The Lancet Editorial - Rediscovering the Americas

The Americas is now the most urbanised region in the developing world, with 79·4% of its 556 million inhabitants living in cities and towns. Six of the world's largest cities are in the region: Buenos Aires, Los Angeles, Mexico City, New York City, Rio de Janerio, and São Paulo. And nearly 31% of the urban population lives in irregular settlements arising from rapid and unplanned urban growth. In recognition of the region's changing landscape, governments promised to develop urban health policies to address issues such as air and noise pollution, unhealthy environments, and violence. They also promised to reform urban health services to promote and improve coverage, especially for vulnerable groups.

Ministers agreed a plan of action to reduce another side-effect of rapid development: increasing road traffic injuries. Such injuries are the leading cause of death in children aged 5—14 years in the western hemisphere. The plan calls on countries to update legislation on the principal risk factors of traffic injuries: excessive speed, alcohol consumption, and non-use of seat belts, helmets, and child restraints. Countries took further action on alcohol, with approval of a strategy that promotes measures including increased taxes on alcohol sales, restrictions on marketing, and training for primary health-care workers in screening and treatment for high-risk drinkers. Such steps are desperately needed in the region. According to WHO, alcohol consumption was the leading risk factor for deaths and illnesses in the Americas in 2004 and was responsible for more than 347 000 deaths.

Some of the region's older foes, such as malaria, were also the subject of discussion. Governments pledged to maintain the region's reduction in malaria cases and deaths by stepping up efforts in malaria prevention, diagnosis, and rapid treatment. As The Lancet's recent Series noted, malaria elimination using present control methods seems most feasible for countries in the Americas. Renewed regional commitment to tackle the disease is therefore welcome.

The Americas could certainly be the region to watch when it comes to its efforts to tackle both infectious diseases and newer burdens arising from increasing development, such as non-communicable diseases (NCDs). Countries already have an impressive track record in tackling vaccine-preventable diseases. The Expanded Program on Immunization in the Americas, thanks largely to leadership from PAHO, is one of the most successful vaccination programmes in the world, achieving the elimination of endemic poliomyelitis in 1991, measles in 2002, and rubella in 2009. Although imported cases of measles and rubella are still recorded in the region, effective mass vaccination programmes have prevented their expansion. Other regions and nations that are striving to increase vaccination rates have much to learn from the experience in the Americas. China has already seized this opportunity, sending a delegation to PAHO last year before embarking on its nationwide measles vaccination campaign targeting 96 million children.

A PAHO/WHO report, Non-Communicable Diseases in the Americas: Building a Healthier Future, released at the recent UN High-Level Meeting on NCDs in New York draws attention to several country models that could be replicated in both higher-income and lower-income countries. For example, the Central America Diabetes Initiative, which focuses on improving the clinical skills of health providers and providing education and support to communities for people with NCDs, has helped to prevent premature deaths among people with NCDs in Guatemala, El Salvador, Nicaragua, and Honduras. Brazil too is registering reductions in age-standardised NCD mortality after implementation of policies to decrease tobacco smoking and expand primary care, as highlighted in The Lancet's Brazil Series.

Although there are many successes to celebrate, the region's continuing struggles with NCDs, infectious diseases, and poverty should not be forgotten. This diverse region includes some extremely poor nations, such as Haiti, which ranks 145th of 169 in the UN Human Development Index, and whose plights can be overshadowed internationally by crises in African nations. There is much to be gained in rediscovering the Americas, remembering both the lessons learned from its health successes as well as the formidable challenges that it still faces.