Panama: Chronologic Review Of Landmark Projects And Social Determinants Of Health

Analysis of existing evidence, relating historical landmarks, public health approaches and health data, showed interplay of these elements and outcome. 1881-1889: Construction of French Canal begins and fails (1889), leaving 25,000 deceased workers from malaria, yellow fever, dysentery and other causes. 1903-1914: The Republic of Panama comes to light (2003) and action was quickly taken on social determinants of health: housing, breeding sites, basic sanitation, with yellow fever elimination (1906); malaria mortality decrease from 350 yearly (1881-1889) to 10 (1911). 1960-1989: Generational struggle for sovereignty over the 'Canal Zone' makes crisis during the infamous student massacre (1964). The Military coup (1968) put this struggle on the national agenda. Created MOH (1969) with adoption of social determinants: community participation, food, water, and housing. Achievements: elimination of Aedes aegypti (1971 to 1985), elimination of Poliomyelitis (1972), Sylvatic Yellow Fever (1974), and Diphtheria (1982). Panama Treaty signed (1977). Military regime crisis: General Torrijos death (1982); US invasion of Panama (1989). 1990-2010: Neoliberal reform policies: Health system abandoned primary care strategy, adopted disease centered approach, with fragmentation and segmentation, causing public health setbacks. 2010-2016: Health Dialogue Table installation, with health associations, patients and state institutions, analyzed state of health system, finding infant mortality increase, 12.2 to 15.0 (2009-2013); falling vaccination coverage by 2014, 96.4% of children <1 year living in districts with polio coverage <95%. Proposal elaborated with intersectorial axis, addressing social determinants of health, empowering all actors responsible for sectors such as labor, education, transportation, housing, environment, economy, safety, justice, migration, food security.

Claude Betts & Lizbeth Benitez

Sociedad Panamena de Salud Publica

Claude Betts, MD, MPH, MBA.
President of the Panamanian Public Health Society.
Lizbeth Benitez, MD, MPH, Pediatrician.
Head of the Scientific Commission of the Panamanian Public Health Society.