THE VALUE OF HEALTH A HISTORY OF THE PAN AMERICAN HEALTH ORGANIZATION MARCOS CUETO Scientific and Technical Publication No. 600 THE VALUE OF HEALTH A HISTORY OF THE PAN AMERICAN HEALTH ORGANIZATION MARCOS CUETO Historian and Senior Professor, School of Public Health and Administration, Universidad Peruana Cayetano Heredia in Lima, Peru 525 Twenty-third Street, N.W. Washington, D.C. 20037, U.S.A. 2006 Also published in Spanish (2004) with the title: El valor de la salud: historia de la Organización Panamericana de la Salud Publicación Científica y Técnica de la OPS ISBN 92 75 31600 7 PAHO HQ Library Cataloging-in-Publication Cueto, Marcos The value of health: a history of the Pan American Health Organization. Washington, D.C.: PAHO, © 2006. (Scientific and Technical Publication No. 600) ISBN 92 75 11600 8 I. Title II. Series 1. PAN AMERICAN HEALTH ORGANIZATION - history 2. PUBLIC HEALTH - history 3. HEALTH PLANS AND PROGRAMS 4. PREVENTIVE MEDICINE 5. RIGHT TO HEALTH 6. LATIN AMERICA NLM WA11 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Area, Pan American Health Organization, Washington, D.C., U.S.A., which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2006 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The opinions expressed in this publication are the author’s alone. Photos: p. 2, Matt Morgan, “Yellow Jack Monster” [1873]. Library of Congress, Prints and Photographs Division, Washington, D.C, U.S.A. Reproduction Number LC-USZ62-35697. pp. 2, 8, 30, 46, 72, 96, 118, PAHO. Contents FOREWORD v ACKNOWLEDGMENTS vii INTRODUCTION 3 1. THE ORIGINS OF INTERNATIONAL PUBLIC HEALTH IN THE AMERICAS 9 Maritime Public Health in the Old and New Worlds 9 The Rise of Export Economies and the Institutionalization of Pan Americanism 14 The Era of Walter Wyman 18 The Control of Urban Yellow Fever 23 2. THE BIRTH OF A NEW ORGANIZATION 31 The First Sanitary Meetings 31 The Second Director of the Pan American Sanitary Bureau: Rupert Blue 41 3. THE CONSOLIDATION OF AN IDENTITY 47 The Hugh S. Cumming Years 47 The Permanence of a Code 50 The Conferences of the 1930s and the Second World War 57 The Origins of the World Health Organization 65 4. FOR A CONTINENT FREE OF DISEASE 73 Fred L. Soper and the Cold War 73 The Growth of the Organization 78 Eradication as Doctrine 86 The Warrior’s Rest 93 5. HEALTH, DEVELOPMENT, AND COMMUNITY PARTICIPATION 97 Abraham Horwitz, the First Latin American Director 98 A Building and New Programs 105 Primary Health Care 109 The Victories over Smallpox and Poliomyelitis 113 6. VALIDITY AND RENEWAL 119 Endnotes 127 Bibliography 151 ~ iii ~ ~ iv ~ Foreword To accomplish great things, we must not only act, but also dream; not only plan, but also believe. Anatole France (1844–1924) n late 2002, the Pan American Health Organization asked Dr. Marcos Cueto to write a history of PAHO. This book is the result of that assignment. Its pages tell of more than a century of uninterrupted work in the field of public health aimed at prevent- I ing, controlling, and eradicating disease and promoting health. The history of PAHO is the work of men and women who proved their idealism, knowledge, dedication, and resolve. That work, across generations, has made it possible for millions of people in the Americas to enjoy a healthier life. The achievements are, in large part, the result of the technical cooperation of PAHO with its Member Governments. The past century saw impressive advances in health that are worthy of being told here. We are proud of having made and maintained, in the majority of the countries, noteworthy progress in the field of public health, and of having helped to reduce mortality rates and to extend life expectancy. All of this has been accomplished despite successive and protracted economic and political crises and the unacceptable social exclusion of major population groups that have affected our countries throughout their history. This work recreates the voices of the Organization’s members and all the public health workers of the Americas who devoted themselves, generously and enthusiastically, to pro- moting health and protecting life. The eight Directors who have preceded me paved the way for excellence in service and transparency in administration. They were building an aus- tere, careful institution, protective of its human resources and the collective capital of knowl- edge accumulated in collaboration with the countries. By reading this history we can again affirm, without fear of error, that our Organization has a solid foundation. Health workers everywhere have devoted themselves to achieving the established goals and demonstrating the value of health in its contribution to reducing pov- erty and achieving a more equitable, sustainable human development. Its leaders have ~ v ~ geared the collective actions to ensure success, and our partners and allies have supported us and entrusted us with financial and technological resources to help us to accomplish our objectives. I hope this book will help us remember the past, respond to the present, and, above all, continue to plan for the future. As Director Emeritus Dr. George A. O. Alleyne once noted, “the past is always prologue.” In other words, the history we are building today is always the most important. Dr. Marcos Cueto has done an excellent job. His meticulous thoroughness in choosing the countless sources consulted and the resulting extensive bibliography are complemented with a lively and entertaining narrative that together make this book a lasting contribution to the history of our beloved Pan American Health Organization. Mirta Roses Periago Director ~ vi ~ Acknowledgments owards the end of 2002, Drs. George A. O. Alleyne and David Brandling-Bennett, then Director and Deputy Director of the Pan American Sanitary Bureau, the Secre- tariat of the Pan American Health Organization, gave me the opportunity to do some T research, which turned into this book and became a true joy for me. So I should start by thanking them. I am also indebted to the 2001–2002 Fulbright New Century Scholars Pro- gram, Challenges of Health in a Borderless World, directed by Dr. Ilona Kickbusch, in which I participated during 2002. Many of the ideas that helped me to organize my research were developed during the course of this program. I am also eternally grateful to Dr. Mirta Roses Periago, the current Director of the Bureau, who supported the project of writing a history of the Organization. Special recognition goes to Dr. Judith Navarro, Manager of PAHO’s Publications Area, and the members of her team, for their support throughout the process of researching and editing the manuscript. During the first five months of 2004, thanks to a resident research fellowship at the Woodrow Wilson International Center for Scholars in Washington, D.C., I was able to devote time to cor- recting and polishing the manuscript. Many thanks to Dr. Joseph S. Tulchin, Director of the Center’s Latin American Program, and Mrs. Rosemary Lyon, Director of the Scholar Selection and Services Office. I also wish to thank Dr. José Romero Teruel for his invitation to a meeting of former Bureau staff members in late 2002 in Washington, D.C., which was filled with anecdotes and affection for the institution. Dr. Pedro E. Brito, a Headquarters staffer, provided support during various stages of the project. Thanks also go to the directors and staff of the archives and libraries that I consulted and which are listed in the bibliography. Dr. Elizabeth Fee, Chief of the National Library of Medicine’s History of Medicine Division, located in Bethesda, Maryland, U.S.A.; Dr. Ineke Deserno, Head of Records and Archives at WHO in Geneva, Switzerland; Irma Betanzos, Director of the His- torical Archives of Mexico’s Ministry of Health; and Dr. Darwin Stapleton, Director of the Rockefeller Archive Center in Sleepy Hollow, New York, deserve special mention. ~ vii ~ My thanks to the PAHO/WHO Representatives and employees in the countries I visited, and to the managers of the Organization’s centers, institutes, and programs who answered my ques- tions and sent me essential information. I especially want to mention Drs. Joaquín Molina, PAHO/WHO Representative in Mexico, and José Moya, a staff member in that Country Office, who made it possible for me to interview Dr. Héctor R. Acuña, former Director of the Sanitary Bureau from 1975 to1983. In Havana I enjoyed the support of Dr. Eduardo Patricio Yépez and had the honor of talking several times with Dr. Gregorio Delgado García, the noted Cuban medical historian. I was fortunate to have the collaboration of Dr. Manuel Peña, former PAHO/ WHO Representative in Jamaica, who taught me about the rich public health tradition of the English-speaking Caribbean.