Cartas / Letters


La Revista Panamericana de Salud Pública/Pan American Journal of Public Health se complace en publicar cartas de los lectores dirigidas a estimular el diálogo sobre los diversos aspectos de la salud pública en las Américas, así como a esclarecer, discutir o comentar de manera constructiva las ideas expuestas en la revista. Las cartas deben estar firmadas por el autor y especificar su afiliación profesional y dirección postal. Cuando se trate de comentarios sobre un artículo que requieran contestación del autor, se procurará conseguir esa respuesta con el fin de publicar ambas cartas. La Redacción se reserva el derecho de editar las cartas recibidas y resumirlas para mayor claridad.

The Revista Panamericana de Salud Pública/Pan American Journal of Public Health publishes letters from readers for the purpose of stimulating dialogue on various aspects of public health in the Americas and of constructively clarifying, discussing, and critiquing the ideas expressed throughout its pages. Letters should be signed by the author and include his or her professional affiliation and mailing address. If a commentary on a given article requires a reply from the author, an effort will be made to obtain the reply and to publish both letters. The editorial team reserves the right to edit all letters received and to condense them so as to improve their clarity.





I would like to extend my congratulations to the Revista Panamericana de Salud Pública/Pan American Journal of Public Health for the two interesting, timely articles and the accompanying editorial about the surveillance of noncommunicable diseases (1-3).

After searching for evidence and dissecting the problem analytically, the authors of these papers concluded that a great majority of the prevalence studies carried out in Latin America and the Caribbean on noncommunicable diseases (NCDs), particularly hypertension, are not very useful for surveillance or for defining interventions to use with these emerging conditions. This was a common hypothesis among those who have dedicated much time to these issues, but it was never clearly proved before (4). As the authors suggested, it is necessary to build common minimum standards for variables used in surveys and surveillance, especially for NCDs. In other words, as with Esperanto, a new language is needed in this field. Otherwise, large amounts of resources will continue to be expended without producing reliable, comparable results. The lessons learned with large carefully designed countrywide studies have demonstrated their power in this sense (5). This has been true, for example, with the multinational MONICA project of the World Health Organization (WHO) to monitor trends and determinants in cardiovascular diseases, the Countrywide Integrated Noncommunicable Disease Intervention (CINDI) program of WHO's European Regional Office, the WHO's global INTERHEALTH program for the integrated prevention and control of noncommunicable diseases, and the Pan American Health Organization's program in Latin America and the Caribbean called the Conjunto de Acciones para la Reducción Multifactorial de las Enfermedades No Transmisibles (CARMEN) (Actions for the Multifactorial Reduction of Noncommunicable Diseases). Finally, I agree that the STEPwise approach of the WHO is also an excellent tool for making progress in this important field of health surveillance (3), particularly in developing countries, where resources are very limited.



Alfredo D. Espinosa-Brito
Main researcher, CARMEN demonstration area, Cienfuegos, Cuba
Hospital Dr. Gustavo Aldereguía Lima
Cienfuegos, Cuba



1. Silva LC, Ordúñez P, Rodríguez MP, Robles S. A tool for assessing the usefulness of prevalence studies done for surveillance purposes: the example of hypertension. Rev Panam Salud Publica 2001;10(3):152-160.

2. Ordúñez P, Silva LC, Rodríguez MP, Robles S. Prevalence estimates for hypertension in Latin American and the Caribbean: are they useful for surveillance? Rev Panam Salud Publica 2001; 10(4):226-231.

3. Bonita R, Strong K, de Corten M. From surveys to surveillance [editorial]. Rev Panam Salud Publica 2001;10(4):223-225.

4. Espinosa AD, Espinosa AA. Factores de riesgo asociados en los fumadores: resultados de la medición inicial del Proyecto Global de Cienfuegos. Rev Cubana Med. (Forthcoming).

5. Puska P. Do we learn our lessons from the population-based interventions? J Epidemiol Community Health 2000;54(8):562- 563.

Organización Panamericana de la Salud Washington - Washington - United States