The International Sanitary Bureau was formed by nations of the Western Hemisphere to discuss diseases and other health matters specific to the Americas.
From December 2 through 5, 1902, the First International Sanitary Convention of the American Republics met in Washington, D.C., to promote health in the Western Hemisphere. The convention gave birth to the oldest continuously operating, region-specific health agency: the Pan American Sanitary Bureau, later known as the Pan American Health Organization (PAHO). The convention’s first meeting involved eleven countries from North, Central, and South America that were brought together by common health concerns.
European nations first recognized the need for a cooperative approach to the management of disease, and in the mid-nineteenth century, the chief health concern was the epidemics that swept through the Old World. The Black Plague had shaped the history of the European continent for centuries; cholera was the principal scourge at the time of the International Sanitary Conferences in Europe. The first and second conferences were held in Paris in 1851 and 1859, the third in Constantinople in 1867, and the fourth in Vienna in 1874. These conferences, however, were unsatisfactory for the participants from the New World, because the Europeans focused primarily on cholera, whereas the Americans were confronting different problems.
Although at the time it posed little threat to Europe, yellow fever was a major threat to the Americas. In the 1870’s, a yellow fever
Because of the need for a region-specific organization, the conference recommended the formation of a bureau to represent the American republics, one that would be specifically charged with the formulation of sanitary or health agreements and regulations, including facilitating communication about diseases; studying their transmission, spread, and treatment; quarantining; and regularly holding health conventions to discuss relevant discoveries and treatments. The organization, called the International Sanitary Bureau of the Americas, would be officially known as the Pan American Sanitary Bureau and would have a permanent executive board headquartered in Washington, D.C.
The first International Sanitary Convention (as opposed to the International Sanitary Conferences of the nineteenth century) met in Washington from December 2 to 5, 1902. Eleven member countries were represented, and U.S. surgeon general Walter Wyman was designated as the organization’s first chairman. In 1905, the second International Sanitary Convention again took place in Washington, D.C. Yellow fever continued to be the major focus of discussion; fortunately, efforts at controlling the disease had been successful in Cuba, Panama, and Mexico. Conference delegates decided that national health authorities were to manage disease control and quarantine for their respective regions and that such matters would not be determined by the bureau. This action proved to be an important precedent that showed the efficacy of local (rather than continental) control of diseases. The third convention met in Mexico City in 1907 and established the Office of International Public Hygiene,
The name of the next meeting was officially changed from the International Sanitary Convention to the International Sanitary Conference. It met in San José, Costa Rica, from December, 1909, to January, 1910. The change in nomenclature coincided with a change in the nature of the meetings, in which the focus shifted from quarantine issues to promotion of health as a whole. Vaccinations against smallpox and malaria, campaigns against tuberculosis, and promotion of national legislation involving tropical diseases, however, were also of central concern. The fifth International Sanitary Conference met in Santiago, Chile, in November of 1911, and recommended that delegates be recognized as authorities in sanitation and medicine in their individual countries. The sixth conference was scheduled for 1915 but was postponed because of World War I.
Beginning in World War I and until the end of World War II, there were three recognized health authorities in the world: the Office of International Public Hygiene, the health section of the League of Nations, and the Pan American Sanitary Bureau. Of these, only the bureau would grow and endure. After the conference’s postponement during World War I, the sixth conference convened in Montevideo, Uruguay, in December, 1920. Several important events occurred during this meeting. U.S. surgeon general Hugh S. Cumming was elected to head the bureau, the first executive committee was created, and a pan-American sanitation bulletin was envisioned. The first bulletin contained articles from authorities throughout the Americas, including the famous Brazilian scientist Carlos Chagas. The articles covered such topics as leprosy, hookworm, tooth care, sanitary engineering, diphtheria, water disinfection, yellow fever, syphilis, tuberculosis, industrial hygiene, and malaria. Additionally, there was a regular feature summarizing the presence of infectious diseases within the Americas. Once again, the name of the conference changed, this time to the International Sanitary Conference and Bureau of the Americas. The name of the bulletin also changed to reflect the different designation.
The bureau grew in the two decades leading up to World War II, distinguishing itself as the clearinghouse for health information. Beginning in 1924, the group issued an annual report on health conditions in member countries, appointed epidemiological assistants, and promoted the careful collection of statistical data on member governments. The eighth conference, in 1927, increased the interval between meetings from twelve to eighteen months and proposed a constitution for the Pan American Sanitary Bureau. The constitution was approved in 1934 at the ninth Pan American Conference.
Health conditions in the Americas grew increasingly complex during the 1930’s and 1940’s. There were several outbreaks: plague in Ecuador, Peru, Argentina, and Chile; yellow fever in Brazil; typhus in Bolivia, Brazil, Chile, Mexico, and the United States; undulant fever in the United States; and onchocerciasis (caused by filarial worms) in Guatemala and Mexico. Malaria, tuberculosis, and smallpox were constant problems, and the cancer rate began to increase.
The Pan American Sanitary Bureau continued its war on communicable diseases well after the end of World War II. After the creation of the United Nations, the Pan American Health Bureau recognized the need to cooperate on issues of world concern, but there was no desire for the group to be completely absorbed into the World Health Organization. In 1949, the bureau was converted into the Regional Office of the World Health Organization, and its name changed to the Pan American Health Organization, although it continued to maintain its autonomy.
The last cases of smallpox were seen in 1971, and smallpox eradication provided a model for the eradication of other diseases by inoculation and vector control. In the last half of the twentieth century, PAHO’s emphasis shifted from communicable diseases to chronic diseases such as diabetes, arthritis, and asthma, and emerging diseases such as HIV/AIDS and the hemorrhagic fevers. Although the specific concerns of the Pan American Health Organization have evolved, it has continued its invaluable work and retained a unique identity as an organization devoted to promoting health in the Americas.
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Johnson, Harold J. United Nations: U.S. Participation in Five Affiliated International Organizations. New York: Diane, 1999. Discusses the status of the organizations affiliated with the United Nations, including the PAHO. -
Pan American Health Organization. Pro Salute Novi Mundi: A History of the Pan American Health Organization. Washington, D.C.: Author, 1992. Provides a detailed account of the PAHO. -
_______. Public Health in the Americas: Conceptual Renewal, Performance, Assessment, and Tools for Action. 2 vols. Washington, D.C.: Author, 2006. Comprehensive reference work about health and medicine in the region. New editions are published every four years.
Formation of the Plunket Society
Chlorination of the U.S. Water Supply Begins
U.S. Public Health Service Is Established
Rockefeller Foundation Is Founded
Wolman Begins Investigating Water and Sewage Systems