George A. 0. Alleyne, Director, Pan-American Health Organization,
Eighth Summit Implementation Review Group, Summit of the Americas

(Washington, D.C., 6 March 1997 )

Let me repeat the we1come 1 gave yesterday and say how pleased I am to have Mr. Iglesias, Mr. Gaviria and Mr. Rosenthal with us today. It is always gratifying to see the institutions of the Inter-American system working in concert. Like my colleagues, I wish to give some of our ideas of what the agenda for the Santiago Summit might be and what might be the focus of attention of the Heads of State and Government when they meet next year. It is a tribute to the SIRG process that we are able to have these discussions and hopefully this Process will allow us to participate in refining the agenda and program. as we go, along.

We have to consider the thematic possibilities in the light of the degree of completion of the Plan of Action, and we, like others, will be helping our Member Governments to report on their progress in the specific areas. But I believe that the main areas of emphasis will develop in very much the same open and transparent way as occurred in 1994. The agenda will deal with some major areas of concern for all the countries -- some real and burning problems of our societies. The issues that flow from this concern must be politically viable and give the possibility of genuine intersectoral action, and this does not only refer to the public sector; we refer to many of those actors of civil society that are increasingly vocal in the governance of our countries. The final criterion I see as- important is that the theme should have operational principles and plans of action should favor a Pan American approach. There should be some specific attention given to the possibility, nay, the necessity of the countries of the Americas working together.

But even as we look at these criteria for establishing some kind of agenda, we will have to indicate what level of progress, if any, there has been. I was pleased to hear yesterday of the significant advances and accomplishments in the various areas. I believe that the considerations of the Heads of State should not have a backdrop of negatives, because, at least in the field of which we have some knowledge, the countries of the Americas can show progress.

Let me refer to some of the standard indicators of health and the way they have changed for the

better. All of our countries show a steady reduction of their infant mortality rates, and life expectancy of their citizens is increasing. The maintenance of our Hemisphere free of poliomyelitis has to be one of the triumphs of public health of this century. To have rid our children of the scourge of paralysis from polio through eradicating the virus from our Hemisphere is a monument to the commitment of our governments and the dedication of numerous health workers. I am pleased to be able to acknowledge the support of the IDB and President Iglesias' personal interest in this effort, as well as from USAID. However, until the rest of the world has caught up with the Americas, we must maintain our vigilance and continue to insist on vaccination of our children.

On the occasion of the Miami Summit, 1 was privileged to address the First Ladies and could persuade them. to focus their attention on another major enterprise the elimination of measles from. our Hemisphere. The First Ladies responded magnificently and as a result of concerted effort at the country level, the results have been impressive indeed. In 1994, there were 23,583 cases of measles reported and confirmed in the Region; in 1996, this figure had fallen to 1,464 and for the last 12 months, as far as we know, there has been not a single case of measles imported into the United States of America from Latin America and the Caribbean. This has been another fine example of the Pan American approach to problems.

Almost every one of our countries is involved in the reform of their health services and I believe that the process will accelerate during the coming years. I believe that there is a growing confluence of concepts and practices between ourselves, ECLAC and the Inter-American Development Bank in this area.

The situation for some other specific diseases is also heartening. The countries of the Southern Cone have made tremendous stride in eliminating Chagas Disease that had plagued them for decades if not centuries. I would also point to advances in such areas as oral health and the public health approach to violence, particularly the domestic violence that is almost always directed against women. The improvement in environmental health has been slow but 1 believe that the Santa Cruz Declaration has given us more assurance of what is the proper course. What has been done and the progress made is a stimulus for doing even more.

But the truth is that there are still major problems in health that cry out for attention. There are too many unacceptable differences in health status between and within countries. Too many children still never live to see their first birthday and will never be able to profit from the proposed educational reforms. Women still die needlessly in childbirth and the health differentials between the rich and the poor, the urban and rural communities are unacceptable. Cholera is still with us as an indication of our environmental deficiencies. We estimate that about 300 million people of the countries of Latin America and the Caribbean are threatened by diseases transmitted through drinking water. These are diseases such as typhoid fever, and a myriad of gastrointestinal infections. We can find many specific aetiological agents for these problems but for us, the overarching concerns that impede progress in improving the public's health are poverty and its sister inequity. These will be as dominant in 1998 as they were in 1994.

To address the health consequences of poverty and the inequities in health. we will have to continue to work to secure equitable access to services as the 1994 Summit Plan instructed us to do, but in addition there has to be an appreciation at the highest level as to what are the true determinants of health. All must appreciate that it is the social and physical environment, the behavior patterns of groups and individuals as well as health services that impact on health. That appreciation is as critical as the understanding that concern for health is not only a moral imperative, but it is absolutely necessary if the investments made to increase economic growth are going to bear fruit. In this forum I need not explain the relationship between health and a country's economic development, or between health. and the possibility of domestic stability and even democracy. I need not strengthen the arguments made yesterday for an emphasis on education by emphasizing how intimately health and education are linked and mutually supportive.

But it is not enough to suggest that we continue more of the same. There have been advances in the last few years that lead us to propose a major health theme for the Santiago Summit that builds on the agreements reached in Miami. It is a theme of the future that has the seeds of success in achievements of the past. I wish to see us explore the theme of "Health Technology Linking the Americas."

Why am I certain of success? It is because the history of health conditions of the Americas has shown-the impact of health technologies in reducing the burden of disease, increasing life expectancy and decreasing the number of children and mothers who die. In addition, we now have the possibility of making even more health technology available to our countries and shortening the interval between generation of knowledge and development of the appropriate technology. 1 wish to cite a few examples of specific initiatives that could be developed under this rubric.

We would propose a Regional initiative for vaccines that will address research, development, production and utilization of vaccines. This initiative builds on the success of national immunization programs in the Region such as polio eradication and elimination of measles and neonatal tetanus. This initiative would incorporate the first in our Region for increased application of biotechnology. It could stimulate even more collaboration among some of the larger developing countries and would provide a concrete area of common interest to agencies like ours and the multilateral lending institutions. It is 100 years since the first vaccine was given, but the speed of development in the last few years and the real possibilities of the wide application of these agents make it clear to us that this is the technology of the future. If there is one thing on which all health workers agree is that vaccines represent the most cost-effective health technology yet devised.

We could have, in a relatively short time, millions of children and adults in the Americas protected against vaccine preventable diseases through the wide availability of quality vaccines. We could have a critical mass of scientists trained to participate in the new advances in biotechnology and we could envisage a genuine public-private partnership in which there is benefit to all. There are already some countries in Latin America that have made significant investment in constructing or modernizing their facilities. Such an initiative would strengthen them and make it possible to widen the net of those involved.

Health technology would embrace communications, because there is no doubt that the rapid development of information technology will revolutionize our approach to health. But the intonation to be managed by the new technology is in many ways restricted by the reliability of the basic data. Thus, we envisage a major effort to improve the capacity of all our countries of the Americas to capture health information, and perhaps restore some prestige and emphasis to the critical area of vital statistics. We will never be able to measure need and speak intelligently of inequities in health unless we have basic data on health.

The information technology will see other uses. The Region is moving towards the use of telemedicine as a mechanism for increasing access to some services. There are discussions on the development of simple devices that can capture data at the point of collection, thus facilitating analysis and use. The world of information technology also envisages the democratization of health information such that more persons have access to the data, information and knowledge to make decisions. There could be strengthening of existing regional networks of health science information through use of better technology such that all health care workers have access to material to he1p them make correct decisions.

We would envisage better communication to support the harmonization efforts in the area of essential drugs. There is much to be done in order to standardize and define better the common regulations and requirements to register and produce essential drugs in the countries of the Americas. PAHO has some experience in this area through its joint work with some of the subregional commissions on drugs. A focus on health technology linking the Americas would include our capacity to monitor the emergence of new diseases and the resurgence or reemergence of old ones that we had ignored. AIDS will not be the last epidemic. The Ebola epidemic of Zaire frightened the world with the realization that diseases can be rapid1y transmitted through our modem means of communication. We are now appreciating the magnitude of the problem of tuberculosis- an estimated 60,000 to 75,000 of our citizens in the Americas died from this disease in 1995 and over 400,000 new cases occurred. We cannot allow this to continue.

The foundation for any logical approach to these diseases is a good surveillance system, good research and laboratory infrastructure and perhaps strengthening of the International Sanitary Regulations. The possibility of a good surveillance system will depend in large measure on the use of suitable information technology.

We must not forget the possibility of new technologies improving our environmental health. We know that the water can be protected at various places - we can ensure the safety of the water sources, we can apply physicochemical means and try to make safe water available in conventional distribution systems. In some countries the systems that are proposed are no doubt efficient, but they are costly Capital investment for piped water systems reach over $ 100 per person served. We can demonstrate technologies for use at the household level that cost no more than $1.00 to $4.00 per family per year. Once the water is available, there is no excuse for a family not to have ít as a benefit rather than a risk to health. There are similar newer developments in the field of solid waste disposal and promising ideas for returning waste to agricultural areas. thereby in the medium term, enhancing food production. I believe that these approaches will allow us to give form and substance to some of the items of the Plan of Action for the Sustainable Development of the Americas that accompanied the Declaration of Santa Cruz de la Sierra.

An initiative for Health Technology Linking the Americas will have enormous potential for public-private partnerships in areas beside vaccine development. Telecommunications is one example that comes to mind immediately.

I said initially that any sectoral issues put before the Santiago Summit should be within the context of the overriding theme of reducing poverty and inequity, be politically viable, give possibility of intersectoral and interagency collaboration and foster the Pan American approach. I believe that the initiative of Health Technology Linking the Americas could fulfill these criteria. The basic thesis is that this would enhance health and reduce inequities. The wide application of the health technologies 1 have mentioned will improve health and thereby reduce poverty and particularly the health information technologies will he1p to define the inequities more clearly as well as giving the possibilities of reducing them.

1 could show the political viability of this approach in a more detailed proposal pointing out the advantage of Presidents and Heads of State being able to inform their people of specific actions that affect their daily life and their living. And there is no doubt that all 1 have mentioned would facilitate collaborative work among the American countries.

Mr. Chairman, the Pan American Health Organization, by its very name, speaks to its purpose of improving the health of the Americas. We hope that the mandates of the Santiago Summit will, as did the Miami Summit, provide space for those actions that have health as a major concern.

We in PAHO will be ready to support a process of consultation with governments and civil society that will lead to a Pan American agreement in Santiago on improving Health for All in the Americas. Our mission is...

--to cooperate technically with die Member Countries and to stimulate cooperation among them in order that, while maintaining a healthy environment and charting a course to sustainable human development, the peoples of the Americas may achieve Health for All and by All.

We will continue to work, as President Clinton proclaimed in his closing speech at the Plenary Session of the I Summit, to ensure that dichos become hechos that "words are turned into deeds.