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The Chilean physician Abraham B Horwitz (1910-2000) was an outstanding personality of World and Pan American public health during the second half of the twentieth century. He was member of a family that, emigrating due to ethnic persecutions in Russia, took refuge in Chile. He became a relevant physician, a specialist in infectious diseases and public health. He was highly influential in the birth of the Public Health School at the University of Chile and the Chilean Health Service. He became Executive Director of the Pan American Health Organization, holding that position for 16 years. During this period, the institution experienced a great development. He stimulated research in the areas of basic sanitation, nutrition and eradication of transmissible diseases. He also opened unexplored areas such as the relation between economy, modern administration and health. During his last years, he chaired a successful Nutrition Committee at the United Nations. The most outstanding achievement of this Committee was the promotion of widespread vitamin A use. His intellectual and social deed is continued by The Pan American Foundation for Health and Education and this institution established an annual prize in his memory.

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The combination of inspiration, science, and politics is a cornerstone precept for the common good of humanity, towards the fulfillment of social objectives. Based on this precept, this paper reviews core experiences of the Chilean Health Sector. Health sector key events taking place during the first half of the 20th century were the creation of the National Health Service and the development of mother and child healthcare policies. After the earthquake of 1939, the future President of Chile, Doctor Salvador Allende, set up the Special Sanitation Council, to balance policies. Also, he launched the Social Security reform process, which endured financing restrictions and the animosity of physicians opposing the socialization of medical care. In 1951 the reform was approved, to extend coverage to blue collar workers and their families; separate health provision from healthcare security; emphasize preventive pediatric care in mother's health, and reproductive health. The basic tenets of healthcare reform were the right to health, solidarity, and equity, as the pillars of policy-making and healthcare programming. The question of whether the evolution of social security in Chile has been consistent with the original healthcare reform tenets is raised by the author.

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The basic concept of this article is the need to adapt the health systems to demographic and epidemiologic changes, considering that, at the present time the principal health problem of the world is adult health: non transmissible chronic diseases and accidents. As in the previous epidemiological cycle, when maternal and child health problems predominated, the aim must be put in health promotion and prevention, encouraging behavioral changes that decrease or avoid risk factors. The basic tools to incite the change are social communication, the introduction of health educational contents in formal education and the global reorientation of health systems from a predominance of curative actions towards preventive actions. At the present time, the analysis and debate of this topic has allowed the creation of multidisciplinary teams, integrated by epidemiologists, economists and sociologists, that will have to stratify the problems according to the needs and resources of a developing world. In Chile, a project searching for equity in the 35 poorest and postponed communities in the whole country is in operation. The most important result of this exercise has been the resemblance between the opinions of the community and of the public health specialists, which greatly helps the search for solutions.

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The present hospital situation and a projection for the XXIth century, the national and international information, is analyzed. Outstanding characteristics include better health indicators and an explosive growth of costs due to technological advance and health insurance. Inadequate use of resources is noted. The state expense in public health was greatly decreased during the Chilean military government who privileged private investment. At present, the public sector counts 184 hospitals, 373 outpatient clinics and 1053 rural health posts and takes care of the health needs of 80% of the population. There has been no increase in expenses in the public sector compared to a 150% increase in the number of beds in the private sector. Decentralization, a redefinition of the health care model, an investment program and better administration are needed to improve the situation long-term. The health system and levels of health care as well as a model for hospitals in the coming century are described.

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This is the lecture given by Jorge Jiménez MD, Minister of Health at the 1990 Chilean Congress of Internal Medicine. He states that clinicians today are directing their attention to epidemiology and to the community health problems, focusing their medical activity towards primary prevention of diseases. Knowledge emerging from evolutionary pathology, natural history of diseases, human genetics, the influence of environment upon health and human behavior, enriches the new outlook of epidemiology. The concept of promotion of health overlaps the classical concept of prevention.

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A long-term follow-up of idiopathic pulmonary hemosiderosis in 10 patients treated with corticoids and immunosuppressors. Ten patients with I.P.H. are studied from the clinical, radiological, hematologic and respiratory functional viewpoints. The long-term evaluation (mean 7.4 years) is described together with the response to steroidal treatment (prednisone) associated with an immunosuppressor (6 +/- mercaptopurine). Only one out of the 9 patients did not return to control following 1 year of treatment. A relationship between the decrease or suppression of one or both drugs and the appearance of relapses is observed in all patients. Comments are made on the usefulness of the associated treatment and its administration is suggested for long periods giving prednisone every 48 hours. The possibility to discontinue both drugs is discussed, but not before the patient has remained asymptomatic for at least one year. Recent studies with ultramicroscopy tending out the pathogenesis of the disease are stressed.

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