Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Special Centennial Edition
Volume 7, Number 2, 2002

For the past 30 years it has been fashionable to speak of the epidemiologic transition as if epidemiologic stages progressed steadily from one to another. Vivid accounts described the three stages of a transition: the age of pestilence and famine would be followed by the age of the receding pandemics, until finally we would reach the age of chronic diseases such as cancer and cardiovascular diseases. In fact, the health development of our countries shows more of a mosaic pattern. We now have to confront the mosaic of chronic diseases that are increasingly important, while at the same time we must cope with new and emerging infections. It has been a salutary lesson for us that microbes will never go away, and we have to learn to inhabit the earth with them.

We can expect that new discoveries in science will shed more light on the relation of life in utero to the future development of a wide range of diseases, thus introducing the possibility of genuine early intervention and prevention. But we must never lose sight of the possibility that new diseases or new forms of old diseases may come to haunt us.

I can see the improvement of the environmental conditions that impact on health. The past decade has brought an improvement in the availability of potable water to the population. I am cheered by the recent efforts at collaboration between ministers of health and ministers of the environment that are focused specifically on joint approaches to improving human health.

I can see the health sectors of our countries accepting the need for their efforts in health sector reform to result in a more equitable distribution of health goods, and the state accepting the responsibility for the discharge of essential public health functions. We will see a wider acceptance of the thesis that health is an important contributor to human development, and national as well as international development agencies will direct their attention even more to the health of the people and ways to improve it. Those of us who see gender inequality as a societal issue will take heart from the wider acceptance of the belief that gender diversity is essential for health development, and women will assume roles in health beyond their traditional ones.

Having surveyed the surroundings and taken a new guard, we can now ask, What are the characteristics of PAHO that will make for its continued existence and increase the possibility that it will score another century in fine style?

First, its hemispheric character is a strength. We are more fortunate than other regions in that we have a geographically defined limit, and the notion of pursuing a Pan American ideal has a long history. The importance of the hemispheric approach and the concept of health as a hemispheric venture has been emphasized repeatedly in various presidential summits that have also validated the usefulness of the inter-American institutions.

The focus of PAHO on information and the use of information as a tool of technical cooperation has been one of our Organization's strengths from its inception and will continue to be such. The growth in the importance of information as power, coupled with the ever expanding availability of technology, will further strengthen our capacity to assist countries in knowing what problems the people face and what measures must be taken to address those problems. Our use of information and the accompanying technologies will not merely be passive, but will also contribute to changes in the behaviors that account for so much of the morbidity and mortality from the diseases that appear within the epidemiologic mosaic.

Another strength must be the nature and caliber of human resources. Over the years we have seen a greater disciplinary diversity as the nature of the health problems we face has changed. We have a greater appreciation of what is meant by our technical cooperation and of the means by which such cooperation is played out not only between ourselves and our countries but also between our countries. The deployment of these human resources such that the Organization has a physical presence in the countries must be another one of our strengths. The countries see the face of PAHO and feel its presence beyond the cold documents that are the inevitable product of any bureaucracy.

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