Costa rica's 'white legend': How racial narratives undermine its health care system

Lisa Campo-Engelstein, Karen Meagher

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


A dominant cultural narrative within Costa Rica describes Costa Ricans not only as different from their Central American neighbours, but it also exalts them as better: specifically, as more white, peaceful, egalitarian and democratic. This notion of Costa Rican exceptionalism played a key role in the creation of their health care system, which is based on the four core principles of equity, universality, solidarity and obligation. While the political justification and design of the current health care system does, in part, realize this ideal, we argue that the narrative of Costa Rican exceptionalism prevents the full actualization of these principles by marginalizing and excluding disadvantaged groups, especially indigenous and black citizens and the substantial Nicaraguan minority. We offer three suggestions to mitigate the self-undermining effects of the dominant national narrative: 1) encouragement and development of counternarratives; 2) support of an emerging field of Costa Rican bioethics; and 3) decoupling health and national successes.

Original languageEnglish (US)
Pages (from-to)99-107
Number of pages9
JournalDeveloping World Bioethics
Issue number2
StatePublished - Aug 2011
Externally publishedYes


  • Costa Rica
  • Cultural narratives
  • Health care disparities
  • Health care system
  • Race

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Health Policy


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