—from Epidemiological Bulletin,
Vol. 23 No. 1, March 2002—
Editorial: 100 Years of Epidemiology
at the Pan American Health Organization
This year the Pan American Health Organization (PAHO) celebrates
100 years of work dedicated to improving public health in the Region of the
Americas. In this edition, the Epidemiological Bulletin presents a synopsis
of the most important facts related to PAHO’s role in epidemiology and health
information during the past century. These facts also highlight the areas of
work for which the countries have requested special efforts in the future.
Stemming from the countries’ concerns about the increasing burden
of contagious diseases and the need for international collaboration to prevent
their dissemination, the Pan American Sanitary Bureau (PASB), PAHO’s technical
arm, was created in 1902 during the First International Sanitary Conference
in Washington, DC. In 1907, the compilation and communication of public health
information was mandated as one of the strategic functions of the Organization.
As a result, PAHO was transformed into a center for exchange and distribution
of information on health problems in the countries of the Region.
The first issue of the Pan American Sanitary Bulletin
(that evolved into the current Pan American Journal of Public Health)
was published in 1922. Initially, this publication presented a global summary
of infectious disease notification. In response to social and economic consequences
of the crash of the New York stock market, the Weekly Sanitary Reports
were created in 1929 as the first systematic reporting of this nature.
An important milestone in PAHO’s history was the ratification
of the Pan American Sanitary Code in 1924. The code provides a solid legal base
for the fulfillment of its functions and defines procedures and guidelines to
curtail the spread of disease in the countries of the Region. As a result, PAHO
urged the countries to establish statistical services for mortality and morbidity,
and medical services at ports of entry to diagnose contagious diseases. At the
end of the 1930s, the first assessments were done on the collection and use
of vital statistics for public health purposes and recommendations were given
for the standardization of diagnostic methods and disease registration. Through
this process, the foundations were laid for the development of public health
surveillance, now recognized as an essential public health function. To complement
information routinely generated by the countries, PAHO established technical
services to study public health problems and, in 1946, established the Institute
of Nutrition for Central America and Panama (INCAP).
In 1950, PAHO became the WHO Regional Office in the Americas,
and its membership gradually increased. Its mandates for information collection,
analysis, and dissemination were expanded. Information gathering was discussed
in 1911, but the first evidence of health situation analysis on different aspects
of health (such as health problems, or resources and response of the health
services) in the countries of the Region was the first publication of “Health
Conditions in the Americas “, in 1954. This publication still represents one
of PAHO’s most important and continuous efforts to analyze and disseminate health
information. It culminates this year with the publication of “Health in the
Americas, 2002”. The interest and use generated by this publication is highlighted
by the more than 500,000 users worldwide that have consulted the Spanish and
English versions on the Internet since 1998.
The PAHO electronic vital and health statistics databank was created
in 1956, as an essential resource for health monitoring and analysis. The databank
has continued and evolved into a more comprehensive system that, starting in
1996, presents not only mortality, morbidity, and population information, but
also a Regional Core Health Data and Country Profile System. Besides, socioeconomic
information, this system integrates health risk factors, resources, access,
and coverage of health services. It is available on the Internet, by means of
a prize-winning tabulator. In an effort to revitalize the national vital and
health statistics systems, the Regional Advisory Committee on Health Statistics
was recently reactivated to guide and assist work in this area.
In 1979, in a changed epidemiological context and with the availability
of more advanced information and communication technology, PAHO discontinued
the publication of the Weekly Sanitary Reports. Subsequently, the role
of reporting on infectious diseases globally was assumed by WHO through the
Weekly Epidemiological Record. In 1980, the Epidemiological Bulletin
was launched, and for 22 years it has disseminated relevant information
about the practice of epidemiology (such as health situation analysis, methodologies
for analysis and presentation of information, guidelines on public health procedure
and standards) as a response to the changing needs of the health services in
the Region.
The 1980s were an important period for the practice of epidemiology
in the Organization and the countries. In November 1983, during a seminar in
Buenos Aires (Argentina), the state of epidemiological practice for the control
of diseases, health evaluation, and services planning was reviewed. Its implications
for the progress in research, training in epidemiology, and the development
of services were analyzed. In the countries, the results of the meeting had
an important impact in the production and dissemination of knowledge through
publications, scientific and epidemiological congresses, training of human resources,
and the expansion of the practice of epidemiology in health services. As a result,
workshops and national meetings in epidemiology and for the strengthening of
health situation analysis were organized in the countries of Latin America and
the Caribbean.
Responding to identified needs in training, the first Modules
of Principles of Epidemiology for the Control of Diseases were produced. A second
edition will be published in 2002. In 1991, PAHO commenced a Summer Session
in Intermediate Epidemiology. This program reached its 12th session in 2002,
and has already trained more than 350 epidemiologists in the Region. Taking
advantage of computer and communication technologies that reduce the difficulties
linked to distance, starting in 2000, PAHO has offered training courses in epidemiology
through the Internet. Even though the needs for qualified human and technical
resources for health analysis still exist, another challenge facing epidemiology
is its use as an indispensable tool for the management of health services. For
this, health situation analyses must be integrated and translated into an accessible,
specific, and effective format, allowing for the rational orientation of political
decisions. This could in turn lead to the reduction of health inequalities,
convergence of health interventions in the most vulnerable areas and population
groups, evaluation of the efficiency of health interventions, and orientation
of health plans and programs based on evidence and population needs. PAHO is
producing methodological guidelines to facilitate health situation analysis
and is generating technological tools (communication networks, geographic information
systems, and information analysis systems to mention a few) that will facilitate
and support this process. Country experiences will be an additional input that
will further develop this process.
For 100 years, the Organization has adapted to changes in the
health situation and to the needs of the region’s population. Initially based
on the control of infectious diseases, PAHO’s technical cooperation evolved
to include other diseases and dimensions of health such as health services,
policies and financing, environment, nutrition, and healthy practices. Throughout
the years, the practice of epidemiology has always had a significance in the
activities of the Organization, among other things through constant efforts
to compile and improve the quality of information, production of routine and
special studies, and the wide dissemination of this information. Epidemiology
also has evolved conceptually and methodologically. The definition of the use
of epidemiology has extended from a critical instrument for the prevention and
control of diseases to an intelligence tool for the holistic understanding of
health, orienting priorities, utilizing resources rationally, and strategically
conducting health services. Today, the training in and practice of epidemiology,
and the production of health situation analyses and dissemination of relevant
health information in the countries of the Region use new technology such as
the internet. With these advances however, the epidemiological vision remains
the same and PAHO’s cooperation efforts are still directed towards improving
the level and distribution of health of the peoples of the Americas.
Return to Index
Epidemiological Bulletin, Vol. 23 No. 1, March
2002
