Pan American Health Organization

International cooperation in promoting health allows nations to support global and regional health outcomes, as well as their national objectives. The Pan American Health Organization (PAHO) was founded in December 1902 with an aim of furthering United States interests, but its mission developed over time to be more inclusive of interregional public health, health policy, and research needs. PAHO, formerly known as the Pan American Sanitary Bureau and Pan American Sanitary Organization, is the oldest international health agency in the world. The forces which led to the creation of PAHO include fear in the United States of spread of infectious disease brought by immigrants and trade (Howard-Jones, 1981). Maritime trade with South and Central America and an influx in European immigrants led to the introduction of yellow fever and cholera outbreaks. The United States sought an international agreement which promoted international collaboration in combatting the spread of infectious disease due to these threats (Howard-Jones, 1981). Thus nationalist fears associated with increased international trade and movement introduced a need for an international alliance.

Interregional collaboration in combatting spread of infectious disease in trade between the United States and Latin America was particularly desirable considering the U.S.’ interest in benefitting from the rich resources of South and Central American countries (Fee & Brown, 2011). This led to the creation of the International Sanitary Bureau (later the Pan American Sanitary Bureau) which included seven members; three from the United States and one member each from Mexico, Cuba, Costa Rica, and Chile (Fee & Brown, 2011). Due to the distance between members, the Bureau did not meet very often and the majority of actions were carried out by the chairman of the group, the surgeon general of the United States (Fee & Brown, 2011). The first concerns of the Bureau were regulating sanitation in seaports, but moved to encompass more general health promotion through sanitation (Acuña, 1977). This included the implementation of a Pan American Sanitary Code in 1942, which outlined agreements to prevent spread of infectious disease, promote cooperation, and facilitate sharing of statistics and information (Acuña, 1977). Much of PAHO’s early history was grounded in the fears, needs, and actions of United States and their hope to expand trade in South and Central America.

As PAHO grew, it shifted to become more inclusive of Latin American and global interests. In 1947 PAHO (the Pan American Sanitary Bureau at the time) became a regional office of the World Health Organization (WHO). WHO was born out of the post-World War II conviction that increased international collaboration could promote peace. The move was promoted by PAHO officials who believed that WHO was integral to advocating international public health (Cueto, 2006). PAHO was able to retain its name and distinct character while integrating with WHO, allowing it to continue to effectively address regional needs. However, this move was staunchly opposed by Hugh S. Cummings, director of the International Sanitary Bureau at the time, who felt this interference would impact PAHO’s efficacy and autonomy (Cueto, 2006). After its integration into the World Health Organization, PAHO began to hire a more international staff and in 1959 it elected its first Latin American director, Dr. Abraham Horwitz of Chile (Fee & Brown, 2011). Horwitz focused on the connection between health and economic development, specifically the ability of the society to participate in the economy, and implemented programs to increase access to clean water and adequate nutritional intake (Cueto, 2006).

One key development was the establishment of regional research centers. These centers allowed health officials to research local health problems and find solutions for the community (Acuña, 1977). These centers included the Pan American Zoonoses Center in Buenos Aires, the Caribbean Food and Nutrition Institute, the Latin American Center for Perinatology and Human Development, and the Pan American Center for Sanitary Engineering and Environmental Sciences (Acuña, 1977). More recently, PAHO opened a regional bioethics center in 1993 for Latin America and the Caribbean. This focus on ethics corresponds with local struggle to allocate resources, address patient rights, monitor research, and engage with family planning and end-of-life issues (Fins, 1993). Through these centers PAHO increased disease surveillance capacity and ability to address pertinent diseases and ethical dilemmas in the countries it serves.

In 1961, PAHO signed the Charter of Punta del Este which acknowledged the impact of the social determinants of health and included a Ten-Year Health Plan which sought to increase access to clean water and lower rates of communicable disease and infant mortality (Acuña, 1977). PAHO collaborated on projects with 17 Latin American governments which included “consultation in waterworks design, financing, and organization” aimed at improving access to clean water (“Pan American Health Organization, 1960,” 1961). However, PAHO’s focus was not limited to sanitation. During the 1960’s PAHO was involved in malaria eradication through spraying of insecticides in multiple Latin American countries, including Mexico, Jamaica, Surinam, and Venezuela (“Pan American Health Organization, 1960,” 1961). Additionally, PAHO was involved in assisting in immunization campaigns for smallpox and polio, yellow fever eradication, monitoring leprosy, and the surveillance of yaws and tuberculosis (“Pan American Health Organization, 1960,” 1961). Through these campaigns, PAHO implemented both structural reforms and vertical programs aimed at disease eradication.

In 1972, health ministers agreed on a new Ten-Year Plan which defined health as a “manifestation of the innate and acquired capacity of each person” (Acuña, 1977). To promote sustainable access to healthcare and community participation, PAHO sponsored community organizations which strived to provide culturally appropriate and affordable care, such as the gaurdianes de salud in Guatemala which trained healthcare workers to treat common ailments in rural communities (“Pan American Health Organization, 1960,” 1961). Through these collaborative efforts and PAHO initiatives, the organizational focus was redirected to better address the concerns of the local community. However, within PAHO there was not always consensus on the best way to implement change during the 1970s and 80s. As described by Marcos Cueto in his book The Value of Health (2006), some officials advocated for the incorporation of public health into socioeconomic development, including institutional development and technical programs. Others emphasized community-based programs, allowing the community to choose and implement programs (Cueto, 2006). Those who focused on socioeconomic development included Abraham Horwitz and his focus on improving participation in the economy (Cueto, 2006). Therefore, PAHO’s staff from across South, Central, and North America did not share a single vision of their objectives and methods for implementing change.

PAHO has continued to fight infectious disease in more recent years. Over the late 1960’s to early 2000s PAHO implemented a plan to eradicate smallpox and poliomyelitis. This commitment dates back to 1950, when the XIII Pan American Sanitary Conferences recommended countries comply with intensive vaccination and revaccination (Cueto, 2006). PAHO changed the structure of their vaccination programs to focus on community participation, rather than reliance on technological innovation. The last case of smallpox was recorded in 1971 and eradication of poliomyelitis was confirmed in 1994 (Cueto, 2006). PAHO continued by implementing plans to eliminate tetanus in 1989 and measles in 1994 (Cueto, 2006). Endemic transmission of measles was later effectively eliminated in Latin America, along with rubella (“Progress Toward Interrupting Indigenous Measles Transmission,” 2000). These campaigns were carried out through a commitment to primary health care, improving health infrastructure and community engagement. These values were also present in PAHO’s success in limiting mortality from cholera in Peru in 1991 and later attempts to address HIV/AIDS in Haiti in the late 80s to early 2000s (Cueto, 2006). Currently, PAHO functions both as an international agency and a regional representative of WHO. The current Director of PAHO, Doctor Carissa F. Etienne, has focused PAHO on addressing noncommunicable diseases and increasing capacity for universal health coverage (Pan American Health Organization).

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Additional Resources

Bernardini-Zambrini D. A. (2013). The Pan American Health Organization: New Challenges, New Roles, New Responsibilities. Colombia medica (Cali, Colombia), 44(1), 5–6.

Jiménez de la Jara, J. (2003). Abraham Horwitz (1910-2000) Padre de la Salud Pública Panamericana. Revista médica de Chile, 131(8), 929-934.

Kickbusch, I. (2003). The contribution of the World Health Organization to a new public health and health promotion. American journal of public health, 93(3), 383-388.

References

Acuña, H. R. (1977). The Pan American Health Organization: 75 Years of International Cooperation in Public Health. Public Health Reports (1974-), 92(6), 537-544.Cueto, M. (2007). The Value of Health. A History of the Pan American Health Organization.

Fee, E., & Brown, T. M. (2002). 100 Years of the Pan American Health Organization. Am J Public Health, 92 (12), 1888–1889.

Fins, J. (1993). PAHO's Progress. The Hastings Center Report,23(2), 2-2.

Howard-Jones, N., & World Health Organization (1981). The Pan American Health Organization: origins and evolution.

PAHO (1961). Pan American Health Organization, 1960. Public Health Reports (1896-1970), 76(12), 1097-1098.

PAHO/WHO (n.d.). About the Pan American Health Organization (PAHO). https://www.paho.org/hq/index.php?option=com_content&view=article&id=91:about-paho&Itemid=220&lang=en. Last Accessed: 8 May, 2019

Progress Toward Interrupting Indigenous Measles Transmission — Region of the Americas, January 1999–September 2000. (2000). Morbidity and Mortality Weekly Report, 49(43), 986-990.