Nationalism, international public health assistance, and epidemiologic transitions

The United States Agency for International Development (USAID) describes itself as “an independent federal agency that conducts foreign assistance and humanitarian aid to advance the political and economic interests of the United States” (http://www.usaid.gov). The explicit nationalism in this mission statement raises a problem that stretches far beyond any particular ideology: How should the public health community respond when any nation A exerts an active interest in the public health of any nation B to further the economic and political interests of nation A?

For Dr Avilés, the answer is that when nation A is the United States and nation B is El Salvador, the response should be condemnation.1 He concludes from his case study of Ayalde's report on Salvadoran public health2 and Omran's epidemiologic transition theory3 4 that both extol a harmful, Eurocentric colonialism; fail to consider the social, political and economic determinants of public health; and ignore health disparities.

In his critique of epidemiologic transition theory, Dr Avilés disregards the fact that the causal response of “patterns of health and disease...to social and economic changes” is the theory's primary subject matter (page 3).4 He also overlooks the emphasis Omran placed from the start on examining transition disparities by socioeconomic measures such as gender and race: “The epidemiologic transition among the nonwhite population of the U.S. was …