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Rx for Survival — A Global Health Challenge

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Global Health Champions

Dr. Jaime Sepulveda

Jaime Sepulveda Amor, PhD

Director General
Mexican National Institutes of Health

Dr. Jaime Sepulveda Amor, as director general of the National Institute of Public Health of Mexico, has confronted a wide variety of public health challenges, from staunching a cholera epidemic to founding an HIV/AIDS prevention program to designing Geographical Information Systems for disease control and health surveillance.

"Fifteen years ago, the poor countries were simply asked to apply knowledge generated by the rich ones," says Sepulveda. "But we must recognize that disease burdens are changing." Indeed, as Mexico has moved from a poor, developing country to a newly developed nation in just a few decades, Sepulveda realizes greater trials may lie ahead. Not only must he help solve problems of malnutrition; now he must cope with obesity as well. "The rising burden of chronic disease in Mexico will change research agendas and challenge us to translate research into policies that will benefit all our people," he says. "We will need private-public partnerships to succeed — from academic researchers to business groups to civil society as well."

One of Sepulveda's first major tests came early in his career, in 1991. Mexico's inadequate sanitation systems had contaminated the water supply with the marine bacterium Vibrio cholerae, leaving the country vulnerable to cholera. After a century's absence, an epidemic was sweeping through Peru, Ecuador, and Colombia, and Mexico lay in its northward path. Victims of the dreaded disease suffer such acute diarrhea and vomiting that many often die from dehydration in as little as eight hours.

"Cholera was definitely associated with poverty," Sepulveda says. "Having cholera was not good news." As a newly appointed undersecretary of state for health, he knew that his country's economic future, especially in tourism and trade, depended on its handling of the crisis.

"We rang the bell: It's coming; we have to take preventive measures," he says. The first step was intercepting carriers of the disease at airports and other points of entry into the country. "Microbes don't travel with passports; they don't stop at borders. Every person in every airport that had symptoms of diarrhea was monitored for five days," he recalls.

But the first case arrived in a surprising place — a remote community high in the mountains of Central Mexico, where it took the life of a 68-year-old man. Soon there were 27 cases of the disease. Sepulveda spearheaded an intensive investigation and tracked all 27 cases to a nearby river. Still, the spread of cholera could not be contained, and by the end of the year, there were 2,700 cases — a full-blown epidemic.

Sepulveda then launched a massive clean-water program, with an aggressive communications campaign to alert people to the ways cholera is transmitted and also prevented. But it would take an investment of $1 billion to create a modern water and sewage system to finally bring the threat to an end. With this investment, Mexico has reduced all diarrheal diseases by 80 percent. "By investing heavily in water filtration and infrastructure," Sepulveda says, "we accomplished a tremendous benefit to public health."

And to economic development as well: As Mexico's Minister of Health Julio Frenk says: "You don't spend on health; you invest in health. And it is not something you do after you grow; it's something you do so that you can grow."

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