Equity and the goal of Health for All.

Abstract

First let me thank you not only for the opportunityto address you here in Venezuela but also for hav-ing given me the opportunity to reflect again moreseriously on the concept of equity as it applies towhat we do. I hope to show you how the concept of equity is embedded in the vision of Health forAll, and the relevance of both to the struggles of the countries of the Americas for a better life for all their citizens. This is the centennial of the PanAmerican Health Organization (PAHO), and it isfitting that those of us who serve the Organizationtake time to reflect on some of the essential valuesthat underpin what we do. I believe that this hasbeen a forte of my predecessors throughout theyears as they must have believed, as I do, that no or -ganization can survive and flourish unless it hassome bright vision of what might be and the way toget there. I believe that the noble vision of Healthfor All, explicitly or implicitly, must have guidedwhat we have done and what we are.When I was a medical student, we weretaught that the social and physical environmenthad an effect on the development and progress ofdisease, and one could see obvious examples of thatalmost every day. But the focus was predominantlyon the individual. As I became a practicing internistmy concern was still mainly, if not exclusively, forthe health and well-being of my individual patient,and I believe that that is the proper focus of thoseengaged in personal-care medicine. Success wasmeasured in terms of the outcome of treatment Ihad prescribed or to the extent I could have him orher protected against some risk to health. I have toconfess that from time to time as I saw patientscome for treatment late in the course of their diseaseor saw their disease affected by conditions of depri-vation that were not of their own making, I couldnot help but reflect on the apparent social injusticethat made some healthy and others not.Later I became much more aware of the call ofpopulation medicine, or rather population health.Perhaps that is one of the reasons for my joining thePan American Health Organization 20 years ago.There is a basic difference between the causes ofdisease in patients and the incidence of disease inpopulations. We know that cigarette smokingcauses cancer of the lung. If everyone in a popula-tion smoked, some would develop cancer, but wewould never be able to identify tobacco as an etio-logic factor. However, if one is seeking to enhancethe health of populations, which is the main focus