Health in the Americas

“Health in the Americas”
Speech delivered by Dean Donna Petersen, USF College of Public Health
June 2, 2008. Ciudad del Saber, Panama

Dean Donna Petersen, at right, celebrates the official opening of USF Health International Foundation with Dr. Arlene Calvo, a foundation officer.

Below: full text of Dean Petersen’s speech…

It is entirely fitting that we are here commemorating the opening of a USF Health office in
the Americas, an office dedicated to improving the health of all people in this region
and indeed, around the world. It is fitting that we do this here in Panama, the site
of some of the most profound discoveries in public health in the last 200 years.

General (William) Gorgas had a job to do – a canal needed to be built to provide a much-needed trade route from east to west and back again – but that job could not have been done until he had completed an almost more daunting task- the task of keeping thousands of laborers alive and well, free of diseases, in an environment that was stacked entirely in favor of the diseases and against him and his workers. knowing, perhaps consciously, perhaps unconsciously, that this monumental effort toward economic development was entirely dependent on health, General Gorgas set about to find a way to protect his workers from disease and found he could do so by reducing the route of transmission, reducing exposure to the disease carrier. By accomplishing this task, he was not only able to complete the original job he was sent to do, but he launched a revolution in disease control that has saved millions of lives for more than 100 years. The diseases he was dealing with are no longer commonplace in much of the world, and his discoveries spurred others to engage in their own research in disrupting the cycle of disease transmission, reaping countless benefits still.

We too have a job to do. We know that the world is changing, that the economic powers
are shifting, and while we know now empirically that human development and human health
are inextricably linked, we don’t always act on this knowledge and sometimes our well-meaning efforts have unintended consequences. Who would have anticipated that incentives to produce bio-fuels to reduce harmful environmental pollutants would trigger a world food shortage? Who would have thought that additives designed to preserve food and make it easier to transport would contribute to the rising rates of obesity? Who would have believed that drugs designed to cure would ever instead kill? And so our work goes on – anticipating new threats, battling wits with old enemies, cleaning up the remnants of our good intentions. The pursuit of health is like the pursuit of truth, we can get close but we can never quite reach it. We grow wiser but we are never all knowing.

An old proverb says, “He who has health has hope and he who has hope has everything.” We open this office with the greatest of hope and a robust team of professionals eager to give their all to the pursuit of health in the Americas, here, in Panama, at the Ciudad del Saber. Our goals are quite simple really – to provide a nexus for the integration of knowledge through discovery, translated into state of the art learning, tailored toward action for results. We do it here in Panama, not only because our forefathers made this a center of excellence in the sciences of health, but because Panama is already a center for so many things that are good in the Americas. People can get here easily, information can be transmitted to here and from here easily, goods and services can be exchanged here easily, discovery and learning can happen every day. It is the right place for us to be to do the job we need to.

What is that job? The widening of the Panama Canal serves as the perfect metaphor for the continued development of this region of the world into 21st century prosperity. Like General Gorgas before us, we cannot do that job until we master the other task, that of keeping millions of laborers, leaders and luminaries alive and well, free of disease. Ah, but the task is not so simple as it once was. While we still battle infectious diseases – the veneer of civilization is after all quite thin – we now must also match wits with a burgeoning array of chronic diseases, including those born of want and those born of excess. A recent report by P.A.H.O. reveals staggering statistics: in Latin American countries, chronic diseases are now the leading cause of premature mortality in nearly every country, representing 2 out of every 3 deaths. The root causes of this shift from infectious to chronic disease? I wish I could say it was due to our success in controlling infectious diseases, but while this is partially true, the rising tide of chronic disease is powered by a ruthless combination of poor diet, inadequate physical activity, excessive tobacco use, and inequitable access to preventive and primary healthcare.

Add to this other emergent concerns in the areas of mental health, environmental degradation, traffic safety, the built urban environment, emergency preparedness, and disaster management and you have a potent mix that would challenge the best of us.

But it is the best of us we bring to partner with the best of you, here in Panama and across Central and South America in forging a new path toward HEALTH – whether it’s better trained clinical professionals, a better educated public health workforce, the building of the scientific knowledge base or an engaged community working to translate learning and research into real actions, we come here to do the work necessary to finish the job.

We also bring a new model of HEALTH, a model that recognizes that the forces that conspire to steal our health do not work in isolation, they work in combination and so must we. If we wait for a condition to present itself in the hospital, it is too late. If we exhort our patients to engage in healthier behaviors without assuming that they have the means to do so, we have wasted our time and made them feel worse. If our efforts to build infrastructure at the environmental and community levels fail to include the healthcare components, we have done little more than contribute to an already fragmented system.

At USF Health, we believe in a holistic model that recognizes the contributions of biology, behaviors and the socio/economic/political/structural environment to health. Believing in this model leads us to an inevitable conclusion: we must prepare our future physicians, nurses, therapists and public health professionals to work in concert to address these myriad threats to help. Our research must be trans-disciplinary and translatable from the bench to the bedside to the backyard and to the boardroom. The goal of everything we do must be to improve health.

A recent analysis of mortality data in 31 countries of the Americas reveals the breadth and depth of the challenge we face and makes clear why a collaborative partnership among us is so important:
- Ischemic heart disease was the leading cause of death in 13 countries
- Cerebrovascular disease was the leading cause of death in 6 countries
- Diabetes in 3
- Heart failure and heart disease in 2 countries
- Influenza and pneumonia in 2 countries
- Hypertension in 2 countries
- HIV/AIDS, homicide and cardiac arrest were each the leading cause of death in 1 country

Other causes in the top 3 leading causes of death included intestinal infections, conditions of the perinatal period, malignant neoplasms of the trachea, bronchus and lung, cirrhosis of the liver, chronic lower respiratory disease, diseases of the urinary system and land transport accidents.

But mortality statistics only show us the tip of the iceberg. The end result of our attempts to successfully promote health and assure everyone an opportunity to enjoy a full life, full of good health, and free of disease and complaint. A glance of the last three issues of the Pan-American Journal of Public Health gives us a different glimpse into the public health issues of concern across the Americas.

I will mention a few:
- Hypertension in adults in Mexico, HIV risk behaviors of Latin American and Caribbean men
- The costs effectiveness of hepatitis A vaccine in Chile and of routine rotavirus vaccination in Brazil
- Alcohol use and problem behaviors among school aged youth in Puerto Rico
- Implementing a new tobacco law in Chile
- Dietary patterns and access to food among families displaced by armed conflict in Colombia
- Comparing P.C.R. and bacterial culture for salmonella detection in the Muscovy duck in Trinidad and Tobago
- The epidemiologic environment and response to the HIV epidemic in Bolivia
- Rotavirus gastroenteritis with high mortality in Nicaragua
- Making secondary care a primary concern: the rural hospital in Ecuador
- Therapeutic uses of investigational drugs: research extension, compassionate use and expanded access

A list of the public health issues of concern to the ministers of health across the Americas is one last way to illustrate the nature of the opportunity for us to work collectively on the shared goal of improving health and development of all nations and all people in the Americas. It also makes clear the breadth of public health and the huge span of influence that those of us working in health possess to improve economic security, promote quality of life and support peace and continued prosperity in this region.
- HIV/AIDS, tuberculosis and malaria remain concerns but efforts are being strengthened across the Americas to reduce their burden
- Access to good nutrition and food, particularly in the priority countries of Bolivia, Guyana, Haiti, Honduras and Nicaragua, priorities because it is clear that attending to the health of the people in these countries is critical to their economic success
- The further development and dissemination of vaccines like those for HPV, rotavirus and pneumonia
- Continued planning for emergencies, including pandemic flu and for our rapid and effective response to disasters when they are unavoidable
- The eradication of foot & mouth disease among livestock
- The promotion of gender equality and equality in healthcare access, cost and quality
- Access to clean water and sanitation
- Attention to mental health
- And finally, attention to our most vulnerable – pregnant women, children, adolescents, the elderly and indigenous populations.

In identifying these priority issues the ministers of health in the Americas also made clear their collective understanding that it is imperative that they work in solidarity in order to be successful in improving health and development for each in order to do so for all. We come here from USF Health with a similar mission – to work in partnership with you, here in this place, to discover, to learn, to contribute, to share knowledge and ideas toward our mutual goal of assuring everyone the best opportunity for health, prosperity and hope.

We are honored and grateful to you for your warm welcome and we thank you for letting us join you in this humble pursuit.

Dean Donna Petersen, June 2, 2008, Ciudad del Saber, Panama.

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