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© 2002 American Public Health Association
EDITORIAL |
Cesar G. Victora is with the Universidade Federal de Pelotas, Pelotas, Brazil, and is an International Associate Editor of the Journal.
Correspondence: Requests for reprints should be sent to Cesar G. Victora, MD, PhD, Universidade Federal de Pelotas, CP 464, Pelotas, Rio Grande do Sul 96001-970, Brazil (e-mail: cvictora{at}terra.com.br).
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INTRODUCTION |
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 TOP INTRODUCTION REPRESSION AND INEQUALITYPAHO’S DIFFERENT...HOPE FOR THE FUTUREReferences |
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The Pan American Health Organization (PAHO) will be 100 years old this December. In this issue of the Journal, many of the achievements of PAHO in its century of existence are highlighted by Alleyne1 and by Fee and Brown.2 I have nothing to add to this impressive list; instead, I would like to offer personal testimony about how PAHO contributed to my decision to become involved in public health, a story that is probably familiar to many of my Latin American colleagues.
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REPRESSION AND INEQUALITY |
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TOPINTRODUCTIONREPRESSION AND INEQUALITYPAHO’S DIFFERENT...HOPE FOR THE FUTUREReferences |
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I entered medical school in 1971 in southern Brazil. My country, like most of South America, was then under a harsh military dictatorship. The official propaganda stated that an "economic miracle" was taking place and that we would soon join the developed world. The fact that only the upper classes seemed to benefit from the miracle did not receive wide attention. There was heavy censorship of the press, affecting not only political news but also news about all aspects of life. For example, news of a massive meningococcal meningitis epidemic was censored—reportedly because the authorities did not want to raise panic in the population, but probably also because it would not be appropriate for a country undergoing an economic miracle to be affected by an epidemic disease of the poor. The press was also prohibited from reporting increases in infant mortality in several major metropolitan areas during the economic boom.
Meanwhile, the differences between the rich and the poor, in health as well as in wealth, remained unacceptably wide, making Brazil one of the world’s leaders in economic inequalities—a position that we unfortunately still hold.3,4
This political and economic climate was reflected in medical teaching. The school I attended, one of the best in the country, had just built a brand new teaching hospital. High-technology, tertiary inpatient care was the number one priority, and professors dedicated most of their time to highly specialized private clinics. During my whole 5-year training, I remember perhaps 20 days or so in which I worked in outpatient departments, the rest of the practical teaching being devoted to inpatients. Professors constantly complained about "mass medicine," a derogatory term that applied to any attempt to deliver health care outside private, fee-for-service clinics.
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PAHO’S DIFFERENT PERSPECTIVE |
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TOPINTRODUCTIONREPRESSION AND INEQUALITYPAHO’S DIFFERENT...HOPE FOR THE FUTUREReferences |
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However, there was one refuge in this high-tech world. Our library received all of PAHO’s publications, free of charge. It was there that, along with a few interested colleagues, I first found evidence that a different approach to medicine and to public health was possible. PAHO not only provided its own and World Health Organization (WHO) periodicals, scientific reports, and books, but it also organized an interlibrary loan system through the Regional Library of Medicine (BIREME) in São Paulo that supplied photocopies of requested articles, free of charge. I soon became an avid reader of the thick monthly Index Medicus—there was no online access in those days—from which I selected several papers that I ordered from BIREME.
Our group of public health–minded students organized a journal club and a bulletin board in the medical school where we pasted both technical papers and newspaper clippings. The latter, however, did not escape internal censorship. The head of the anatomy department, on whose wall we placed the bulletin board, summoned us and threatened us with expulsion from the school—a threat backed by a government decree allowing students involved in political activities to be expelled without recourse. Public health was regarded as a potentially subversive activity in those days.
Some of the PAHO/WHO publications from that time remain in my memory. La Salud por el Pueblo ("Health by the People") was a collection of experiences from several countries—Cuba, China, India, Guatemala, Tanzania, and others—showing how communities themselves could organize and deliver preventive and curative health care.5 Patterns of Mortality in Childhood reported on the findings of a large multicountry study in the Americas, aimed at comparing the immediate causes and distal determinants of mortality in different communities and at understanding how they could be prevented.6 These were 2 of many publications available showing how broad the determinants of health were, how much they extrapolated from curative medical care, and how a different approach to health care was possible.
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HOPE FOR THE FUTURE |
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TOPINTRODUCTIONREPRESSION AND INEQUALITYPAHO’S DIFFERENT...HOPE FOR THE FUTUREReferences |
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Among all the WHO regional offices, PAHO is certainly the leader in raising the importance of health inequities. It states that "inequity continues to be the leading health problem in the Americas."7 Most public health practitioners from Latin America, myself included, are forever indebted to PAHO for opening our minds to the complex world of the determination of health status and showing us how to organize a collective response to the problem of health inequities. Let us all hope that well before PAHO completes its second centenary, in 2102, we will see some real progress in eradicating the unacceptable inequalities that afflict our region.
Accepted for publication September 12, 2002.
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References |
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TOPINTRODUCTIONREPRESSION AND INEQUALITYPAHO’S DIFFERENT...HOPE FOR THE FUTUREReferences |
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1. Alleyne GAO. The Pan American Health Organization’s first 100 years: reflections of the director. Am J Public Health. 2002;92:1890–1894.
2. Fee E, Brown TM. 100 years of the Pan American Health Organization. Am J Public Health. 2002;92:1888–1889.
3. World Development Report 1998/99. Washington, DC: World Bank; 1999.
4. Human Development Report. New York, NY: United Nations Development Program; 2001.
5. Newell KW, ed. La Salud por el Pueblo. Geneva, Switzerland: World Health Organization; 1975.
6. Puffer RR, Serrano CV. Patterns of Mortality in Childhood. Washington, DC: Pan American Health Organization; 1973. Scientific publication no. 262.
7. Leading Pan American Health. Washington, DC: Pan American Health Organization; 1998. Official document no. 287.
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