Health policy and the politics of health: priorities and planning for health care in Puerto Rico.

Puerto Rico, with the rest of the Caribbean, inherited the historical legacy of colonialism, slavery, and ethnic diversity. With its neighbors, Puerto Rico shares a tropical climate, a strategic location, and an agricultural past. Despite such similarities, Puerto Rico's health systems have evolved at rates and in directions different from its Caribbean neighbors. The ways in which services are organized have varied as a function of each country's political relationship with its respective metropolitan power, its stage of economic development, its endowment in terms of natural and other resources, its size and population, and its cultural environment, among other factors. For this reason, the Caribbean presents a veritable kaleidoscope of patterns of delivering health care. The following comments are primarily devoted to Puerto Rico, where the author is directly involved with health policy and the politics of health.