Volume 15, Number 10—October 2009
Lessons from a Special Service for Public Health, Brazil
To the Editor: Many thanks for your interesting and informative special section on infectious diseases in the Amazon Region (1). Your readers should also be interested in a little known, but extremely successful, sustainable health program that had its start in the Amazon.
In 1942, the governments of Brazil and the United States agreed to establish a special service for public health (called the Serviço Especial de Saúde Pública). The purpose of this program was to improve health conditions in key areas in the Amazon, expedite the collection and export of native rubber, and counteract the growing influence of Nazi Germany in Latin America (2). The program spread to the Vale do Rio Doce, where there were resources of iron ore, mica, and optical quartz, which were important for the war effort. Although the program eventually moved to all states of Brazil, the Amazon program remained an important activity for ≈50 years before it was integrated into the Brazilian Ministry of Health (3).
The program in the Amazon focused primarily on infectious disease. It comprised programs of immunization, provision of small sustainable water systems, development of privy programs (sewer systems in the larger centers of population), malaria control, improvement of residences and living conditions for Chagas disease control, epidemiologic intelligence, and extensive training for auxiliary and professional personnel.
The effects of this program are shown by the increase in life expectancy for all age groups, with an increase of >10 years for those childhood age groups for whom infectious disease control would have the greatest effect from 1939–1941 to 1950–1951 (4). This program contains many lessons for the planners of health and disease control projects in tropical, low-income countries.
- Infectious diseases in the Amazon. Emerg Infect Dis. 2009;15:625–80.
- US Public Health Services, Bureau of State Services. 10 years of cooperative health programs in Latin America: an evaluation conducted by the US Public Health Service for the Institute of Inter-American Affairs. Washington: The Services; 1953.
- Bastos NC de Brito. SESP/FESP: evolução histórica, 1942–1991. Brasilia (Brazil): Ministério de Saúde; 1991.
- Moraes NC. Avaliaco de um programa de profilaxia geral estudo de 18 cidades do interior da Amazonia (Tese de Concurso) Saúde Publica. São Paulo: Universidade de São Paulo; 1954.