The Pan American Health Organisation (PAHO) is an international public health agency working to improve the health and living standards of the people of the Americas.
It is part of the United Nations system, serving as the Regional Office for the Americas of the World Health Organisation (WHO) and as the health organisation of the Inter-American System. It is known in Latin America as the OPS or OPAS (Spanish: Organización Panamericana de la Salud; Portuguese: Organização Pan-Americana da Saúde).
The organisation was founded in December 1902. It was originally called the Pan-American Sanitary Bureau. In 1949, PAHO and WHO signed an agreement making PAHO the American Regional Office (AMRO) of WHO. Today the usual phrasing is “Regional Office for the Americas”. The first hemisphere-wide effort to eradicate smallpox was made in 1950 by the PAHO. The campaign was successful in eliminating smallpox from all countries of the Americas except Argentina, Brazil, Colombia, and Ecuador.
PAHO has scientific and technical expertise at its headquarters, in its 27 country offices, and its three Pan American centres, all working with the countries of the Americas in dealing with priority health issues. The health authorities of PAHO’s Member States set PAHO’s technical and administrative policies through its Governing Bodies. The PAHO Member States include all 35 countries in the Americas; Puerto Rico is an Associate Member. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are the Participating States, and Portugal and Spain are the Observer States.
The Organization’s essential mission is to strengthen national and local health systems and improve the health of the peoples of the Americas, in collaboration with Ministries of Health, other government and international agencies, non-governmental organisations (NGO), universities, social security agencies, community groups, and many others.
PAHO promotes universal health coverage and universal access to health and strengthening of health systems based on primary health care strategies. It assists countries in fighting infectious diseases such as malaria, cholera, dengue, HIV and tuberculosis as well as the region’s growing epidemic of noncommunicable diseases such as cardiovascular disease, cancer and diabetes. PAHO engages in technical cooperation with ministries of health and facilitates coordination with other sectors to promote health in all policies. PAHO also promotes the use of research evidence to inform health care decisions and policymaking through the implementation of knowledge translation strategies such as the Evidence-Informed Policy Network – EVIPNet Evipnet. Through the Elimination Initiative, it targets HIV/AIDS.
In its efforts to improve health, PAHO targets the most vulnerable groups including mothers and children, workers, the poor, the elderly, and refugees, and displaced persons. It focuses on issues related to equity for those who lack access to health, and on a Pan American approach, encouraging countries to work together on common issues and build lasting capacities.
Specific initiatives spearheaded by PAHO include the Expanded Programme on Immunisation, which played a major role in the elimination of smallpox and polio from the Americas; the Tobacco-free Americas initiative; the Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola; the Salt Smart Consortium; the Pan American Network for Drug Regulatory Harmonization; and a blood safety initiative that seeks to improve blood safety and efficiency by helping countries reach 100% blood supplies from unpaid voluntary donors.
A major priority for the Americas is cutting infant mortality, and PAHO is mobilising new political, institutional, and financial resources to prevent an additional 25,000 infant deaths every year through the application of the Integrated Management of Childhood Illness strategy, a simple and practical approach in which primary health care workers are taught a complete process to evaluate the health status of children brought to a health post or clinic. They learn to recognise signs of disease and evaluate and treat them. They learn to give parents information on how to prevent disease in the home. If they see danger signs indicating the infant could die, they are taught to treat the child immediately or take him or her to a hospital.
Improvement of drinking water supplies, adequate sanitation, and increased access to health care for the poor are still top priorities for PAHO, with a focus on equity. The Organisation is intensifying its efforts to have countries know the true state of health of their populations and where the inequalities lie. Programme efforts focus on correcting inequality, taking into account decentralisation and change of state functions, on showing that health has a role to play in the success of other sectors, and on how attention to health affects positively other aspects of human development. Advocacy in this area is also directed to reducing pernicious gender inequity, which reflects in some health problems of women.
The Pan American approach is a part of PAHO history and the spirit of Panamericanism continues to stimulate technical cooperation among countries in health. PAHO has helped countries work together toward common goals, and to initiate multi-country health ventures in Central America, the Caribbean, the Andean Region, and the Southern Cone. Experience has shown practical benefits such as the solidarity that helped Central America after hurricane Mitch, and there are numerous other examples. Health collaboration found expression at the highest political level when American heads of state in their Summit in Santiago accepted a health initiative called “Health Technology Linking the Americas.”
The countries of Latin America and the Caribbean joined together over 20 years ago to buy vaccines through a revolving fund, bringing them tangible benefits and helping advance PAHO’s efforts to eliminate or control vaccine-preventable diseases. These are among the Organisation’s most notable successes, starting with the eradication of smallpox from the Americas in 1973; a triumph followed five years later by global eradication of the dreaded disease.
A major effort committing the Americas to embark on polio eradication in 1985 succeeded in September 1994, when a distinguished International Commission declared the Americas officially polio-free. The last case of polio in the Americas was identified on August 23, 1991, in a young boy named Luis Fermín Tenorio Cortez, in Junín, Peru. Since then, despite intensive surveillance, no cases of polio have been detected anywhere in the Americas, and the WHO is now working toward the goal of eradicating polio globally. PAHO assists the countries in mobilising the necessary resources to provide immunisation and treatment services for all vaccine-preventable diseases. PAHO is close to accomplishing the goal of eliminating measles from this hemisphere and is pressing on with the introduction of new vaccines that are currently available, such as Haemophilus influenzae B. to reduce meningitis and respiratory infections. PAHO works to reduce the toll of death and illness from diarrheal diseases, including cholera, through case management and oral rehydration therapy to prevent deaths from dehydration, and to provide adequate diagnosis and treatment of acute respiratory infections, thus saving the lives of hundreds of thousands of children each year.
PAHO disseminates scientific and technical information through its publications program, its Internet site, and a network of academic libraries, documentation centres, and local health care libraries.
The Organisation provides technical collaboration in a variety of specialised public health fields and organises emergency preparedness and disaster relief coordination. It supports efforts to strengthen national health systems, develop national health research systems, control malaria, Chagas’ disease, urban rabies, leprosy, and other diseases that affect the people of the Americas. PAHO collaborates with governments, other agencies, and private groups to address major nutritional problems including protein-energy malnutrition, and is now working to eliminate iodine and vitamin A deficiencies.
It engages in and facilitates health promotion to help countries deal with health problems typical of development and urbanisation, especially non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, accidents, smoking, addiction to drugs and alcohol, and injuries among others. Beyond health promotion, PAHO also addresses health systems and quality of care issues in support of national efforts to respond to the NCD pandemic.
The Organisation also executes projects for other United Nations agencies, for international organisations such as the World Bank and Inter-American Development Bank, for official development cooperation agencies of various governments, and for philanthropic foundations.
PAHO strengthens the health sector capacity in the countries to advance their priority programmes through intersectoral action, promoting an integrated approach to health problems. It also works to improve women’s health, promoting the greater integration of women in society, as well as awareness of their importance as both recipients and providers of health services.
PAHO trains health workers at all levels, through fellowships, courses and seminars, and the strengthening of national training institutions. It leads to the use of advanced communications technologies for information, health promotion, and education, working with journalists in many countries.
The Organisation recognises the role of the private sector in the delivery of services and fosters dialogue and partnerships with the Ministries of Health. In addition to its core budget financed by quota contributions from its Member Governments, PAHO also seeks outside funding to help implement special programmes and initiatives in response to vital health needs. Voluntary tax-deductible contributions for PAHO health and education projects in the Americas may be made to the PAHO Foundation.
In March 1960, President Eisenhower signed into law a bill passed by the US Congress authorising the US government to purchase and donate a lot for the PAHO headquarters in Washington, D.C. At the meeting of its Executive Committee in April 1960, the PAHO decided to accept the USG’s offer and set forth parameters for proceeding with the project of a new headquarters building. PAHO decided to use an international open competition as the means of selecting an architect for the project, following the recent successful model of other international organisations (most notably the United Nations New York headquarters inaugurated in 1952, and the UNESCO Paris headquarters in 1953 – both resulting in landmark designs of modernist architecture). PAHO framed the competition based on standards developed by the International Union of Architects and determined that the competition should be open to architects from all countries of the Americas. The vision was that “the new building should be a monument to international health cooperation.”
Following a review of 58 entries, the PAHO in October 1961 declared Uruguayan architect Román Fresnedo Siri the winner of its competition. At the ceremony announcing him as a winner, the organization’s Director Abraham Horwitz said “this beautiful building will become a monument to the ideal of better health for the peoples of the Americas.” He described the winning design as one of “both grace and utility,” and said, “it reflects the high ideals of the Pan-American spirit in an age when we must move ahead to build a better future for our peoples.”
The building was designed in a modernist style by Fresnedo Siri in part as a tribute to Le Corbusier, a key influence on Fresnedo Siri’s work. Constructed in 1965, the exterior features 29 round bronze seals of the founding nations of the Pan American Health Organisation set in black stone. Each medallion is 2.5 feet (0.76 m) in diameter and were designed by American sculptor Michael Lantz. They were originally meant to be carved in granite. The east side of the south façade (left to right) seals are for: France, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, the Netherlands, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, United Kingdom, United States, Uruguay, and Venezuela. The west side of the south façade seals are for: Argentina, Barbados, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, and El Salvador. In 1993 the seals were surveyed by the Smithsonian Institution’s Save Outdoor Sculpture! program and were described as needing conservation treatment.
The building is situated on a triangular lot of just over one acre nestled between Virginia Avenue, E Street, and 23rd Street, Northwest, in the Foggy Bottom neighbourhood of Washington. Constructed of reinforced concrete over a steel frame with an exterior of glass and marble, the building is one of Washington’s most recognised examples of mid-century modern architecture. The building is divided into two distinct volumes: a gracefully curved ten-story building that hosts the organization’s main offices, and an adjoining four-story cylindrical annex that serves as the congress hall for formal assemblies of the PAHO member state delegates, as well as other meetings and events. It is surrounded by George Washington University to the north and east, the Columbia Plaza office/residential complex to the west, and the State Department to the south across the E street expressway underpass.
The main building features soaring white vertical columnar ribs evenly separating dark vertical columns of glass. There are no horizontal lines to compete with the vertical symmetry; the building’s vertical ribs disappear along “blind gables” into an invisible roofline. In the formalism and attention to symmetry, Fresnedo Siri said he was trying to stay true to the “classic spirit of the city of Washington.” The interplay of light and dark is accentuated by the use of white American marble, black Mexican granite, and dark gray glass. The building’s slender, windowless west and east sides are clad in white marble, while the black granite frames all the ground floor elements, including the entry portico, the hidden downward ramp to an underground garage, and the reflecting pool and garden elements.
Fresnedo Siri placed the main building on 20 rounded pilotis (columns) that lift it a full story above ground level. He employed this signature element of mid-century modernist design to maximise the open pedestrian plaza space on the relatively small and unusually shaped lot while enhancing visual transparency and flow. He added reflecting pools with fountains at the base of each building – his vision was that the cylindrical congress hall, in particular, would appear to be “emerging from the water.” The thin vertical streams spurting up from the fountains would echo the symmetry of the columns and vertical ribbing of the main building. A row of 42 flag poles (representing each PAHO member state) reinforces still further the building’s dancing array of vertical symmetries, while also gracefully delineating the Northeastern edge of the property site. Unfortunately, the reflecting pools years later were eliminated, filled in and replaced by garden plots.
Fresnedo Siri purposefully placed the convex side of the curved main office building to the north, smoothly integrating it into the urban streetscape of similarly sized office, university and residential buildings. This allowed the concave side of the building to face the open side of the lot, gently cradling the congress hall annex while framing the contours of the small but appealing pedestrian plaza area that flows toward the site’s open southern side.
The cylindrical annex’s around the central congress hall are about 92 feet (28 m) in diameter and seat up to 300 people. The single open space soars upward, filling the top three levels of the building. Fresnedo Siri designed a dramatic spider web-like steel structure to support the building, allowing the entire interior space to be free of any supporting columns. The resulting internal space, naturally lit by windows throughout the cylinder’s full 360 degrees, achieves an impressive sense of openness and purity of design. The cylindrical building is encased on the outside by a lattice-like grill of diamond-shaped hexagons composed of white marble, quartz and Portland cement. The recessed ground floor space of the cylinder is encased in the same Mexican black granite used for all the site’s ground-level elements, creating a striking contrast with the white honeycomb grill of the upper levels it supports.
After studying the main diplomatic congress halls at the UN, State Department, the OAS and elsewhere, Fresnedo Siri devised a “floating seat” solution for the chairs in the PAHO’s hall. The seats are all anchored to the floor in the rear to curved latitudinal support elements running behind each row (and serving as hidden conduits for the simultaneous translation cabling), achieving what he described as “a great functional and aesthetic purity.” All of the furnishings for the main halls and meeting rooms were designed under his specifications by Knoll Associates, a leading New York-based producer of modernist furniture including landmark designs of the era like the Saarinen womb chair and Mies Van de Rohe’s Barcelona chair. Fresnedo Siri designed the magisterial backdrop to the presidium of the Congress hall, using vertical slats of six different kinds of wood including Honduran mahogany, Brazilian jacaranda, American walnut and oak, arranged in his words “to accentuate the dimension of the space and the importance of the function it served.” Fresnedo Siri also designed the central chandelier of the Congress hall, calling the piece “a sculpture in light.” Measuring 20 feet in diameter and weighing 16,000 pounds (7,300 kg), it consisted of 3000 long rectangular pieces of Lucite, the translucent acrylic resin invented by Dupont in the 1930s for industrial and military uses then enjoying an early-60’s boom as a “space age” material for vanguard furniture and art.