Daniel López Acuña

Daniel López Acuña directly oversees 120 staff members in three key areas: Governance, Policy and Partnerships; Planning, Program Budget, and Project Support; and Strategic Health Development. López Acuña graduated from the National University of Mexico and holds a doctorate in public health from Johns Hopkins University. He has worked as an epidemiologist, writer and journalist and joined PAHO in 1986. He sees PAHO in the 21st century as an organization of new challenges and alliances that continues to be an inspiration for public health workers throughout the continent.

When did you first become interested in public health?
When I was 7, I received your classic doctor's bag as a present. I was definitely going to be a doctor. Years later, when I started medical school at the National University of Mexico, I was immediately drawn to public health and community and preventive medicine. I always viewed health in its wider context of social and economic problems. So I always wanted to go beyond clinical medicine, where you see individuals one by one in a clinical setting. Epidemiology seemed the appropriate specialization, with a focus on health planning.

Were you involved in politics during your university years?
I started medical school in '73. It was a very intense year, because the university was reopening after a 12-month strike. There was a lot of student activism. There were 5,000 of us entering medical school, so it was really a macro-school and very active, very connected with the rest of Latin America. Politics was really in the air, part of the legacy of the student movement of '68. And we won some major student demands.

I understand you began your writing career at medical school.
I started writing about social medicine in magazines and newspapers. I wrote a weekly column for El Nacional in Mexico and for El País in Spain. In 1979, I wrote La salud desigual en México ["Unequal Health in Mexico"], which was published as a text book in three editions. It brought together a lot of my journalistic writing about social problems related to health in my country—inequalities, differential access to services for different population groups. I also edited a collection of essays by classic authors in public health, called Salud y sociedad ["Health and Society"]. It circulated widely at a time when there were not many texts on public health available in Spanish.

Was your journalism experience useful in your later work?
Journalism taught me to systematize my thinking—both mentally and in written expression—and to write the ideas I want to convey as clearly as possible and under time pressure. To this day that experience helps me to systematize and convey my ideas.

Your image is that of a political as well as a technical person. Is that correct?
If that's the perception, I agree. I very much value technical excellence, but I have always been interested and active in policy and politics in the broadest sense of the word. For me, health policy is a key subject.

Before you joined PAHO, what did you think of the organization?
For me, PAHO was always one of the major reference points and paradigms in public health at the regional level. It was a true icon of joint work among countries. On a personal level, my first visit to the organization was a dream come true. Seeing and talking with those experts I had read and heard in seminars in Mexico turned out to be essential for my career. Moreover, PAHO gave me the opportunity to study; I bought my books at subsidized prices through the Expanded Textbook and Instructional Materials Program [PALTEX].

Photo by Armando Waak/PAHO

Do see PAHO's mission changing?
PAHO has evolved with the times. What we've seen is that today countries' national capacities are more developed and, for that reason, the organization has to produce value-added. It has to find its ecological niche if it is to stay relevant and make new contributions. Forty years ago, the level of institutional development in public health was much lower. I think we have to see it as very positive that the gap between national institutional capacities and international capacity has been narrowing, because we have helped build these national capacities.

So it's a success story for technical cooperation?
Success is closing down programs that are no longer relevant and finding new areas of action. PAHO is looking for these new areas at the same time it is consolidating its space as a continental forum. Definitely, for the public health work force, PAHO and the actions it promotes are authoritative voices.

You see PAHO's mission clearly.What is your mission?
At this point, my responsibility is program management, trying to structure in the best possible way the work of PAHO's governing bodies. Also, producing medium- and long-term strategies and policies for meeting the countries' demands and needs. Another responsibility I have is to search constantly for strategic alliances and to develop relationships, with the idea that international cooperation in health should be carried out with diverse partners in order to maximize PAHO's work. The task, in short, is to translate policies into budget programs that allow us to carry out work in all areas at the country level. And to prepare a regional budget program that emphasizes support for the neediest countries.

What are the budgetary effects of the new country focus?
The idea is that 40 percent of the organization’s resources be directed toward country programs, that these programs receive direct financial support for their execution. PAHO depends not only on quotas but also on mobilizing resources to more or less match the quotas, and this is something we do directly with donors: banks, foundations, the private sector, etc. In this sense, we have signed umbrella agreements with USAID, with the governments of Spain, Sweden and Norway, to strengthen our programs and to bridge the gaps that sometimes appear in our regular finances. We also have gained greater access to funds from WHO; we have received $15 million in the last 12 months, a figure that exceeds what we got in the previous biennium.

Is that primarily for programs that address the Millennium Development Goals?
The millennium goals are our frame of reference. They're often thought of as being directed at the least-developed countries, like those in Africa and Southeast Asia. But I think they are of central importance in Latin America and the Caribbean, where there have been setbacks in many health indicators—for example, in nutrition and access to potable water. If we don’t make important changes in investments in health, the region will not be able to meet the MDGs. We need to change course to reverse the situation, because 50 years ago there was less inequality than today. We cannot allow ourselves to regress when it took so much to achieve what we have. We have to correct this regression right away.

How do you envision PAHO 50 years from now?
I think PAHO's role will be more normative and multilateral, and less tied to assistance. It will have a more central role in scientific and technical exchange and in creating norms for joint action in public health and for the development of global public goods. I think its work in institutional development and capacity building will diminish.

What is your chief motivation in your work?
People are always my inspiration. Sometimes the sheer pace of work can make me feel distant, but the closeness of faces, perceptions and concrete needs remains the motor that drives my daily work.