The former prime minister of Trinidad and Tobago, the Right Honourable Patrick Manning, transformed how non-communicable diseases are tackled in the Caribbean, and the progress he led became central to his legacy
By C. James Hospedales, executive director of the Caribbean Public Health Agency
Leaders in health can come from all walks of life – public, private or civil society. In the Caribbean, the leader who has made the largest contribution to global or regional health of relevance to universal health coverage is the Honourable Patrick Manning, who was prime minister of Trinidad and Tobago from 1990 to 1995 and again from 2001 to 2010. This leadership led to the recognition of the twin-island republic and the Caribbean as the birthplace of the global movement on non-communicable diseases.
Shortly after his death, at their 2016 conference, the Caribbean Community heads of government stated, “Mr Manning displayed the finest qualities of regionalism and had an unswerving commitment to building his country and the wider CARICOM. His progressive ideas for strengthening the regional integration movement led to many initiatives which redounded to the enhancement of the sense and spirit of community among our Member States.”
At that same meeting, the secretary-general of CARICOM, Irwin Larocque, said, “Mr Manning led the way in recognising the dangers, highlighted by the region’s experts, that non-communicable diseases posed to our community, and hosted the groundbreaking Special Summit of CARICOM Heads of Government on NCDs in September 2007. This recognition led to the initiation of a United Nations High Level Meeting on combatting NCDs.”
Leading the charge on NCDs nationally and regionally
Under Prime Minister Manning’s leadership, Trinidad and Tobago launched the National Chronic Disease Action Programme in 2003 to respond to the growing NCD epidemic. The CDAP provides free medicines for people living with chronic diseases, such as hypertension, diabetes, hyperlipidaemia, asthma and glaucoma. This programme has been shown to increase access to essential medicines for people with NCDs, and has had a positive impact in reducing mortality from cardiovascular disease, with the effect growing over time.
This bold national step was a herald to far-reaching leadership in 2007 and 2009. In 2007 in Port-of-Spain, Prime Minister Manning hosted the historic special summit of CARICOM leaders on NCDs, which issued the Declaration of Port-of-Spain: Uniting to Stop the Epidemic of Chronic NCDs, a 15-point mandate with 27 commitments.
The commitments included building the capacity of national and regional institutions; establishing national NCD commissions; legislating tobacco control; establishing care and treatment plans to achieve 80% coverage for persons living with NCDs; educating the public; promoting physical activity and healthy diets; and carrying out surveillance and research.
It also led to establishing the Caribbean Wellness Day every September, which has stimulated the Pan American Health Organization/World Health Organization to establish the Wellness Week. Annual monitoring was initiated by the University of the West Indies in 2008, tracking 26 progress indicators and producing a colour-coded performance grid, with annual reports to the health ministers. The monitoring grid was shown to be useful for cost-effectively documenting progress on those indicators.
A comprehensive evaluation of the Port-of-Spain Declaration at 10 years was conducted by a consortium of institutions led by the UWI George Alleyne Chronic Disease Research Centre and funded by the International Development Research Centre, with a set of papers published in a special edition of the Pan American Journal of Public Health.
The global impact of the CARICOM NCD summit
The CARICOM summit galvanised several global events leading to the United Nations High Level Meeting on NCDs in 2011:
April 2009: The Summit of the Americas in Port-of-Spain, hosted by Prime Minister Manning, included 14 CARICOM member states and endorsed CARICOM and PAHO/WHO policies and plans to prevent and control NCDs. July 2009: The 30th Conference of CARICOM Heads of Government in Guyana decided to advocate for a UN General Assembly special session on NCDs.
November 2009: The Commonwealth Heads of Government Meeting in Trinidad and Tobago, hosted by Prime Minister Manning, underlined the threat of NCDs, committed Commonwealth countries to prioritise NCDs, and called for a UN meeting on NCDs.
May 2010: The UN General Assembly decided to hold a high-level meeting on NCDs in September 2011.
December 2010: The scope and modalities of the HLM were agreed for 19 – 20 September 2011.
The CARICOM summit in 2007 in Trinidad and Tobago was historic. It was the first time that heads of government anywhere in the world sat down to look seriously at the issue of NCDs and what can be done to prevent and control these problems. At this summit, together they made the highest-level political choice.
Under Prime Minister Manning’s leadership, the national capacity of Trinidad and Tobago was strengthened to benefit people living with NCDs.
Regionally, his leadership contributed to the Caribbean’s increasing attention to and investment in preventing and controlling NCDs. The CARICOM summit he hosted in 2007 had a traceable global impact, leading to the UN HLM on NCDs in 2011, through to the Summit of the Americas and Commonwealth meetings of 2009 in Trinidad and Tobago.
The Port-of-Spain Summit also clearly signalled the need for a multi-sector all-of-society approach to NCDs. Since NCDs have a relationship to climate change – industrialised agriculture and motorised transport contribute to unhealthy diets and physical inactivity – the prime minister’s leadership was also a stimulus to addressing the existential threat of a changing climate.