Since its inception 61 years ago, Health in the Americas has been recognized as the flagship publication of the Pan American Health Organization (PAHO). It fills a special information niche as a one-of-a-kind report on major progress, challenges, and trends in health in the Region of the Americas.

Historically, Health in the Americas emerged in response to a mandate from the 7th PAHO Directing Council in 1953, in which Member States requested the Director of the Pan American Sanitary Bureau (PAHO’s secretariat) to prepare a periodic report on regional health conditions. Since its groundbreaking edition in 1956, the publication has been issued 15 times.

This latest 2017 edition reflects major innovations in the extension and development of Health in the Americas. We have expanded on the publication’s traditional epidemiological focus to include a new prospective dimension that provides scenarios constructed on the basis of historical trends and anticipated occurrences. Moving beyond merely observing, describing, and explaining past or present events, this edition goes one step further to forecast the future of health in the Region.

For the first time, the printed edition of the publication—which historically captured a snapshot in time—is being complemented by an interactive platform, Health in the Americas+, that will be regularly updated with new data and content as they become available. This platform will enable Member States to both retrieve and contribute timely information and to share analyses and reflections on their progress toward the achievement of universal health.

Another novelty in this edition’s development was the input from diverse stakeholders involved in health at the country level, which has added richness and depth to the publication’s content. Special fora were convened by PAHO country offices to enable this broad stakeholder contribution. Last but not least, a team of external reviewers and an expert technical advisory group were enlisted to contribute to and conduct a critical analysis of the publication.

Health in the Americas+ 2017 arrives as the world commits to the 2030 Agenda for Sustainable Development, a set of 17 ambitious and visionary goals aimed at achieving sustainable development. While the Sustainable Development Goals represent the new way forward, it is undeniable that unprecedented progress was achieved by the countries of the Americas in pursuing the Millennium Development Goals between 2000 and 2015. Health in the Americas+ 2017 highlights how this Region and the countries have steadily increased coverage and access to health services, improved life expectancy, and decreased the gap in inequalities. Reductions in infant and under-5 mortality and in the burden of infectious diseases are some of the successes detailed in this new edition.

Perhaps our most important achievement has been our enhanced understanding of the gaps that remain in health and the specific obstacles that must be overcome to attain our ultimate goal of universal health.
We are keenly aware, for example, that achieving universal health will not be possible if health systems remain fragmented and segmented and as long as people are forced to purchase services in order to address their health needs. In addition, our analyses indicate that there is need for increased public investments in health. It is also crucial that the private sector, academia, civil society, and communities contribute by investing and co-managing actions and best practices to ensure that no one is left behind.

Our Region is very heterogeneous in terms of its epidemiologic trends, as we note many countries bear the double burden of both communicable and noncommunicable diseases. Noncommunicable diseases, including cardiovascular diseases, cancer, diabetes, mental illness, neurological and substance abuse disorders, and violence and accidents, are the leading causes of illness, disability, and death in the majority of our countries. While many effective interventions are available, they are not, however, accessible to everyone. We must therefore address these inequities.

Communicable diseases, including emerging and reemerging ones, pose an ongoing threat for the entire Region. Implementation of the International Health Regulations is progressing but accelerated efforts are needed to ensure sustainable achievements in this area. Over the last few years, our Region has experienced outbreaks of chikungunya, cholera, Ebola, yellow fever, Zika, and other public health events that have severely tested our preparedness and response capacities. At the same time, the countries of the Americas have led the world with the elimination of communicable diseases: rubella and measles are the most recent examples, but other diseases, such as onchocerciasis and maternally transmitted HIV and syphilis, are now well positioned to be eliminated. In this regard, PAHO is advancing a comprehensive elimination agenda that includes concrete, quantifiable, and verifiable targets.

Population aging is forcing us to rethink health and redesign our health systems. Our people are living longer, a positive development, but meeting their changing health needs requires innovation and special attention to avoid discrimination. The life-course paradigm helps us to ensure that our work in health is inclusive of all populations along the entire age spectrum.

Another important challenge we face is to ensure environmental sustainability. The health sector, in concert with other sectors, must engage in responsible actions and behaviors to promote environmental health and ensure steady progress toward universal access to potable water and basic sanitation. Additionally, reducing pollution and mitigating the impacts of climate change will be crucial for preserving our planet.

This report offers important insights and analyses of these and other major health challenges and opportunities facing our Region today. The information presented in Health in the Americas+ 2017 is essential for rational decision making, as we forge a common regional health agenda—aligned with and bolstered by the 2030 global agenda. It is our hope that these findings will be used by countries to develop and refine health frameworks that will allow each individual the possibility of achieving the highest attainable standards of health. Such frameworks should be constructed with the understanding that the 2030 Agenda for Sustainable Development is the chosen pathway, health in all policies will be essential to advance along the way, and universal health is the end goal.

Carissa Etienne, Director
Pan American Health Organization