In February, Mirta Roses Periago, MD, began her second term as director of the Pan American Health Organization, continuing her stretch as the first woman to helm the world’s oldest health institution. During her swearing-in ceremony, Roses said she would work to keep PAHO at the “forefront of the response to the regional and global challenges in public health and, particularly, to serve as an instrument for bringing good health to the most neglected, vulnerable, marginalized and excluded populations.”
With an extensive professional history in global public health, including numerous positions within the World Health Organization, Roses was elected as APHA’s vice president for Latin America at the Association’s 2007 Annual Meeting in Washington, D.C. For more information about PAHO’s activities, visit www.paho.org.
What are some of the most pressing public health problems that are unique to the region that PAHO works in?
 |
|
Mirta Roses Periago attends 2007’s Vaccination Week in the Americas in the tri-state border area of Brazil, Argentina and Paraguay. Photo by Gilles Collete, courtesy PAHO |
Health is a public and instrumental good for individuals, families and communities. Thus, it should be within the reach of all. However, the region unfortunately continues to be the most unequal in wealth distribution, while simultaneously bearing the burden of cumulative social debt. Therefore, PAHO continues advocating to reduce inequity and social exclusion by renewing and fostering primary health care-based health systems.
We must also react to the tyranny of averages, since poverty is often concealed by global figures, and our Faces, Voices, and Places Initiative makes the most neglected communities seen and heard to empower them to make the (global Millennium Development Goals) a reality for all.
The region’s health needs call for a three-pronged approach. First, we must strengthen the national responsibility and the institutional capacity of governments, as well as international support provided to the priority countries. We must also ensure that the unique situation of the region’s middle-income countries remains visibly present on the international agenda to avoid the risk of setbacks, and we must prepare in advance to address the situation of island nations and small countries that must deal with the impact of climate change and with the consequences of the globalization of trade and labor and of its resulting migratory patterns.
How big of a milestone was the 2007 launch of the Health Agenda for the Americas? And how is the agenda already helping to shape public health efforts?
The Health Agenda for the Americas 2008–2017 is the highest-level political instrument for health development in the region of the Americas. For the first time in over 30 years, the countries of the Americas collectively agreed upon a long-term health agenda as their independent political expression.
It is already helping to shape public health efforts, i.e., as a basis for sub-regional health agendas in the Caribbean, Central America and Latin America, in guiding the plans of international organizations in the health arena and as a reference for key national health planning in countries throughout the region.
The agenda points to sexual and reproductive health as a top priority. How will improving this area of health contribute to improving health for entire populations?
Sexuality and reproduction are fundamental facets of human life and health aspects related to them must be part of a comprehensive approach in health promotion and care. The cost of treating sexual and reproductive diseases and disorders further impoverishes families, disrupts interpersonal dynamics and generates anxiety and depression. (The) sexual and reproductive health agenda aims at averting problems during pregnancy and childbearing and ensuring the highest attainable standard of health for the baby, for the woman, for the family and for the community as a whole, including ensuring healthy aging.
The agenda mentioned that increased urbanization in parts of the Americas is often associated with more people adopting unhealthy lifestyle choices. Because of this, is PAHO witnessing an increase in health problems tied to poor diet and sedentary lifestyles?
The shift from rural to urban and city living is greatly influencing the diet and physical activity levels of the people in the Americas. Chronic noncommunicable diseases once thought of as “diseases of affluence” have become far-reaching and indiscriminate, affecting the region’s poor far more than the wealthy. The main causes of the majority of chronic noncommunicable diseases, such as heart disease, stroke, cancer and diabetes, are linked to modifiable risk factors. In 2006, member states approved a Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases, including Diet, Physical Activity and Health. Initiatives to date include the Let’s Eat Healthy & Get Moving Americas! campaign against obesity and the Trans Fat Free Americas initiative.
How big of an obstacle do weak public health infrastructures present to overcoming the public health problems in Latin America and the Caribbean?
 |
|
PAHO Director Mirta Roses Periago talks with a hospital patient in 2004 in Santa Cruz del Quiche, Guatemala. Photo by Orlanda Sierra, courtesy Getty Images |
The region has witnessed outstanding strides in the improvement of basic health indicators in recent decades but there are still significant challenges. Avoidable mortality, for example, still surpasses 1 million deaths annually. The slow and uneven progress can be explained partly by weaknesses in the public health infrastructure. The public health work force is lacking in numbers, training and balance in composition. Health professionals are largely concentrated in urban areas, laboratory capacity is obsolete and essential medicines and vaccines are not yet universally available. Health surveillance and epidemiological systems are fragmented, hindering the identification of the health needs of the population. National health authorities lack organizational and institutional capacity and most of the financing is focused on personal services, leaving the public health sector with insufficient resources. All of these factors contribute to exacerbating health inequities.
More and more, public health officials are speaking out on climate change and its health effects. How does addressing climate change fit into PAHO’s overall health priorities?
We consider climate change as such an important threat to our achievements on the health of people, particularly the poorest and more disadvantaged populations.
Climate change is already causing health problems, especially among populations that are exposed to environmental pollutants or living in unsustainable settings. PAHO has conducted workshops in the region, such as in Barbados and Costa Rica, to identify adaptation options to climate change based on local vulnerabilities, and a meeting will be held in Brasilia to draw up a regional plan of action to be launched in late 2008.
How important is it that policy-makers around the world see public health as a “global” mission rather than a “local” mission?
The recognized interdependency that marks this new century has overcome the distance between the local and the global, the individual and the collective, the micro and the macro, the biological and the environmental, making the global nature of threats and the global capacity to respond to them increasingly evident. No country or region, regardless of its size, development level or geographical location, can face the most pressing public health challenges alone.
In this regard, we need to coordinate our activities, increase our connectivity, create networks for collaboration, and enlist new actors and institutions to confront the risks and specifically protect the most vulnerable among us. Preparing the countries of the region to meet these global challenges is thus one of PAHO’s main objectives.