Remembering Owen Arthur while Highlighting Health Economics in these COVID 19 times

​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