Pan American Health Science (1902+)

Around the turn of the last century, the threat of epidemic diseases was all too real throughout the Americas. American nations were drawn closer together than ever before by international commerce and the many U.S. interests in Central and South America. The age-old tropical killers, especially yellow fever, as well as diseases like cholera, typhoid fever, and even the bubonic plague (brought from Asia) were a threat to the developing inter-American community. To ensure the unimpeded flow of commerce (and thus U.S. economic and political dominance), public health officials began an effort to sanitize port towns in order to prevent the spread of epidemics. The organization they formed in 1902 to accomplish this, the International Sanitary Bureau (ISB) (later renamed the Pan American Sanitary Bureau [PASB] and, ultimately, the Pan American Health Organization [PAHO]) not only succeeded in protecting inter-American commerce, but would actually reshape how governments and individuals in North and South America conceived of the objectives, purpose, and meaning of public health.

Historian of medicine Marcos Cueto averred that the PAHO helped propagate a new idea about health; it was no longer a mere personal aspiration, but an individual's legal and human right for which the state was responsible. Such a result could not have been realized without the fin-de-siècle convergence of new medical advances, such as Carlos Finlay's work on yellow fever, and the tightening of political relationships among the American republics brought on by the necessities of commerce (Cueto 2007). Soon, these countries began implementing the sanitation measures the PAHO created for ports in their other urban eras, promulgating public health to the people at large. (See the PAHO's "Sanitary Code" in the sources for details of their current objectives. Although the efforts began to protect trade and U.S. power, the PAHO has made general public health its priority).

Although the U.S. was and remains the most powerful of the thirty-five countries in the Pan American community (the main office is still in Washington, D.C.), Latin American countries were able to use the PAHO to realize policies that were often in opposition to those of the U.S. Anne-Emanuelle Birn pointed out how Latin American countries, building on native traditions and French influence, promoted maternal and child care at PAHO meetings long before such practices were in the mainstream and, despite initial resistance by the U.S., made infant mortality a priority throughout Latin America (Birn 2002). The sources on prenatal care and obstetrics illustrate just how important women's and children's health are to Latin America and, consequently, are first among the PAHO's current objectives.

Similarly, at the Pan American Congress for Eugenics and Homiculture (which met concurrently with the PASB), Latin Americans refused to adopt the far more racist variation of eugenic science endorsed by the U.S. According to historian of medicine Nancy Leys Stepan, Pan American eugenics was actually dominated by Latin Americans, who preferred social medicine, such as education and sanitation, to the harsh practices of the U.S., especially the forced sterilization of those deemed genetically unfit (Stepan 1991).

For over one hundred years, the PAHO has attempted to rid the Americas of disease, unsanitary living conditions, and ignorance regarding personal and public health. By refusing to be relegated to the periphery of this organization, Latin American countries have made the PAHO as truly Pan-American as possible.

Questions for further exploration:

1. Consider the two cartoons meant to instruct the general public on sanitation (those on how to prevent cholera and chagas' disease). How has the pan-American health community contributed to the production of posters like these?

2. Look at the source on AIDS. Is the PAHO's approach to fighting this relatively new disease similar or different to how it fought against endemics like yellow fever?

3. The two international groups that have been most influential in shaping modern health practices in Latin America are the PAHO and the Rockefeller Foundation. Compare these two organizations. Which has had a larger overall impact on health and medicine in Latin America?

4. How have Latin American countries shaped the PAHO's priorities and how has it benefited from them?

5. Considering information found in this as well as other topics, how has the U.S. impacted the role of science and medicine in Latin America during the twentieth-century?

Further reading:

Birn, Anne-Emanuelle. "'No More Surprising Than a Broken Pitcher'? Maternal and Child Health in the Early Years of the Pan American Sanitary Bureau." Canadian Bulletin of Medicine. 19: 1 (2002): 17-46.

Cueto, Marcos. The Value of Health: A History of the Pan American Health Organization. Rochester, NY: University of Rochester Press, 2007.

Miller, Francesca. "The International Relations of Women of the Americas 1890-1928."  The Americas. 43: 2 (October 1986): 171-182.

Pan American Health Organization website: www.paho.org.

Stepan, Nancy Leys. "The Hour of Eugenics": Race, Gender, and Nation in Latin America. Ithaca: Cornell University Press, 1991.

AIDS

Date: c. 1980
Owner: National Library of Medicine
Source Type: Images

 

This AIDS awareness poster was distributed in Uruguay with the support of the Pan American Health Organization. The caption reads: "This HIV carrier does not have AIDS, but she can transmit it." It goes on to describe how someone can remain healthy and attractive for several years while carrying the HIV virus before any symptoms of AIDS appear. It then encourages people to use condoms to prevent the spread of this disease.

The fight against HIV/AIDS has become a major initiative of the PAHO. According to their estimates, 3-5 million individuals in the Americas are currently infected with HIV, and the majority of these are these are people living in poverty, especially women and children. The number of people infected with the disease in Latin America and the Caribbean is still rising. The PAHO's current goal is to halt the spread of HIV by 2015 and, through administering treatment, begin to reverse the epidemic.

Although HIV/AIDS has only become an international health issue in the last few decades, the PAHO's efforts to stem its growth have been reminiscent of earlier campaigns against contagious diseases. Preventing the spread of HIV has been the primary goal, just as the campaign against Yellow Fever stressed containment over one hundred years ago. Yet the social values of the ISB's/PAHO's efforts have changed significantly over the last century; whereas the initial goal was to ensure that infectious diseases did not impede commerce, the health of women and children has now become a principle aim.

Reference: Regional HIV/STI Plan for the Health Sector, 2006-2015. Washington, D.C. Pan American Health Organization, 2005.
 
CITATION: Es portadora vih no tiene sida, pero lo contagia. United States National Library of Medicine, National Institutes of Health. Order #: C01055.

DIGITAL ID: 13048

 

Cholera Sanitation

Date: c. 1980
Owner: National Library of Medicine
Source Type: Images

 

This poster, administered by Brazil's State Commission for Preventing and Fighting Cholera, is representative of several public sanitation efforts resulting from the Pan American Sanitary Bureau's work in Latin America. Before the PASB began sanitizing port cities in the early twentieth century, Latin America had very little infrastructure for ensuring that urban centers, much less rural areas, were disease free environments. Yet the pubic sanitation bureaus have proven unable to eliminate ailments like cholera, dengue fever, malaria, and Chagas' disease, diseases that remain most common in the poorest parts of Latin America. National sanitation offices have thus worked to educate the public on how individuals and families can protect themselves from these conditions.

Cholera is an incredibly fatal disease resulting from exposure to a bacterium most often found in untreated water supplies. By the 1920s, cholera had been largely destroyed in the U.S. and Europe and had thus come to be considered an exclusively tropical disease. It could, however, still be exported from the tropics in tainted foodstuffs, thus the PASB hoped to install checks at all Latin American ports to ensure that this disease remained relegated to the tropics.

The goal of this poster is to ensure that Brazilians know how to prevent the spread of cholera, a disease that the government has failed to eliminate. Like other such sanitation propaganda, the message is conveyed through a cartoon, a medium meant to be instructive to those living in poverty with little education. It instructs Brazilians that washing fruits and vegetables, thoroughly cooking seafood, and drinking only treated or boiled water are necessary steps to protecting them from cholera. It also recommends that one avoid eating at restaurants with "poor hygiene conditions."
 
CITATION: Colera veja como evita-la. United States National Library of Medicine, National Institutes of Health. Order #: A031840.

DIGITAL ID: 13042

 

Family Planning

Date: c. 1980
Owner: National Library of Medicine
Source Type: Images

 

This Brazilian poster informs the public about several different birth control methods, including birth control pills, IUDs, condoms, vasectomies, the calendar, and diaphragms. Although public education on birth control has become quite common throughout the Americas, the early twentieth century debate about birth control was inextricably wrapped-up with the controversial new science of eugenics. Like other scientific movements of this era, eugenics took on a hemispheric aspect. The Pan American Association of Eugenics and Homiculture met concurrently with the PASB and tried to homogenize how eugenics was understood and practiced throughout the Americas.

Since the Association's very first meeting (in Havana, 1927), there was an ideological rift between eugenicists from the U.S. and those from Latin America. According to historian Nancy Leys Stepan, U.S. eugenicists hoped to implement strict policies, such as forced sterilization, that did not go over well with Latin Americans who favored a "softer" form of eugenics. Because Latin American eugenicists continually resisted pressure from the United States and Puerto Rico to pass hard measures regulating marriage, immigration, and social actions aimed at racial "purity," the Pan American Association of Eugenics disintegrated after only its second meeting (in Buenos Aires, 1934).

Most Latin Americans eugenicists hoped to improve their nations' gene pool by ensuring that children and mothers received sufficient prenatal care. Thus the Pan American Association that brought them together helped to spread important public health measures, like Uruguay's Codigo del Nino, throughout Latin America. Birth control, in its most positive form, was meant to help the lower classes avoid poverty and to ensure that women had a measure of control over their own health.

Stepan, Nancy Leys. "The Hour of Eugenics": Race, Gender, and Nation in Latin America. Ithaca: Cornell University Press, 1991.

CITATION: Planejamento Familiar. United States National Library of Medicine, National Institutes of Health. Order #: A031920

DIGITAL ID: 13045

 

Pan American Sanitary Code

Date: 1924
Owner: Pan American Health Organization
Source Type: Images

 

This comprehensive code for regulating hemispheric sanitation practices was ratified by the twenty-one countries that attended the seventh meeting of the Pan American Sanitary Bureau (PASB) in Cuba, 1924. Note how the very first objective listed on this manifesto is to prevent the international spread of infectious diseases, a goal made necessary by the great increase in international commerce during the early twentieth century. At this time, the PASB was, unofficially, a U.S. led organization, one that the U.S sponsored to ensure that it could continue to exploit the natural resources of Latin America without importing its diseases.

The Code also reserved the PASB's right to employ select personnel in health and sanitation institutions throughout the Americas. This stipulation encouraged the diffusion of a decidedly Anglo-American approach to sanitation. The plus side of this is that health and sanitation did improve in many urban areas of Latin America, especially port cities. The downfall, however, was that certain aspects of public health that were emphasized by Latin Americans, namely infant and maternal care, received less attention when public health was regulated by U.S. physicians.

In general, the PASB (and later the PAHO) succeeded in implementing the objectives of this code. The code, like the practices it encouraged, did much to downplay the idiosyncrasies of regional medicine and homogenized how health was understood in the Americas as a whole.

CITATION: "Pan American Sanitary Code." In Basic Documents of the Pan American Health Organization, Sixteenth edition. Washington, D.C.: Pan American Health Organization, 2002, pp. 3-7. http://www.paho.org/English/D/OD_308_ch1-3.htm

DIGITAL ID: 13047

 

Prenatal Care

Date: c. 1980
Owner: National Library of Medicine
Source Type: Images

 

This poster, published by Brazil's Program for Women's and Children's Health, encourages pregnant women to "Have a Prenatal Exam" because "mother and child cannot count on luck." The health of women and children is now one of the major objectives of the PAHO, but--until the 1940s--the Pan American Sanitary Bureau (precursor to the PAHO) largely ignored these issues. Beginning with its formation in 1902 (as the International Sanitary Bureau), the focus was on public sanitation, especially of Latin American port cities, an objective that reflected U.S. interests in Latin America. The U.S. sought to ensure that bacteria and parasites were not spread through inter-American commerce (which increased dramatically with construction of the Panama Canal) because diseases inhibited the U.S.'s ability to profit from trade with Latin America.

According to historian Anne-Emmanuelle Birn, it was Latin American delegates who did the most to make women's and children's health important to the PASB as a whole. Latin America had a strong tradition of emphasizing the health of women and their children, a cultural predisposition that can be traced back to indigenous healers in the pre-contact era. Also, Latin American physicians often trained in France, and the French school of medicine saw obstetrics as a major issue. Latin America's nascent feminist movement played a role in this as well by advocating that these issues be addressed at the ISB/PASB meetings held throughout the Americas.

It would not be until the ISB's fourth congress (in Costa Rica, 1909), that women's and children's health was even brought up. Costa Rican doctors decried the high mortality rates and abysmal conditions of their hospitals, and thus recommended that the obstetric practices of England be introduced throughout the Americas. Indeed, Latin American delegates asked that the issue of child mortality be addressed at every conference in the 1920s, but the issue was continuously ignored. It would not be until the 1940s that these important health issues would finally be brought to the fore.

Reference: Birn, Anne-Emanuelle. "'No More Surprising than a Broken Pitcher?' Maternal and Child Health in the Early Years of the Pan American Sanitary Bureau." In Canadian Bulletin of Medicine, vol. 19, no. 1 (2002), pp. 17-46.

CITATION: Faca exame pre-natal. United States National Library of Medicine, National Institutes of Health. Order #: A032067

DIGITAL ID: 13046

 

Preventing Chagas Disease

Date: c. 1980
Owner: National Library of Medicine
Source Type: Images

 

The Pan American Health Organization, in conjunction with Bolivia's Ministry of Public Health, published this poster to teach rural Bolivians the sanitation measures necessary to prevent Chagas' disease (for more on the disease itself, see the Tropical Medicine topic). The disease was spread by triatomas, insects that lived in poorly-built homes and passed the parasite trypanosoma cruzi to humans through bites to the face (as illustrated in the upper-left portion of this source).

According to historian Marcos Cueto, the most important impact of the PASB's and PAHO's work in Latin America was instilling average citizens with the idea that it was the duty of their government to provide them with a sanitary environment and the peoples' natural right to be healthy. This was a new way of thinking about health, one that promulgated several national agencies meant to ensure that sanitation and health care were disseminated democratically.

Like many other initiatives by the PAHO, the focus here is preventing the spread of disease vectors through improving local sanitation. To secure one's home against the triatoma, the PAHO recommended keeping the house clean and domestic animals penned far from human residences. Most importantly, one must shore up the cracks in the walls and ceiling because triatomas usually live in the walls by day and come out to eat (and spread Chagas' disease) by night. The caption of the happy and healthy family on the bottom-right informs Bolivians that "avoiding Chagas' disease is everyone's responsibility." This is both a practical message about personal sanitation and an admission that national sanitation bureaus throughout Latin America have remained unable to eradicate the vectors of harmful diseases like Chagas'.

Reference: Cueto, Marcos. The Value of Health: The History of the Pan American Health Organization. Rochester, NY: University of Rochester Press, 2007.

CITATION: Eliminemos a las vinchunas transmisoras del mal de chagas. United States National Library of Medicine, National Institutes of Health. Order #: A025981.

DIGITAL ID: 13044

 

Source References

Web Sites

Pan American Health Organization (World Health Organization)

Publications

Birn, Anne-Emanuelle, Raquel Pollero y Wanda Cabella. "No se debe llorar sobre leche derramada: el pensamiento epidemiologico y la mortalidad infantil en Uruguay, 1900-1940." Estudios Interdisciplinarios de America Latina y el Caribe. 14: 1 (2003):

Birn, Anne-Emanuelle. "No more surprising than a broken pitcher? Maternal and child health in the early years of the Pan American Sanitary Bureau." Canadian Bulletin for Medical History. 19: 1 (2002): 17-46. 

Bustamante, Miguel. "Los primeros cincuenta anos de la Oficina Sanitaria Panamericana." Boletin de la oficina Sanitaria Panamericana. 33: 6 (1952): 471-531. 

Cueto, Marcos. Culpa y Coraje: Historia de las politicas del VIH/Sida en el Peru. Lima: Consorcio de Investigacion Economica y Social/Universidad Peruana Cayetano Heredia, 2001.

Cueto, Marcos. Salud, Cultura y Sociedad en America Latina. Lima: Instituto de Estudios Peruanos y Organizazion Panamericana de la Salud, 1996.

Cueto, Marcos. The Value of Health: A History of the Pan American Health Organization. Rochester, NY: University of Rochester Press, 2007.

Hernandez, Mario and Diana Obregon. La Organizacion Panamericana de la Salud y el estado colombiano: cien anos de historia, 1902-2002. Bogota: OPS, 2002.

Larvie, Patrick. "Nationa, Science and Sex: AIDS and the New Brazilian Sexuality." in Disease in the History of Modern Latin America: from malaria to AIDS. D. Armus, ed. Durham: Duke University Press, 2003. p. 290-314.

Marques, Maria Cristina da Costa. A historia de uma epidemia moderna - a emergencia politica AIDS/HIV no Brasil. Sao Paulo: Editora UEM, 2003.

Miller, Francesca. "The International Relations of Women of the Americas, 1890-1928." The Americas. 43: 2 (October 1986): 171-182.

Parker, Richard G. AIDS no Brasil, 1982-1992. Rio de Janeiro: ABIA, 1994.

Stepan, Nancy Leys. "The Hour of Eugenics": Race, Gender, and Nation in Latin America. Ithaca: Cornell University Press, 1996.

Yellow Fever Quarantine

Date: c. 1930
Owner: National Library of Medicine
Source Type: Images

 

This image shows a room crowded with passengers from Latin America who have been quarantined on suspicion of having yellow fever. Many of them have thermometers in their mouths. Controlling the spread of yellow fever was the primary focus of the International Sanitary Bureau's first director, Walter Wyman. In 1901, Wyman led the initiative to stop yellow fever because it was one of the largest deterrents to increasing trade between the U.S. and Latin America.

At the first meeting of the ISB in Washington, D.C. (1902), the ISB agreed that public sanitation was the most efficacious way to fight yellow fever. This conference was attended by Carlos Finlay, the Cuban doctor who had determined that mosquitoes were the vector of yellow fever. In order to prevent mosquitoes from traveling with shipments of fruit and other goods, Wyman and the ISB began an initiative to clean up port cities and thus eliminate the fetid environments in which mosquitoes thrived. Sanitation efforts soon replaced quarantines, like the one pictured here, as the most effective and common method of preventing the spread of yellow fever.

The ISB had a profound impact on how Latin Americans conceived of health. It made them consider public sanitation to be a governmental duty that had its own intrinsic value outside of facilitating commerce. As early as 1907, the ISB began to conduct mosquito eradication campaigns in areas that had no direct relevance to pan-American commerce and helped Latin American countries develop sanitation and health infrastructures ex nullius.

Reference: Cueto, Marcos. The Value of Health: A History of the Pan-American Health Organization. Rochester, NY: University of Rochester Press, 2007.
 
CITATION: Overseas passengers undergo temperature check to guard against yellow fever. United States Public Health Service Photo. United States National Library of Medicine, National Institutes of Health. Order #: A018335.

DIGITAL ID: 13049