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Reviewed by:
  • El Valor de la Salud: Historia de la Organización Panamericana de la Salud
  • Steven Palmer
El Valor de la Salud: Historia de la Organización Panamericana de la Salud. By Marcos Cueto. Washington, D.C.: Organización Panamericana de la Salud, 2004. Pp. viii, 211. Illustrations. Notes. Bibliography. Index.

For an eminent professional historian there can be few things more daunting than a commission to write a synthetic history of a powerful international agency whose motivation and objective is a centennial celebration. Marcos Cueto has embraced the task, using his immense range as a historian, his disarming sincerity, and his gift for presenting complex issues with a light, lucid touch to create a remarkable history of one of the 20th century's most important international institutions. The work is at once critical and celebratory. It is a marvelously rich "corporate and family" history that should make anyone associated with the Pan American Health Organization (PAHO) positively intrigued with their heritage. But Cueto also delivers a sophisticated portrait of PAHO's social and political history, its place in the history of medical and public health science, and its role in the development of vital programmatic public health activities in the hemisphere.

PAHO is to be congratulated for having the rare sense and courage to get the perfect person for the job. Cueto has been on the cutting-edge of the historical study of science on the periphery, the imperial characteristics of U.S.-based international philanthropies, the attack on public health perpetrated by neo-liberal regimes, the social and ecological history of disease, the hybrid medical projects of indigenous practitioners, and HIV/AIDS in Peru. The fruits of these labors have been rich, and the holistic pay-off is evident here. Cueto is able to structure El valor de la salud around the tenure of six PAHO directors and their distinct institutional projects, while showing how each of them was in many ways an expression of a particular epistemological and programmatic wave in international public health. Both these levels are then used as platforms to explore the social history of PAHO through the eyes of physicians, nurses, and technical people on the ground. Cueto employs an impressive array of primary sources, among them the directors' personal papers, reports from the field, scientific publications, and oral history work with staffers.

The book restores the agency of Latin American public health actors and governments during the PAHO's first 50 years, when it is often dismissed by historians as a mere handmaiden to U.S. imperial interests. In a passage typical of the author's [End Page 680] approach, this point is explored through a letter from the eminent scientist, Oswaldo Cruz to his wife while he was Brazilian delegate to the 1907 meeting of the Sanitary Bureau in Mexico. Cueto gives majesty to the personal and institutional politics behind the agency's post-World War II re-birth as a regional office of the World Health Organization that, nevertheless, enjoyed enormous autonomy. Under the command of Fred Soper, PAHO grew enormously in prestige, personnel, and resources during the next decade and embarked on ambitious programs. We are treated to an excellent explanation of the demise of these public health methods as the DDT-reliant war on malaria began to reveal its eco-social limits and costs. With the appointment of the first Latin American directors of PAHO (the Chilean Abraham Horowitz in 1959, followed by the Mexican, Hector Acuña in 1975), Cueto guides us through the PAHO's return to an emphasis on social and community-based medicine and the worldwide move by international health organizations to advocating primary care and a more holistic approach to public health by relying on strong community involvement (famously codified in the Alma-Ata declaration of 1978 calling for an acceptable level of health for all the peoples of the world by the year 2000). Cueto brings us back down to earth, along with PAHO, through a measured account of how the legacies of the primary health care movement informed the PAHO role in the fight against AIDS and cholera in the 1980s and 1990s.

The book enjoys a full scholarly apparatus...


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pp. 680-681
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