The Pan American Health Organization: 120 years in the Americas hemisphere

In 1902 eleven countries of the Americas created the first international public health intergovernmental agency. The International Sanitary Bureau evolved over the years to become the Pan American Health Organization (PAHO).¹ The history of public health has been embodied by great successes, but also by setbacks and PAHO does not escape this fate. Encapsulating 120 years of service is not a straightforward task, particularly when it is about protecting the health and wellbeing of the people.

At the core of the chronicle of PAHO is the signing of the Pan American Sanitary Code – The Code – by 18 countries in 1924. The Code has been probably the greatest achievement in health policymaking, and the most defining development to shape the future of public health in the region. The Code, still in force today, primed the Organization to take on the number one killer of people in the region of that time: infectious diseases. In 1950 PAHO led the first hemispheric effort to eradicate smallpox which prompted the World Health Assembly to undertake a global initiative to eradicate smallpox.² In 1991 the Americas was the first region to eliminate poliomyelitis,³ which was followed by rubella, congenital rubella, and neonatal tetanus. Today, several other communicable diseases are not far from elimination.⁴

The region has advanced on leveraging and implementing effective policy making on health promotion, prenatal care and maternal health, nutrition, vaccinations, and water and sanitation. Life expectancy increased from 41 years in 1900 to 77 years in 2019 in the Americas.⁵ Child mortality rates (under-five years) per 1000 live births in Latin America and the Caribbean (LAC) decreased from 208.7 in 1950 to 16.2 in 2021.⁶

The contributions of PAHO in the provision of sound technical cooperation and norms, implementation of high-quality public health programs, preparedness and response to emergencies, catalysation of cooperation between countries, and mobilization of technical and financial resources cannot be overlooked. The Revolving Fund for Access to Vaccines has played a crucial role in the decline of morbidity and mortality of vaccine preventable diseases.⁷ The Strategic Fund for Essential Medicines and Public Health Supplies is advancing access to quality medicines and commodities.⁸

Gains in health, however, are usually fragile and subject to U-turns. Unless well-financed resilient health systems rooted on primary health care are in place to successfully confront both persisting and new challenges, the threat of regression will be always looming. The best example is the COVID-19 pandemic which reversed or stopped the advancement of key health achievements in the region, including the prospect of realizing the Sustainable Development Goals (SDGs).⁹ In addition, it exacerbated major existing health barriers such as inadequate financing of health, fragmented health systems, and dependence on imports of pharmaceuticals, vaccines, and other health technologies from outside the region, as is the case for LAC.

Limited access to quality health services, mostly by vulnerable populations, is probably the most critical problem the countries need to aggressively focus on without delay.¹⁰ Despite laudable efforts to tackle it, inequality in LAC continues to spread across gender, ethnicity, wage, education, and employment. Furthermore, with the top 10% of the population capturing 55% of the average national income,¹¹ LAC has a long and winding road to walk to address the perilous crisis of inequalities.

PAHO’ role in the next five to 10 years will be crucial for the region to move forward and recover from the impact of the pandemic with equity and fairness for all. Furthermore, how the Organization positions itself will be decisive to boost the likelihood of achieving universal health for all, the SDG-3, and other SDGs relating to health. The region will not be able to achieve the personal state of health and wellbeing for all, without assertively addressing the increased burden of non-communicable diseases, the ominous threat of emerging and reemerging infectious diseases, the complex social and environmental determinants of health, the overdue modernization of information systems, and the vast equity gap the peoples of the region currently are experiencing. Innovation, research, and development for health will require a major transformation. Leveraging the advantage of prestigious academic centres and institutes of health that exist in the region will be critical to make the leap forward.

Unless health is positioned at the core of the development and political agendas of our leaders and policy makers, the region will be at a major risk of not meeting the health needs of its people. PAHO is in a leading position to catalyse the necessary changes for health to become one of the top priorities of the countries of the region, if not the uppermost. An all of government and society approach is cardinal to ensure that health sits at the main table and not at the back of the dining room.

Happy Birthday PAHO! Keep supporting countries in the Americas to combat diseases, lengthen life, and promote the physical and mental health of the people.¹ More importantly, furthering the provision of health for all through a revolution of bold innovations. The next 120 years will be fun!

Contributors

ME is the sole author of this Comment. He was responsible for conceptualisation, investigation, and for drafting and finalising the text.

Declaration of interests

ME is employed by PAHO/WHO. The author is responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the Pan American Health Organization.