A Century of Public Health in the Americas: A PAHO Family Album

Since its founding in 1902, the Pan American Health Organization (PAHO) has been a central part of a century-long pursuit to bring health to all the peoples of the Americas. The world's oldest international health organization, PAHO has a history that is rich with the stories of dedicated individuals who faced major challenges and who, in many cases, achieved remarkable success. This "PAHO Family Album" salutes their valuable work and their accomplishments of 100 years of Pan American efforts in public health.

Originally published in "Perspectives in Health Magazine, The Magazine of the Pan American Health Organization," Volume 7, Number 1, 2002

In July 1902 the Monthly Bulletin of the International Bureau of the American Republics reported on the conference that planted the seeds for the creation of the Pan American Health Organization (PAHO): "The Second International Conference of the American States further recommends...that a general convention of representatives of the health organizations of the different American Republics shall be called...to meet at Washington, D.C., within one year...that said convention...shall designate a permanent executive board of not less than five members...to be known as the 'International Sanitary Bureau,' with permanent headquarters at Washington, D.C."

buletin — Photo courtesy of the Martin Luther King Library,Washington, D.C.

Dr. Carlos Finlay (1833-1915), a distinguished Cuban physician and student of yellow fever, was one of four members of the 1902 organizing committee charged with setting up the new International Sanitary Bureau (the forerunner to PAHO). Dubbed "the mosquito man" by his critics, Dr. Finlay (on the right) had argued as early as 1881 that the mosquito was the sole vector for yellow fever, but he was unable to prove his theory.

When in 1900 Maj. Walter Reed's Yellow Fever Board proved Finlay right, the stage was set for eradication efforts that routed the disease in the Caribbean and allowed completion of the Panama Canal.

Members of the first executive board of the International Sanitary Bureau (clockwise from top) were: Dr. Juan J. Ulloa of Costa Rica, Dr. Eduardo Moore of Chile, Dr. Rhett Goode of the United States, Dr. Eduardo Licéaga of Mexico, Dr. Juan Guiteras of Cuba, and Dr. A.H. Doty of the United States.

Dr. Walter Wyman (center), surgeon general of the United States, became the Bureau's first chairman. His experience transforming the U.S. Marine Hospital Service into a comprehensive national public health agency helped shape the early work of the Bureau, which he headed until 1911.

The 4th Sanitary Conference

The conference's agenda covered inter-American cooperation in smallpox vaccination, malaria and tuberculosis control, national health legislation, and tropical disease research. The final document included this timely call:

"[We] request...of the Governments of the American Republics that they favor the establishment in seaports and important cities of laboratories where not only diagnoses may be made in order to comply with the requirements contained in the resolutions of our sanitary conventions, but where also original investigations in tropical medicine and general pathology can be made along lines which the sanitary authorities deem practicable."

dr blue — Dr. Rupert Blue, Photo left ©U.S. Public Health Service | Photo right ©American Red Cross

U.S. Surgeon General Dr. Rupert Blue (1868-1948) was the International Sanitary Bureau's second chairman, serving from 1911 to 1920.

He had carried out crucial campaigns against bubonic plague in San Francisco (right) in 1902-04 and after the earthquake and fire of 1906.

Yet his years at the Bureau were marked by a decline in inter-American health cooperation, an indirect result of the outbreak of World War I.

Dr Cumming — Dr. Cumming ©U.S. Public Health Service

Dr. Hugh S. Cumming (1869-1948), the third U.S. surgeon general to serve simultaneously as director of PAHO, was a prominent U.S. expert on immigration and quarantinable diseases.

Under his leadership, the Bureau's budget more than quintupled, and its activities expanded to cover a wide range of public health issues.

He was the longest-serving PAHO director, from 1920 to 1947.

Pan American Union headquarters Photo ©OAS — Pan American Union headquarters, Photo ©OAS

PAHO started life in December 1902 as the International Sanitary Bureau, a paper organization with no permanent staff or office space.

By 1921, the Bureau had found a home in the Ibero-Renaissance-style headquarters of the Pan American Union (forerunner of the Organization of American States).

Renamed the Pan American Sanitary Bureau in 1923, the health agency finally became known as PAHO in 1958.

The Pan American Sanitary Code

The 1924 Pan American Sanitary Code was the first treaty to be signed by all the republics of the Americas. Dr. Carlos Graf, delegate of Chile (seated far left), wrote of the occasion...

A portrait of the signatories of the 1924 Pan American Sanitary Code.

"We delegates gather once again, yearning for progress and the possible perfection of our health institutions, taking new steps that will be firm and sure in the spirit that guides us, to maintain the health, well-being, and correct development of our peoples, to liberate them from the snares of the 100-headed hydra of vice and pain, and when possible, to extend those benefits to the rest of the world's peoples, for by natural law, the younger, with their strength, should help the eldest."

Dr. Carlos Chagas (1878-1934), delegate of Brazil to the Sixth Pan American Sanitary Conference, discovered American Trypanosomiasis, known as Chagas' disease, in 1909. An early antimalaria campaigner and onetime director of Brazil's Department of Public Health, he was nominated twice for a Nobel Prize, though he never won the award.

Dr. John D. Long, PAHO's first "traveling representative," worked for the Organization for 25 years, promoting sanitation campaigns against epidemic diseases including bubonic plague. A coauthor of the Pan American Sanitary Code and the health codes of Chile, Ecuador, and Panama, Long received numerous honors from the countries of the Region.

Children and youths called "legionnaires" helped carry out antimalaria campaigns in Venezuela in the 1930s. PAHO has promoted community participation in public health projects throughout its history.

Dr. Hugh S. Cumming places a wreath on a memorial to Mexican physician and public health pioneer Dr. Eduardo Licéage (1839-1920). In his memoirs, Lineage wrote: "Relations between the health authorities of Mexico and the United States...grew to be very cordial and beneficial for maintaining our independence in health affairs, contrary to the tendency of that nation to impose itself on the Latin American republics."

The Pan American Sanitary Bureau

Bureau staff — The offices and staff of PAHO, still known as the Pan American Sanitary Bureau, in 1940. At back center, Director Dr. Hugh Cumming (left) and Secretary Arístides A. Moll. Moll also served as scientific editor of the Bulletin of the Bureau, which for many decades served as the most widely known and read source of information on public health in Latin America.

Illegible Scan of Bulletin of the Bureau — Bulletin of the Bureau

PAHO's staff in the 1950s gathers for a group portrait outside headquarters at 2001 Connecticut Avenue in Washington, D.C.

In 1949, PAHO Director Dr. Fred Soper (seated far right) signs an agreement with the World Health Organization (WHO) making PAHO the Regional Office for the Americas of WHO. Under Soper's energetic leadership, PAHO's budget increased from less than $100,000 in 1947 to $10 million in 1958. Its staff grew from 88 to 750. Soper remained director until 1959.

For Fred Soper at 80
...Scientific papers tell

That friend and foe shed ne'er a tear,
As Ankylostoma heard the knell
When Soper's entourage drew near.
On Aedes he cast a spell;
Anopheles soon quaked with fear.
"Eradicate!" we learned to yell
As Soper's couriers sped like deer,
O'er land and sea his creed to sell.
...Triumphant he in public health,
We rightly call him sage and seer.
For none can measure all the wealth,
The joy that he has made appear.

-Dr. Myron E. Wegman (PAHO secretary-general, 1957-60)

Dr. Fred L. Soper (1893-1977), director of PAHO from 1947 to 1959, won wide renown for his unrelenting dedication to the eradication of yellow fever, smallpox, and malaria.

black and white shot of paho hq in the 50s — PAHO HQ on Connecticut Avenue

By mid-century, mosquitoes were becoming resistant to insecticides, and "eradication" efforts began to include not only spraying, but also stepped-up targeting of larval habitats and mass treatment of the population with antimalaria drugs.

Malaria eradication workers at work in Colombia in the 1950s.

Malaria eradication workers at work in Brazil in the 1950s.

Malaria eradication workers at work in Guatemala in the 1950s.

A lab worker examines blood proteins at the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala City, part of an effort to assess the nutritional status of different population groups.

INCAP was one of three international research and training centers established by PAHO during the 1950s. The others were the Pan American Foot-and-Mouth Disease Center (PANAFTOSA) in Brazil and the Pan American Zoonoses Center (CEPANZO) in Argentina.

Participants in the First Conference of Schools of Public Health.

The First Conference of Schools of Public Health, held in San Miguel Regla, Mexico, in 1959, and subsequent PAHO-supported conferences, facilitated the exchange of information and experiences about public health education in the Region.

Members of a health statistics team in Port-au-Prince, Haiti, during the 1950s. Their section chief (standing, right) received training through a PAHO fellowship at the Inter-American Center of Biostatistics in Santiago, Chile.

By the mid-1950s, vaccines were available against TB, diphtheria, influenza, pertussis, polio, smallpox, and tetanus. PAHO supported member countries' efforts to carry out immunization campaigns.

Costa Rican children prepare to receive the BCG vaccine for tuberculosis in 1952.

In the mid-1950s, PAHO adopted a long-term plan for training health workers in the Region and placed new emphasis on preventive and social medicine.

A public health nurse on a home visit in Asunción, Paraguay, in 1952 instructs an elderly midwife on basic hygiene.

A public health nurse making home visits in Asunción, Paraguay, in 1952.

Dr. Abraham Horowitz (1911-2000), of Chile, was PAHO's first Latin America director, serving from 1959 to 1975.

His tenure spanned a time of social and political upheaval in the Americas, but also one of growth in PAHO's influence and activities, and progress in health and development throughout the Region.

PAHO HQ in Washington, DC, opened in 1965. PAHO's new, modern headquarters was designed by Uruguayan architect Román Fresnedo Siri and built with financing from the W.K. Kellogg Foundation on land donated by the U.S. government. The Organization moved to the building in 1965.

Professors and students of a course on leptospirosis at the Pan American Zoonoses Center (CEPANZO) in Azul, Argentina, in 1961. For 35 years, CEPANZO conducted training and research on diseases that can be passed between animals and humans.

Nursing class in the sixties — A nursing instructor provides training to nurses' aides at Guatemala City's General Hospital in the mid-1960s. PAHO's work in this decade focused heavily on improving the Region's health services through training and education of health personnel.

Smallpox vaccination campaign — Residents of Baranquilla, Colombia, listen as a health worker discusses a new antismallpox campaign in 1962. With PAHO support, member countries stepped up their vaccination efforts, and the Region succeeded in eradicating the disease by 1973.

Health worker visits rural family — A rural family receives a visit from a community health worker, part of growing efforts in the Americas to widen access to health services. A PAHO-supported goal for the Region during the 1970s was "to provide primary health care to all by the year 2000."

Health worker in Guatemala — At the home of a rural indigenous family in Guatemala in the 1970s, a health worker tests a small boy's intellectual development as part of PAHO-supported research on the effects of nutritional status on child development.

Community meeting in rural Peru — A member of a joint field mission discusses a community problem with indigenous farmers in Peru in the 1970s. PAHO teamed up with organizations including de International Labour Organization, the Food and Agriculture Organization, and UNESCO to promote development of indigenous communities in the Andean region.

Dr. Héctor R. Acuña, of Mexico, was named PAHO director in 1975 after 20 years at the Organization. In response to member countries' growing public health capabilities and progress in health throughout the Region, he spearheaded a major reorganization of PAHO emphasizing information and management systems and delegating greater responsibility to its field offices.

Malaria Eradication

Despite decades of eradication efforts, the disease remained endemic in the Americas.

In a 1977 address to members of the Study Group on Malaria Control in the Americas, PAHO Director Dr. Héctor R. Acuña noted, "We see programs stalled in some countries and in certain areas an outright deterioration in the disease's epidemiological situation."

A government health worker administers antimalarial drugs to children in Paraguay during a vaccination campaign in 1978.

Dr. Pedro N. Acha (1931-1988), a world-renowned public health veterinarian, spent nearly 30 years at PAHO.

His contributions included building new links between the health and agriculture sectors and factoring economic and social considerations into public health.

Veterinary Public Health

His Zoonoses and Communicable Diseases Common to Man and Animals (coauthored with Boris Szyfres) became the definitive text on the subject.

Today PAHO presents an annual award in his name to encourage research in veterinary public health.

A young Venezuelan boy gets a measles shot at school. PAHO-supported vaccination campaigns have helped member countries to greatly reduce the incidence of measles, making progress toward its eradication from the Americas.

Haitian schoolchildren receive vaccines as part of a countrywide immunization campaign. PAHO worked with its member countries to eradicate polio form the Western Hemisphere, an achievement that was finally certified in 1994.

A man places a rose on the AIDS Memorial Quilt in Washington, D.C.. By 2002, acquired immunodeficiency syndrome had claimed more than 600,000 lives in the Americas and made more than 1 million of the Region's adults and children ill.

Dr. Carlyle Guerra de Macedo served as director of PAHO from 1983 to 1995. A distinguished public health figure in Brazil, he pursued an international career and launched PAHO's successful drive to eradicate polio from the Americas.

Dr. Macedo was named director emeritus following his retirement in 1995.

Dr. George A.O. Alleyne became director of PAHO in 1995 after first joining the Organization nearly 15 years earlier. His stewardship of PAHO has focused on equity and Pan Americanism, promoting the goal of "Health for All" throughout the Americas.

A native of Barbados, Dr. Alleyne has been awarded the Order of the Caribbean Community, the highest honor bestowed on a Caribbean national, and in 1990 he was knighted by Her Majesty Queen Elizabeth II in recognition of his contributions to the medical field.

A pediatrician examines Luís Fermín Tenorio Cortéz, of Peru, the last confirmed case of poliomyelitis in the Americas.

A nurse hugs an AIDS patient at a hospital in Brazil. Since the disease's discovery in 1981, PAHO has worked steadily with its member countries to reduce the epidemic and relieve the suffering of those it affects.

At the dawn of the 21st century, PAHO's focus is on helping the countries of the Americas ensure the benefits of health to all their peoples. PAHO is working to strengthen national and local health systems in cooperation with government and other international agencies, nongovernmental organizations, universities, professional and community groups, and individuals.

The future of the Americas lies in the health of its peoples. PAHO and all those who work for, with, and alongside it are members of the PAHO family, sharing a common commitment to the goal of "Health for All by All" in this century as well as those to come.