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E-18--Annex B--363-380 Pan American Health Organization Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action. Washington, D.C.: OPS. Scientific and Technical Publication No. 589 ISBN: 92 75 11589 3 I. Title II. Author 1. Public Health 2. Steering Role of the Health Sector 3. Essential Public Health Functions (EPHF) 4. Public Health Workforce 5. Performance evaluation of health services 6. Techniques for evaluation Book cover illustration: Gustav Klimt, Hygieia. Work/Art “Medicine”. Ceiling panel for the Magnum Hall of the University of Vienna, 1900–1907. Oil on canvass 430 X 300 cm., destroyed in 1945 in the Immen- dorf Castle. Reproduced from the photographic archives by permission of ARTOTHEK. Hermfeldstrasse 8 D-82362 Weilheim, Germany. Pan American Health Organization, 2002 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 reserved. The designations employed and the presentation of the material in this publication do not imply the ex- pression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the de- limitation 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 na- ture that are not mentioned. Errors and omissions excepted, the names of proprietary products are distin- guished by initial capital letters. The authors alone are responsible for the views expressed in this Publications. Preface This book represents the realization sure that people enjoy that “posses- sitions that have altered their epi- of a dream of a work on public health sion” that is universally valued above demiological profiles. The nature of in the Americas that was worthy of all others. the burden of public ill health has being a Centennial publication of the changed. The data show clearly that Pan American Health Organization It is proper and natural in considering it has been the discovery and use of (PAHO). I did not wish this to be a this as a Centennial publication to re- technology that has played a major document that analyzed the data on vert at least briefly to our origins and role in the improvement of the health the characteristics of the health of the the public health of that day. The na- indicators of populations. We have people of Latin America and the Ca- ture of scientific knowledge of 100 experienced the power of technology ribbean. There are other publications years ago made it inevitable that the to add years to life, and in the enthu- that will show in great detail the major concern would be for infec- siasm for the magic of the technolog- health situation and the trends that tious diseases, and the appreciation ical imperative for individual benefit are occurring. Therefore, I am pleased that it was possible to control these we have tended to lose sight of the that we have in this book, a work that through social and sanitary engineer- difference between sick individuals reflects on the context in which pub- ing in the widest sense, was a major and sick populations. The concern for lic health is perceived and practiced development. There was no doubt the health of the public had been con- and sets out the extent to which those about the role of the government in sumed by the fervor for individual functions that are essential to pro- so modifying the environment that care as the miracles of scientific re- moting and preserving the public’s the health of the public would be im- search promised ever greater good for health are being discharged. No text proved. The data PAHO collected individual life and health. on the people’s health is definitive, it were related to infectious diseases and can at best be one of the rivulets that the possibility of informing decisions We were witnesses to the growing join but enrich the stream of think- about quarantine measures. concern in developed countries about ing about one of the most important the state of their public health enter- problems of our time-how to improve But we live in different times. All our prise even in the midst of a veritable the health of our people, how to en- countries have undergone health tran- cornucopia of scientific advances iii that augured so well for individual and prevent illness, the focus was pre- ing a measure that is useful for our health. The enquiry in the United dominantly on the individual and countries in improving health. States showed a public health system there tended to be neglect of the in disarray and the situation was little health of the public. The organized It is especially gratifying to note the better in the United Kingdom. At- efforts of society were not being fo- emphasis placed here on the acqui- tracted as I was to the working defini- cused on the public’s health. sition of information, the role of tion of public health used in the latter epidemiology in establishing whether study—“the science and art of pre- But in order to determine how these the functions are being discharged, venting disease, prolonging life and efforts should be directed, it is intu- and the definition of systems neces- promoting health through organized itively obvious that there must be sary to measure any change that efforts of society,” I expressed my dis- some measure of the functions that might occur. It is epidemiology that quiet as to whether in our Region we the state must discharge if the public’s forms the bridge between the concern could indeed discern what were these health is to be promoted and avoid- for the individual and the wider pub- organized efforts of society and how able illness prevented. We have lic. PAHO was born out of a necessity they were made operational. Rudolf posited repeatedly that the responsi- for the collection and dissemination Virchow is one of my heroes and bility of the state and that of the gov- of information, and throughout its many of my concerns of today can be ernment are not coterminous, and history there has been steady growth found in his writings. In 1848, as he this book makes it clear that it is not and maturation of the methods and too agonized over the state of public only the government that has the sole systems for carrying out that pristine health, he wrote: and unique responsibility for dis- mandate. Now in PAHO’s 100th year, charging all these functions. But let us this Centennial publication shown “It is not enough for the gov- be clear that there are some that are that provision of information about ernment to safeguard the mere indeed within the nondelegable re- what is upon the people is the first of means of existence of its cit- sponsibility of the government as the the essential public health functions. izens, i.e. to assist everyone principal actor within the state. This certainly speaks to a continuity whose working capacity is not of focus and purpose. sufficient to make a living. The The exercise of measuring the extent state must do more. It must help to which there are essential public This work by PAHO is intended everyone to live a healthy life. health functions and they are being mainly for the Americas, but we This simply follows from the discharged, has been an open and know that it has informed practice in conception of the state as the participatory process as indeed any other agencies and in other parts of moral unity of all individuals exercise of this nature must be. The the world. The spread of any ap- composing it, and from the ob- selection of the functions is a result of proach opens one to wider critique, ligation of universal solidarity.” repeated iterations and consultations but that is healthy. Perhaps we should as a basic premise that in this field say as John Graunt did when he pre- We saw the call for solidarity take there is no absolute truth. It is highly sented the famous Bills of Mortality: shape more recently in the call for eq- likely that there will be others in dif- uity, and this has been a value that has ferent places who will establish differ- “How far I have succeeded in underpinned much of the reform of ent functions as being essential to be the Premisses, I now offer to the health sector that is occupying the discharged in the quest for improved the world’s censure. For herein attention of almost all our govern- public health. But what will stand is I have like a silly Scholeboy, ments. But in the reform movements the concept behind the exercise, the coming to say my Lesson to that sought equity in the delivery of methodology that sustains it and the the World (that Peevish, and services needed to promote health basic and prosaic purpose of provid- Techie Master) brought a bun- iv dle of Rods wherewith to be of the functions that must be carried I hope you enjoy this Centennial whipt, for every mistake I have out by organized society to ensure the publication of the Pan American committed.” health of the public, nor the meth- Health Organization. ods in applying the tools that have Any mistakes that there may be are been developed in great part by the George A.O.
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