"Focusing on Primary Health Care"
Interview With Dr. Mirta Roses Periago, Director of the Pan American Health Organization, January 2003
Could you explain what PAHO is and how it works?
The Pan American Health Organization is a very creative instrument that the 11 founding republics of the Americas imagined and built very early in the last century. It is a mechanism to bring together the countries, set common objectives and ideas on the health situation and the goals that they would like to achieve, and then work together in order to get there. The Organization works by pooling the resources, knowledge and experiences from the countries of the Americas and sharing this information and knowledge so that they can work together and collectively achieve what they have decided.
You are the first Argentine and the first woman to be Director of the Organization. Could you tell us how it feels to be the first woman in charge of PAHO, and if you feel a special commitment as a woman?
As you say, I will be the first woman and the first Argentine to be sworn in as the Director of the Pan American Health Organization. It is a little scary, because one sets high standards and commitments for oneself and because the people that surround you have high expectations. I am confident that the people who have expectations are ready to support me in the work that I am going to do, that they are feeling confident that I will listen, and that I will bring all the experience of my career and my knowledge of the Organization, the countries and public health to this job. At the same time, I do think that as women we can contribute to a different style of management. We can be more transparent, we are not afraid of showing feelings, passion, happiness, and emotional intelligence because everybody expects that women will use their emotional intelligence in management. I do hope that I will be able to help men to use their emotional intelligence because they have it.
What do you consider as the top priorities, the subjects that you will focus on when you take the leadership of the Organization? What do you think are the most urgent things to deal with, the first things that you really want to do?
As soon as I get into the office February 3, I think that, of course, the first thing will be to look at the Organization itself, although I know the Organization quite well. There are always things to set from the very first moment, and that is to transmit the vision and the goals that we think that are the ones that this Organization and the countries require at the beginning of the 21st Century. So that is very important for everybody to share with the leadership, and so we can put our brains and our enthusiasm, our energy immediately to work. One of the things, undoubtedly, will be to get in touch with the political leadership of the Hemisphere because as you know, we are living in an era where everybody wants to have direct contact with the leadership and among the leadership. That is why we have so many summits. At the same time, I would like to center the attention of the Hemisphere this year, the year that we will celebrate the 25th Anniversary of the Conference on Primary Healthcare in Alma-Ata. I want to focus the attention of the Hemisphere on the millennium goals and to the contribution of health to the millennium goals as well as the experiences, successes and failures that the Hemisphere learned during these 25 years of primary healthcare since the call for Health for All. I would like to call for a renewal of that important political commitment of Health for All and reflect on the meaning of Health for All at the beginning of the 21st Century.
In speaking of Health for All, how do you see the situation of the groups that have been the most neglected from the standpoint of public health?
The vision of the Americas is a very special region, because in spite of all the public health achievements and successes that the Hemisphere has in terms of that are reflected in the elimination of diseases, the extension of the life expectancy and a lot of new technologies, innovation, and systems and methodologies that the Hemisphere had been able to develop, there are still tremendous inequities. We have those that have been chronically, historically, marginalized and that we have failed to reach, but at the same time, we also have increased levels of poverty, we have numbers of people that are excluded from the health services for financial reasons, mainly. We also have gone back in certain aspects, particularly in the provision of basic services, like water and sanitation, or even basic services for elderly people that are increasingly showing deficiencies in the Hemisphere. We have the problems now of new challenges, new diseases, but also how to guarantee that the achievements are not lost in the new millennium and that we keep the people at peace with development and access to the new technologies. For instance, we have been very successful in immunization, we have eliminated diseases, but every year new vaccines are being developed. How are we going to cope with this situation and to guarantee that every person in the Hemisphere has access to these new technologies?
Do you consider that public health in the Americas is under-funded?
In talking about financing public health, I think that one of the very important things that the unfortunate events of September 11th have brought to the table is a reflection about the public health infrastructure and its performance. Usually, the only time when people think about these issues is when they feel vulnerable, and so for the last 20 years, most of the people in power and at the decision making level have felt they were very well protected by advances in medical technology and healthcare. The cost of healthcare has been progressing exponentially, at the expense of some public health measures that are low cost and very effective. So one of the things that we need to start discussing and focusing on is the health level and status that we collectively would like to have so that we could feel safe, while strengthening human security and population security. This kind of social discussion would immediately lead to setting ourselves standards and goals in terms of health, in terms of protection, in terms of access to basic health services. We would be able to identify what we call public health goods like nutrition, immunization, safe water, safe blood, healthy housing, and food. Those are good public health goals and standards that we would like to have and share as a society, and we will value the investment in promotion, prevention and protection more than investment at the end of the chain in repairing and containing the damage to health that has been receiving so much of our financing.
Does the Pan American Health Organization have something to contribute in the area of public health infrastructure and security, in particular, after the September 11th terrorist attacks on the United States and the fear of biological, chemical or nuclear terrorist acts?
In terms of human security and hemispheric security, I think that health can contribute a lot not only to the measures, but also to reflection and thinking about the issue. We have, for instance, worked together for the elimination of measles. For the last 10 years the number of measles cases imported to the United States has been dramatically reduced to the point of disappearance. That is an indicator of national security and vulnerability which links us to the concept that we are safe when the people that surround us care for us, when they are safe, we are safe; when they are healthy, we are healthy. This is a very important concept that I would like to share and that has been the basis for the United States to contribute so much to the Pan American Health Organization and also to commit its own human and technical resources and share them with the rest of the countries in the Hemisphere. The basis for the solidarity, for the sense of safety in a shared world is there, and it has been always there since the inception of the Organization itself. Everybody wins when the society, the community is healthy, is well educated, and is capable of working and trading, of sharing resources. These are the things on which we base our work. We also share experiences about good public health infrastructure, the importance of a network of laboratories and a network of trained physicians to detect outbreaks, to identify pathogens, to be able to respond to the community. We also know the importance of public health communication, risk communication and public health information, because those are the things that provide for awareness in the community. They are definitely the starting point for the protection and the defense of the individuals and the communities.
Should we be using more social communication in public health?
In public health, the role of social communication is really crucial, especially in three areas. One is for behavior change; we really have to use much more social communication if we would like to see the kind of changes in communities and in individuals that are needed to adopt healthy behaviors. The other area is communication of public health information, new developments and scientific information that need to be transmitted in a way that people understand, that they can use in their own responsible attitude; to change their own minds, but also to change beliefs and to replace them with new evidence-based knowledge that is so important. The third area is communication among workers, among health institutions, communication in networks that are responsible for learning, sharing experiences, and developing new ideas. In this world, as you well know, with information technology, one of the results of financial development and growth of scientific knowledge and technological innovation has been as a result of better communication among communities, among peers, among people who share the same worries, that are interested in the same problems, and that are searching for solutions.
What do you consider some of the main health problems that the Americas face?
The Region of the Americas is facing very challenging times because it has a mix of different problems that need to be addressed. This is an organization that is very much centered on the priorities and demands from its member countries, and member countries are not at the same level of development, so for us it is very difficult to establish a short list of priorities. What we say always is that we have global priorities, we have regional priorities and of course, there are country priorities and even priorities at the sub-national level. The first regional priority is to protect what we have achieved. If we do not call on governments and communities to protect these things, we can have serious problems because poverty levels and the level of access of the population to basic health services and to basic vital services is a worrisome situation in the Hemisphere right now. The second thing is to draw attention to forecasting what comes ahead. What are the problems that we already know some countries are facing that will become common issues in most of the countries, so that we can act collectively before we are faced with a tremendous burden? What are the health problems that derive from the age of the population and the healthy life styles? We are talking about chronic diseases, we are talking about the need not only to protect children, but to link the problems of children with problems that the aging population is facing now and the children of tomorrow will be facing. We are talking about improving health through nutrition, an active life style, a safer workplace and prevention and early detection of diseases so that people can enjoy not only longer but also healthier lives.
Was there a defining moment for you in your decision to study public health and in your career as a regional health leader?
One of the critical moments was the large polio epidemic in Argentina in 1955. I remember very well the panic. Different cities or communities or provinces which did not have cases were closing roads to people escaping from areas where there had been polio cases. It was really a panic situation. I learned about risk, vulnerability and solidarity. But I also valued the response of the community at that time. Later on when I decided to study medicine, at first I thought about pursuing surgery, but then I realized that was very routine and focused on individuals, with very little power to change the situation in a sustainable way. Then I started thinking that infectious diseases were the area that expressed in a better way those principles that I acquired during the polio epidemics. That orientation was also influenced by my professors and mentors. When I told my father that I was going to go into infectious disease and tropical medicine and not into surgery, he said I would not find work because infectious diseases were disappearing. I told him I was not in this for money and I liked the work in infectious disease and tropical medicine. My father called me the first time he read about HIV/AIDS. I was already a professor of infectious diseases and expert in tropical medicine. I was in Trinidad and Tobago, and I had already seen my first case of HIV/AIDS when my father called me and said, "I read an article in the newspaper about the new disease and I want to tell you that maybe you were right when you decided to go into infectious diseases."
Thinking ahead, after you finish your term, what would you like your legacy to be, what would you like people say that you did at PAHO?
At the end, well, five years is a very short time, but one has to be very realistic about the changes that one can make or at least the seed that one can plant. Maybe you won't see the tree, but you can plant the right seed on the right soil for others to nurture. We are just one step in history, but we have to be responsible for the time frame that is allotted to us and I have to honor what the previous directors of PAHO have done, all of them in a very important and in a very transcendent way. This is a very important time because it is a symbolic time, we are at the beginning of the millennium and the first steps are the ones that put us in the right direction. One of the most important things is to strengthen the relationship with the countries and to focus our attention on the countries because they are the basis, the most important and strong component of the life of the Organization. The other critical thing that I would like to rebuild is the trust among the countries. At the beginning of the Organization, that was the prevailing value. When you have an organization to share information among nations, it requires trust, and that is something that in the last years and especially after September 11th is very important to rebuild. We depend on the flow of information among the countries and they have to value the importance of being together, of sharing information, of making good use of the information and understanding that everybody wins when you share information, resources, and problems. The solution to your own problems will eventually come from the sharing of these resources and experiences, and not only from the strength that you have within your boundaries. The third thing is the enthusiasm, passion, the satisfaction of the people who work within and with the Organization. I think that the most important thing is to light the flame and keep it alive of the commitment and the joy of serving the countries in the area of public health. If you have those three things, the focus on the countries, the trust among the countries and the flame in the people working for and with the Organization, I think that the millennium will be a wonderful one.
To Learn More:
Biography of Dr. Mirta Roses Periago
Dr. Mirta Roses Periago Photo Gallery
Video Interview With Dr. Mirta Roses Periago
Sound Bytes for Radio Stations