My journey in public health in the Caribbean.

As part of its 100th-anniversary celebration, the Pan American Health Organization has named 12 persons as "Public Health Heroes of the Americas" in recognition of their noteworthy contributions to public health in the Region of the Americas. Over the course of this year, the Revista Panamericana de Salud Pública/Pan American Journal of Public Health will be carrying pieces written by or about these heroes. Como parte de la celebración de su Centenario, la Organización Panamericana de la Salud (OPS) ha distinguido con el título de Héroes de la Salud Pública a 12 personalidades que se han destacado por su valiosa contribución a la salud en el continente americano.

Forty years. An introduction to the development of a Caribbean public health.

The development of public health and primary care in Jamaica is examined with particular reference to the historical events which paved the way for their development: notably, the collaborative work undertaken by the Rockefeller Foundation (Commissions on hookworm, tuberculosis, malaria, yaws); recommendations of the Moyne Commission (leading to the establishment of the West Indies School of Public Health); and the Irvine Commission which recommended the establishment of the University College of the West Indies. A confluence of political, social and international activity in the 1970s proved catalytic in the development of the current ethos of primary health care, and the Department of Social and Preventive Medicine was instrumental in the training of the most innovative addition to the primary care health team, the community health aide. Undergraduate and postgraduate training programmes of the Department are highlighted as it celebrates its fortieth anniversary.

Public health training programs at the University of the West Indies.

The Department of Preventive Medicine of the University of the West Indies was established in 1957 with the idea of improving undergraduate teaching facilities to enable medical students to study patients in their homes and social environment. The authors describe the two public health diploma programs available at the University and cite pertinent enrollment and geographic distribution statistics. Candidates for the Diploma in Public Health are registered medical practitioners who take a series of compulsory and elective subjects and have a period of supervised field training and research during the 12-month course.

Approaches to primary health care in the Commonwealth Caribbean.

In this article, the authors present a brief review of the health problems of the Commonwealth Caribbean and of the primary care activities being implemented to solve them. Special attention is given to programs which develop new categories of health workers and direct health manpower toward learning a technology appropriate to the conditions in which they work. These programs enable the health worker and allied health personnel to adapt their roles and functions accordingly and thus provide quality health care within limited resources.

Longitudinal study of heart disease in a Jamaican rural population. 3. Factors influencing changes in serial electrocardiograms.

A longitudinal survey of heart disease in adults in a representative rural population in Jamaica provided an opportunity to study factors influencing the progression and incidence of electrocardiographic abnormalities in serial tracings taken at a 5-year interval. An analysis of changes occurring in those with ECG abnormalities compatible with ischaemia at the first survey showed that progression from a less severe to a more severe category was greater in men than in women, in hypertensive than in normotensive subjects, and, among men, in those with the amplitude criteria of left ventricular hypertrophy. The incidence of abnormal Q/QS patterns was greater in men than in women, and that of all abnormalities suggesting ischaemia was greater in hypertensive than in normotensive persons; in men, it was greater in those with high amplitude R waves.

Longitudinal study of heart disease in a Jamaican rural population. 2. Factors influencing mortality.

The relationship between cardiovascular characteristics and mortality was investigated in an epidemiological study of heart disease in a representative adult rural community in Jamaica. Of 449 men and 469 women followed up for 5 years, 36 men and 28 women died and the data concerning their status as regards arterial pressure, electrocardiographic abnormalities, and histories of effort pain at the intial survey have been analysed. Cardiovascular disease, and heart disease in particular, was the major cause of death in this population.

Longitudinal study of heart disease in a Jamaican rural population. I. Prevalence, with special reference to ECG findings.

A long-term epidemiological study of heart disease in a representative rural community in Jamaica was started in 1962-63 and the first follow-up survey was carried out in 1967-68. This report describes the prevalence of several cardiovascular characteristics at each survey, and their associations with other measurements. The nature of the electrocardiographic abnormalities and their relationship with symptoms of effort pain and prolonged chest pain suggests that much of the disease seen in this population is ultimately ischaemic in origin despite evidence that classical myocardial infarction and severe coronary atheroma are relatively infrequent.