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The Next 100 Years
The months leading up to the centennial of the Pan American Health Organization (PAHO) have offered an extraordinary opportunity for reflection, for examining the deep public service roots of what is today the oldest ongoing international public health agency in the world. We know well how, at the turn of the last century, the nations of the Americas faced plague, yellow fever, malaria and cholera. We are awed by and salute those who fought back and made a difference. In founding PAHO in 1902, these Pan American health pioneers saw, in the words of World Health Organization Director-General Gro Harlem Brundtland, "that no country not even the strongest among them will benefit from standing alone."
Throughout the past century, public health workers across the continent joined forces in a grand venture to make the Americas a better place to live. They healed the sick and halted epidemics, traveling by horse, boat or foot, delivering vaccines, looking for signs of new diseases, cleaning up pestilent swamps, teaching the poor how to avoid disease and assessing health conditions. Their successes were legion even as their challenges mounted. They fought to reduce the pernicious inequalities that resulted in unacceptable numbers of children and mothers dying, and they lobbied to underscore the links between health and development.
The century of important achievements in health in the Americas is worthy of celebration, but we must continue to look ahead to the daunting challenges we still face. In this special issue of Perspectives in Health, the focus shifts to the future, honoring PAHO's centennial by looking at the future of public health. These glimpses of the future are imaginative and authoritative, written by distinguished authors who have agreed to share not only their knowledge but also their bold willingness to prophesy developments that might affect the future of public health.
The tone of this special centennial edition is set by PAHO Director George Alleyne, who assesses the prospects for another century of Pan American cooperation in health by first surveying the current state of public health in the Americas. Far from predicting Armageddon, Dr. Alleyne's analysis leads him to conclude that the trends we have observed in the recent past can be used as portents of a much rosier health future for the Region.
Sir Gustav Nossal, Australia's eminent vaccinologist, draws on the nearly two centuries of efforts to develop vaccines against all manner of disease, the most notable being smallpox globally and polio in the Americas. In forming predictions, Dr. Nossal points to promising new alliances, particularly the public private philanthropic partnerships for vaccine research and development that have taken root in the last several years. He discusses the importance and likelihood of developing and delivering new vaccines, especially for HIV/AIDS, malaria and tuberculosis.
Following the ebola outbreaks in Africa several years back, the world seemed consumed by fears of hemorrhagic fevers and other emerging and reemerging diseases. Dr. C.J. Peters, the virus hunter who was called on to confirm those outbreaks, makes no effort to quiet our fears in predicting a future full of microbial surprises. His essay highlights the critical links between health and the environment and the pressing need to bolster public health infrastructure.
The burgeoning field of genomics, perhaps as no other, allows us to see today some of the marvelous possibilities of the future. Juan Enríquez and Rodrigo Martínez, of Harvard Business School's Life Sciences Project, point out that DNA-embedded silicon biochips can already screen for individual genetic defects, while in the near future the antigens in mosquito saliva could deliver vaccines instead of disease. Yet availing ourselves of the marvels of the so-called life sciences revolution, they warn, will require major investments in science, technology and research.
Dr. Ilona Kickbusch, a leader in the field of health promotion, notes that in the late 20th century, public health increasingly turned its focus toward prevention of disease and promotion of healthy lifestyles. Building on its successes, health promotion in the new century will incorporate community participation, individual and social empowerment, and the actions of diverse stake-holders in a reoriented health system. Dr. Kickbusch questions where our health choices might take us and just how far the search for better health should go. Asking, "How do we want to live?" she poses perhaps the question for the future, not just for public health, but for humanity.
The authors in this issue lay a solid foundation for further discussion by posing questions, posturing predictions and offering suggestions about the paths we might take to the future. But in describing new visions, their words also recall those who came before us: the men and women who strove to make sure that children would not be scarred by smallpox, who set out to vaccinate whole countries on a single day. As we in international public health brave the future, we follow in the footsteps of those pioneers, heeding the words of Winston Churchill: "We shall not fail or falter; we shall not weaken or tire. Neither the sudden shock of battle nor the long-drawn trials of vigilance and exertion will wear us down. Give us the tools, and we will finish the job."
Bryna Brennan
Executive Editor
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