His career in international public health and human development spans six decades-anachievement few can claim. Yet his legacy is still incomplete. As he nears 87 years of age, the words and actions of Dr. Abraham Horwitz continue to inspire those who seek his counsel and request his presence.

On his 80th birthday, Dr. Horwitz invoked the words of Chilean poet Julio Barrenechea to share with colleagues his conviction that the most important years were not those already lived, but those yet to be lived. Since then, he has pressed words into action with an enduring vision that has filled his agenda with noble causes.

The world best remembers Dr. Horwitz as the Director of the Pan American Health Organization (PAHO) from 1958 to 1975, even though this tenure represented neither the first nor the last of the considerable gifts this Chilean doctor would bestow upon us as humanist, scientist, professor, and public leader. Nevertheless, he led the oldest continuing international public health agency in the world into a time of sweeping political, technological, and social change. The Cold War. Woodstock. The walk on the moon. In our Hemisphere, the Alliance for Progress, and the birth of sovereign nations throughout the Caribbean.

At the close of the first millenium, the days in the life of Dr. Abraham Horwitz start early as always. The desktop in his office on the top floor of the PAHO Headquarters building in downtown Washington, D.C., is far from bare; nor is it excessively neat. On it rest numerous works in progress by the chairman of the International Vitamin A Consultative Group and president of the Pan American Health and Education Foundation. He is also fully engaged as Special Advisor to PAHO s current Director, Dr. George A. O. Alleyne.

In his every motion, Dr. Horwitz has a plan. He acts with the profound inner conviction that his great battles for better health in the Western Hemisphere are designed with a clear notion of an expected result. He acts with good reason: his visionary plans and ideas for harnessing the future of public health through persistent and disciplined research; his observations on the relationship between health and wealth and, conversely, sickness and poverty; and his tireless promotion of the integration of health, as a social good, into economic development, are all part of his living legacy-a legacy that becomesincreasingly valid with each passing day.

You are considered a pioneer of the health and development concept. Are these areas truly united today?

Their linkage is essential if we wish to make the world a better place to live, and I am honored that this idea is attributed to me. It is inconceivable to think of a development process that does not prioritize health. Have we achieved this unity? I am not certain. There still is a long road ahead. There are significant sectors in society that have not yet fully embraced this concept, including governments and communities. Therefore, there is a task ahead for PAHO in tirelessly promoting its quintessential message: without health, there is no development. I believe Dr. Alleyne is giving this message a new resonance. His sincerity is palpable.

The development of high-quality medical and scientific research and the exchange of this information among the specialized public health disciplines throughout the Americas are objects of primary concern for you. Within this framework, what effect will globalization have in closing the gap between the developed and the developing countries in the research arena? How would you characterize the current situation in our Hemisphere and what do you see as the role of the private sector, the universities, and the State, regarding this issue?

When I was young, it was said that only the rich were the topic of research.

He smiles. His eyes, which seem to mirror the most profound serenity, also show the strength of a decision-maker. He pauses before continuing:

Naturally, this flawed concept has been discarded, and for good reason. We investigate problems or issues in accordance with their social significance. At least that should be-and I believe it is-the position of international organizations. Before, it was also asserted that research was conducted only in universities. This is not true: research is also conducted in the public services and the corporate world. Research is called for whenever answers are sought; whenever misalignments inhibit human progress and compromise the possibility of social improvements, thereby requiring an effective response. Yet even as our ability to share solutions across geographical boundaries becomes increasingly enhanced, we must accept the Americas vast cultural diversity and recognize the uniqueness of each community s makeup.

In one of your papers on Health For All and the role of the university, you stated that "the concept of health requires an ethical interpretation and an operational interpretation."

Health For All represents a collective moral imperative. Who would want to deny health to others? From that very moment, one is exercising a moral mandate, but how it will be done must be resolved, and this represents an operational process. Here we will have differences of opinion, which is healthy. In other words, it will depend on the perspective of each community, its leaders, and its educators: of the distinct shadings they wish to give to health within the context of their social environment.

Modern thought is beginning to accept that any rational approach to health must go beyond purely epidemiologic issues. International financial institutions, including PAHO, are investing more in health and developing a keener appreciation for the specialized expertise of health economics, sociologists, those concerned with the legal and ethical issues related to health. What is your reaction to this?

I totally agree with that approach. Health does not belong exclusively to doctors, just as wars do not belong only to the generals. Health is a social product that is everyone's responsibility. Therein lies the problem, since one needs viable, feasible, and harmonious planning that ultimately requires the cooperation of spheres of interest outside health­the environment, education, labor, housing, and tourism, to name only a few.

From Punta del Este in 1967 to the more recent presidential summits held in Miami in 1994 and Santiago in 1998, the heads of state of the nations of the Americas have included various health issues in their final declarations. How do we reconcile this apparent concern with the fact that at the close of the 20th century there continue to be significant segments of the population without access to affordable and quality health care, decent housing, and clean drinking water?

This is certainly a lamentable, shameful situation that should not exist. Political leaders are respectable human beings. I recognize that infrastructure requires investments, and that the resources are not always available in the amounts required to respond adequately to these challenges, even though we know their technical characteristics very well. At the same time, the process is political. Politicians have values that lead them to prioritize activities differently from the way many health experts would prioritize them. The task is not simple, although I believe that international organizations such as PAHO have the moral obligation to call the political world s attention to the responsibilities that today's leaders will incur if they do not invest in solving prevailing problems.

What would you like to see take shape as regards health in the Americas?

I would like to see Health For All become a reality, whatever the mechanism, whatever the mode of action. I realize this is not simple. To achieve health for each and every person is a daunting task. The nature of the problems varies, as do the quality and quantity of resources. Human knowledge, attitudes, and behavior are diverse. There are many people who are either unconcerned about health, or unaware of the tools of prevention at their disposition that can protect them from disease and remarkably improve their state of well-being.

What events have most profoundly marked your life?

We were a family of five children-three became doctors, including two psychiatrists. I became interested in social problems and primarily in the achievement of health. When the proposal for Health For All first emerged, I took it very seriously while also becoming aware of its great difficulties. As Director of PAHO, I recognized that on the one hand health was the right of every human being, and that health for some -a deep-rootedreality-was losing acceptance. Yet, on the other hand, I realized we were speaking of fullytwo out of every five persons in our Hemisphere who were without access to health care. The results have varied, because there are factors that international organizations cannot and should not govern. Governments are not static features of life; they change frequently. No two presidents will give the same priority to health, and nearly always they do not give health the priority it must have in order for their countries to achieve the other national goals set during their term in office. In this sense, PAHO must be patient and persistent. Fortunately, governments do change, and PAHO must work to move health higher up on the political agenda.

What does being a medical doctor mean to you?

For me, to be a medical doctor is to be a public servant. This is not to underestimate the contribution of those who dedicate their knowledge and experience to serve the private sector, which is also essential for the public good. I am proud to have been Director of PAHO because of the value that I assign to the Organization and the great privilege it afforded me to serve the countries of the Americas in the social arena, specifically in the area of health.

The 19th-century Cuban writer José Martí once noted that there are men born under a lucky star. They are without ostentation and moderate; their vocation is public service nourished by a spirit of humility. They gaze into a future that is forged from rising above disappointments and defeat. They are removed from good works that unabashedly trumpet their successes and from the world s empty noise that distracts and harms. Theirs is to integrate, link processes, generate ideas and concepts. Dr. Abraham Horwitz is made of this mettle.

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Eugenio Gutiérrez has served as foreign correspondent in Washington, D.C., and Europe for various Latin American newspapers and magazines. Currently he is a consultant in PAHO's Office of Public Information.