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V olume 8 No. 3 • 2003 The Magazine of the Pan American Health Organization Regional Office of the World Health Organization Violence What Can Public Health Do? www.paho.org Food Thein the BiotechAmericasDivide(p.18) The Many Faces of Public Health Violence is clearly among the most menacing threats to human welfare around the world, yet it has not generally been thought of as a public health matter. Traditionally violence has been viewed primarily as a law enforcement issue, with a focus on punishment and deterrence. There may always be a need for these remedies, but as our Perspectives in Health • cover story shows, violence is largely a preventable problem, and therefore the tools and Volume 8, No. 3 perspectives of public health have much to offer in dealing with it. Public health methods of measuring the problem, investigating its causes, designing and implementing interven- Published by the Pan American Health Organization Features tions and evaluating their success provide a promising approach to finding a solution. (PAHO) Mirta Roses Periago, Director Our second article is a photo essay featuring the stunning and poignant photographs of Bryna Brennan, Executive Editor Brazilian photojournalist Sebastião Salgado. A modern-day philanthropist, Salgado has 2 The Violence Pandemic Donna Eberwine, Editor by Donna Eberwine lent his considerable talent and energy to the noble cause of global polio eradication. The Paula Andaló, Contributing Editor Americas eliminated polio and were declared free of the disease in 1994. But through Gilles Collette, Art Director Bola Oyeleye, Designer Violence claims the lives of more than a million people every year and Salgado’s powerful images we see how polio still affects boys and girls, men and women in Alex Winder, Production leaves many more with physical and mental scars. The authors of the the countries where it has remained endemic. We also see that there is an end in sight to Armando Waak, Photographer first World Report on Violence and Health argue that it is largely a this totally preventable disease. Following health workers as they carry out a multi-country preventable problem and that public health can play a critical role in immunization campaign, Salgado documents what should soon become one of the finest Perspectives in Health (ISSN 1020-5551) is published by the helping to bring it under control. Pan American Health Organization (PAHO), the oldest successes of global public health. continuing international public health agency in the world and Regional Office for the Americas of the “Battling over Biotechnology” tackles an issue that has emerged as much more contro- World Health Organization (WHO). Chronicling the End of Polio contents versial than was foreseen in the exciting early days of this field. Much to the consternation Its headquarters is located at 525 Twenty-third Street, N.W., 10 by Paula Andaló of scientists and companies working in this area, adamant objections have been raised to Washington, D.C. 20037. Tel: (202) 974-3000 Columns genetically modified (GM) foods, due to doubts about their potentially adverse effects on Fax: (202) 974-3663 Internet: http://www.paho.org/ Photojournalist Sebastião Salgado has traveled the world to document First Word health and the environment. While the evidence supporting these objections remains © 2003 Pan American Health Organization human travails in an era of globalization. But his most recent work was From the Director inspired by hope: It chronicles the final thrust in the global campaign to sparse, the concerns cannot be ignored. Public health can play a critical role in addressing All rights reserved 31 Mailbox them by applying science-based criteria to the evaluation of new GM products. As our ar- eradicate a crippling disease. Articles do not necessarily represent the official viewpoint of the Pan American ticle reports, the Pan American Health Organization (PAHO) is actively working with its Health Organization. Letters and editorial queries should be addressed to the editor. 32 Last Word A Cure for Member States to incorporate GM food and crops into their existing food safety systems. Reprints: Articles reprinted with permission must carry the following credit line: Discrimination “Reprinted from Perspectives in Health, the magazine of the Pan American Health First Word Organization, published in English and Spanish.” Reprints must carry author’s 18 Battling over Biotechnology This issue also features an article on PAHO’s Pan American Foot-and-Mouth Disease name and two copies must be sent to Perspectives in Health. by Donal Nugent Center (PANAFTOSA), showing how veterinary public health is integral to human public POSTMASTER: Send address changes to Perspectives in Health magazine, health. While foot-and-mouth disease is not directly dangerous to humans, Office of Public Information (DPI), Pan American Health Organization, 525 Twenty-third Street, N.W., Washington, D.C. 20037. Genetically modified crops are becoming the rule rather than the excep- PANAFTOSA’s efforts to control it have been essential to ensuring food safety and secu- tion in North American agriculture, and they are showing up in a growing rity in our region while protecting meat production and trade. number of Latin American countries as well. But lingering doubts about PAHO Member States their safety have prompted governments to take new action to address Antigua and Barbuda public concerns. This issue closes with two articles on communicable diseases, each with a very different Argentina Bahamas focus. In a review of several recent books, “Purple Death: the Great Flu of 1918” treats us Barbados Belize to a brief but absorbing history of the deadly Spanish flu. It reminds us of our vulnerabil- Bolivia Brazil ity to such pandemics and is particularly sobering in the aftermath of the severe acute res- Canada Chile 24 Crusaders for Animal Health piratory syndrome (SARS) epidemic earlier this year. Colombia by Alexandre Spatuzza Costa Rica Cuba As a final note, our “Last Word” column broaches the enduring issue of stigma and dis- Dominica Dominican Republic Since foot-and-mouth disease was first introduced into the Americas in crimination against people living with HIV/AIDS. It calls attention to the regrettable fact Ecuador El Salvador the 19th century, it has been the single most enduring threat to the that such discrimination can be found where it is least acceptable: in the health sector, Grenada region’s livestock. Now, with help from the Pan American Foot-and- Guatemala where everyone is by training and vocation purportedly committed to promoting patients’ Guyana Mouth Disease Center, the region is on track to eradicate the disease by Haiti mental and physical well-being. The column is based on a recent PAHO study of this issue Honduras the end of this decade. Jamaica and coincides with the launching of a regional campaign designed to eliminate stigma and Mexico Nicaragua discrimination from the health sector. Panama Paraguay Peru Saint Kitts and Nevis Purple Death: The Great Flu of 1918 olume 8 No. 3 • 2003 28 olume 8 No. 3 • 2003 V From the cover story to the “Last Word,” the articles in this issue of Perspectives in Saint Lucia by Sara Francis Fujimura Front cover: V • Saint Vincent and the Grenadines • Health illustrate the many faces and many strengths of public health. They provide evi- Suriname More than 4,000 people Trinidad and Tobago worldwide die from violence dence once again that our tried-and-true methods and our unique perspective—which sees United States At least twice during each of the last three centuries, a mutant strain of every day. For some coun- Uruguay tries, it has become a leading all problems as at least partially preventable—can be applied fruitfully to virtually any threat Venezuela the influenza virus has emerged, killing hundreds of thousands around cause of death. Now public to human health. • the world. By far the most devastating of these was the Spanish flu of health advocates are rallying Participating States 1918. A number of recent books on the subject make sobering reading a far-reaching response to France what they say is largely a The Netherlands today, when experts say the world is due for a new pandemic. preventable problem (see United Kingdom story page 2). • Photo illustration by Bola Oyeleye Associate Member (photo source- Artville Stock Images) Mirta Roses Periago Puerto Rico • Perspectives in Health Director Perspectives in Health Observer States Portugal Spain • 1 P AN AMERICAN HEALTH ORGANIZATION With an average of seven firearms For every death there are many deaths daily (according to 2000 Half of all violent more injuries due to physical and sex- The data), Rio de Janeiro has among the ual assaults. Yet data on these are highest homicide rates in the world. harder to come by because fewer But it is by no means alone in facing deaths are suicides, countries have good surveillance in a crisis of violence. Violence has be- this area. come one of the leading causes of a third are “A large amount of violence does not death throughout Brazil, as well as in get reported systematically but needs to other countries of the Americas and be found out through specifically de- Violence other regions of the world. Globally, homicides, and a fifth signed surveys,” Krug says. “In those Pandemic nearly 4,400 people per day died as a surveys, we find some of the most result of violence in 2000. And rates shocking numbers in our report.” of violence appear to be increasing in are war related. Based on studies of nonfatal violence How Public Health Can Help Bring It Under Control most places where it is high. from more than 50 countries, the by Donna Eberwine Many would argue that violence is 100,000 double those of high-income World Report on Violence and Health an inevitable part of the human con- countries.