A Window on History, Health, and Change

Anne-Emanuelle Birn holds the Canada Research Chair in International Health at the University of Toronto. She was a resident in PAHO's Training Program in International Health in 1994 and wrote this memoir of her experience for PAHO Today.

As a historian of public health in Latin America, I found PAHO's international health residency to be an incredible opportunity to bring history forward—in the sense of understanding the current dilemmas, debates, and developments of the field—and to bring the challenges of the present to the past, that is, examining the historical roots of contemporary international health issues and exploring dimensions of the past revealed by contemporary international health ideologies, practices, and institutions. While I had had extensive research experience in Mexico and had worked in several AIDS policy positions in the United States and Spain, I had little firsthand knowledge of the international health field in Latin America.The PAHO residency opened up vast areas for me, both intellectually and substantively.

During my residency, I had the great fortune to work with Alberto Pellegrini in the Research Division, developing a new initiative on the history of health reform in Latin America. Given the reform processes most health systems were undergoing at the time—and the crises faced by the health sector in many countries of the region—the initiative was aimed at incorporating a historical perspective into health reform. On one level, historical analysis could contribute to understanding why and how public health systems had developed over time and help explain current configurations and dilemmas. On another level, a historical perspective could offer ideas about the potential successes and pitfalls of reform in particular contexts and junctures of time. At yet another level, the initiative was designed to stimulate social and political historians in Latin America to take on public health as a principal subject of inquiry, both in terms of the substantive issues raised and as a window on societies undergoing change.

We developed a three-pronged strategy to promote the initiative, through: a research competition on the history of health reform, open to historians of the region; a bibliographic database of secondary work on the history of public health and health reform in Latin America, institutionalized at the Casa Oswaldo Cruz (Fiocruz) in Rio de Janeiro; and a model syllabus for a course on the history of public health in Latin America, which the Peruvian historian Marcos Cueto and I published in História, Ciências, Saúde – Manguinhos. For me, this was an unparalleled opportunity to get to know the historians and histories of the entire region, and I am delighted that the network of scholars created through the initiative has proven durable. In May 2005, a conference at the University of Toronto on "Latin American Perspectives on International Health" brought many of these historians together again for discussion and further scholarship.

Without a doubt, the highlight of my residency was working with my eight fellow residents; I remain in close contact with at least half of these wonderful colleagues. The mix of their backgrounds, national origins, and experiences and our interactions in formal training and educational activities and on health study trips in the United States, Canada, and the Caribbean contributed invaluably to our international health learning.

More than a decade later, I find myself continually influenced by the ideas we discussed during the residency year, and I remain professionally connected to the people with whom we worked. This legacy of intellectual and professional continuity is but one element of the incredible vision and foresight of PAHO, and especially of María Isabel Rodríguez, in launching the residency program in international health.

Related article:
Two Decades Shaping Health Leadership in the Americas