Chikungunya, an arboviral disease previously unknown in the Americas, became an epidemic in the Region after its first indigenous circulation was reported in December 2013.  From that point on, the epidemic spread throughout the Region at an unprecedented pace, and the generation of scientific knowledge that has an impact on public health has become a high priority.

A partir del año 2008 Ecuador reconoce en su Constitución el derecho a la salud con una visión sistémica, vinculándolo con el ejercicio de otros derechos.  Para realizar su visión, y para acomodar el aumento en la demanda para servicios de salud, en Ecuador se llevó a cabo una reforma integral del sistema de salud.

Este número especial de la Revista Panamericana de Salud Pública analiza la experiencia reciente de Ecuador a través de una serie de artículos sobre áreas de su sistema de salud que han experimentado una transformación importante.

Implementation research is a crucial component of effective public health and clinical policies and programs. It promotes the generation and use of health policy and systems research (HPSR) as a means to improve health and health systems, and is particularly effective in low- and middle-income countries. HPSR, including implementation research, has been promoted by the World Health Organization (WHO) as an effective mechanism with which to identify gaps in a health system’s capacity, efficient functioning, and sustainable use of funds. 

This special issue of the Pan American Journal of Public Health on “HIV/AIDS prevention, care and treatment in the Region of the Americas: achievements, challenges and perspectives” presents the current response to HIV/AIDS in the Region with a focus on three main areas: HIV prevention, HIV care and treatment, and the elimination of mother-to-child transmission of HIV and congenital syphilis.    

Though the devastating health effects of tobacco use are well known, tobacco’s negative repercussions extend well beyond the obvious health outcomes. Tobacco consumption creates a significant economic burden on societies because of both the high costs of health care and the associated lost productivity. In addition, tobacco use contributes to health inequalities and exacerbates poverty within and between countries through the diversion of resources away from food and other essential needs as well as through foregone income.

Rapid climate change poses direct and unprecedented challenges to human health on a global scale. These include the burden of disease from environmental risks—expected to rise steadily over the coming years—and direct and indirect effects on human health due to disruptions and shifts in services provided by ecosystems.