Editorial from Vol. 23, No. 1, March 2002 of the Epidemiological Bulletin
This year the Pan American Health Organization (PAHO) celebrates 100 years of work dedicated to improving public health in the Region of the Americas. In this edition, the Epidemiological Bulletin presents a synopsis of the most important facts related to PAHO’s role in epidemiology and health information during the past century. These facts also highlight the areas of work for which the countries have requested special efforts in the future.
Stemming from the countries’ concerns about the increasing burden of contagious diseases and the need for international collaboration to prevent their dissemination, the Pan American Sanitary Bureau (PASB), PAHO’s technical arm, was created in 1902 during the First International Sanitary Conference in Washington, DC. In 1907, the compilation and communication of public health information was mandated as one of the strategic functions of the Organization. As a result, PAHO was transformed into a center for exchange and distribution of information on health problems in the countries of the Region.
The first issue of the Pan American Sanitary Bulletin (that evolved into the current Pan American Journal of Public Health) was published in 1922. Initially, this publication presented a global summary of infectious disease notification. In response to social and economic consequences of the crash of the New York stock market, the Weekly Sanitary Reports were created in 1929 as the first systematic reporting of this nature.
An important milestone in PAHO’s history was the ratification of the Pan American Sanitary Code in 1924. The code provides a solid legal base for the fulfillment of its functions and defines procedures and guidelines to curtail the spread of disease in the countries of the Region. As a result, PAHO urged the countries to establish statistical services for mortality and morbidity, and medical services at ports of entry to diagnose contagious diseases. At the end of the 1930s, the first assessments were done on the collection and use of vital statistics for public health purposes and recommendations were given for the standardization of diagnostic methods and disease registration. Through this process, the foundations were laid for the development of public health surveillance, now recognized as an essential public health function. To complement information routinely generated by the countries, PAHO established technical services to study public health problems and, in 1946, established the Institute of Nutrition for Central America and Panama (INCAP).
In 1950, PAHO became the WHO Regional Office in the Americas, and its membership gradually increased. Its mandates for information collection, analysis, and dissemination were expanded. Information gathering was discussed in 1911, but the first evidence of health situation analysis on different aspects of health (such as health problems, or resources and response of the health services) in the countries of the Region was the first publication of “Health Conditions in the Americas “, in 1954. This publication still represents one of PAHO’s most important and continuous efforts to analyze and disseminate health information. It culminates this year with the publication of “Health in the Americas, 2002”. The interest and use generated by this publication is highlighted by the more than 500,000 users worldwide that have consulted the Spanish and English versions on the Internet since 1998.
The PAHO electronic vital and health statistics databank was created in 1956, as an essential resource for health monitoring and analysis. The databank has continued and evolved into a more comprehensive system that, starting in 1996, presents not only mortality, morbidity, and population information, but also a Regional Core Health Data and Country Profile System. Besides, socioeconomic information, this system integrates health risk factors, resources, access, and coverage of health services. It is available on the Internet, by means of a prize-winning tabulator. In an effort to revitalize the national vital and health statistics systems, the Regional Advisory Committee on Health Statistics was recently reactivated to guide and assist work in this area.
In 1979, in a changed epidemiological context and with the availability of more advanced information and communication technology, PAHO discontinued the publication of the Weekly Sanitary Reports. Subsequently, the role of reporting on infectious diseases globally was assumed by WHO through the Weekly Epidemiological Record. In 1980, the Epidemiological Bulletin was launched, and for 22 years it has disseminated relevant information about the practice of epidemiology (such as health situation analysis, methodologies for analysis and presentation of information, guidelines on public health procedure and standards) as a response to the changing needs of the health services in the Region.
The 1980s were an important period for the practice of epidemiology in the Organization and the countries. In November 1983, during a seminar in Buenos Aires (Argentina), the state of epidemiological practice for the control of diseases, health evaluation, and services planning was reviewed. Its implications for the progress in research, training in epidemiology, and the development of services were analyzed. In the countries, the results of the meeting had an important impact in the production and dissemination of knowledge through publications, scientific and epidemiological congresses, training of human resources, and the expansion of the practice of epidemiology in health services. As a result, workshops and national meetings in epidemiology and for the strengthening of health situation analysis were organized in the countries of Latin America and the Caribbean.
Responding to identified needs in training, the first Modules of Principles of Epidemiology for the Control of Diseases were produced. A second edition will be published in 2002. In 1991, PAHO commenced a Summer Session in Intermediate Epidemiology. This program reached its 12th session in 2002, and has already trained more than 350 epidemiologists in the Region. Taking advantage of computer and communication technologies that reduce the difficulties linked to distance, starting in 2000, PAHO has offered training courses in epidemiology through the Internet. Even though the needs for qualified human and technical resources for health analysis still exist, another challenge facing epidemiology is its use as an indispensable tool for the management of health services. For this, health situation analyses must be integrated and translated into an accessible, specific, and effective format, allowing for the rational orientation of political decisions. This could in turn lead to the reduction of health inequalities, convergence of health interventions in the most vulnerable areas and population groups, evaluation of the efficiency of health interventions, and orientation of health plans and programs based on evidence and population needs. PAHO is producing methodological guidelines to facilitate health situation analysis and is generating technological tools (communication networks, geographic information systems, and information analysis systems to mention a few) that will facilitate and support this process. Country experiences will be an additional input that will further develop this process.
For 100 years, the Organization has adapted to changes in the health situation and to the needs of the region’s population. Initially based on the control of infectious diseases, PAHO’s technical cooperation evolved to include other diseases and dimensions of health such as health services, policies and financing, environment, nutrition, and healthy practices. Throughout the years, the practice of epidemiology has always had a significance in the activities of the Organization, among other things through constant efforts to compile and improve the quality of information, production of routine and special studies, and the wide dissemination of this information. Epidemiology also has evolved conceptually and methodologically. The definition of the use of epidemiology has extended from a critical instrument for the prevention and control of diseases to an intelligence tool for the holistic understanding of health, orienting priorities, utilizing resources rationally, and strategically conducting health services. Today, the training in and practice of epidemiology, and the production of health situation analyses and dissemination of relevant health information in the countries of the Region use new technology such as the internet. With these advances however, the epidemiological vision remains the same and PAHO’s cooperation efforts are still directed towards improving the level and distribution of health of the peoples of the Americas.