Foreword

The Region of the Americas has made important strides in health over recent decades, including gains in life expectancy, expanded access to care, and measurable progress against some of the most persistent diseases that have afflicted our populations. Yet, as this edition of Health in the Americas makes clear, much of the disease burden borne by the people of our Region remains potentially avertable – that is, many of the diseases or health conditions that people face could be treated and managed appropriately through timely, quality health care or prevented altogether through public health actions and primary prevention, such as antitobacco policies. Indeed the data show that other countries around the world have already achieved better results for those same diseases and health conditions. The challenge before us is no longer simply one of generating evidence – what works and why it matters is increasingly understood. Instead, the challenge is strong stewardship and effective governance. This includes the capacity of countries to translate evidence into action, resources into measurable results, and commitments into quality care delivered at scale. 

This report, with its focus on prioritizing avertable disease burden to maximize impact, arrives at a pivotal moment. Health loss in the Americas is increasingly concentrated in a focused but complex set of conditions – cardiovascular diseases, diabetes, cancer, and mental health conditions – for which effective, affordable prevention and care interventions exist but too often remain out of reach. We find nearly 40% of the total disease burden in the Region is potentially avertable based on performance achieved elsewhere. While not every country can close this gap fully or immediately, it points to concrete opportunities for improvement. Our health systems have the evidence they need. What they require now is the institutional and service capacity to act on it.

In this context, we discuss stewardship and governance as the ability of health authorities and their partners to set clear priorities, align policy and financing, build coalitions and partnerships for implementation, and hold health systems accountable for results. Without this capacity, even the most cost-effective intervention packages and the most generous budgets will fall short of their potential. In an era of constrained resources, as governments across the Region face mounting fiscal pressures, effective stewardship and governance are crucial for sustained progress.

This conviction reflects not only the findings of this report but also the challenges and aspirations that countries have shared with us directly, including through PAHO’s Strategic Plan 2026–2031. Health authorities across the Americas have consistently identified stewardship and governance as among their most pressing needs. They have also affirmed their ambition to accelerate progress toward eliminating diseases for which proven interventions exist, reduce preventable premature mortality, and build health systems that are resilient enough to withstand future emergencies. Integral to this shared agenda are PAHO’s Disease Elimination Initiative – aimed at ending more than 30 communicable diseases and related conditions by 2030 – and our commitment to primary health care as the backbone of resilient health systems. So too is our pandemic preparedness work, where global health security is only as strong as the capacity of the weakest local system.

I invite all Member States to make full use of the evidence and analytical tools in this report to identify where health gains are greatest, quantify and define the avertable burden, and design and align priority interventions through primary health care. The evidence is clear and the opportunity is substantial: prioritize the burden that can be averted, build institutional and service capacity to implement at scale, and hold health systems accountable for results. PAHO stands ready to accompany every country on this journey. Together, we have the opportunity to reduce disability and illness, save millions of lives, and build a healthier Americas for all.