​GOFAD was in the process of composing this week’s blog when the sad news of the death of former Barbadian Prime Minister Owen Arthur was received. We extend our deepest sympathy to his wife, daughters and the rest of his family and also to the people of Barbados. Already,  the many tributes to the former Prime Minister hail his inestimable contributions as a political leader, scholar, and an advocate for Caribbean Integration, among others. He is  highly acclaimed as an Economist and for his vision  of the Caribbean Single Market and Economy. Especially at this time, it is important to recall that he was one of the leading voices with Prime Minister Denzil Douglas of St Kitts Nevis at the CARICOM Heads of Government Meeting in July 2001, that promoted the Nassau Declaration,  “The health of the Region is the Wealth of the Region”. Prior to this, Prime Minister Arthur   convened   the first international Conference on HIV/AIDS  in Barbados, September, 2000 with the support of CARICOM, PAHO, UNAIDS and the World Bank. He called for  a Pan Caribbean  Cooperation to fight the HIV pandemic. By February 2001, while  Chair of the Caribbean Community, he was among the six signatories  to the charter establishing the Pan Caribbean Partnership against HIV/AIDs (PANCAP) at the PAHO Regional Office in Barbados. He included   the Barbados Commission for HIV  chaired by Dr  Carol Jacobs  into the office of the Prime Minister, demonstrating the importance he placed on the fight against HIV to the economy of the country. He also secured the agreement of Cabinet to contribute US$ 30,000 to the Global Fund for AIDS, Malaria  and TB. This is  arguably one of the few, if  not the only developing country on record to do so. Perhaps, most significant,   was the prominence he  gave to the Study of the Health Economics Unit, then led by Prof Karl Theodore at the Barbados AIDS Conference in 2000.  That study provided estimates of the economic losses associated with HIV/AIDS in Jamaica, Trinidad and Tobago and St. Lucia and quantified the level of resources needed to adequately respond to the HIV/AIDS.  In addition, while holding the  portfolio responsibility  in the CARICOM Cabinet for the Single Market and Economy, Prime Minister Arthur  as Chair of the Caribbean Community in July 2007, promoted  the Needham Point Declaration of CARICOM Heads of Government,  “Functional Cooperation: a Community for All.” His voice on behalf of the CARICOM Movement resonated  and commanded  respect at the UN, the EU, in  Africa  and in the global arena generally. He would have been  pleased to learn of and promote the most recent work of the Health Economics Unit(HEU). it is also to be noted that HEU on the St Augustine campus , UWI is located in the Sir George Alleyne Building ,a Caribbean icon  and a respected colleague and compatriot of Owen Arthur. 
 
The Biannual Report in Context of HEU's Portfolio
 
 GOFAD, highlights some issues in HEU's  Biannual Report (July 2019). In a subsequent blog  we  will explore more fully the wider range of HEU's  extensive scope of work which illustrates its valuable contribution to policy making and advocacy for the cause of Health and Development  in the Caribbean. What is more intriguing is the HEU's costing tool with built in formulas for projecting from the available  epidemiological data, the  trends  on the social determinants of health and economic  costs and benefits . Hopefully these products will form the essence of webinars and other forms of dissemination to engage  regional and international audiences  and thereby shine a brighter light on this  important work.  To read or download a copy of HEU Biannual Report,   please use the following link: https://drive.google.com/file/d/1zotei_mcc7vHMPvsqekbk9MiXgZlZLSy/view?usp=sharing
 
Macroeconomic Fall out  in the Caribbean
 
The Report shows that as a result of COVID- 19,  the economies of the Caribbean are expected to fall by an average of just over 6% in 2020; employment levels reduced in response  to the curtailment in the supply and demand chains with labour intensive sectors —  trade, transportation, restaurant  and hotels—bearing the brunt. It also   estimates contraction of tourism of between  8%-25% in 2020 depending on whether travel bans currently  in place  in most countries, are extended to 3-6 months or more. All this can result in increasing levels of poverty. Accordingly,  the uncertainties about the  length and depth of the “lockdown” on the economies are compounded by negative trends in the global economy. For starters, the general projections  reveal a substantial decline in remittances from abroad which contribute 21% of Haiti's GDP  , 16% in Jamaica 11% in Guyana.   
 
Stimulus Packages
 
While the Report  refers to the fact that countries have embarked on stimulus packages to shore up sagging economies , it does not provide details. What is clear, is that with the lack of fiscal space for most Caribbean economies and relatively high debt-GDP ratios -- above 60% before COVID-19 in two-thirds of Caribbean Countries-  government borrowing is not a feasible option. The most recent data from country reports  (July 2020) provide a useful idea of the priorities adopted.  There are plans for reopening the respective economies in five to six  phases  with  the initial phase  already in process including essential services,  hurricane preparation, delivery and construction.  
 
In The Bahamas,  its support measures totaling  US $38M accounts for 0.6% of GDP. Barbados is targeting 1% of GDP less than the 3% indicated in  March and has placed emphasis on refurbishing hospitals and schools, provision of critical medications and capital spending, and social programs to support displaced workers and supplementing unemployment benefits through the national insurance scheme.  Jamaica has announced tax cuts around 0.6% in GDP and up to 0.5% to counteract the effects of COVID 19. Trinidad and Tobago  announced a six-phase reopening plan with phase 5 starting on June 22 to include  sporting activities without spectators, cinemas, bars, gyms, beaches with schools remaining closed until September.  It is currently preparing for a General Elections on August 10, 2020. Guyana in the height of an election stalemate has along with the Dominican  Republic and Haiti   received pre-manufactured housing from the UN High Commission on Refugees and PPE from UNICEF to contain the spread of COVID 19.  It is currently at phase 3 of six phases for opening the economy.  Its stimulus includes wavers on VAT and duties on COVID medical supplies, water and electricity. Small businesses and farmers affected by the virus are receiving assistance.
 
 
Social Conditions of Health  
 
The HEU Report points  to some of the implications of COVID 19  around mental health caused by  an environment of emotional distress  and "longing for the life we once had, even though filled with uncertainty". According to  Dr. Varna Deyalsingh, President of TRT Psychiatric Board,  these conditions are caused by anxiety, anger, panic attacks, thoughts of self-harm, exacerbation of pre-existing mental health conditions and in extreme cases, violence and suicide.   Clinical Psychologists,  Dr Peter Weller, helps us  to understand adverse child experiences  due  to functioning in this new normal environment which highlight the inequities in access to technologies  that facilitate online learning and living and other social conditions that militate against social distances, access to basic sanitation, nutrition and on time information. 
 
 
Grasping Opportunities: Strengthening the Regional Movement in Honour of Owen Arthur
 
Former Prime Minster Owen Arthur would have been a foremost advocate for reimaging the role of the regional institutions and recognizing their value to stimulate functional cooperation and building economic resilience regionally in response to the coronavirus. The Caribbean Development Bank (CDB),  the Caribbean Public Health Agency (CARPHA),  the Caribbean Disaster Emergency Agency  (CDEMA) the Eastern Caribbean Central Bank (ECCB), and UWI all institutions with  which he was actively engaged ,   have already stepped up to the plate in various ways that have been described in previous blogs.   The response to the preparedness prior to COVID 19 noted in the HEU Biannual Bulleting  should be accelerated.  These include PAHO's  training health workers in  Caribbean Member States  in influenza surveillance and pandemic preparedness and response to strengthen the capacity to prepare for the recovery from an acute health event. Then there is  the need for cooperation between CARPHA and PAHO to  increase capacity for testing and increasing access appropriate health services.  And now we are discovering the valuable role of HEU.   In addition,  the provisions of the Caribbean Cooperation in Health (CCH) coordinated by CARICOM,CARPHA and PAHO,  facilitate the application of international health regulations (IHR,)  pooled procurement of medicines and access to  personal protective equipment (PPE), reagents, kits, swabs, aspects of functional cooperation that would restrict public health risks. These are all  essential prerequisites of  a more viable regional response  for achieving  Owen Arthur’s dream of a  Caribbean Single Market and Economy. As he so aptly stated during the 30 year celebration of the signing of the Treaty of Chaguaramus in 2003 "Great causes are not won by doubtful men [and women].  Now is not the time to doubt ourselves."
 
Eddie Greene
 

As we examine lessons learned from the  economic effects of COVID-19, there is need to be reminded of the  recommendations from the seminal 2006 Report of the Caribbean Commission on Health and Development, chaired by Sir George Alleyne. That Report made the case for action to increase investment in health in the Caribbean Community and more poignantly according to its Chair “to  make the region’s leaders converts to the cause of health”.  The lynchpin of this conversion is  the strategy for the consolidation of functional cooperation through the Caribbean Cooperation in Health. It is aptly branded in the 2000 Nassau Declaration, The Health of the Region is the Wealth of the Region.  See full report here: Report of the Caribbean Commission on Health and Development By The Caribbean Commission on Health and Development
                                                       
 
Key Messages - then: Persistence and Relevance - now  
 
The Report is as relevant today as it was 14 years ago,  if for no other reason than its key messages  assert  the role of health in development as follows:

• Strengthen the public health infrastructure.
• Regard and treat health [and health emergencies]  as a  threat to the region’s productive capacity.
• Invest in public health with appropriate lag time leading  to enhancement of economic growth factors.
• Face squarely the problem of non-communicable diseases, especially obesity with its co-morbidities that constitute a major disease threat to economic development.
• Invest in better surveillance and health information systems and the institutions for establishing and maintaining them.
• Continue and intensify the actions to control the epidemic of HIV/AIDS, the spread of which is facilitated by the social and economic vulnerabilities of many groups and individuals.
• Deal with the problem that health financing represents for all countries.
• Address the “export” of health services, particularly nursing services.
• Strengthen the Caribbean Cooperation in Health (CCH).

 
The Report identified the tremendous progress that the Caribbean had made over the decades and the real possibility that if sustained, the region would have achieved or surpassed most of the Millennium Development Goals (MDGs) 2000-2015, which it did. Most of the MDGs centered on reducing infant mortality and  similar advancements  in all the classic indicators of population health. These included reducing  poverty which compared favorably  with other countries of the world that  were at similar levels of wealth and geographies. The Commission concluded that this was a result of government policies that  emphasized water and sanitation, nutrition and the essentials of primary health care.
Yet the Report pointed to several challenges to be faced, including: the size and fragility of Caribbean Economies with limited resources for sustained health financing;   increasing demands for maintaining a health sector more responsive to the legitimate demands for equity of access by  a population exposed to information about the range of possibilities from other cultures and other realities; and continuous threats of national disasters that compound the pressures on the health system. None of these conditions has changed but they have been compounded  by COVID 19 specific salutary lessons for which the messages of the Caribbean Commission 14 years ago prepared the Caribbean for actions required  based on issues to be addressed.

 
Conclusions : Build Back Better
 
The Caribbean has lagged in social investment in recent years, with debt servicing diverting resources due to  lack and inadequacy of resources that have constrained  investments in such critical areas as education, sanitation, healthcare, housing, work programmes and skills development. This is according to ECLAC’s Special Report COVID-19 No. 5, entitled Addressing the growing impact of COVID-19 with a view to reactivation with equality: new projections. It is therefore heartening to note that functional cooperation through the Caribbean Cooperation in Health during the coronavirus pandemic has resulted in relatively low rates of spread and deaths in the Caribbean.  As important, is that Caribbean youth are  engaged in  discussions on their role  in averting the effects of COVID-19 and NCDs. It is a venture  which even unwittingly, links  the considerations  of the Caribbean Commission 14 years ago, and the current preoccupation with  the effects of COVID on the region's health and development. They articulate that their legacy is to “build back better”. GOFAD will follow up on this mission  and feel optimistic that the youth will play a critical role in shaping the world where their generation and future generations thrive. In this case, they will make worthwhile our revisiting the Report of the Caribbean Commission on Health and Development.     

The COVID-19 pandemic has brought to the fore the importance of health to economic growth. This realization is neither  novel nor new.  The Wealth of the Nations (1773)  highlights Adam Smith's insight about the true engine of wealth creation as  the division of labor, which itself is dependent on the size and extent of markets.  This is relevant to understanding the underlying  risks  of the coronavirus pandemic due  to negative labour shocks,  caused by a rapidly declining working age population and  its effects on the supply chain across borders.  This, in essence, was   the vision behind the CARICOM Heads of Government Declaration, the Health of the Region is the Wealth of the Region (July 200O) when HIV was literally a death sentence. The 1998   Nobel Laurette in Economics,  Amartya Sen,  had previously concluded that health,  like education is among the basic capabilities that gives value to human life. Then,  The Commission on Macroeconomics and Health established by World Health Organization (WHO)  in 2000 and chaired by Professor Jeffrey Sacks,  established that health is both a central outcome of development and an  important  investment  to promote economic development and poverty reduction, especially in the world’s poorest countries. This was the period of the Millennium  Development Goals (MDGs) that  committed the world to dramatic reductions in poverty and marked improvements in the health of the poor by 2015, requiring seriousness of purpose, political resolve and an adequate flow of resources from high to low income countries on a sustained and well targeted basis.  
 
To what extent has this mission been achieved?  There are several  lessons from the coronavirus   pandemic that illustrate the need for a healthier and more prosperous future.
 
First, coronavirus exposed the weakness of the World's infectious -diseases- surveillance response to pandemics. It included the slow start up in many countries: in public communications, testing , contact tracing, critical care capacity and other systems for containing infectious disease.  As a result,  the case for strengthening the world’s pandemic-response capacity at the global, national, and local levels is compelling. According Mc Kinsey's "Crushing coronavirus uncertainty: The Big unlock of our Economy" (May 2020), the economic disruption caused by the COVID-19 pandemic could cost between $9 trillion and $33 trillion—many times more than the projected cost of preventing future pandemics.  Preventive investment estimated at $40 billion annually,  could substantially reduce the likelihood of future pandemics.
 
Second, reports from the IMF research (July 2020) shows that health continues to stimulate growth,   accounting  for about one-third of the overall GDP-per-capita growth of developed economies in the past century.
 
Third,  is the need to invest in health to build resilience. The COVID-19 pandemic has hit people with underlying health conditions hardest—for example, diabetes, hypertension, chronic obstructive pulmonary disorder, and obesity, which are common across most of the world’s economies. They have been associated with higher risk from COVID-19.  Hence it is predicted that by using what we know today, can improve the health of the world’s population, and that would not only build resilience against future pandemics but also dramatically improve the quality of life of millions of people.
 
Fourth,  is focusing on reducing economic and social inequalities. In many countries, the pandemic has disproportionally hurt minorities and low-income households. In the United States, for example, mortality rates have been much higher among Latinos and Black people than among the white population. Similarly, in the United Kingdom, ethnic-minority groups reported mortality rates 40 to 200 percent higher than those of white British people. Minorities and low-income households face a double whammy of health and economic risk. Black Americans are almost twice as likely to live in the counties at highest risk for health and economic disruption if the pandemic hits those counties. Even before the COVID-19 pandemic, researchers found a ten-year gap in life expectancy between the most and least disadvantaged groups in the United States. Disparities of this magnitude are observed in most countries and societies around the world. Poorer people tend to have worse health, which can limit their economic potential.
 
Fifth, is the building on COVID driven innovations. According to a WHO Report (July 2020) scientists around the world have shared more than 50,000 viral genome sequences, and around 180 vaccines were in the pipeline, many representing cross-sector and cross-country collaborations.  In addition, the adoption of telemedicine has skyrocketed: in 2019, 11 percent of US consumers used telehealth services; now 46 percent use them to replace in-person consultations suspended during the crisis. The pandemic response has also demonstrated that when the situation demands it, the architecture of healthcare can be transformed rapidly.
 
Sixth, are the lessons learned from the accelerated response to HIV.    In the final analysis, eliminating unnecessary deaths is at the core of global health efforts, from responses to COVID-19 to HIV, non-communicable diseases, and maternal mortality. However, experience with HIV shows that reducing mortality especially in the absence of a vaccine,  requires a more robust approach to tracking and intervening than has been used in the COVID 19 response in many counties, especially the USA,  to date.  A UNAIDS presentation at the recently concluded virtual International AIDS Conference (July 6-12)  shows that  38 million people are living with HIV, a consequence of a pandemic that spread worldwide. The multinational AIDS response grew out of a global concern for the catastrophic loss of life, as HIV devastated communities in highly burdened countries. From a time when it seemed impossible for interventions to reach people globally, today about 79% of all people living with HIV know their status, and more than half of all people living with HIV have achieved viral suppression using advanced antiretroviral therapy. This according to UNAIDS is an  historic response  that has saved more than 11 million lives in the past decade alone.
 
However, progress against mortality has slowed considerably. They are far off-track from the globally agreed goal of fewer than 500 000 HIV-related deaths by 2020.  Nevertheless, the UNAIDS Report concludes "as global health efforts mature, the HIV experience can provide lessons for tackling mortality from other causes" .
 
 
 
Conclusions  
 
We started this blog by referring to  the mission of equity,  inspired by placing health at the center of economic development. It is therefore fitting to refer to a new book, by Martin Sandbu, Economics of Belonging: a radical plan to win back the left behind and achieve prosperity for all, (Princeton 2020). Its premise  is that behind today’s political liberalism and rejection of globalization is a widespread feeling that economic opportunities are reserved for an elite to which “normal people” do not belong. It sets out an agenda to create an economy where everyone feels they belong. Hence it is heartening to note from a report in the Washington Post (July 15) that  leaders from Canada, Ethiopia, South Korea, New Zealand, South Africa, Spain, Sweden, and Tunisia have issued a joint call for any coronavirus vaccine to be distributed equally and according to a “set of transparent, equitable and scientifically sound principles.” The statement comes as worries grow that protectionism may prevent poorer countries from receiving a vaccine at the same time as richer ones. That would be in contradiction to the primacy of health to economic development.
 
Eddie Greene

​The recent IMF Report (July  8, 2020)   projects global growth  at - 4.9 percent in 2020. This is 1.9 percentage points below the April 2020,  World Economic Outlook (WEO) forecast. This is attributed to the COVID-19 pandemic that has had  a more negative impact on activity in the first half of 2020 than anticipated. The conclusion from the  IMF report is ominous:  ”recovery is projected to be more gradual than previously forecast. In 2021, global growth is projected at 5.4 percent. Overall, this would leave 2021 GDP some 6½ percentage points lower than in the pre-COVID-19 projections of January 2020. The adverse impact on low-income households is particularly acute, imperiling the significant progress made in reducing extreme poverty in the world since the 1990s.”
 
There are several common challenges posed by these trends to countries globally but are particularly relevant to the small Caribbean Countries.
 
Flattening the curve as a basis for stimulating the Economy
 
Flattening the curve is associated with reducing the spread of the virus. The WHO tracker reveals that even though coronavirus cases are low in the Caribbean relative to its small population size, in several countries  the curve has  begun  to flatten. Yet there is still need for caution.  Although the Caribbean Public Health Agency (CARPHA) health experts say social distancing and quarantines are critical, the economic uncertainty that comes with those measures provides a powerful counterweight – particularly in communities  where reliance on face-to-face transactions is high and where living and other socio-economic conditions preclude all but the privileged to confirm to safe spaces for physical distancing and opportunities for working and studying from home.
 
The CARICOM Statistical Unit explains some of the difficulties with establishing  trends for the  Caribbean due to inaccuracies in country reports including  limited information  on sex ,  by hospitalization and number of person tested.  It identifies the causes for sharp increases  during March-April 2020 in some countries like Jamaica and Trinidad and Tobago with specific events resulting in 700 new cases over 24 days. Yet with the exception of four-five of the 22 CARICOM Community Member and Associate  countries experiencing an increasing trend in transmission by  May 2020, there has been a relatively low rate of transmission reflected in new cases.
 
Execution of protocols such as  increased randomized testing, closing  of borders , applications of contact tracing and quarantine  measures have led to optimistic signs that more countries are ready for a phased opening of their economies. There are also positive signs with respect to the education sector by the  recent signal from the University of the West Indies that its campuses are being readied for on campus classes and from the new Vice Chancellor of the University of Guyana that that institution is considering a blended learning environment that includes both online and on campus course delivery.
 
 
Revamping the approaches to attract Intra Regional Tourism
 
According to the IMF Report (July 8, 2020) there is a possibility  that tourist arrivals could drop by as much as 75% in the last half of 2020. With the sector screeching to a standstill, the repercussions are already enormous, especially given the already high debt-GDP ratio in the region.  A compounding factor is that GDP  relative to pre-crisis expectations is likely to fall by 10 percentage point for Bahamas,  6.5 % for Barbados and 5.4% for Jamaica.  In all three countries tourism contributes between 34-48% of GDP. Because most Caribbean islands have seen relatively few cases of COVID-19, the main concern is keeping infections out which may prove to be an anomaly if not an impossibility  with the aim to bring tourists in.  During  the peak tourism season for example, cruise ship tourists number approximately 20,000 per day.    Under these circumstances the largest single untapped source of business for Caribbean tourism is the Caribbean itself.  It leaves as a policy option for consideration, the possibility of tapping into tourism from within the region.
 
The "Syndemic"  of COVID 19 and Climate Change 
 
Occurrences   of various natural disasters  that exacerbate major pandemics is referred to as a “syndemic”. With the hurricane season on the horizon,  any natural disaster will only add to the impacts of a pandemic that is already converging with economic recession. The most recent reminder   is the disastrous effects  which Hurricane Dorian inflicted on the Bahamas included  losses that amounted to $3.4 billion, or 27% of GDP.  The most comparable are the effects of climate change and COVID-19  in that they  both require  urgent society wide responses mainly through  social cooperation and behavior modification.  In the case of COVID - social distance, hand washing and mask wearing. Responses to climate change require  managing extreme disasters, protecting coastlines, preventing sea level rise and protecting energy and public infrastructure.  Both COVID -19 and Climate Change require placing emphasis on a viable health care system  for the public and  planet,  respectively.
 
Health essential to Economic Growth
 
The COVID-19  pandemic  has fully demonstrated the importance of health to  economic  growth. GOFAD will follow up  on this  policy debate which often focuses on controlling healthcare costs rather than on the bigger picture.  A recent Mckinsey Global  Institute study Prioritizing health: A prescription for prosperity, shows that the bigger picture shines light on  the pandemic and its effects that  will cost the global economy up to 8 percent of real GDP in 2020.  Yet each year, poor health costs twice as much—around 15 percent of global real GDP from premature deaths and lost productive potential among the working-age population. At the same time,  organizations around the world are looking  for tools to speed up economic recovery, rethink health as an investment, not just a cost. This is a useful mantra that countries in the Caribbean and elsewhere should consider for  accelerating  growth for decades to come, even in the face of a pandemic and a 'syndemic'.
 
Eddie Greene
 

​This week GOFAD shines its light on Professor  Paloma Mohamed Martin and offer warmest congratulations  on her recent appointment as the 11th Vice Chancellor of the University of Guyana. The new Vice Chancellor brings to the position some spectacular attributes as an academic and a proponent of the dynamics of  the arts and culture of the Caribbean. She was educated at the University of Guyana, Harvard and the University of the West Indies and has published extensively in the fields of social and behavioral change, communications strategy, and education policy and practice. Her 11 books and numerous  articles in academic journals in addition to a wide range of children’s books and collections of poetry fully demonstrate her  talents and productivity.  What is more, she comes to the position with a  highly rated reputation of academic leadership at the University of Guyana:  as Director of the Centre of Communications Studies,  Dean of the Faculty of Social  Sciences, Deputy Vice Chancellor of Philanthropy, Alumni and Civic Engagement  and over the past year, Chair of UG’s  Transitional Management Team. She is also Adjunct Professor of Cultural Diplomatics at Trent University, Canada.
 
Professor Mohamed Martin has also made significant contributions to the film and theatre industries, especially in Guyana, but also in the Caribbean region and the Diaspora.  Her playwriting prowess and theatre productions are highly acclaimed.  They include such recognition as a three-time winner of the Guyana Prize for Literature, the City of New York Award for Culture in 2013 and the first woman Caribbean Laurette  for Excellence in the Arts and Letters in 2015.
 
 
GOFAD is grateful the ANSA Caribbean Awards for Excellence Committee for allowing us to  use its video biography to provide a glimpse of the abounding creative talent of UG’s first woman Vice Chancellor.