58th World Health Assembly Speech

by

The Honourable John Maginley

Minister of  Health

on

17th May, 2005

Madam President, I wish first of all to congratulate you on your election as President of the 58th World Health Assembly. I also wish to thank the Director General Dr. Lee for his detailed report and to note Madam President the presentation by Mr. Bill Gates.

Colleague Ministers, Heads of Delegations and Delegates, as Minister of Health of Antigua and Barbuda, I have the honour and privilege of addressing the 58th World Health Assembly, on behalf of the Caribbean Countries which are organized in the Caribbean Community as CARICOM. I would also like to bring greetings on behalf of the Prime Minister of Antigua and Barbuda, the Honourable Baldwin Spencer and to state his continued appreciation and recognition of the work of the World Health Organization.

The World Health Report has highlighted the need to address the major concerns related to maternal and child health cases in an integrated and coordinated manner. The CARICOM states also recognize the need to harmonize best practices and promote greater efficiencies in maternal and child health services through improved regional and sub regional integration and cooperation. We consider that technical cooperation between countries (TCC) both north/south and south/south can be beneficial to our region specifically with regard to HIV/AIDS that continues to adversely affect many of our women and children.

The Caribbean is well known internationally as a quality tourist destination. CARICOM member states are geographically dispersed and diverse in economies of scale and peoples. In addition to offering quality entertainment and cultural diversity visitors generally have a glamorous impression of the Caribbean. However, our region still has challenges of poverty, significant health needs and regularly faces the disastrous effects from hurricanes and other forces of nature. For example, in the past year we have been adversely affected by Hurricane Ivan and severe flooding that caused mass destruction in the Caribbean. Grenada suffered a severe setback as a result of this devastating hurricane in September of 2004 and it is estimated that 90% of the island’s buildings were damaged. Hurricane Ivan also caused terrible destruction in Jamaica, the Cayman Islands, and the Bahamas, damaged homes and the health infrastructure and placed many people at risk from disease, contaminated water and food shortages. In Guyana early this year, heavy rainfall caused severe flooding in its densely populated low-lying costal areas. An estimated 40% of Guyana’s population was affected and thousands were forced to flee their homes. This left approximately 15% of the population homeless. The flooding also resulted in an outbreak of leptospirosis.

Madam President, we need to thank WHO, PAHO, the European Union, the United States and Canada for the immediate support that they provided in the response to these disasters. However, we must seize this opportunity to restate the point that vulnerability to natural disasters must be factored into the development assessment equation.  Against the backdrop of the disturbing frequency of hurricanes, and the real threats of seismic/volcanic activity and coastal flooding, CARICOM continues to take serious issue with traditional measures of economic status such as per capita income and life expectancy. Experience teaches that years of investment in education, health care and economic infrastructure can be erased within a few hours of nature’s fury.  In our vulnerable and small land masses, a hurricane affects the entire socio-economic plant.  Additionally, mothers and children suffer the most in these circumstances as disasters can negatively affect transportation and health services.

These damaging events have a huge negative impact on our people and economies and time after time we have had to rebuild our nations, health systems and health facilities. We have to rise to this challenge as our region’s principal source of income is derived mainly from tourism which accommodates approximately 26 million overnight visitors each year. We would welcome increased efforts from WHO and PAHO to increase their support to our region to develop effective preparedness, response and recovery strategies and programs.

Madam President, the Caribbean is a region of high mobility that demands a close surveillance system for communicable diseases. This high mobility also requires that residents also attain a high immunization status. This helps to ensure that not only residents remain disease free but also that the many visitors to our shores remain healthy as well. The elimination of measles and Congenital Rubella Syndrome are just two examples of why our Expanded Programme on Immunization (EPI) can be used as a model internationally. Effective immunization has indeed increased child health in our region and we are pleased to join the fight with other nations in the prevention of the spread of poliomyelitis since a single case in the world means that we are all at risk.

Our existing capacity to respond to international health threats is limited and we need the support of PAHO/WHO in this area. The Caribbean, through the Caribbean Epidemiology Center (CAREC) has been doing rather well in surveillance particularly for communicable diseases. Although we welcome the improvements with the revised International Health Regulations, we realize that these new regulations will require necessary investments for implementation. Preliminary estimates indicate that millions of dollars will be needed over the next three years in our region in order to adequately respond to the requirements of the proposed new International Health Regulations.

We in the Caribbean are faced with challenges in financing and specifically health care financing. Additionally, many of the Caribbean countries are making a big sacrifice with the new budget distribution from PAHO, wherein the budget of the PAHO offices in several of our countries will be reduced. This budget reduction in the region will further constrain the already limited health budgets of the countries and also put our health achievements, such as the high level of immunization, of recent years under significant pressure.

Madam President, the region has a HIV prevalence of 2.6%, second only to Sub Saharan Africa. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that between 1.9% and 3.1 % of Caribbean adults of reproductive age, was living with HIV during 2003. Although we consider the WHO 3x5 initiative a very useful initiative to increase the number of People Living With HIV and AIDS in therapy, the necessary supporting services such as laboratory services and monitoring and evaluation, should accompany therapy. In fact, we are of the opinion that successful therapy will be most effective in an environment of strengthened health systems.

Madam President we need to thank the PAHO/WHO for the support that they have provided for the Caribbean Commission on Health and Development (CCHD), taken after the Commission on Macroeconomics in Health and chaired by Sir George Alleyne, former director of PAHO. Several studies from this Commission have provided the evidence to establish national and regional health promotion strategies and to guide policy decisions for our countries and for the region. Maternal and child health programs also continue to be a priority.

In addition to the worrying status and impact of the HIV/AIDS epidemic, the impact of chronic non-Communicable diseases and related risk factors are of a specific concern. Madam President, the Caribbean countries realize that behavioral change is the single most important cross cutting element in addressing lifestyle diseases such as HIV/AIDS and non-communicable diseases including diabetes, hypertension, violence and accidents. Obesity, now considered a disease in its own right is an escalating epidemic in our region. We note as well that obesity disproportionately affects women and has a negative effect on maternal health. These diseases are all preventable with a change in behavior. We believe that more is needed to address the risk factors for these diseases such as tobacco use, alcohol abuse, risky sexual behavior and reduced physical activity. In addition to the resolutions on the Global Strategy on Diet Physical Activity and Health and the Framework Convention on Tobacco Control (FCTC), we would like to urge WHO to develop a global framework and approach to behavioral change. If we improve the chronic conditions that predate pregnancy, we may be able to achieve better outcomes for women and children.

Premature maternal deaths occur as a result of cancer of the cervix which is extremely high in our region. We ask WHO to address this preventable disease that kills many of our women in early adult life. We need access not only to appropriate treatment programs but also to effective screening techniques for cervical cancer prevention and control.

A lack of resources continues to challenge the delivery of health services in our region, particularly with respect to maternal and child health services. The recruitment of trained health professionals by more developed countries compromises our ability to deliver adequate services. Director General, we appeal to you to assist us with this issue of the migration of our health care professionals. We thank you for all the good work in the region but we wish to emphasize that much of this work is threatened by the migration of our health care professionals. Additionally this drain on our human resources also threatens our ability to achieve the Millennium Development Goals, particularly Goals 4 and 5 that relate to maternal and child health.

Madam President, ladies and gentlemen, we would not be here today if our mothers had not had safe births. We all therefore have an obligation to ensure that not only mothers but that all women are given the opportunity to live fully productive lives. This can be achieved once we continue to work together in an integrated and coordinated manner against diseases and other factors that negatively affect women and children. THANK YOU.