Cesar Victora: leader in child health and development

Abstract

Cesar Victora thought he would be a mathematician or a nuclear physicist until he was 17 years old. But then he left Brazil on a scholarship to study at secondary school in the USA. The year he spent living just outside San Francisco at the tail end of the 1960s altered the course of his life. “It really changed my mind about a lot of things”, he said. “It was a very important year in my life.” Above all, he became interested in environmental issues, he said, and when he got back to Brazil, he thought he would study ecology, but there were no courses available. Then he read a book by the medical missionary and winner of the Nobel Peace Prize, Albert Schweitzer, who had dedicated his life to the health care of impoverished Africans. “I thought maybe that's what I want to do”, he said. “I switched from the exact sciences to medicine because I felt I could do something more useful.”37 years later, Victora is one of the world's leading epidemiologists in child health and despite his frequent trips to Africa, Geneva, London, the USA, and elsewhere—and invitations to join the United Nations and prestigious universities in the wealthiest countries of the world—he lives in the small Brazilian city of Pelotas, in a house looking out onto a lagoon. “I thought I wanted something I could do where I could live in a small city and be helpful to people.” Colleagues at WHO, where he is a consultant to the department of child and adolescent health and development, say he is a leading thinker in the field, but he is also a practical man, with his feet firmly planted in his Brazilian homeland. “He is a leading epidemiologist in child health and is basically one of the big thinkers in terms of child health epidemiology”, said Elizabeth Mason, director of WHO's department of child and adolescent health and development. “The fact that he continues to live and work in Brazil keeps him in touch with reality.”After qualifying as a doctor at the Federal University of Rio Grande do Sul, Victora did his residency in the slums. Like all who went to college at that time in Brazil, he was from the upper-middle classes. “It was a big shock”, he said. “I kept seeing the same kids over and over again with the same illnesses. We were not doing anything about changing the factors that cause diseases. That struck me very much. That's when I decided to do epidemiology.” Few of his colleagues at that time were interested in prevention of disease. During his residency, a new medical school was established in Pelotas. It was the chance he wanted to move out of Porto Alegre, the state capital, to a quieter town in the countryside. He taught at the school for 4 years before heading to the UK and the London School of Hygiene and Tropical Medicine for a PhD in health care and epidemiology. His thesis was on land tenure and child health. The children of landless parents in rural Brazil were far more likely to suffer disease and early death. “I have always been very concerned about issues of social inequity”, he said.Victora came back to Pelotas and in 1984 set up a new research department at the university, which is now one of the best-known centres for epidemiology in Brazil. His work on breastfeeding, nutrition, and infant growth, based on research among the local children, has international respect. A birth cohort study he started in 1982 of 6000 babies born in Pelotas, which is ongoing, is one of the longest prospective studies of its kind ever undertaken. It has provided a wealth of information about the effects that conditions in early life have on adult health. In 1997, he became a senior technical adviser to WHO, helping to assess its global strategy on the integrated management of diarrhoeal and respiratory diseases and other major causes of mortality in children. Then, in 2003, he became the joint coordinator, with Jennifer Bryce, of the groundbreaking Lancet child survival series. He describes his past 10 years as “trying to raise the visibility of child health in the world”. He explains how “There are fashions in aid and global research. There was a child survival revolution, with strong leadership from UNICEF, but it has gone off the agenda since.” Other issues, such as HIV/AIDS, became the priority. That is understandable, but “we can't just concentrate on some priorities and forget about others”, Victora insists.If his work has a political dimension, Victora is not himself a political animal. Some of his Brazilian colleagues in public health joined the armed resistance against the military dictatorship in the 1970s and 1980s while there was no clear social agenda and then moved into politics as the regime became more liberal, but Victora said that was not for him. “I wouldn't survive as a politician”, he said. “I find politics a bit too vague for me.” According to Robert Scherpbier of WHO's department of child and adolescent health, Victora “recognises the importance of political issues, but he is not driven by them. That makes it very pleasant to work with him. He concentrates on the technical issues and formulates them in such a way that they have political appeal.”Victora is a researcher to whom objectivity is essential and his work is a testimony to his commitment to child health and development. Although he works prodigiously hard and is very productive, he also knows how to have fun. He goes to the beach and his greatest passion, outside of work, is windsurfing on the lagoon beyond his window. “I will always find time for my windsurfing”, he says. “If I'm home and the wind is behaving, I'm there every day. I like to go for 10 miles and come back. Just me and the ducks.” Cesar Victora thought he would be a mathematician or a nuclear physicist until he was 17 years old. But then he left Brazil on a scholarship to study at secondary school in the USA. The year he spent living just outside San Francisco at the tail end of the 1960s altered the course of his life. “It really changed my mind about a lot of things”, he said. “It was a very important year in my life.” Above all, he became interested in environmental issues, he said, and when he got back to Brazil, he thought he would study ecology, but there were no courses available. Then he read a book by the medical missionary and winner of the Nobel Peace Prize, Albert Schweitzer, who had dedicated his life to the health care of impoverished Africans. “I thought maybe that's what I want to do”, he said. “I switched from the exact sciences to medicine because I felt I could do something more useful.” 37 years later, Victora is one of the world's leading epidemiologists in child health and despite his frequent trips to Africa, Geneva, London, the USA, and elsewhere—and invitations to join the United Nations and prestigious universities in the wealthiest countries of the world—he lives in the small Brazilian city of Pelotas, in a house looking out onto a lagoon. “I thought I wanted something I could do where I could live in a small city and be helpful to people.” Colleagues at WHO, where he is a consultant to the department of child and adolescent health and development, say he is a leading thinker in the field, but he is also a practical man, with his feet firmly planted in his Brazilian homeland. “He is a leading epidemiologist in child health and is basically one of the big thinkers in terms of child health epidemiology”, said Elizabeth Mason, director of WHO's department of child and adolescent health and development. “The fact that he continues to live and work in Brazil keeps him in touch with reality.” After qualifying as a doctor at the Federal University of Rio Grande do Sul, Victora did his residency in the slums. Like all who went to college at that time in Brazil, he was from the upper-middle classes. “It was a big shock”, he said. “I kept seeing the same kids over and over again with the same illnesses. We were not doing anything about changing the factors that cause diseases. That struck me very much. That's when I decided to do epidemiology.” Few of his colleagues at that time were interested in prevention of disease. During his residency, a new medical school was established in Pelotas. It was the chance he wanted to move out of Porto Alegre, the state capital, to a quieter town in the countryside. He taught at the school for 4 years before heading to the UK and the London School of Hygiene and Tropical Medicine for a PhD in health care and epidemiology. His thesis was on land tenure and child health. The children of landless parents in rural Brazil were far more likely to suffer disease and early death. “I have always been very concerned about issues of social inequity”, he said. Victora came back to Pelotas and in 1984 set up a new research department at the university, which is now one of the best-known centres for epidemiology in Brazil. His work on breastfeeding, nutrition, and infant growth, based on research among the local children, has international respect. A birth cohort study he started in 1982 of 6000 babies born in Pelotas, which is ongoing, is one of the longest prospective studies of its kind ever undertaken. It has provided a wealth of information about the effects that conditions in early life have on adult health. In 1997, he became a senior technical adviser to WHO, helping to assess its global strategy on the integrated management of diarrhoeal and respiratory diseases and other major causes of mortality in children. Then, in 2003, he became the joint coordinator, with Jennifer Bryce, of the groundbreaking Lancet child survival series. He describes his past 10 years as “trying to raise the visibility of child health in the world”. He explains how “There are fashions in aid and global research. There was a child survival revolution, with strong leadership from UNICEF, but it has gone off the agenda since.” Other issues, such as HIV/AIDS, became the priority. That is understandable, but “we can't just concentrate on some priorities and forget about others”, Victora insists. If his work has a political dimension, Victora is not himself a political animal. Some of his Brazilian colleagues in public health joined the armed resistance against the military dictatorship in the 1970s and 1980s while there was no clear social agenda and then moved into politics as the regime became more liberal, but Victora said that was not for him. “I wouldn't survive as a politician”, he said. “I find politics a bit too vague for me.” According to Robert Scherpbier of WHO's department of child and adolescent health, Victora “recognises the importance of political issues, but he is not driven by them. That makes it very pleasant to work with him. He concentrates on the technical issues and formulates them in such a way that they have political appeal.” Victora is a researcher to whom objectivity is essential and his work is a testimony to his commitment to child health and development. Although he works prodigiously hard and is very productive, he also knows how to have fun. He goes to the beach and his greatest passion, outside of work, is windsurfing on the lagoon beyond his window. “I will always find time for my windsurfing”, he says. “If I'm home and the wind is behaving, I'm there every day. I like to go for 10 miles and come back. Just me and the ducks.” Early childhood development: the global challengeIn 1978, WHO and UNICEF made immunisation and the prevention and control of endemic disease key elements of primary health care and Health for All, set up a new programme for the promotion of oral rehydration therapy (ORT), and supported their widespread adoption and promotion in developing countries. Within 15 years, the practice of ORT had multiplied exponentially, reaching all continents and most countries of the world. By 1990, WHO estimated that the number of children aged under 5 years who died from diarrhoea and dehydration each year had fallen from 5 million to 4 million. Full-Text PDF Developmental potential in the first 5 years for children in developing countriesMany children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data—the prevalence of early childhood stunting and the number of people living in absolute poverty—to use as indicators of poor development. Full-Text PDF Open Access