling heaviest on women, children, racial minorities and the poor. In the case of COVID lockdowns, such hammer blows have included rape and other sexual violence, including incest and murder; a vast array of mental and physical illnesses; addictions; suicides; etc., etc. And while I cannot adduce conclusive proof, the disparity in excess deaths suggests that the world’s military hyper-power has experienced a far grimmer pandemic than the unarmed, “tiny tropical nation”  whose “increase in health,” to quote Gawande, has for decades “far outpaced its increase in wealth.”

Gawande describes Costa Rican public health officials studying “up-to-the-moment rates of COVID cases and deaths by age, sex, and neighborhood.” This in itself was nothing special, just “the kind of report I’d seen in the hands of local public-health officials in the United States.” But because those officials “remain outside” the private “healthcare system, they had to beg providers to respond with adequate testing and vaccination.” When that “proved insufficient,” they were “forced,” starting “from scratch, and in a mad rush,” to “launch their own operations,” heroic efforts that were “all too delayed and temporary.” In Costa Rica, by contrast, their counterparts can immediately:

…see the places with the greatest need and deploy doctors, nurses, and community-health workers to do testing and vaccination. Amid COVID, Costa Rica had demonstrated yet again how primary-care leaders could make health happen.

 

It is inconceivable to me that such ‘health’ would be ‘happening’ in Costa Rica without the country’s revolutionary demilitarization. The dramatic, ironically aggressive moment of abolition was recaptured by David Barash in The Los Angeles Times in December 2013:

65 years ago this month, [President] José Figueres made a fiery and eloquent speech, after which he took a sledgehammer and bashed a hole in a huge stone wall at the nation’s military headquarters, Cuartel Bellavista. Its imposing towers and massive gates had loomed over the capital city of San José since 1917, the country’s premier symbol of military power and the home of the ‘Tico’ military establishment. … At the conclusion of the ceremony, he publicly handed the keys to the minister of education, announcing that Bellavista would be transformed into a national art museum and the nation’s military budget would be redirected toward healthcare, education and environmental protection.

The social democrat leader made his move in the turbulent wake of a six-week Civil War (March-April 1948), after decades of unstable, right-wing, de facto military control of government. It has been suggested he was motivated primarily by self-preservation, removing the main threat to his power (and life ). But the gamble itself ran the risk of provoking a coup; and as Barash writes, Figueres was also “clearly aware of the ‘opportunity costs’ associated with military spending, the simple fact that resources expended on the military could not be used to support domestic needs.”

Some members of the abolished Army fled to Nicaragua, and the warm embrace of American-backed dictator Anastasio Somoza. In 1955, armed and funded by Somoza, they invaded Costa Rica but – with almost no popular support – were beaten back by a civil police force possessing the kind of minimal defense capability envisaged as legitimate even by advocates of that now radical-sounding but once-mainstream goal of the United Nations, General and Complete Disarmament (GCD ).

It is true there have been periodic attempts by Washington to make Costa Rican disarmament much less general and complete, e.g. by encouraging a stealth militarization of the civil guard. And there have been intense internal debates about the tools required for law enforcement and border patrol . But “to this day,” as Barash celebrates, Costa Rica “has no army, navy or air force, no heavy weapons of any kind. … If you walk along a beach in Costa Rice and see lines of pelicans flying in perfect formation, consider it the Tico air force, out on maneuvers.”

 

Yet this is – as Barash laments, and Gawande’s article exemplifies – precisely what “most Americans, even among the many who travel to Costa Rica for an eco-vacation,” fail to see, admiring a country they:

…have no idea is demilitarized, even as they enthusiastically partake of the many benefits this decision has helped generate: democratic institutions, the remarkably healthy and happy population, and, not least, the fact that Costa Rica has been able to invest not only in its people but also in preserving about 25% of its land area in either national parks or biological reserves.

Perhaps this blindness is related to the natural beauty, the disarming peacefulness, of the country: what real-world trouble, after all, could threaten such a paradise? Yet the spectacularly successful experiment has been conducted in one of the most violent, troubled regions on Earth, bordered by Nicaragua to the north and Panama to the south, both long-suffering victims – along with their neighbors Guatemala, Honduras and El Salvador – of US interventions ranging from covert operations (including assassinations) and election-meddling, to the arming and funding of right-wing paramilitaries (and death squads), to regime-change invasion (Panama, 1989), to protracted occupation (Nicaragua, 1912-33).

In the 1980s, the Reagan Administration sought Costa Rican help to crush the left-wing Sandinista government in Nicaragua (overthrowers, in 1979, of the Somoza dynasty). President Óscar Arias proposed instead a regional peace plan based on free and fair elections, protection and expansion of human rights, and an end to foreign intervention and interference. Signed by Costa Rica, Guatemala, El Salvador, Honduras and Nicaragua in August 1987, the pact won for Arias the 1987 Nobel Peace Prize and, in September that year, an invitation to address an informal session of the US Congress, despite his having, as the Nobel Committee noted, “refused the USA permission to use Costa Rican territory and resisted US attempts to alter the contents of the peace plan.” He also, the Committee added, “rebuked the Sandinistas for their lack of democracy,” an authoritarianism which has since hideously blighted – and politically perverted – the revolution.

Arias’ Nobel Lecture, “Only Peace Can Write the New History” (delivered in the presence of José Figueres) opened with a quote from Erasmus – “Peace consists, very largely, in the fact of desiring it with all one’s soul” – and the claim that the “inhabitants of my small country” have “realized those words”:

Mine is an unarmed people, whose children have never seen a fighter or a tank or a warship.

Candidly, Arias conceded that “in these years of bitterness in Central America, many people in my country are afraid that, driven by minds diseased and blinded by fanaticism, the violence in the region may spread to Costa Rica” – as would surely have happened, had he taken Reagan’s bribes. “Some,” he continued, “have given way to the fear that we would have to establish an army to keep violence away from our borders. “Such ideas,” he declared:

…are worth less than the thirty pieces of silver handed to Judas. Costa Rica’s fortress, the strength which makes it invincible by force, which makes it stronger than a thousand armies, is the power…of its principles. When one honestly lives up to one’s ideas, when one is not afraid of liberty, one is invulnerable to totalitarian blows.

 

This double denunciation of militarism – as incompatible with genuine security and corrosive of domestic freedom – resonated strongly with the revolutionary changes then underway in Soviet policy under President Mikhail Gorbachev, aimed at nothing less, as he told the UN in 1988, than accomplishing the “demilitarization of international relations” and reversing “the militarization of thought.”  This latter aim requires a profound commitment to peace education, for while it is necessary, as the Prophet Isaiah enjoined, for nations not to “learn war anymore,” peace also needs be placed at the center, not just of curricula, but culture and citizenship.

In his Nobel speech, Arias stated concisely that “my country is a country of teachers. It is therefore a country of peace,” where “children go with books under their arms, not rifles on their shoulders.” Such security brings with it, he stressed, not arrogance but awareness, a cultivated ability to “discuss our successes and failures in complete freedom.” Indeed, precisely “because my country is a country of teachers”:

…we believe in convincing our opponents, not defeating them. We prefer raising the fallen to crushing them, because we believe no one possesses the absolute truth.

This obverse of “American exceptionalism” –- the belief in a God-given, ‘manifest destiny’ to not just drive but dictate world development –- is not ‘Costa Rican exceptionalism,’ but a respectful, non-supremacist advocacy and practice of cooperative non-violence, an inclusivity naturally encompassing diverse perspectives. One of the profoundest consequences of this ‘demilitarization of thought’ is a new gendering of political discourse, a rejection of hero-worship – soldier as manly defender of the ‘motherland’ – and embrace of caring, compassionate, humane being.

On the 70th anniversary of Figueres’ ‘sledgehammer’ that cracked rather more than a nut, USA Today’s Amanda Rejos quoted a “famous expression”: “Blessed is the Costa Rican mother who knows her son at birth will never be a soldier.” For many Americans, even after two decades of incessant post-9/11 war, such a sentiment seems blasphemous: an unthinkable thought. And at the heart of this mental darkness, I suggest, is the spell cast by American patriarchy’s most violent ‘achievement’: the Bomb.

 

In the concluding section (‘Let Weapons Fall Silent’) of his Nobel lecture, Arias argued that “the horrors of what we have heard about the nuclear end of the world” had “made us uncaring about conventional war”: “Memories of Hiroshima are stronger than memories of Vietnam!” Nuclear weapons can kill hundreds of millions of people in minutes, and must be abolished, but that gives no one “the right to forget the 78 million human beings killed in the wars of this twentieth century.”

A third of a century later, the plague of conventional war is growing in virulence, while the Cold War obsession with Armageddon has, in much of the militarized Global North, been replaced – despite steeply rising risks – by atomic amnesia and apathy. Many nations in the Global South, however (and a handful, e.g. Austria and Ireland, in the North), remain determined to ban not just the Bomb but war; and Costa Rica, unsurprisingly, was in the vanguard of those states pushing for a radical new measure – the UN Treaty on the Prohibition of Nuclear Weapons (TPNW), adopted by 122 states in 2017 – dedicated to finally “achieving effective progress towards general and complete disarmament.”

In acknowledging the disproportionate impact of nuclear weapons and ionizing radiation on women and girls, and in stressing the importance of women’s participation and perspectives in advancing peace and security, the TPNW is a striking example of the modern trend — begun in earnest with the 1997 Ottawa Convention banning landmines — towards ‘feminist humanitarian disarmament.’ Addressing the United Nations in October, Costa Rica’s Ambassador, Maritza Chan, said that her country “calls for a feminist approach to nuclear disarmament which challenges the archaic assumption that power competition is the right way to conduct foreign relations and ensure national security.”

The “future,” she argued, “will only be secure when states decide to honor,” as “Costa Rica has advocated for decades,” two crucial articles of the UN Charter: Article 11, under which the General Assembly is empowered to make recommendations to the Security Council regarding “the principles governing disarmament and the regulation of armaments;” and Article 26, under which the Security Council is responsible for the “maintenance of international peace and security with the least diversion for armaments of the world’s human and economic resources.”

 

Such a world would surely look much more like Costa Rica than the United States. As Ambassador Chan lamented, “while the world continues to prepare for war, an invisible virus has brought us to our knees.” Everyone has suffered: but because it had already vanquished the virus of war, the Central American minnow has suffered less, and will doubtless ‘build back better,’ than the North American Colossus. And though motivations, context, and details differ, currently 20 states “do not,” to quote the scholar Tyson Sara ), “possess an armed instrument of national power with which to defend themselves”: Andorra, Costa Rica, Dominica, Grenada, Haiti, Iceland, Kiribati, Liechtenstein, Marshall Islands, Mauritius, Federated States of Micronesia, Nauru, Palau, Panama, St. Lucia, St. Vincent and the Grenadines, Samoa, Solomon Islands, Tuvalu, Vanuatu.

Many of these states are small and vulnerable, particularly to the effects of climate breakdown. Demilitarization is not a panacea for any of them, but is one curse lifted, and an important example set. Indeed, this seemingly scattered and marginal post-military bloc accounts for 10% of UN membership, represents 23 million people, and “most astonishingly,” shares “a maritime Exclusive Economic Zone (EEZ) of over 15 million square kilometers, which is larger than the EEZ of any single country and larger than the EEZs of Indonesia, Canada, and Brazil combined.”

In Sara’s summary: “By sovereign representation, economy, population, land area or EEZ size, the amount of the world that is undefended by military forces is significant.” What if, as Costa Rica’s Ambassador to Australia, Armando Vargas-Araya, recently suggested, these states began to identify as a group, working “together to give voice to common positions against the arms race and war, stimulate the development of a culture of peace and trust, promote academic studies and comparative research on security and defense in countries without a standing army,” and “offer their experience to other nations that might consider taking the same peaceful path.”

To honor Costa Rica’s trailblazing role, such an initiative should be launched in San José. With no military honors. And a pelican fly-past…

Featured image: Manzanillo Beach, Costa Rica, by Jaimedelamata, CC BY-SA 3.0 via Wikimedia Commons

 

 

Sean Howard is adjunct professor of political science at Cape Breton University and member of Peace Quest Cape Breton and the Canadian Pugwash Group. He may be reached here.