I was born in Lima, Peru in 1953, the first of four siblings. My mother was an immigrant who at age 12, along with her family, escaped the scourges of Spain’s civil war and eventually settled in Piura, a tropical northern province of Peru. There she met my father, a Peruvian civil engineer, who dedicated his life to planning and building water and sewage grid systems. He showed me the way to sports and gave me his own acid sense of humour, while my mother instilled in me her love for painting and books.
In the 1960s I was to school, and early in the 1970s went to San Marcos University in Lima with the firm decision to become a medical doctor, which I was by the end of the decade. The university experience extended well beyond the classroom, biochemistry and hospital work, and opened my eyes to Peru’s social inequities, and to something impossible to ignore at the time: a sweeping youth revolution that occupied the global stage to proclaim peace, love and social justice.
My first job out of medical school was as a physician in Lima’s northern shanty towns, where I devised plans to prevent and control diarrhoea among children. That job fed into my growing interest in public health nutrition and research, so by 1985 I also had a fellow’s teaching post in the Instituto de Investigacion Nutricional in Lima. Just a few months later I moved into a small rural Andean community 400 kilometres distant in north-east Peru, to conduct epidemiological and dietary studies associated with childhood diarrhoea. This work continued for nearly two years, and concluded with production of sanquito, a home-made weaning-food based on local food stuffs and local culinary traditions.
Despite the indifference or hostility of the local medical community, sanquito was used and was popular with the public, particularly mothers, for as long as it was supported by a communication campaign. During this period I received valuable professional influence from Kenneth Brown and Hillary Creed-Kanashiro, the senior leaders of the project.
In 1989 I got an MPH degree from the Johns Hopkins University school of public health, and thereafter returned to Lima where I continued to work on infant and child nutrition, this time with a focus on programme planning, implementation and evaluation. In 1995, the educational-psychologist Santiago Cueto and I joined Ernesto Pollitt from the University of Califormia, Davis, to study the behavioural and cognitive impact of morning fasting among school-age children in Peru. This collaboration extended for about four years and resulted in several publications. These noted that while breakfast was important to children’s cognitive performance and scholastic achievement, it also was important for their general nutritional status and the quality of the school environment.
During the 1990s I started to pay attention to the obesity epidemic and the nutritional problems associated with it. The nutrition transition issues fascinated me. I started to study them, and joined the epidemiology service at the Ministry of Health of Peru to conduct one of the first studies on obesity and associated chronic conditions in several Peruvian cities.
In 2000 I was appointed regional advisor on healthy diet and active living at the Pan American Health Organization in Washington. DC. My work there has included coordination of the regional implementation of the WHO Global Strategy on Healthy Diet, Physical Activity and Health; organisation of the WHO/PAHO working group ‘Trans Fat Free Americas’; and development of strategic partnerships with the sustainable transportation and urban development movement in the Americas. This has led to numerous research initiatives; the emergence of the Ciclovias Network; and also the ‘Active Cities, Healthy Cities’ contest that awards cities that show leadership becoming more livable, sustainable and healthy.
From 2009 through 2011 I worked as WHO regional focal point on the issue of marketing food to children, and helped to assemble a PAHO expert consultation to formulate policy recommendations to member states. From August 2011 to April 2012 I was appointed Vice-Minister of Health of Peru