PRESENTATION
Economic Value of Health: an almost forgotten essay
José Ruben de Alcântara Bonfim
The Fifth World Health Assembly 1 was held in Geneva, from May 5th to May 22nd, 1952. In the Brazilian delegation, were M. J. Ferreira, Professor of Public Health, at the Faculdade Fluminense de Medicina; A. G. de Almeida e Castro, director of the National Plague Service of the Ministry of Education and Health; and E. de Paiva Ferreira Braga, superintendent of the Public Health Special Service of the Ministry of Education and Health. C. A. de Souza e Silva from the Permanent Delegation of the United Nations European Office served as an advisor.
The ninth Plenary Session, on May 21st, chaired by Manoel José Ferreira included technical discussions about "The Economic Value of Preventive Medicine" and "The Methodology of Health Protection for Local Areas". Two renowned experts were there and presented an overview on the theme "The Economic Value of Health": Winslow2, professor of public health, and Professor Myrdal3, executive secretary of the European Economic Commission.
The essay Economic Value of Health, written by Paulo de Assis Ribeiro, Manoel José Ferreira and Ernani Braga, is now being published for the first time, thanks to the initiative of José da Rocha Carvalheiro, editor of the Brazilian Journal of Epidemiology.
In July 1974, after the death of the first author of this essay, Paulo de Assis Ribeiro (1906-1974), Manoel José Ferreira (1897-1978), wrote: [...] "The Economic Value of Health, published in a limited mimeographed edition to be presented as part of the Technical Discussions at the World Health Assembly in Geneva, shows the maturity of the man who had joined Raphael de Paula Souza in the National Campaign Against Tuberculosis, and later in the original and incomparable approach in launching the Bases for Agrarian Reform". [...]4.
It is also possible to infer from the excellent text about the work of another co-author, Ernani Braga (1913-1984)5, that The Economic Value of Health remained unpublished, not even in mimeographed copies. The Economic Value of Health is not mentioned either in the book SESP-FSESP: 1942 - Evolução Histórica - 1991, by Nilo Chaves de Brito Bastos6, even though it was written under the auspices of the Special Service of Public Health.
47 years after The Economic Value of Health was written, sanitarians will be able to appreciate the concept of its authors, as summarized in the opening sentence: "The purpose of this study is to explain the value of health from the viewpoint of the expenses and losses caused by disease and other physical deficiencies which, in all age groups, reduce or hinder the full normal productiveness of the healthy man in a specific period; and losses in productivity_ resulting from premature deaths and causing a reduction in the number of individuals in each age group in ages below the normal age of Lexis for the region under consideration - throughout the period between the age when death occurred and the respective normal Lexis ages" (reference 4).
When editing the essay, a few typing errors were corrected, the presentation of charts and tables was improved, the mathematical symbols handwritten in Greek alphabet were typed, and the bibliography was standardized (38 references), since it presented several flaws. In spite of efforts in Brazil and abroad, most bibliographic references (11, 21, 22, 29, 32, 35 and 38) that included notes between brackets were not located. Although we could not find the other ten references in the libraries in São Paulo (3, 5, 6, 9, 20, 21, 22, 25, 26, 27, 28), we feel that the documents may be located elsewhere, either because they meet bibliographic standards, or because their failure to meet such standards does not impede the search, since they are partially valid.
As to bibliographical information on the authors, I enthusiastically recommend reading the following texts that are presented in the Bibliographic Notes and References:
A) Paulo de Assis Ribeiro: references 4and 7
B) Manoel José Ferreira: references 8, 9, 10 and 11
C) Ernani Braga: reference 5
I would like to express my gratitude to professor José da Rocha Carvalheiro for his help in the preparation of the editorial; to Dr. José Esparza, from UNAIDS Joint United Nations Program on HIV/AIDS, for kindly providing copies of excerpts of the technical discussions of the Fifth World Health Assembly relating to the theme (reference 1); to professor Fernando Guilherme Tenório, of the Fundação Getúlio Vargas, in Rio de Janeiro, without whose help I would not have been able to make contact with Maria Guilhermina Esteves, a retired IBGE researcher who gave us a copy of the valuable biography of Paulo de Assis Ribeiro4.
Bibliographic Notes and References
1. Fifth World Health Assembly. Official Records of the World Health Organization nº42. Geneva: WHO; November 1952, p.3, 129-131.
2. Charles - Edward Amory Winslow (1877-1957). According to George Rosen (Uma História da Saúde Pública, 2ª ed., Hucitec-Editora Unesp-Abrasco, 1998) "A public health leader, both in the United States and in the world, a truly distinguished man. Among the fields in which he worked, we may include public health, organization of medical care, history of public health, and international health. An active teacher, editor and author, he left an enduring mark on American Public Health". He wrote, among other works, The Evolution and Significance of the Modern Public Health Campaign (New Haven, Connecticut: Yale University Press; 1923)
3. Karl Gunnar Myrdal (1898-1987). A Swedish economist, sociologist and politician, he won the 1974 Nobel Prize on Economics with Hayek. He created the theory of circular causation, according to which the vicious circle of backwardness and poverty may be broken by the planned application of reforms that cause cumulative and directed changes in the circle of the causes of socioeconomic inequalities. He was Minister of Commerce in Sweden (1945-1947) and UN economic advisor for Europe (1947-1957). Among other works, he wrote the books Economic Theory and Underdeveloped Regions / Teoria Econômica e Regiões Subdesenvolvidas (1957, 3rd edition, Rio de Janeiro, Brasil: Saga; 1972), Challenge to Wealth / Desafio à Riqueza (1963), Political Aspects of Economic Theory / Aspectos Políticos da Teoria Econômica (1st edition, São Paulo, Brasil: Abril Cultural, 1984), and The Challenge of the Poor World / O Desafio do Mundo Pobre (1970).
4. Assis Ribeiro, CJ. Apontamentos sobre a vida e a obra de um apóstolo do humanismo e da cultura. Contribuição ao estudo biográfico de Paulo de Assis Ribeiro. Rio de Janeiro: Serviço Gráfico do IBGE; 1975. 249p.
5. Braga, Ernani Paiva Ferreira. O pensamento de Ernani Braga. Organizado por Paulo Marchiori Buss. Rio de Janeiro: Programa de Educação Continuada/Escola Nacional de Public health; 1984. (Coleção memória da saúde pública, v.1)
6. Bastos, Nilo Chaves de Brito. SESP-FSESP. 1942 - Evolução Histórica - 1991, 2ª edição. Brasília: Fundação Nacional de Saúde; 1996. 524p.
7. Vultos da Estatística Brasileira. Professor Paulo de Assis Ribeiro (por Alberto Alexandre de Souza). R. Bras. Estat. Rio de Janeiro, 35(138): 261-266, abr-jun 1974.
8. Pereira Neto, André de Faria. Palavras, Intenções e Gestos. Os interesses profissionais da elite médica. Congresso Nacional dos Práticos (1922). Volume Anexo. Manoel José Ferreira (p.30-32). [Tese de Doutorado em Saúde Coletiva]. Rio de Janeiro: Centro Biomédico, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro; 1997.
9. Tribuna Médica nº 324, março de 1967, p.17.
10. Ferreira, Manoel José. Indivisibilidade - Um novo princípio na inter-relação das ciências econômicas e sanitárias. Article submitted to the National Academy of Medicine to run for the vacancy left by Manoel de Abreu - Ciências Aplicadas, 27 de agosto de 1963 (mimeo). 27p.; available from the Academia Nacional de Medicina.
11. Professor Dr. Manoel José Ferreira (1897-1978). Lecture given by Dr. N.C. de Brito Bastos, on November 27th 1978, in Natal, Rio Grande do Norte, at the opening of the "Reunião de Técnicos da Fundação Serviços de Saúde Pública (mimeo). 8p.; available from the Academia Nacional de Medicina.
José Ruben de Alcântara Bonfim is a sanitarian at the Institute of Health of the São Paulo State Secretariat of Health and executive coordinator of the Sociedade Brasileira de Vigilância de Medicamentos (Brazilian Society for Drug Surveillance). E-mail address: sobravime@sti.with.br
Publication Dates
-
Publication in this collection
16 July 2005 -
Date of issue
Dec 1998
