Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century. / A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX.

In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

A profilaxia e o tratamento das enfermidades do oeste paulista: o Serviço Sanitário e o tracoma no princípio do século XX / Prophylaxis and treatment of diseases in western São Paulo state: the Sanitation Service and trachoma in the early twentieth century

Resumo Em 1906, Emílio Ribas reorganizou o Serviço Sanitário e centralizou na capital os serviços de saúde pública do estado de São Paulo. Nesse projeto, a campanha de combate ao tracoma, uma enfermidade oftálmica, foi implantada. Este artigo analisa essa campanha que atendeu os enfermos das propriedades rurais em um processo que antecedeu ao Código Sanitário Rural de 1917. O material empírico foi composto por relatórios governamentais, decretos, periódicos médicos e jornais. Concluímos que Ribas, ao criar uma estrutura que unificou os esforços dos distritos sanitários com as equipes de atendimento das Comissões do Tracoma, buscou formar um complexo aparato para combater as enfermidades presentes tanto nas áreas urbanas quanto na zona rural.

Abstract In 1906, Emílio Ribas reorganized the Sanitation Service and centralized São Paulo state public health services in the state capital. A campaign to combat trachoma, an ophthalmic disease, was implemented as part of this project. This article analyzes this campaign, which provided care for the sick living on rural properties in a process that predated the 1917 Rural Sanitary Code. The empirical data was obtained from government reports, decrees, medical journals and newspapers. We conclude that Ribas, by creating an organization that integrated the efforts of the sanitary districts and the Trachoma Commission medical teams, sought to form a complex apparatus to combat the diseases present in both urban areas and the countryside.

The prevention of leprosy related disability as an integral component of the government health delivery programme in Indonesia: perspectives on implementation.

This paper presents a record of three interviews with groups of Ministry of Health personnel and consultants that took place in Jakarta, Indonesia in May 2012. Those contributing to the first interview were provincial and district supervisors with responsibility for leprosy. Those contributing to the second interview were consultants, three of whom were seconded to the Ministry of Health and one was a WHO consultant. A third interview was conducted with the Head and a technical staff member of the Sub Directorate of Leprosy and Yaws Control Programme, Ministry of Health, Indonesia. Leprosy control in Indonesia had been targeted for further enquiry after it became apparent, through an earlier survey of national programme managers and consultants, that the programme had been relatively successful in integrating POD into the government health delivery programme. The perspectives of significant representatives and actors in the national programme were recorded through the interviews undertaken in Jakarta. Limitations This report does not purport to be a study of integration of leprosy services in Indonesia. The perspectives of representatives and significant actors are offered here to enhance understanding of factors that contributed to POD becoming a routine component of general health care in Indonesia. It is also declared here that no independent verification of statements was undertaken and that the effectiveness of measures taken to integrate leprosy related POD has not been independently evaluated.

Sustainability of integrated leprosy services in rural India: perceptions of community leaders in Uttar Pradesh.

As part of a community-based action research to reduce leprosy stigma, village committees were formed in 3 hyper endemic states of India. From a total of 10 village committees with nearly 200 members from Uttar Pradesh, a systematic random sample of 69 men and 23 women were interviewed in-depth regarding their views on sustainability of integrated leprosy services, as currently adopted. Their recommendations were also sought for further enhancement. Percentages were computed and compared for statistical significance using the z-normal test. The findings show that less than 50% of the respondents were confident that the present trend in voluntary early reporting for MDT and management of complications was adequate to sustain the integrated leprosy services. There were no differences by men or women members and they felt that lack of proper facilities, training and orientation of staff are most influencing factors. Many suggestions were given for improving the sustainability.

[The cholera epidemics and the development of public health in Meiji Japan. 2. Strength and weakness of public health politics]. / Le choléra et la naissance de la santé publique dans le Japon de Meiji. 2. Forces et faiblesses d'une politique de santé publique.

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show that in Japan as well as in western nations public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.

Region consultation on the Revised International Health Regulations: information document

1. The International Health Regulations (IHRs) are mechanisms for sharing epidemiologicalinformation on cross- border spread of diseases and other events of international public healthimportance. The World Health Assembly (WHA) initially adopted these regulations in 1951as the International Sanitary Regulations. The current IHRs were adopted by the WHA in1969, and the latest version was finalized in 1981. Since the adoption of IHRs, the publichealth situation has significantly changed: Smallpox has been eradicated; poliomyelitis istargeted for eradication; dracunculiasis, measles and leprosy have been selected forelimination. Other deadly diseases, such as viral haemorrhagic fevers, acquiredimmunodeficiency syndrome (AIDS) and severe acute respiratory syndrome (SARS), haveemerged. The threat of accidental or intentional release of deadly biological, chemical ornuclear agents is a reality that needs to be addressed.2. Therefore, the WHA, through Resolution WHA56.28, decided to revise the current IHRsand urged the Director-General to ensure participation of all Member States. The WHORegional Office for Africa, with support from WHO headquarters, held consultative meetingsand received valuable input from country delegates to improve the IHRs working paper. Theoutcomes of the consultation were as follows:

Prophylaxis and exclusion: compulsory isolation of Hansen's disease patients in São Paulo.

This article aims to retrieve the history of Hansen's disease in Brazil, analyzing the medical thinking of the time and the shaping of health policies that permitted the implementation, in São Paulo, of a prophylactic policy of compulsory exclusion for all Hansen's disease patients. It also analyzes how the structuring and implementation of this policy led to a "São paulo model" that strongly influenced the rest of the country. It addresses the creation of the state's network of leper colonies, their characteristics and the emergence of a veritable "parallel state" that endured until 1967, with complete disregard of all the changes taking place in both national and international prophylactic policymaking.

The anti-leprosy campaign in Colombia: the rhetoric of hygiene and science, 1920-1940.

Since the 1920s, the medical community realized that the strategy of leprosy control based on segregation and persecution of patients was inefficient and expensive. In the 1930s the new liberal government incorporated leprosy within the general sanitary institutions, by merging the Bureau of Lazarettos and the National Department of Hygiene. The disease-apart approach started to be replaced by a more general public health strategy, which involved controlling other illnesses. Prevention and research played a more influential role, and the new sanitary officials saw leprosy in the light of the economic rationality of expenditures, placing more emphasis on therapies and making them mandatory for all patients. Improvements in leprosy treatment became widely known and available. However, the image of leprosy as a special condition and the practice of segregation were deeply entrenched within the Colombian culture and institutions. The rhetoric changed, but to break with several decades of persecution was a difficult task.

The world health report 1998: life in the 21st century A vision for all

What will life in the 21st century? Will the world continue to grow healthier, with ever more diseases conquered by scientific advances, and life expectancy extending even longer? Or will new diseases and failing drugs cancel out these gains? If populations live longer, will these extra years be healthy and productive or merely an extended sentence of suffering? Will continuing population growth finally stifle the panet's life, depleting finite resources, polluting beyond repair, and making megacities and urban slums the home for more and more? Or will better finally planning options - and mounting deaths from AIDS - reverse recent trends? Will we conquer malnutrition, obesity, drug abuse, poverty, depression, and the common cold? Will we eradicate polio, leprosy, measles and other anciest foes? Will deaths from heart disease and cancer finally begin to decline? And when will be able to afford them? Will the gaps between the health of rich and poor grow ever wider? These are some of the many questions addressed in The World Health Report 1998. Issued as the World Health Organization marks its 50th anniversary, the report takes an expert look at health trends over the past five decades, assesses the current global situation, and predicts how health conditions, diseases, and the tools for managing them will evolve up to the year 2025. Using the latest data gathered and validated by WHO, the report paints a picture of a world posed to achieve unprecedent good health - if the lessons learned during recent decades are understood and heeded

The world health report 1998: life in the 21st century A vision for all / The world health report 1998: life in the 21st century A vision for all

What will life in the 21st century? Will the world continue to grow healthier, with ever more diseases conquered by scientific advances, and life expectancy extending even longer? Or will new diseases and failing drugs cancel out these gains? If populations live longer, will these extra years be healthy and productive or merely an extended sentence of suffering? Will continuing population growth finally stifle the panet's life, depleting finite resources, polluting beyond repair, and making megacities and urban slums the home for more and more? Or will better finally planning options - and mounting deaths from AIDS - reverse recent trends? Will we conquer malnutrition, obesity, drug abuse, poverty, depression, and the common cold? Will we eradicate polio, leprosy, measles and other anciest foes? Will deaths from heart disease and cancer finally begin to decline? And when will be able to afford them? Will the gaps between the health of rich and poor grow ever wider? These are some of the many questions addressed in The World Health Report 1998. Issued as the World Health Organization marks its 50th anniversary, the report takes an expert look at health trends over the past five decades, assesses the current global situation, and predicts how health conditions, diseases, and the tools for managing them will evolve up to the year 2025. Using the latest data gathered and validated by WHO, the report paints a picture of a world posed to achieve unprecedent good health - if the lessons learned during recent decades are understood and heeded

[Hansen disease in Mercosur]. / Enfermedad de Hansen en el Mercosur.

In the context of the important changes of a political economic, social and health order upon which the Argentina, Brazil, Paraguay and Uruguay have now embarked in the framework of the commitment undertaken to create instruments for the Common Market of the South America (MERCOSUR), the importance of leprosy for public health in this new region is analysed. In this connection a description is given of the background and reasons which led to the creation of the MERCOSUR Committee for technical cooperation on leprosy, composed of the heads of the national leprosy control programmes of the countries in question, for the purpose of implementing the Protocol of Intention signed by the representatives of the Ministers of member countries, with the object of establishing policies of technical cooperation in activities to control this disease, with a view to attaining the goal proposed by WHO of eliminating leprosy as a public health problem by the year 2000. Using the data contributed by the different programmes, the epidemiological situation existing in this region in December 1995 is outlined, with analysis of certain epidemiological, demographic and operational variables, showing that MERCOSUR has a prevalence of 6.03 per 10,000 population, one of the highest rates in comparison with other WHO regions; a high percentage of cases lost to view (abandons); and a low rate of coverage with multidrug therapy. In this region a total of 33,654 new cases were detected during 1995, of which more than 50% were multibacillary forms, while nearly 10% of them were youngsters of less of 15 years of age. The action carried out jointly among the four countries, the successes achieved and the results to be achieved in the short term are also described.

The 20th Kellersberger Memorial Lecture, 1994. Leprosy and tuberculosis combined programmes: an uneasy partnership?

One of the purposes of this memorial lecture is to relate progress and difficulties in the field of leprosy to work in other fields. Tuberculosis is a disease closely related to leprosy and in 1982 the Kellersberger lecture was given by Dr. Styblo, someone whose name is synonymous with the development of effective Tuberculosis Control Programme in Africa. His title was "Tuberculosis and its control: lessons to be learned from past experience, and implications for leprosy control programme" (1). Many countries in Africa, including Ethiopia, have adopted the strategy of a combined leprosy and TB control programme. In this lecture then, I will examine more closely the strategy of combining the two programmes. I want to look at some of the problems that may arise and then draw out the ways in which each side of the partnership can contribute to the other, so that the combination can be more effective than either programme could hope to be on its own. This lecture will focus mainly on management issues, which are currently the most important barriers to effective control of both diseases, but the socio-economic aspects of disease, so much a part of Dr. Kellersberger's working life, will also be prominent.