EDITORIALS
Seventy-Five Years of International Health It seems fitting that the year which draws to its close this month should mark both the seventy-fifth anniversary of the oldest living official international health agency, the Pan American Health Organization (PAHO), and the birth year of the International Health Section of the American Public Health Association. While we salute PAHO for its 75 years of service to the peoples of the Americas, we may wonder why it took 75 years for the Association's concerns with international health to flower formally as a section. Between 1891 and 191 1, the 20 years surrounding PAHO's birth, seven meetings of the APHA were held in other countries of this hemisphere and seven (35 per cent) of its 20 presidents were citizens of other American countries. The most famous of these 20 presidents was Dr. Carlos J. Finlay, elected thirtyfirst President of APHA at a meeting in Havana in 1904, two years after the birth of PAHO. Dr. Finlay was a Cuban physician to whom we are indebted for the classic formulation of the theory that yellow fever was transmitted by the Aedes aegypti mosquito. There have been no Latin American presidents of APHA since 1907 and no annual meetings of the Association south of the border since 1911. Since 1934, however, one of the Association's three vice presidential slots has been filled annually by a Latin American. Dr. Myron E. Wegman, a former President of APHA and a former Secretary-General of the Pan American Sanitary Bureau, the secretariat of PAHO, provides the Journal readers this month with an historical account of PAHO's growth and a scholarly discussion of the field of international health as exemplified by the PAHO program.' Dr. Wegman's affiliation with PAHO spans two decades-he served as a staff member of the organization from 1952 to 1960, the last four years of which were as Secretary-General, and has continued as a consultant to the present time. The period extending from the founding of PAHO as the International Sanitary Bureau (later the Pan American Sanitary Organization) through the routine tenure of the U.S. Surgeon General as its "elected" director could be termed its organizational childhood, dominated by the father figure to the north. The period ended with the inauguration of President Franklin Roosevelt's Good Neighbor Policy, when respected and accomplished U.S. civilian professionals functioned as its Director, and an important link with the newly established World Health Organization was forged. The advent of Dr. Abraham Horwitz of Chile as the agency's first Latin American chief, 56 years after its founding, can be taken to signal the onset of its maturity. Comparable stages of development can be described for PAHO's political, cultural and scientific counterpart, the Organization of American States. Another aspect of PAHO's development has been described by its current Director, Dr. Hector R. Acufia.2 It is characterized by the theme chosen by PAHO's Directing Council for its seventy-fifth anniversary, "Community Participation in Health." The theme, in Dr. Acufia's words, signifies that in the past "developing countries adopted models and methods from the developed countries, even though AJPH December 1977, Vol. 67, No. 12
the cultural, political, and socioeconomic conditions of the former had very little in common with those of the latter" and that "all conditions must improve-educational, economic, social, and, of course, health-if there is to be any lasting improvement.' '2 The fact that technology transfer from the industrially developed to the developing world may be difficult, impossible, or even undesirable has been recognized before. However, the failure of the Green Revolution to enhance equity in developing countries and the onslaught of energy and environmental crises in the industrially developed countries have altered perspectives3 more drastically than the quaint reports of social scientists. The era surrounding PAHO's birth was accompanied by significant advances in public health practice. Although we tend to associate them with the building of the Panama Canal, we would do well to remember that while General William Gorgas was eradicating disease in the Canal Zone, Dr. Oswaldo Cruz was performing smiilar miracles in the city of Rio de Janeiro. It would be a mistake, however, to attempt to understand and interpret this era in isolation from the political events which characterize it. Those were the days when American imperialism was on the march. The prevalent feeling of "manifest destiny" was neatly caught in a statement made by U.S. Secretary of State Richard Olney, in 1895: "Today the United States is practically sovereign on this continent, and its fiat is law upon the subjects to which it confines its interposition." Shortly thereafter the American flag flew over Puerto Rico, Cuba, and the Philippines; and John Hay, who had called the Spanish American war a "splendid little war," negotiated a new treaty with Great Britain, winning that country's "approval" to operate, fortify, and defend a canal across the Isthmus of Panama. The Colombian Congress, however, did not agree to the terms of a 1903 Treaty under which such intentions could materialize, and in the same year President Theodore Roosevelt "took the Canal Zone."4 As this piece is being written, the U.S.A. seems to be re-waging an internal political war over this same canal, almost as if nothing much had changed in 75 years, and Theodore Roosevelt, John Hay, and Alfred T. Mahan (the prophet of the navy) were still among us. The situation is ironic in many ways. The seeds of inter-American cooperation, whose flowering we celebrate in PAHO, were planted in 1826 in what is now the country of Panama. Here Sim6n Bolivar convened the first inter-American congress (at which delegates from the United States failed to arrive). A century and a half has elapsed since the collapse of Bolivar's dream. Differences in politics and behavior among the countries of the Americas continue to manifest themselves-as a previous editorial in this year's Journal reminds Us.5 However, the problems arising from these differences can only be intensified by our own return to juvenile jingoism and the big stick. As Dr. Wegman's article makes plain, our neighbors to the south and the international health agency 1 139
EDITORIALS
which binds us to them in human and professional fellowship have come of age. Let us hope our own level of maturation now matches theirs.
ALFRED YANKAUER, MD, MPH EDITOR REFERENCES 1. Wegman, M. E. A salute to the Pan American Health Organization, Am. J. Public Health 67:1198-1204, 1977.
2. Acufia, H. R. Community Participation in Health. World Health, August-September, 1977, p. 3-7. (WHO, Geneva). 3. Saint, W. S. and Coward W., Jr. Agriculture and behavioral science: Emerging orientations. Science, 197:733-737, 19 August 1977. 4. Herring, H. A History of Latin America. New York, Alfred A. Knopf, 1963 (2nd ed. rev.). 5. Yankauer, A. The quiet desperation of public health conscience (editorial) Am. J. Public Health 67:20-21, 1977.
State-of-the-Art Report on Health Systems Research in Progress The Study Group on Health Systems Research, University of Munich, a research group of the Institute for Medical Information Processing, Medical Statistics and Biomathematics of the LudwigMaximilians-University, Munich, is attempting to contact scientists and research institutions involved in health systems research, in order to: 1. Give a report on the actual state of the art in health systems research, 2. Provide documentation on all scientists and institutions currently performing health systems research, and 3. Establish a computerized literature analysis and retrieval system on health systems research.
In seeking such cooperation, the Study Group would like to assure anyone that he will have access to the results of their work. Scientists and institutions who are working in this field and who have not yet been contacted, should inform the Study Group. A questionnaire requesting documentation on current research and bibliography will then be sent, which should be completed as soon as possible for the Study Group's state of the art report. The anticipated completion date of the report is the end of 1977. The English version of the report will be available early in the summer of 1978. Contact: Dr. Wolfgang Koepcke, Study Group on Health Systems Research, University of Munich, ISB, Marchioninistrabe 15, Munich, Germany. The project has been funded through a contract from the Robert Bosch Foundation.
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AJPH December 1977, Vol. 67, No. 12
Seventy-Five Years of International Health It seems fitting that the year which draws to its close this month should mark both the seventy-fifth anniversary of the oldest living official international health agency, the Pan American Health Organization (PAHO), and the birth year of the International Health Section of the American Public Health Association. While we salute PAHO for its 75 years of service to the peoples of the Americas, we may wonder why it took 75 years for the Association's concerns with international health to flower formally as a section. Between 1891 and 191 1, the 20 years surrounding PAHO's birth, seven meetings of the APHA were held in other countries of this hemisphere and seven (35 per cent) of its 20 presidents were citizens of other American countries. The most famous of these 20 presidents was Dr. Carlos J. Finlay, elected thirtyfirst President of APHA at a meeting in Havana in 1904, two years after the birth of PAHO. Dr. Finlay was a Cuban physician to whom we are indebted for the classic formulation of the theory that yellow fever was transmitted by the Aedes aegypti mosquito. There have been no Latin American presidents of APHA since 1907 and no annual meetings of the Association south of the border since 1911. Since 1934, however, one of the Association's three vice presidential slots has been filled annually by a Latin American. Dr. Myron E. Wegman, a former President of APHA and a former Secretary-General of the Pan American Sanitary Bureau, the secretariat of PAHO, provides the Journal readers this month with an historical account of PAHO's growth and a scholarly discussion of the field of international health as exemplified by the PAHO program.' Dr. Wegman's affiliation with PAHO spans two decades-he served as a staff member of the organization from 1952 to 1960, the last four years of which were as Secretary-General, and has continued as a consultant to the present time. The period extending from the founding of PAHO as the International Sanitary Bureau (later the Pan American Sanitary Organization) through the routine tenure of the U.S. Surgeon General as its "elected" director could be termed its organizational childhood, dominated by the father figure to the north. The period ended with the inauguration of President Franklin Roosevelt's Good Neighbor Policy, when respected and accomplished U.S. civilian professionals functioned as its Director, and an important link with the newly established World Health Organization was forged. The advent of Dr. Abraham Horwitz of Chile as the agency's first Latin American chief, 56 years after its founding, can be taken to signal the onset of its maturity. Comparable stages of development can be described for PAHO's political, cultural and scientific counterpart, the Organization of American States. Another aspect of PAHO's development has been described by its current Director, Dr. Hector R. Acufia.2 It is characterized by the theme chosen by PAHO's Directing Council for its seventy-fifth anniversary, "Community Participation in Health." The theme, in Dr. Acufia's words, signifies that in the past "developing countries adopted models and methods from the developed countries, even though AJPH December 1977, Vol. 67, No. 12
the cultural, political, and socioeconomic conditions of the former had very little in common with those of the latter" and that "all conditions must improve-educational, economic, social, and, of course, health-if there is to be any lasting improvement.' '2 The fact that technology transfer from the industrially developed to the developing world may be difficult, impossible, or even undesirable has been recognized before. However, the failure of the Green Revolution to enhance equity in developing countries and the onslaught of energy and environmental crises in the industrially developed countries have altered perspectives3 more drastically than the quaint reports of social scientists. The era surrounding PAHO's birth was accompanied by significant advances in public health practice. Although we tend to associate them with the building of the Panama Canal, we would do well to remember that while General William Gorgas was eradicating disease in the Canal Zone, Dr. Oswaldo Cruz was performing smiilar miracles in the city of Rio de Janeiro. It would be a mistake, however, to attempt to understand and interpret this era in isolation from the political events which characterize it. Those were the days when American imperialism was on the march. The prevalent feeling of "manifest destiny" was neatly caught in a statement made by U.S. Secretary of State Richard Olney, in 1895: "Today the United States is practically sovereign on this continent, and its fiat is law upon the subjects to which it confines its interposition." Shortly thereafter the American flag flew over Puerto Rico, Cuba, and the Philippines; and John Hay, who had called the Spanish American war a "splendid little war," negotiated a new treaty with Great Britain, winning that country's "approval" to operate, fortify, and defend a canal across the Isthmus of Panama. The Colombian Congress, however, did not agree to the terms of a 1903 Treaty under which such intentions could materialize, and in the same year President Theodore Roosevelt "took the Canal Zone."4 As this piece is being written, the U.S.A. seems to be re-waging an internal political war over this same canal, almost as if nothing much had changed in 75 years, and Theodore Roosevelt, John Hay, and Alfred T. Mahan (the prophet of the navy) were still among us. The situation is ironic in many ways. The seeds of inter-American cooperation, whose flowering we celebrate in PAHO, were planted in 1826 in what is now the country of Panama. Here Sim6n Bolivar convened the first inter-American congress (at which delegates from the United States failed to arrive). A century and a half has elapsed since the collapse of Bolivar's dream. Differences in politics and behavior among the countries of the Americas continue to manifest themselves-as a previous editorial in this year's Journal reminds Us.5 However, the problems arising from these differences can only be intensified by our own return to juvenile jingoism and the big stick. As Dr. Wegman's article makes plain, our neighbors to the south and the international health agency 1 139
EDITORIALS
which binds us to them in human and professional fellowship have come of age. Let us hope our own level of maturation now matches theirs.
ALFRED YANKAUER, MD, MPH EDITOR REFERENCES 1. Wegman, M. E. A salute to the Pan American Health Organization, Am. J. Public Health 67:1198-1204, 1977.
2. Acufia, H. R. Community Participation in Health. World Health, August-September, 1977, p. 3-7. (WHO, Geneva). 3. Saint, W. S. and Coward W., Jr. Agriculture and behavioral science: Emerging orientations. Science, 197:733-737, 19 August 1977. 4. Herring, H. A History of Latin America. New York, Alfred A. Knopf, 1963 (2nd ed. rev.). 5. Yankauer, A. The quiet desperation of public health conscience (editorial) Am. J. Public Health 67:20-21, 1977.
State-of-the-Art Report on Health Systems Research in Progress The Study Group on Health Systems Research, University of Munich, a research group of the Institute for Medical Information Processing, Medical Statistics and Biomathematics of the LudwigMaximilians-University, Munich, is attempting to contact scientists and research institutions involved in health systems research, in order to: 1. Give a report on the actual state of the art in health systems research, 2. Provide documentation on all scientists and institutions currently performing health systems research, and 3. Establish a computerized literature analysis and retrieval system on health systems research.
In seeking such cooperation, the Study Group would like to assure anyone that he will have access to the results of their work. Scientists and institutions who are working in this field and who have not yet been contacted, should inform the Study Group. A questionnaire requesting documentation on current research and bibliography will then be sent, which should be completed as soon as possible for the Study Group's state of the art report. The anticipated completion date of the report is the end of 1977. The English version of the report will be available early in the summer of 1978. Contact: Dr. Wolfgang Koepcke, Study Group on Health Systems Research, University of Munich, ISB, Marchioninistrabe 15, Munich, Germany. The project has been funded through a contract from the Robert Bosch Foundation.
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AJPH December 1977, Vol. 67, No. 12
