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—from Epidemiological Bulletin, Vol. 21 No. 3, September 2000— Tribute to Dr. Abraham Horwitz (1910-2000)Dr. Abraham Horwitz, a world-recognized expert in public health and nutrition who served as Director of the Pan American Health Organization (PAHO) from 1958 to 1975, died on 10 July in Washington, DC. He led PAHO through a period of important political, economic, and social changes. Through his important work in the field of public health, he emphasized the relationship between health and economic development, the strengthening of health statistics and the importance of health services organization. Dr. Horwitz also considered epidemiology as an essential tool for the progress of public health and promoted its development in the Americas. He believed that “the solution to many health problems in the Americas will be found using epidemiological processes.” In 1961, during the Symposium on World Medicine at Yale University, he presented three areas of epidemiological practice that became the axes of the development of epidemiology in the Region of the Americas over the last decades: the practice of epidemiology in health services, epidemiological research, and training in epidemiology. PAHO’s cooperation strategy for the strengthening of national epidemiological capacities in the countries of the Region was defined from these perspectives. In the 1980s, the main aspects of this strategy included the support to technical cooperation for the development of direct epidemiological services in the countries, the dissemination of epidemiological information, the support for resources mobilization and cooperation among countries, the collaboration with the countries to determine research needs, and the reorientation of existing training programs in medicine and public health. In the area of research in particular, Dr. Horwitz was precursor of the collaboration among countries, when he promoted what he called “an intellectual common market.” Various studies emerged from these ideas, such as the multicentric infant mortality studies directed by Puffer and Serrano and others on malnutrition in conjunction with infectious diseases directed by Mata and Scrimshaw, among others. During the 1980s, the role and practice of epidemiology were debated in multiple national and international forums. The strengthening of epidemiology has been dependent on the situation of epidemiological practice in the countries, the capacity for health situation analysis, and the response of existing health systems, their limitations and their prospects. Just as Dr. Horwitz described in 1961, many countries of the Americas continue today in what has been known as an epidemiological polarization, where communicable diseases persist and chronic problems occupy a critically important and increasing place. This situation continues to impose great challenges on epidemiology, which must continue to further the knowledge and explanation of different health profiles in order to facilitate the decision-making process in health policy formulation, systems organization, and in the design of interventions aimed at resolving specific health problems. In the area of health services systems, one of Dr. Horwitz’ special interests, the consensus that appeared in recent decades is that epidemiology should intervene in four general fields: 1) health situation analysis, 2) epidemiological surveillance of diseases and other health problems, 3) causal and explanatory research on specific health problems, and 4) assessment of the impact on health of services and other actions. In other words, it should provide an adequate access to the scientific information generated in the countries and put together a training strategy for epidemiology oriented towards action. Epidemiological activities at PAHO still aim at strengthening the analytical capacity and management of health programs and services. The role of epidemiology includes the generation, analysis, dissemination and utilization of strategic information that allows evaluation of the health situation and its trends, to identify the presence of needs and inequalities in health, and to establish effective health actions. The major lines of action include the reorganization and operation of epidemiological and health statistics services, surveillance of the health situation in the Region, production and dissemination of health information, support to training, research and development of methodological instruments, and to health impact assessment. The definition of epidemiology proposed by Dr. Horwitz, as a science that “encompasses all humans interactions with their extended and immediate environment, both in a healthy and sick state” remains valid. He also said that “the principles on which [epidemiology] is based have remained stable” and that the only variables are “the changes and the adaptation to the environment” of all living things, which determine the appearance of diseases. However, epidemiology has become an even more dynamic discipline that makes use of many of the technological and conceptual developments of the last decades. In 1998, Dr. Horwitz described health as “a social product that is the responsibility of all” and that “requires cooperation of spheres of interest outside health.” Similarly, today’s epidemiology has to collaborate closely with other actors inside and outside of the health field, such as health services managers, and their alliance produces policies and strategies that have the greatest impact on the well-being of the populations. The use of new technologies such as Geographic Information Systems in public health now provides new prospects for the analysis of epidemiological data. Through the pedagogical use of Internet for training related to epidemiology, some obstacles to the teaching of this science have also disappeared. Dr. Horwitz’ visionary perspective on epidemiology will remain as a legacy for new generations of sanitarians in their work toward the achievement of equitable health. Read Dr. Horwitz' article, "Epidemiology in Latin America," published in 1961 in the Bulletin of the Pan American Sanitary Bureau.
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