{"id":567647,"date":"2025-11-14T17:51:53","date_gmt":"2025-11-14T20:51:53","guid":{"rendered":"https:\/\/revistapesquisa.fapesp.br\/?p=567647"},"modified":"2025-11-14T17:51:53","modified_gmt":"2025-11-14T20:51:53","slug":"paula-souzas-ideas-still-guide-public-health-in-brazil","status":"publish","type":"post","link":"https:\/\/revistapesquisa.fapesp.br\/en\/paula-souzas-ideas-still-guide-public-health-in-brazil\/","title":{"rendered":"Paula Souza’s ideas still guide public health in Brazil"},"content":{"rendered":"

In the founding documents of the World Health Organization (WHO) in 1948, there is a special reference to a Brazilian. At the opening of his inaugural speech at the 1946 International Health Conference in San Francisco, American surgeon Thomas Parran (1892\u20131968) expressed his thanks to \u201cDoctor de Paula Souza\u201d and \u201cDoctor Szeming Sze.\u201d These two figures\u2014the sanitarian Geraldo Hor\u00e1cio de Paula Souza (1889\u20131951), representing Brazil, and the diplomat Szeming Sze (1908\u20131998), representing China\u2014were, as Parran noted, responsible for the efforts that made the conference possible. They played a key role in introducing health as one of the themes of the assembly that created the United Nations, the so-called Charter of the United Nations, a year earlier. This inclusion ultimately enabled the creation of the WHO.<\/p>\n

\u201cThe UN Charter didn\u2019t even contain the terms \u2018health\u2019 or \u2018hygiene,\u2019\u201d Paula Souza recalled in an interview with the now-defunct R\u00e1dio Excelsior, broadcast on November 26, 1949. In that interview\u2014later cited in a 1984 article in Revista de Sa\u00fade P\u00fablica<\/em>\u2014he recounted that he had proposed the creation of \u201can international public health agency, dependent on the United Nations or affiliated to it.\u201d However, the suggestion was only accepted after \u201clong talks and arrangements,\u201d and the support of the Chinese delegation.<\/p>\n

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Collection from the USP School of Public Health Memory Center<\/span>Paula Souza in his officeCollection from the USP School of Public Health Memory Center<\/span><\/p><\/div>\n

Paula Souza was a prominent figure in both Brazilian and international academic circles. He held a doctorate from the newly established School of Hygiene and Public Health at Johns Hopkins University in the United States and became the first director of the School of Public Health at the University of S\u00e3o Paulo (FSP-USP). In 1925, he led a health reform that expanded the traditional infrastructure-focused approach to include health education. Inspired by the North American model promoted by the Rockefeller Foundation, the reform emphasized the creation of health centers and training courses for health educators, aiming to develop what he called the population\u2019s \u201chealth consciousness.\u201d \u201cPaula Souza\u2019s great contribution was to focus on training public health agents to prevent the spread of many infectious diseases,\u201d says historian Jaime Rodrigues of the Federal University of S\u00e3o Paulo (UNIFESP), Guarulhos campus.<\/p>\n

Coffee-growing elite<\/strong>
\nThe name Paula Souza was already well known and respected by the late nineteenth century, when the future sanitarian was born in Itu, in the interior of S\u00e3o Paulo. His father, Ant\u00f4nio Francisco de Paula Souza (1843\u20131917), a prominent figure in S\u00e3o Paulo\u2019s coffee-growing elite, was a nationally recognized engineer, state deputy, and founder of the Polytechnic School. He served as its first director for 24 years, until his death, and laid the groundwork for what would later become part of the University of S\u00e3o Paulo (USP).<\/p>\n

His son, however, chose the biomedical sciences. At age 16, he enrolled at the S\u00e3o Paulo School of Pharmacy and, three years later, began a second degree at the School of Medicine in Rio de Janeiro. During school vacations, he worked at the Polytechnic School with Swiss-Brazilian veterinarian Roberto Hottinger (1875\u20131942), who later arranged internships for him in Germany, France, and Switzerland.<\/p>\n

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Geraldo Hor\u00e1cio de Paula Souza Collection \/ FM-USP Historical Museum<\/span>Paula Souza (foreground, left<\/em>) with colleagues at Johns Hopkins UniversityGeraldo Hor\u00e1cio de Paula Souza Collection \/ FM-USP Historical Museum<\/span><\/p><\/div>\n

In 1913, after graduating in medicine, Paula Souza began working as an assistant to Hottinger in his laboratory at the Polytechnic School. Together, they conducted a series of experiments to assess the quality of the water distributed in the city of S\u00e3o Paulo. \u201cThey were concerned about waterborne diseases such as typhoid fever,\u201d explains social scientist Cristina de Campos, from S\u00e3o Judas Tadeu University, who studied Paula Souza\u2019s career for her master\u2019s degree at the School of Architecture and Urbanism at USP with support from FAPESP.<\/p>\n

Hottinger and Paula Souza developed a device called the perfector<\/em>, based on ozone, to purify water. Later, as director of the S\u00e3o Paulo State Sanitary Service, his first measure was to introduce chlorination of the city’s water supply.<\/p>\n

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Collection from the USP School of Public Health Memory Center <\/span>Waste from a latrine (right<\/em>) drains into the Saracura Grande stream, in what is now the Bixiga neighborhood, near an area where washerwomen once worked (left<\/em>)Collection from the USP School of Public Health Memory Center <\/span><\/p><\/div>\n

In 1914, Paula Souza took up the position of assistant professor in the Chemistry Department at the newly founded S\u00e3o Paulo School of Medicine and Surgery. A crucial step in his education followed soon after: a doctorate in hygiene and public health in the United States, supported by the Rockefeller Foundation. His training abroad was made possible by an agreement signed in 1918 between the Rockefeller Foundation and the S\u00e3o Paulo state government, which led to the creation of the Institute of Hygiene\u2014the precursor to FSP-USP (see<\/em> Pesquisa FAPESP issue no. 264<\/em>). The agreement provided for two Brazilian doctors to receive scholarships to study at the Johns Hopkins School of Hygiene.<\/p>\n

The selected candidates were Francisco Borges Vieira (1893\u20131950) and Paula Souza, who became the first Brazilians to earn doctorates in hygiene and public health. \u201cAs representatives of S\u00e3o Paulo’s upper elite, they were hand-picked,\u201d notes physician Guilherme Arantes Mello, from UNIFESP, who wrote about this period in Brazilian public health in a December 2011 article in Hist\u00f3ria, Ci\u00eancias, Sa\u00fade \u2013 Manguinhos<\/em>.<\/p>\n

Paula Souza assumed the directorship of the Institute of Hygiene upon his return from the United States in 1921. Ten years later, under his leadership, the institute was transformed into the State School of Hygiene and Public Health and became part of USP in 1934. In 1945, it was renamed the School of Hygiene and Public Health, still under his direction. The institution received its current name in 1969.<\/p>\n

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Collection from the USP School of Public Health Memory Center <\/span>Paula Souza at the signing ceremony for the WHO Constitution, July 22, 1946, in New YorkCollection from the USP School of Public Health Memory Center <\/span><\/p><\/div>\n

In 1922, Paula Souza was appointed head of the S\u00e3o Paulo State Sanitary Service. Three years later, he introduced a new Sanitary Code, which placed particular emphasis on health education for the city\u2019s residents. He argued that a sanitized environment would be ineffective without the development of a \u201csanitary culture.\u201d Economist Maria Alice Rosa Ribeiro, from the University of Campinas (UNICAMP), reproduces in her book Hist\u00f3ria sem fim… Invent\u00e1rio da sa\u00fade p\u00fablica<\/em> (Never-ending story\u2026 Public health inventory; UNESP, 1993) an excerpt from a lecture in which he explains this view\u2014albeit in language that reflects the prejudices of his time: \u201cLet us put the ignorant caboclo<\/em> in the boss\u2019s house and the boss in the caboclo<\/em>\u2019s hut, or the resident of Higien\u00f3polis in the tenement of Br\u00e1s and the uneducated family in the palace of the former, and see how right I am: rapid would be the transformation of the hut and the mucambo<\/em> into places compatible with a dignified life, as well as that of the mansion and the palace into the most dangerous dens of disease and misery.\u201d<\/p>\n

Within this framework, the individual needed to be educated in order not to endanger society as a whole. \u201cThere was a social demand for epidemic control, which affected both rich and poor and caused harm to economic activities,\u201d explains nurse Maria Cristina da Costa Marques, coordinator of the FSP-USP Memory Center, which houses Paula Souza\u2019s archive. \u201cThis was a model that developed in tandem with a broader political and economic project to strengthen the state.\u201d<\/p>\n

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Collection from the USP School of Public Health Memory Center <\/span>Health educator (right<\/em>) instructs a woman on improving her children\u2019s hygieneCollection from the USP School of Public Health Memory Center <\/span><\/p><\/div>\n

Influenced by eugenics\u2014a racist pseudoscience that advocated for the improvement of the \u201cBrazilian race\u201d\u2014this vision aimed to produce a nation of disciplined, healthy, and productive workers. According to Marques, Paula Souza, like many sanitarians of his time, was influenced by eugenics.<\/p>\n

Paula Souza brought from the United States the model of health centers with an essentially preventive role. These centers aimed to promote good hygiene practices and disseminate health information through personal guidance, lectures, printed materials, and exhibitions. Health educators played a central role in this work, conducting outreach in schools and during home visits. To address the shortage of nurses, a Health Education Course was established in 1925 at the Model Health Center located within the Institute of Hygiene. It was designed specifically for elementary school teachers, who were trained to support public health efforts through education.<\/p>\n

From S\u00e3o Paulo, the health center model spread throughout Brazil. \u201cIt was a Rockefellerian tsunami,\u201d jokes Mello. In Bahia, a similar health reform was launched in 1925. Nildo Batista Mascarenhas, a health nurse at the State University of Bahia (UNEB), explains that this reform likewise sought to control infectious diseases through educational efforts in health centers and home visits, conducted by health visitors\u2014the local term for health educators. Paula Souza and Ant\u00f4nio Lu\u00eds Cavalcanti de Albuquerque de Barros Barreto (1892\u20131954), who led Bahia\u2019s Undersecretariat of Health and Public Assistance, \u201cwere products of the same political project for public health, aligned with the group of Carlos Chagas [1879\u20131934] and other prominent hygienists,\u201d says Mascarenhas, a coauthor of an article on public health in Bahia published in November 2020 in Revista Baiana de<\/em> Sa\u00fade P\u00fablica<\/em>. Barros Barreto, the son of a prominent Pernambuco family, also received a Rockefeller Foundation scholarship and earned a doctorate in Public Health from Johns Hopkins University.<\/p>\n

The 1930 Revolution, which made Get\u00falio Vargas the Brazilian president, marked the beginning of a period of centralized health policymaking that curtailed state-level initiatives. \u201cThe new health policy gradually shifted toward medical and hospital care, to the detriment of community-based public health actions,\u201d notes Mascarenhas. Amid political instability and opposition in the state Legislative Assembly, Paula Souza was unable to implement all of the health centers he had envisioned: of the eight planned, only three were established\u2014the model center at the Institute of Hygiene and two others in the Br\u00e1s and Bom Retiro districts.<\/p>\n

Even so, Mascarenhas argues, the seeds of a new model of preventive medicine had been planted. He sees the role of health educator or health visitor as a precursor to today\u2019s community health worker, serving as a bridge between health services and households. \u201cThis model remains in Brazilian public health,\u201d he observes. \u201cThe health center, with its community-based approach integrated into family life, is a clear historical legacy of that strategy.\u201d<\/p>\n

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Collection from the USP School of Public Health Memory Center <\/span>As part of health education, children learn how to brush their teeth at schoolCollection from the USP School of Public Health Memory Center <\/span><\/p><\/div>\n

Nutritional guidance was a key element of the health education promoted by Paula Souza, who had encountered the profession of nutritionist during his time in the United States. Between 1932 and 1933, he led the first survey of dietary habits among S\u00e3o Paulo\u2019s population. The results revealed difficulties in the consumption of beans relative to other foods. In response, he proposed the creation of popular \u201cbean kitchens.\u201d \u201cDistrict kitchens would be set up, where people could purchase cooked beans in small quantities\u2014much like buying bread rolls at the bakery, which had by then replaced home-baked bread. At the time, pressure cookers were not widely available, and beans, though highly nutritious, required the most time and fuel to prepare,\u201d explains Rodrigues. The Industry Social Service (SESI) even opened a district kitchen in the Tatuap\u00e9 neighborhood, but the broader plan for bean kitchens did not move forward.<\/p>\n

With support from FAPESP, Rodrigues compiled 2,600 documents related to the sanitarian, presented in the Analytical Inventory of the Geraldo Hor\u00e1cio de Paula Souza Archive<\/em>, published by FSP-USP in 2007. The research proceeded relatively smoothly, as Paula Souza had preserved all his correspondence and newspaper clippings that mentioned him. \u201cThere were even carbon copies of the letters he sent. It was as if he intended to construct a memory that would endure beyond his lifetime,\u201d says Rodrigues.<\/p>\n

From 1927 to 1929, Paula Souza worked in Geneva at the Health Organization of the League of Nations, which aimed to address global public health challenges. Although the League was later dissolved after the Second World War, part of its mandate was absorbed by the newly established WHO. Paula Souza was appointed one of the WHO\u2019s vice presidents in 1948, a position he held until his death three years later. He died of a massive heart attack at the age of 62, on the eve of a planned work trip.<\/p>\n

The story above was published with the title “Public health guidelines<\/strong>” in issue 351 of May\/2025.<\/p>\n

Projects<\/strong>
\n1.<\/strong> A social history of food in the city of S\u00e3o Paulo (1920s to 1950s) (n\u00b0 05\/51165-3<\/a>); Grant Mechanism<\/strong> Postdoctoral Fellowship in Brazil; Supervisor<\/strong> Maria da Penha Costa Vasconcellos (USP); Beneficiary<\/strong> Jaime Rodrigues; Investment<\/strong> R$63,467.40.
\n2.<\/strong> City and hygiene in S\u00e3o Paulo, 1925\u20131945: Geraldo Hor\u00e1cio de Paula Souza and the institutionalization of public health as an academic discipline (n\u00b0 98\/12910-0<\/a>); Grant Mechanism<\/strong> Master\u2019s fellowship in Brazil; Supervisor<\/strong> Maria L\u00facia Caira Gitahy (USP); Beneficiary<\/strong> Cristina de Campos; Investment<\/strong> R$29,812.34.
\n3.<\/strong> Representations of American public health: Photographs taken by Geraldo Hor\u00e1cio de Paula Souza, 1918\u20131920 (n\u00b0 19\/19712-7<\/a>); Grant Mechanism<\/strong> Regular Research Grant; Principal Investigator<\/strong> Cristina de Campos (USJT); Investment<\/strong> R$32,884.56.<\/p>\n

Scientific articles<\/strong>
\nCAMPOS, C. de. O sanitarista, a cidade e o territ\u00f3rio. A trajet\u00f3ria de Geraldo Hor\u00e1cio de Paula Souza em S\u00e3o Paulo. 1922-1927<\/a>. PosFAUUSP<\/strong>. Vol. 11. June 20, 2002.
\nCANDEIAS, N. M. F. Mem\u00f3ria hist\u00f3rica da Faculdade de Sa\u00fade P\u00fablica da Universidade de S\u00e3o Paulo \u2013 1918\u20131945<\/a>. Revista de Sa\u00fade P\u00fablica<\/strong>. Vol. 18. Dec. 1984.
\nMASCARENHAS, N. B. & SILVA, L. A. A pol\u00edtica de sa\u00fade na Bahia (1925-1930)<\/a>. Revista Bahiana de Sa\u00fade P\u00fablica<\/strong>. Vol. 43. no. 1. Nov. 25, 2020.
\nMELLO, G. A & VIANA, A. L. d\u2019\u00c1. V. Centros de sa\u00fade: Ci\u00eancia e ideologia na reordena\u00e7\u00e3o da sa\u00fade p\u00fablica no s\u00e9culo XX<\/a>. Hist\u00f3ria, Ci\u00eancias, Sa\u00fade \u2013 Manguinhos<\/strong>. Vol. 18, no. 4. Dec. 2011.
\nRODRIGUES, J et al.<\/em> Invent\u00e1rio anal\u00edtico do Arquivo Geraldo Hor\u00e1cio de Paula Souza<\/a>. S\u00e3o Paulo: School of Public Health\/USP, 2007.
\nRODRIGUES, J. & VASCONCELLOS, M. da P. C. A guerra e as laranjas: Uma palestra radiof\u00f4nica sobre o valor aliment\u00edcio das frutas nacionais (1940)<\/a>. Hist\u00f3ria, Ci\u00eancias, Sa\u00fade \u2013 Manguinhos<\/strong>, Vol. 14, no. 4. Dec. 2007.<\/p>\n

Books<\/strong>
\nRIBEIRO, M. A. R. Hist\u00f3ria sem fim\u2026 Invent\u00e1rio da Sa\u00fade P\u00fablica<\/strong>. S\u00e3o Paulo: Unesp, 1993.
\nRODRIGUES, J. Alimenta\u00e7\u00e3o, vida material e privacidade: Uma hist\u00f3ria social de trabalhadores em S\u00e3o Paulo nas d\u00e9cadas de 1920 a 1960<\/strong>. S\u00e3o Paulo: Alameda, 2011.<\/p>\n","protected":false},"excerpt":{"rendered":"Doctor from S\u00e3o Paulo brought the concept of health centers from the USA and promoted good nutrition as a disease prevention strategy","protected":false},"author":131,"featured_media":567656,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[152],"tags":[226,229,241,260],"coauthors":[440],"class_list":["post-567647","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-retrospect","tag-education","tag-epidemiology","tag-history","tag-public-health"],"acf":[],"_links":{"self":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/567647","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/users\/131"}],"replies":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/comments?post=567647"}],"version-history":[{"count":1,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/567647\/revisions"}],"predecessor-version":[{"id":567680,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/567647\/revisions\/567680"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media\/567656"}],"wp:attachment":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media?parent=567647"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/categories?post=567647"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/tags?post=567647"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/coauthors?post=567647"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}