Dr. Cristina V. Beato

Cristina V. Beato became deputy director of the Pan American Health Organization (PAHO) in April. She was formerly acting assistant secretary of health in the U.S. Department of Health and Human Services and assistant U.S. surgeon general. Born in Cuba, she grew up in Panama and the United States. She holds a B.S. in chemistry and biology and an M.D. from the University of New Mexico. At PAHO, she sets general policy and strategic direction, alongside the director, and oversees key programs including Emergency Preparedness and Disaster Relief; Governance, Policy and Partnerships; Planning, Program Budget, and Project Support; and Legal Affairs. She is also responsible for relations between PAHO and the governments of Canada, Puerto Rico, and the United States.

What got you interested in medicine and public health?
I was a very sickly child. I left Cuba on a Red Cross humanitarian flight because they didn't think much could be done for me. I was 6, and I didn't even weigh 40 pounds. I was very bow-legged and couldn't walk, my bones were so weak. I was taken to Jackson Memorial Hospital in Miami, where for the first time in my life I was treated nicely by nurses and doctors. The nurses were so nice I wanted to be like them. Up until then I wanted to be a ballerina, but since I couldn't walk very well, that wasn't going to be possible. After that we moved to Panama, where the medical system was very different. When I was 8, I ended up in the emergency room after breaking my ankle at a friend's house. I remember sitting there in a very long line, and in came another child about my age with a very bad machete wound to her leg. Her leg was almost hanging, and she was crying so much, but they wouldn't take her back. They just kept her sitting there. After that, I didn't want to be one of the nurses-I wanted to be the person in charge.

What was your education like?
My mother taught me how to read and write by the time I was 5, so I started school early. I went to a French nuns' school in Panama, and I did really well in science and math. I see the world a lot in math and science. To me, there's nothing more fascinating than the human body, so that's where medicine came in. And then there's this thing called the human component: the compassion, the love, the passion. What a great gift God has made... We moved to the States when I was 14, and I went to a Catholic high school in New Mexico. I worked for half my tuition, because I really wanted to go there. I had a tough time learning English, so my first year was really hard. I did extremely well in my algebra and French classes, but I flunked everything else. I was totally traumatized because I really did not understand. But I believe total immersion is how you learn. I eventually graduated second or third in my class. I was offered several scholarships, but because my mom was sick with Parkinson's, I took the scholarship to go to the University of New Mexico, close to home.

When was the first time you heard about PAHO?
When I was a child. There was a woman who had a rural clinic outside Panama City, and she was partnering with OPS-that's how we knew it-to give vaccinations to children. I went out a couple of weekends with her to help clean up and do bandaging and things like that. I really think PAHO's crown jewel is its immunization program. PAHO should remember its roots in history, because that's where its strength comes from. The way you get to people is by touching their lives, by delivering something on the ground. PAHO can have an incredible impact, not just in Latin America and the Caribbean but in Latino communities in the United States, which have very close ties with communities in Latin America. You need to empower communities, and you do that by giving them tools and teaching them how to be their own best providers.

What do you see as the main health challenge facing the PAHO region?
It's called chronic diseases. In the next five or 10 years it's going to put an incredible crush not only on longevity and quality of life but on economic systems that are already struggling to compete in the global economy. If we don't start putting our arms around these diseases-diabetes, cardiovascular disease, cancer-it will create incredible burdens on our societies. It will hurt the chances of development, and you don't see societies get improvements in their health care unless they're also getting improvements in economic development. It's linked, and healthy people translate into better economies, so the circle keeps going. The other key is education, whether it's learning how to read and write or health literacy. We have to teach people why they have to take two pills a day for all 10 days, or that clean water is critical, or why breastfeeding is so important. To me the big factors are going to be: one, education, and that's really health promotion; two, creating systems where there is access to public health and basic health services delivery; and three, supporting and nurturing environments where there is opportunity for economic development. People need to be able to freely participate in a market system and in globalization, which is pushing the world forward. And it's creating tools that we need to apply to public health, like satellite systems and telephones that can remind people when their children need vaccinations or that they need to boil their water.

What role do you see PAHO playing in this process?
PAHO has a critical role to play to partner, to reach out, to promote, to provide, to help in any way, shape, and form it can. It needs to build the coalitions and organize collaboration and to be a visible member. It's not just ministries of health; it's communities and other stakeholders. We can partner with universities-there are universities that would love to partner with us-and with NGOs, the Gates Foundation-every foundation in the world is getting involved in global health. And I'm a strong proponent of public-private partnerships. There are very specific roles that government should have and do very well, and then there are roles that private entities and corporations have and do extremely well. And the two of them can combine as a team that has phenomenal capacity to serve. I have no doubt that we can bring in millions of dollars in 365 days with corporate partnerships if we demonstrate that we can be flexible and adaptable, if we demonstrate transparency and accountability, and if we deliver. The issue is not money. The issue is organizing ourselves and coming together as a unified team and saying, this is important to us, this is the world we live in now. There's so much nobility here, so much history, so many good people. We owe it to the past, to today, to the future generations of people in the Americas.

What do you think PAHO's comparative advantages are as an organization?
Our expertise is science and public health. How do we do that best? You do incredible statistics, computations on populations, you incorporate technology, you do modeling, you be the best there is in population studies, in pilot projects. To me, the key is the target population, who we're here to serve. You show how you deliver something in the Andes. What's the difference between Ecuador and Paraguay? What are the best proven methods, the best practices? How do you communicate that quickly? How do you become the best in science and then translate that? PAHO's strength comes from science and the ability to work in the community and to deliver.

Tell us about your family.
I have two children, a daughter who is 19, in her first year at Boston College, and a son who's 17 and a junior at Georgetown Prep. Both of those are Jesuit schools. I strongly believe in Jesuit education. They are very good about critical thinking, really understanding values, and very much into social justice issues and freedom and liberty. My daughter wants to study medicine, and my son wants to do bioengineering, biophysics. He wants to discover the cure for cancer-that's what he tells me. We'll see; maybe some day. In a way it surprises me, because I've hauled these kids around all over the place-hospitals, ERs, clinics, day and night. The fact that they still are interested in medicine is really good.