Reflexiones del Director / From the Director


The Publishing Enterprise at the Pan American Health Organization1


George A. O. Alleyne



"From my first day in office, I have stressed the critical importance of information as one of the most valuable tools for the discharge of our mission and for fulfilling the vision I had¾and continue to have¾for this Organization."

First, let me welcome you to the Pan American Health Organization. We are always happy to arrange interregional meetings here at PAHO, not only because we like to play host to our colleagues from other parts of the World Health Organization (WHO), but because we all learn so much from the sharing of experiences. Although from time immemorial there have been means of communicating across distance, there is really no substitute for the face-to-face encounter in which we learn almost as much from what is implied by gesture or expression as from what is said. It does us good to sit together to enjoy the to-and-fro and the give-and-take of debate and argument and to cement lasting relationships that will facilitate cooperation and coordination. I hope that this meeting has begun and will continue in this spirit.

I had two possibilities for my welcome to you this morning. For one, I could have contented myself with some platitudinous, perfunctory remarks about PAHO and our programs. The other possibility proved more attractive, however. Because of the nature of the audience and the regard that I have for the critical faculties of the wordmistresses and wordmasters on my own staff who work in the area of publications, I decided to devote more serious attention to the nature of our publishing enterprise. I will use this occasion to reflect on my own beliefs, on the philosophical and historical underpinnings of my approach to publishing in PAHO, and on the reasons why I support the work that is being done. From my first day in office, I have stressed the critical importance of information as one of the most valuable tools for the discharge of our mission and for fulfilling the vision I had¾and continue to have¾for this Organization.

Our publications should reflect the values and principles that underpin our work. We hold that the search for equity is one of those principles, and that is why my first annual report was entitled "The Search for Equity." The other important principle is strengthening the Pan American approach, and thus my quadrennial report to the PAHO Governing Bodies last year was entitled "Leading Pan American Health." I feel strongly that the countries of the Americas have done great things and can do even greater things by working together. I hope those of you who read our publications will see these principles reflected in the topics they cover.

My annual report for 1998 is dedicated to information for health, and in its introductory essay I refer again to these principles. I write there of the pride I have in the quality of our scientific publications, which are a powerful tool for disseminating information that is important for health. And I would add here that I am also tremendously proud of the staff responsible for those publications.

You will no doubt hear of our publications policy and the systems we have in place for ensuring some consistency of approach to the selection and processing of the material that we publish. I wish here to pay tribute to the PAHO Publications Committee, which is chaired by PAHO Deputy Director Dr. A. D. Brandling-Bennett, for the work it has done and continues to do in advising about this area of our work. Our publications policy tells more of the "how"¾the processes followed¾and not so much of the reasoning or the conceptual background to our work, but perhaps some of this will surface during the meeting.

No discussion about publications can or should avoid mention of the growth of information technology. I would be rash or arrogant to think that I could add anything original to the dialogue about the still-cresting wave of enthusiasm for the information society. No one can question the role of information in shaping modern mores. Francis Fukuyama is one of my favorite authors. A recent book of his, The Great Disruption, deals with human nature and the reconstitution of the social order. In it, Fukuyama says, "A society built around information tends to produce more of the two things people value most in a modern democracy: freedom and equality." He points out that the freedom of choice has "exploded" and that all forms of hierarchical arrangements are under siege. Information in health will allow those who have to make decisions at all levels to expand their choices. These "decisionmakers" are not only high government officials but every sentient one of us as we go about the mundane chores that occupy us daily.

We have not yet reached the day when publications with information about health will promote more equality between those who currently have the information and those who need it. I have said elsewhere that we can dream of the time when critical health information is so readily available in simple publications that we will have a genuine democratization in health care. The transactions that are now so uneven will become fairer, in the sense that the health worker and the patient will share the same information. We have recently taken some steps in that direction by distributing the Merck Manual of Medical Information, which was prepared and generously made available to us by that pharmaceutical company, in order to put an information tome in the hands of the public.

Decades before Fukuyama was born, those wise persons who created the Pan American Health Organization saw it as having a major responsibility for the collection and dissemination of sanitary information. I have taken this charge very seriously and pondered long and hard on the nature and content of this sanitary information and how we should approach its dissemination in this new age.

We clearly need information on the state of health. We need to collect and analyze data on those conditions that characterize our people and the environment in which they live. We need information on the factors that influence whether or not our people will enjoy health. And if they do not enjoy health, we must know what diseases and forms of illness prevent them from being whole. Some of this information we will produce ourselves, and some we will cull from the records of other institutions that, like us, are concerned with health. Some of the information will be presented to us for our validation and publication because of the reputation we have acquired for only accepting material of quality and relevance.

". . . those wise persons who created the Pan American Health Organization saw it as having a major responsibility for the collection and dissemination of sanitary information."

When we acquire that information we can either focus on being superarchivists and take pride in the beauty of our collections, or we can fulfil our original charge and be aggressive in disseminating the information. It goes without saying that there is a proper and legitimate place within institutions such as ours for an archival function. The manner in which the function is discharged has changed radically with the advent of new technology, but we offend and insult those who produce information of quality if we do not pay attention to preserving it so that it can be retrieved for future use. I presume that your discussions will center on the publication and dissemination of health information. In a strict sense, it is artificial to separate publishing from disseminating information. The act of publishing implies making information available to the public. Obviously, various means are available to us for disseminating the information we generate or acquire, and we clearly place emphasis on making it available in some form that is readily accessible to our various publics. This is a time-honored tradition, because¾although the calligraphic marvels of the medieval monks could not really be described as publishing¾long before those monks wrote for internal consumption, Plato's students had copied his lectures and sold them for profit. Clearly, there is nothing new about the marketing of quality publications.

Throughout WHO, we are constantly challenged to produce publications that are of the highest technical quality, are informative, and are attractively produced. Sometimes I cannot help but marvel at how the raw material is transformed into beautifully finished products. An equally great effort is needed to ensure that those finished products reach the maximum number of users. Toward that end, we have to be equally competent at marketing the material we produce. We do not agree with those who see conflict between our responsibility to make information available at no charge to our primary public and our need to legitimize and sustain our efforts by recovering some of our costs. It is true that part of our mandate is to make available those public goods that in particular arise from collective action on the part of our countries, and information about the health of the peoples of the Americas and its determinants certainly falls into that category.

But we must strike a balance. It is perfectly proper to devise a strategy that permits us to make information available to those who need it and at the same time recover part of our costs from those who can afford to pay for it. Evidently, others besides those who might be considered our primary clients are willing to pay for the value that we add to the data that we collect, analyze, and organize into useful information. Moreover, many who are knowledgeable in these matters have called us naive for not offering more of our products and services for sale. I therefore encourage a well-focused marketing strategy for our publications and would wish to see the same throughout the whole of WHO. This is one area in which we already collaborate, and I welcome any ideas for strengthening that collaboration.

There was a time when almost all, if not all, our publications were on paper and in the nature of documents or periodicals. I like the reference I encountered recently to the two forms of document use, "darts" and "as a means of making and maintaining social groups." I am fascinated by the image of our material flying through space like a missile and landing in the most remote parts of the Region of the Americas to inform those who need the information, perhaps piercing the thick hide of resistance to change, and carrying the ingredients for discussions about better health for our citizens. But the newer forms of publishing have shattered this image. The dart having left the hand of the sender cannot be modified. The advent of electronic publishing opens the possibility of much closer interaction along the whole publishing chain. As a consequence, we see the field of scholarly publishing undergoing tremendous change, with altered social relationships between the producer and the recipient of the information. This will have a profound impact on the possibility of documented information being transformed into knowledge in ever shorter periods of time. I am sure that you will cover the relative merits of print and electronic publishing as applied especially to periodical publications, and will no doubt consider the effect on our capacity to market what we produce in both forms.

"...we have to be equally competent at marketing the material we produce. We do not agree with those who see conflict between our responsibility to make information available at no charge to our primary public and our need to legitimize and sustain our efforts by recovering some of our costs."

I have seen reference to the preference of high-prestige scientists for print journals and much enthusiasm for electronic publishing in journals that reach a very wide audience but do not rank as high in the scientific "pecking order." On the other hand, I have observed recently some of the world's most prestigious scientific journals going on-line without any apparent decline in their readerships. Those who dream of what has been deemed a post-Gutenberg galaxy are quoted as saying, "We think that eventually all journal articles and books will become a network of interlinked databases, continually updated with new articles linked to other articles." It is interesting to speculate whether or not it will be the new technology that will drive the publishing world. I have a strong suspicion that it will be the mighty power of the publishers that will force the technology into a form that is mature enough to serve their purposes.

I hope you address the issue of how decentralized organizations should ensure and maintain quality in the publications they produce. Everyone will agree that it is impossible to monitor and screen the production of scientific information in a large organization. No one wishes to stifle creativity, and, in any case, one of the essential characteristics of information is the impossibility of suppressing it. Information permeates structures. I always recall the famous quotation of President Ronald Reagan before the Berlin Wall: "Information is the oxygen of the modern age, which seeps through the walls topped with barbed wire and wafts across the electrified, booby-trapped borders." We do not have such walls any longer, but it still remains an impossible task to contain information. Perhaps the only answer is one of persuasion and socializing the members of the Organization into the correct form of producing and publishing information. It still concerns me that some of the material we produce has not gone through the time-honored process that transforms a manuscript into the work of art that is a good book. Our scientific publications should be of the highest quality, while nonscientific publications serve different purposes and may be of a lesser quality. In this context, I see WHO offices responsible for scientific publications as the gatewatchers rather than the gatekeepers of the quality of our publications.

I hope you address seriously how there can be copublishing across WHO, and how there can be an agile mechanism for sharing information on all aspects of publishing. I never cease to be impressed at the wealth of material that is produced in all parts of WHO and wonder at the returns in program or financial terms on the effort expended, which brings me to the issue of evaluation of our publications. In commercial enterprises, very precise measures exist for determining the effectiveness and acceptance of a publication, and readership surveys are routine approaches to modifying the product line. Because we can claim to be in the business of producing public goods, we may have the tendency to be less rigorous in the evaluation of our products. This is an error. While we may permit continuity or production of a publication because it fills some constitutional requirement or is of great value for a very small but restricted audience, that decision must be made consciously. We must never forget that information is an expensive commodity, and good information, such as that which finds its way into our publications, is not only expensive, but precious, and the marginal cost is almost always high.

I have not addressed the other aspects of information management in PAHO and the materials we use to inform our various publics about what we do and what we stand for. While there are specific publications devoted to that purpose, I wish you to have no doubt that I also see the scientific publications as contributing to the public image of the Organization. We are known by what we do and also by what we write in our publications.

I am sure your meeting will go very well, and I say to the visitors that I hope the arrangements are to your liking. Perhaps, if they are really to your liking, you will not wait for another interregional meeting to visit us again. And, if your conclusions and recommendations prove innovative and stir my imagination, I will certainly invite you again, and soon.

When pondering a suitable ending to this presentation, I thought of quoting Benjamin Disraeli, whom I have often cited as a great proponent of the value of health to nations. And then I found this quotation:

"Books are fatal: they are the curse of the human race. Nine-tenths of books are nonsense, and the clever books are the refutation of that nonsense. The greatest misfortune that ever befell man was the invention of printing."

. . . which only goes to show that even great men sometimes say nonsense.

Thank you and, once again, welcome to the Pan American Health Organization.


1 Remarks made to participants in the Sixth Meeting of the World Health Organization Interregional Committee on Policy and Coordination of Publications, Washington, D.C., 13 July 1999.

Organización Panamericana de la Salud Washington - Washington - United States