El valor de la salud: Historia de la Organización Panamerica de la Salud (review)

International health is the subject of growing interest on the part of historians, though it has been little explored if compared to other branches of social history, which have taken great strides in recent decades. Since the 1990s, Marcos Cueto has produced some groundbreaking studies that have become beacons of reference for anyone involved in this fascinating topic. Missionaries of Science: The Rockefeller Foundation and Latin America, published in 1994, has played a founding role, much like International Health Organizations and Movements 1918–1939, the book edited by Paul Weindling in the following year.

El valor de la salud is ambitious in its range, running counter to the trend for shorter, single-topic studies. The title and contents of Cueto's book clearly illustrate the care the author took to walk a fine line between showing respect for an institutionalized tradition and critically analyzing it. Cueto's approach is based on a broad range of primary sources and a clear vision of the characteristics of each scenario that succeeded the creation of the International Sanitary Bureau in 1902.

The first chapter presents the tenuous international network set up in the second half of the nineteenth century, which linked up port towns that housed quarantine and isolation facilities for suspected carriers of yellow fever and other diseases that international trade and human migration brought to the forefront as maritime health problems. In the second chapter, Cueto analyzes the unfolding of the International Conference of American States, held in Mexico in 1901–2, beginning with the creation of the International Sanitary Bureau (Pan-American Sanitary Bureau as of the 1920s). Little by little, the idea of compiling epidemiological data and producing guidelines on health in ports was broadened to encompass tuberculosis, malaria, and smallpox vaccination, among other health issues.

In "La consolidación de una identidad," Cueto analyzes the interwar period (1919–48), which was marked by economic, social, and political upheavals and the tragic outcome of Nazi and fascist regimes. International initiatives paralleled a more systematic process of institutionalizing public health in many nations of the Americas, and movements inspired by social medicine broadened the scope of public health. In some countries, public health initiatives started effectively to cover preventative measures against rural endemics. "The danger of a military threat from Europe or Japan accentuated the perceived existence of a community of Pan American interests," writes Cueto (p. 69/my translation) as he analyzes the 11th Pan American Sanitary Conference held in Rio de Janeiro in September 1942. The transnational campaigns to eradicate Aedes aegypti, the vector of urban yellow fever, was the first measure taken in the sphere of avian health. Field work against specific sanitary issues in certain parts of the continent all reinforced inter-American bonds.

Cueto goes on to analyze the Cold War context. Hopes that industrial and capitalist development would be achieved through traditional structures combined, in complex ways, with the illusion that transmissible diseases could be eliminated by top-down programs run by specialists. Fred L. Soper was the leading figure in these campaigns. While he was at the helm of the Pan American Health Organization (1947–59), it took a singular and by and large autonomous stance, both in the geopolitical web that underpinned the establishment of the World Health Organization and in the political machinations of the Cold War. Study grants led to an Americanization of medical education, while new institutional machinery provided public health with greater substance as a supranational objective.

In the 1960s and especially the 1970s, popular movements triggered not only the Cold War crisis but also a new concept of health, strengthening the role of community participation in primary care and prevention programs. The worldwide immunization programs of the period were another case of...