Editorial |
Latin American epidemiology
1 Post-graduate programme in epidemiology, Federal University of Pelotas, Rua Mal. Deodoro 1160—3° piso, 96020-220 - Pelotas, RS, Brazil.
2 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London. London WC1E 7HT, UK.
* Corresponding author. Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Rua Mal. Deodoro 1160–3 piso, 96020-220 - Pelotas, RS, Brazil. E-mail: cvictora{at}terra.com.br
Accepted 17 June 2008
This is a special issue on Latin America, a region that includes Mexico, the Spanish speaking countries in Central America and the whole of South America. Most of Latin America is made up by middle income countries with marked socio-economic inequalities, and therefore includes both highly educated, wealthy populations and populations living in stark deprivation. After emerging from a period of instability and military rule, the region is now characterized by democratically elected governments, high levels of industrialization and a population that is 75% urban and includes four of the world's largest metropoles (Mexico City, Sao Paulo, Rio de Janeiro and Buenos Aires). There is an active research environment in some Latin American countries, with important contributions to epidemiology—over 2000 epidemiological papers a year in Medline, corresponding to roughly 2% of the output on the subject. In this issue, Howard Waitzkin describes a database for making this important scientific production widely available.1
This year, the 18th International Congress of Epidemiology is being held in Latin America for the first time ever, in Porto Alegre, Brazil. It will take place in September, simultaneously with the seventh Brazilian Congress of Epidemiology. At the time this editorial is being written (June 2008), over 5000 participants have confirmed their attendance. Of the 5700 abstracts submitted—about 5000 of which are from Latin America—88% were accepted. The conference will be three to four times larger than previous IEA international conferences.
There are several explanations for the impressive attendance figures. First, epidemiology has undoubtedly gained popularity in Latin America. In Brazil alone, there are now over 30 Masters programmes in Public Health, most of which also offer doctoral degrees, resulting in part from a sustained investment in training epidemiologists abroad in the 1980s and 1990s. Second, unlike other countries, the boundaries between epidemiology and public health are porous. Many categories of professionals who attend epidemiology conferences in our region would be unlikely to attend them in Europe or North America. This reflects the strong links between health services and epidemiological research in our region.
This issue of the IJE reflects the rapid epidemiological and nutrition transitions that the region is undergoing. The deep social inequalities that affect us all led to the concept of a triple burden of disease: infections and undernutrition; chronic degenerative diseases and violence. The transition in Latin America is complex, with different population subgroups suffering from diverse disease conditions, and transitioning (or failing to do so) in different directions at variable rates. Mauricio Barreto aptly wrote about emerging, re-emerging and remaining diseases in our region2 and this issue confirms that the poor, rather than the better off, are more likely to be affected by the three types of conditions.
This special issue of IJE includes 15 original articles that provide a panorama of what is taking place in the region. These articles span over the three leading components of the burden of disease. Studies on diarrhoea, childhood stunting, food security, tuberculosis, HIV/AIDS and hepatitis A confirm the persistence of infections and undernutrition in the region. Additional articles on cancer, child obesity, ageing and dementia attest to the rising prevalence of chronic and degenerative conditions. Finally, reviews of vital statistics highlight the major role of violence—a cause of death that is higher in low—and middle income Latin American countries than in any other region in the world.
There are also important cross-cutting issues in the papers in this issue. Social determinants and inequities are a major feature of epidemiology in our region, where the gaps between rich and poor are self-evident. Jaime Breilh3 provides a historical account of social epidemiology in Latin America. Public Health in Latin America is highly politicized, with no better example than the right to universal access to antiretroviral treatment in Brazil, associated with the push for cheaper antiretroviral drugs, which was so influential internationally. The effect of that policy in the epidemiological pattern of HIV and AIDS in Latin America is also reviewed here.
Another cross-cutting issue is the interface between epidemiology and health services, which as discussed above explains the broad attendance at our IEA congress. Articles based on vital statistics, and on how epidemiology can help improve their quality, as well as studies on access, coverage and costs of health care, show how such issues pervade epidemiological production in the region.
But not all is well in public health and epidemiological research in Latin America. The tradition of social commitment in Public Health departments in many Latin American countries made them obvious targets during the years of dictatorship; and some are still recovering from the consequent havoc. In many countries the career structure is not well defined, salary scales are well below those of other medical specialities and the research funding is severely limited. As a consequence there has been a diaspora, with many researchers leaving and developing careers in the USA and Europe. These emigrés, however, along with large numbers of Latin American epidemiologists who trained abroad and returned to their home countries, allowed our region to become an active participant in the international epidemiological environment. Epidemiology in Latin America has been traditionally open to international, equal standing, research partnerships. Our region has some very attractive features for such research: high incidence of communicable and non-communicable diseases, good quality routine data collection and laboratory capacity, strong involvement with health services and a clear social commitment.
We hope that this issue and the forthcoming IEA congress will corroborate the healthy state of epidemiology in Latin America and attract further international research collaborations, so that colleagues from the rest of the world can join us in a fruitful two-way exchange of knowledge and skills.
References
1 Watkzin H, Iriart C, Shipp Buchanan H, Mercado F, Tregear J, Eldredge J. Perspective: the Latin American Social Medicine Database: a resource for epidemiology. Int J Epidemiol (2008) 37:724–28.
2 Barreto ML, Carmo E, Santo C, Ferreira L, et al. ‘Emergentes’, ‘reemergentes’ e ‘permanecentes’: tendências recentes das doenças infecciosas e parasitárias no Brasil. Informe Epidemiologico do SUS (1996) 5:7–17.
3 Breilh J. Latin American critical (‘Social’) epidemiology: new settings for an old dream. Int J Epidemiol (2008) 37:745–50.
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