Revisiting the Caribbean Commission on Health and Development and Lessons Learned

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.