A public health achievement under adversity: the eradication of poliomyelitis from Peru, 1991.

The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

[Health initiatives in Latin America: a historical assessment from the inception of the Pan American Sanitary Bureau to the Mesoamerican Health Initiative]. / Iniciativas de salud en Latinoamérica: de la Oficina Sanitaria Panamericana a la Iniciativa Mesoamericana de Salud Pública.

Latin America has undergone gradual transformations in public health influenced by historical events locally or at a global level. These epidemiologic transitions have also occurred through the implementation of interventions by public institutions such as the Pan-American Health Organization, by philanthropic foundations, non-governmental organizations, and bilateral or multilateral international donor organizations. These public health initiatives have produced substantial improvements in the heath status of many populations in Latin America. Overall, human development and health have advanced over the past century. However, these public health benefits have not been shared equally among all areas of Latin America. The Mesoamerican Region -the area encompassing from Southern Mexico to Panama- continues to experience profound social inequities focalized to indigenous communities and groups of African-descent living in urban, periurban, or rural areas. The Mesoamerican Health Initiative is a private-public partnership that attempts to close the gap of health inequalities affecting the most vulnerable populations in this region of Latin America.

The Pan American Health Organization and international health: a history of training, conceptualization, and collective development.

A constantly changing and increasingly complex global environment requires leaders with special competencies to respond effectively to this scenario. Within this context, the Pan American Health Organization (PAHO) goes beyond traditional leadership training models both in terms of its design as well as its conceptual approach to international health. As an intergovernmental, centenary organization in health, PAHO allows participants a unique vantage point from which to conceptualize, share experiences and develop projects relevant to international health. Derived from over two decades of experience (1985-2006) training professionals through its predessor Training Program in International Health, the Leaders in International Health Program "Edmundo Granda Ugalde" (LIHP) utilizes an innovative design, virtual and practical learning activities, and a problem-based approach to analyze the main concepts, theories, actors, forces, and processes relevant to international health. In collaboration with PAHO/WHO Representative Offices and national institutions, participants develop country projects based on priority health issues, many of which are integrated into the Organization's technical cooperation and/or implemented by relevant ministries and other entities in their respective countries/subregions. A total of 185 participants representing 31 countries have participated in the LIHP since its inception in 2008, building upon the 187 trained through its predecessor. These initiatives have contributed to the development of health professionals in the Region of the Americas devoted to international health, as well as provided important input towards a conceptual understanding of international health by fostering debate on this issue.

[Between Alma-Ata and the Brazilian sanitary reform: the National Basic Health Services Program (Prev-saúde), 1979-1983]. / Entre Alma-Ata e a reforma sanitária brasileira: o Programa Nacional de Serviços Básicos de Saúde (Prev-saúde), 1979-1983.

The history of the National Basic Health Services Program (Prev-saúde) begins in 1979 with a joint effort involving the Ministries of Health, Social Security and Assistance, Interior, and Economy, as well as the Pan-American Health Organization. The objective was to reorganize basic health services in their connections with other levels of care. Internationally, it was part of the movement sparked by the International Conference on Primary Health Care in Alma-Ata in September 1978. Domestically, the program represented an accumulation of knowledge about the organization of services as well as a movement that was partially adapted to Brazilian health reform agenda. Prev-saúde was a set of health proposals that represented a technical consensus between bureaucracies and leaders of health reform.

A história do Programa Nacional de Serviços Básicos de Saúde (Prev-saúde) se inicia em 1979, na articulação entre os Ministérios da Saúde, da Previdência e Assistência Social, do Interior e da Economia e a Organização Pan-americana da Saúde. Teve como objetivo reorganizar os serviços básicos de saúde em suas conexões com os demais níveis assistenciais. Internacionalmente, inscrevia-se no movimento deflagrado pela Conferência de Alma-Ata, de setembro de 1978. Em termos nacionais, representava tanto um acúmulo de conhecimento sobre organização dos serviços quanto um movimento que se adequava, em parte, à agenda da reforma sanitária brasileira. O Prev-saúde representou um conjunto de proposições para a reorganização da saúde que, naquele contexto, era consenso técnico entre burocracias e lideranças da reforma da saúde.

History and early development of INCAP.

Nevin Scrimshaw was the founding Director of the Institute of Nutrition of Central America and Panama (INCAP), serving as Director from 1949 to 1961. In this article, he reviews the history of the founding of INCAP, including the role of the Rockefeller and Kellogg Foundations, the Central American governments, and the Pan American Health Organization. The objectives pursued by INCAP in its early years were to assess the nutrition and related health problems of Central America, to carry out research to find practical solutions to these problems, and to provide technical assistance to its member countries to implement solutions. INCAP pursued a strategy of selecting promising Central Americans for advanced education and training in the US who assumed positions of leadership on their return. After this early phase, talented non-Central Americans of diverse origins were brought to INCAP, as well as additional researchers from the region. Growth of INCAP, as reflected in its annual budget and in the physical plant, was rapid and this was accompanied by high scientific productivity. Several field studies were launched that contributed impetus and design elements for the Oriente Longitudinal Study, which is the focus of this supplement.

[A 'library without walls': a history of the creation of Bireme]. / Uma 'biblioteca sem paredes': história da criação da Bireme.

Approaching from the framework of social, political, and economic contexts, the article analyzes the process involved in creation of the Latin American and Caribbean Center on Health Sciences Information (Bireme). The period in question coincides with the consolidation of US influence in the West, between the 1950s and 1970s. A recovery and examination of reference documents and testimonies permits a discussion of the issues involved in setting up what was first known as the Regional Library of Medicine, an initiative in cultural and scientific integration that was highly influential in Latin American health sciences. The article offers reflections on the historical development of the institution as an initiative of the Pan American Health Organization and its subsequent role.

[Reluctant partner: Canada's relationship with the Pan American Health Organization (PAHO)]. / Parceiro relutante: as relações do Canadá com a Organização Pan-Americana de Saúde (OPAS).

Despite a strong commitment to multilateralism and international health cooperation in the post World War II era, Canada refrained form joining the Pan American Health Organization - PAHO until 1971. Drawing on letters and memos sent between Canadian diplomats and government representatives, this paper explores official Canadian accounts of the factors that delayed Canada's membership in PAHO. These factors include the initial lack of official relations between Canada and Latin America, US hegemony in the region, and budgetary constraints. Canada's cautious position regarding PAHO is also placed within the context of Canada's overall foreign policy to the region, emphasizing the parallels between Canada's reluctant association with PAHO and the evolution of Canada's engagement with the region as a whole.

Entre Alma-Ata e a reforma sanitária brasileira: o Programa Nacional de Serviços Básicos de Saúde (Prev-saúde), 1979-1983 / Between Alma-Ata and the Brazilian sanitary reform: the National Basic Health Services Program (Prev-saúde), 1979-1983

Resumo A história do Programa Nacional de Serviços Básicos de Saúde (Prev-saúde) se inicia em 1979, na articulação entre os Ministérios da Saúde, da Previdência e Assistência Social, do Interior e da Economia e a Organização Pan-americana da Saúde. Teve como objetivo reorganizar os serviços básicos de saúde em suas conexões com os demais níveis assistenciais. Internacionalmente, inscrevia-se no movimento deflagrado pela Conferência de Alma-Ata, de setembro de 1978. Em termos nacionais, representava tanto um acúmulo de conhecimento sobre organização dos serviços quanto um movimento que se adequava, em parte, à agenda da reforma sanitária brasileira. O Prev-saúde representou um conjunto de proposições para a reorganização da saúde que, naquele contexto, era consenso técnico entre burocracias e lideranças da reforma da saúde.

Abstract The history of the National Basic Health Services Program (Prev-saúde) begins in 1979 with a joint effort involving the Ministries of Health, Social Security and Assistance, Interior, and Economy, as well as the Pan-American Health Organization. The objective was to reorganize basic health services in their connections with other levels of care. Internationally, it was part of the movement sparked by the International Conference on Primary Health Care in Alma-Ata in September 1978. Domestically, the program represented an accumulation of knowledge about the organization of services as well as a movement that was partially adapted to Brazilian health reform agenda. Prev-saúde was a set of health proposals that represented a technical consensus between bureaucracies and leaders of health reform.

Health at the dawn of development: the thought of Abraham Horwitz.

The article explores the ideas of Pan American Health Organization director Abraham Horwitz on the relations between health and development at the time the Alliance for Progress was established, in 1961. Taking development discourse as a public philosophy of international cooperation, the discussion centers on how Horwitz worked to mediate between health and development. Horwitz endeavored to establish arguments that highlighted the importance of social policy, especially in health; he also strove to reach different audiences and drew connections between elements like health, illness, and labor productivity, without ignoring the humanistic considerations so dear to the public health tradition.

A historical perspective on international health.

Between about 1875 and the early twentieth century, most major disease pathogens were identified and their epidemiology clarified. The technical and material developments of the nineteenth century led to a form of practical internationalism that was expressed also in the health sector. The Pan American Health Organization was established in 1902 to coordinate health issues in the Western Hemisphere. The Health Office of the League of Nations, now little known, played an important role in the 1920s and 1930s, particularly in the control of epidemic diseases in Eastern Europe and later in nutrition. The general framework of the League Health Office became the basis of the World Health Organization, founded in 1946. Certain international agencies play a special role in health; of these, United Nations Children's Fund (UNICEF) and the World Bank have a worldwide role. The Institute of Nutrition of Central America and Panama (INCAP) and the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B) are examples of essentially regional organizations with considerable influence. Private voluntary organizations, missions, and foundations have also had a substantial effect on health in certain circumstances.

International developments in adolescent health care: a story of advocacy and achievement.

The contemporary health problems of young people occur within the context of the physical, social, cultural, economic, and political realities within which they live. There are commonalities and differences in this context among developed and developing countries, thus differing effects on the individual's personal as well as national development. Internationally, the origins and evolution of health care for adolescents can be viewed as an unfolding saga taking place particularly over the past 30 years. It is a story of advocacy and subsequent achievement in all corners of the world. This paper reviews the important developments in the international arena, recognizes major pioneers and milestones, and explores some of the current and future issues facing the field. The authors draw heavily on their experiences with the major nongovernmental adolescent health organizations. The special roles of the World Health Organization, Pan American Health Organization, and United Nations Children's Fund (UNICEF) are highlighted, and special consideration is given to the challenge of inclusion through youth participation.

No more surprising than a broken pitcher? Maternal and child health in the early years of the Pan American Sanitary Bureau.

The priorities and activities of international health organizations have historically been determined at the metropolitan level or through a confluence of central and local interests. The case of maternal and child health and the Pan American Sanitary Bureau during the first half of the 20th century demonstrates a different phenomenon. Rather than sparking interest and actions in maternal and child health in Latin America, the PASB ignored this area even though the agency was repeatedly urged by numerous countries in the region over several decades to provide support. This article begins with an examination of the emergence of maternal and child health circa 1900 in Europe, North America, and Latin America, identifying political, demographic, ideological, economic, and cultural commonalities and differences in these regions. We then turn to the PASB's early history and modus operandi, the pressure exerted by Latin American countries upon the PASB to pay attention to maternal and child health, and the Bureau's unwillingness to work in this area. Next we explore concomitant developments in maternal and child health and eugenics within Latin America in the 1920s and 1930s and the PASB's first steps in this area. Finally we discuss the conflict over the PASB's role in maternal and child health on several dimensions: as a manifestation of differing cultural priorities in the U.S. and Latin America; as a question of struggle for organizational power within the PASB; and as part of a richer understanding of the diffusion of early 20th-century public health and medical practices.