05/29/2014 - 07:37

Spotlight on South America

The fight against emerging pathogens can appear in very different lights depending on who you are and where you live. In this roundtable, Africa's efforts to control emerging pathogens have received a lot of attention, while my own region of South America has received less. So I'd like to devote my last essay to illuminating the South American picture.

From the perspective of emerging pathogens, a major difference between South America and Africa is that, when Spain and Portugal began conquering South America in the sixteenth century, they merged with local populations to a very large extent. They traveled not just to the coasts but to most areas of the continent. They imposed their religion and their legal systems. They established new population centers. This meant that they also introduced new diseases—which devastated indigenous populations. But because the Europeans intermarried with local people, immunity to many pathogens was also introduced.

In South America today, because of migration that is motivated by the desire to work or study, or by family considerations, populations continue to mix with one another at a high rate. As South Americans travel from place to place, they often carry no records of their disease history—but they do bring pathogens with them, or interact with new disease vectors along the way. Once they are established in their new locations, they tend to exhibit behaviors—regarding their own health care, for example, or food preparation—that they brought from their previous homes. Pathogens can thrive under such conditions, and diseases such as dengue fever and yellow fever are endemic in a range of South American countries. Meanwhile, the mobility of South American populations makes it very complicated to carry out disease surveillance, determine a disease's epidemiological status, or harmonize policy among nations.

Nonetheless, South America's health system has a lot going for it. Advantages include well-organized ministries of health. They include a cadre of well-trained doctors and scientists, as well as good basic infrastructure such as high-quality laboratories and hospitals devoted to infectious diseases. (Unfortunately, these resources tend to be concentrated in big cities; small towns and rural areas are underserved in comparison.) South America's advantages include regional organizations such as Unasur, which provide forums for discussing health challenges and formulating responses. Advantages also include a shared regional history and a set of shared values, factors that make cooperation across borders relatively easy.

Nonetheless, South America could do a much better job of containing emerging pathogens. With the region continuing to struggle against urgent problems such as poverty and social inequality, inadequate governmental attention and resources are available for public health. In the long run, what South America needs is a common, systemic approach to the fight against emerging pathogens. Some elements of the continent's health system work well, but the various pieces of the puzzle don't fit together optimally.

Each of the world's regions is unique, and each of its health systems is unique as well. Today, with forces such as urbanization and increased international travel presenting new challenges in the fight against emerging pathogens, it is crucial to understand the past and the present of every region. The future of health care depends on it.