The Caribbean experience
Public health successes require an all-of-society response, from the systemic change needed to achieve the Sustainable Development Goals to the involvement of community to drive progress with people at its heart
The Caribbean Public Health Agency was established as a result of an intergovernmental agreement to merge five regional health institutions: the Caribbean Environmental Health Institute, the Caribbean Epidemiology Centre, the Caribbean Food and Nutrition Institute, the Caribbean Health Research Council and the Caribbean Regional Drug Testing Laboratory. CARPHA now operates from its headquarters in Port of Spain, Trinidad and Tobago, with one campus in Jamaica that focuses on medicines, quality control and surveillance and another in St Lucia that focuses on environmental health and sustainable development.
CARPHA’s mandate is to address the Caribbean Community’s contribution to regional public goods, including:
- promoting the physical and mental health and wellness of people;
- providing strategic direction, in analysing, defining and responding to public health priorities;
- promoting and developing measures for preventing disease;
- supporting preparation for and responding to public health emergencies;
- supporting solidarity in health, as one of the principal pillars of functional cooperation; and
- supporting the relevant objectives of the Caribbean Cooperation in Health.
Determinants of health
CARICOM, with its small island developing states and continental states with low-lying coastal areas, is plagued by climate change, and heavily economically dependent on tourism and travel. This geographic region is thus grappling with the globalisation of the determinants of health, while coming to terms with some of the historic determinants, including a heavy burden of chronic disease and risk factors.
According to the Pan American Health Organization, in 2016 countries in the Caribbean exhibited the highest mortality rates from non-communicable diseases in the Americas: seven countries had mortality rates above 584 per 100,000 people. More than 70% of deaths in CARPHA members are due to NCDs.
The CARICOM region acted strategically to avoid overwhelming its under-resourced health systems by blocking the repeated importation of the COVID-19 virus, thus curtailing community spread in one of the most well-coordinated and choreographed expressions of functional cooperation in health. The heads of government made the health of their citizens a stunning political choice. Through a combination of public health and all-of-society non–public health measures – the joint lockdown – CARICOM has preserved life at a great economic cost.
The CARICOM heads are now leading another social experiment by implementing protocols in every sector to try to live, work and play safely with COVID-19. This includes a return to tourism and commercial activity during a very political period, with at least six elections scheduled before the end of 2020. So, the decision to save the health of the most valuable asset of CARICOM – its people – will undergo the ultimate political choice, the vote of the people, testing the famous statement that “the health of the people is the wealth of the people”.
Collaboration with partners
CARPHA managed its pandemic response as a health security issue with heavy reliance on the security cluster of CARICOM, while the Regional Coordination Mechanism for Health Security facilitated regional collaboration with PAHO and other public health agencies.
Its international development partners responded swiftly to support regional public health action. However, the most effective collaboration has been the technical interplay among the chief medical officers, as well as the political collaboration of the health ministers and the whole of CARICOM regional leadership facilitated through the CARICOM Secretariat.
CARPHA has been responding to requests from other sectors such as education and more recently with the COVID-19 Tourism Task Force for the safe return of tourism.
Regional solidarity
I am proud that the per capita rates of COVID-19 infections and deaths have been relatively low in the Caribbean, even since returning to a safe new normal level of commercial and tourism activity. The quality of life that the heads of government sought to preserve has also stayed true to the cultural dictates for religious expression and sporting activities.
This expression of regional solidarity, despite the region’s four languages and many cultural influences, is a testimony to the success of the political construct of the Caribbean Community and the technical buttressing of so many years of functional teamwork in managing health through the Caribbean Cooperation in Health planning framework.
This COVID-19 crisis has revealed the inequalities in a 21st-century world. Access to health is a basic human right, but countries in the Caribbean have been hindered in procuring the essential medical supplies and equipment needed for the fight against COVID-19 by challenges that transcend commonly experienced interruptions in the supply chain.
Nonetheless, among CARICOM’s greatest successes in managing COVID-19 has been the leadership of the heads of government in an all-of-society response. Another great public health success has been the coordinated responses of the CARICOM countries in preventing illness and death. All these decisions and the most recent arrangements with PAHO, the WHO and the African Union to improve access to supplies, have political sensitivities. Ultimately, the systemic change required to achieve the Sustainable Development Goals requires this type of solidarity, as well as the involvement of all sectors and a community of practice with strong political leadership, to sustain people-centred progress.
