Public Health in the Region
Public Health: A Return on Investment

CARPHA is an avenue by which the population’s health may be advanced. In accordance with the principle that the health of the region is the wealth of the region, it is an agency that stands at the cusp of this region’s development possibilities by providing epidemic protection, laboratory networking and leadership in effective public health interventions. Investment in CARPHA is thus economically sound.

A document produced in December 2013, ‘Estimating the Economic Value of the Public Health Coverage Provided by CARPHA’ established that the losses averted by CARPHAs work are approximately US$253M annually. As yearly cost has been estimated at US$11M, the economic return rate of investment in CARPHA is by a factor of overPubli 22. This is further demonstrated by a 2016 study based in Trinidad and Tobago, which calculated the economic impact of diabetes, hypertension and cancer to be US$1.2Bil (4.3% GDP), of which 40% is in direct health costs, and 60% is indirectly by productivity decrease. Programs conducted by CARPHA can greatly mitigate this drain on the economy.

However, as the existing core funding affords a very basic level of public health services, investment is urgently needed. It is worth noting that in 2015 the average health expenditure in the Caribbean was 5.9% of GDP, as compared to the world average of 6.3% (WHO data). This need has been partially offset by resource mobilization success and partnerships, but project resourced funding is not sustainable.

Caribbean Cooperation in Health (CCH)

The Caribbean Cooperation in Health (CCH) aims to achieve more efficient cooperation in common health services by developing and maintaining cost-effective and efficient systems. Each iteration of CCH has evolved with the changing times to meet the needs of CARICOM states, and has delivered significant health gains, such as a scaling up of the response to HIV. CCHIV, which spans 2016—2025, intends to address the goals set by WHO, and the non-communicable diseases that are the leading causes of mortality and an economic burden. The strategic priorities set by CCHIV have guided the strategic plan for CARPHA for 2018—2025.

These five strategic priorities have been identified in the document "CCHlV: Summary of the Regional Health Framework 2016-2025."

  • 1. Health Systems for universal access to health and universal health coverage,
  • 2. Safe, resilient, healthy environments,
  • 3. Health and well-being of Caribbean people throughout the life course,
  • 4. Data and evidence for decision making and accountability, and
  • 5. Partnership and resource mobilization for health.
State of Public Health

CARPHA serves 26 Member States (MS), with a total population of approximately 17 million. The region is undergoing a demographic shift, with an aging population and decrease in the average rate of population change (Graph 1).

An epidemiological shift has also been occurring, as non-communicable diseases (NCDs) have surpassed communicable diseases (CDs) to become the leading causes of mortality (Graph 2). Cardiovascular diseases, diabetes and malignant neoplasms are currently the top three causes of death. As chronic conditions, they are burdens on the economy, and have a serious impact on both the wellness and life expectancy of people. A key factor in NCD morality is the worsening obesity epidemic (Graph 3), propagated by low levels of physical activity and the high consumption of energy dense, sugar-rich food.

Violence and injury is a further significant cause of mortality in the Caribbean. The potential years of life lost as a result, is estimated to be higher than that of CDs. For example, violence and injury were responsible for 10% of deaths in Trinidad, of which 5% was due to interpersonal violence in 2016. Road traffic incidents also remain the leading cause of death in 5-16 year olds.

In terms of CDs, while the proportion of deaths they account for has been reduced, they still remain a source of concern and pose an epidemic potential. The conditions of the Caribbean region, namely the warm climate, large degree of travel, and abundance of mosquitoes, make it suitable for a vector-borne disease outbreak. Surveillance, and programs such as those tackling mosquito breeding, are necessary to prevent epidemics of Dengue and Malaria. The situation with food-borne diseases is similar: food and safety standards from farm to table and ongoing surveillance can help prevent outbreaks of norovirus and salmonella in their inception.

Tuberculosis remains an issue, with 6 MS considered mid or high-incidence countries (Graph 4). Issues contributing to the propagation include lack of detection and the spread of multidrug resistance due to unregulated healthcare. Finally, in regard to HIV/AIDS, the situation has improved remarkably since the early 2000’s (Graph 5), with UNAIDS estimating that the number of HIV related deaths fell by 28% in the Caribbean region between 2000 and 2016. However, the Caribbean region also has the second highest prevalence of HIV in the world. It is estimated that in 2016, 2% of the population in the Bahamas is living with HIV, and the topic remains engulfed in stigma.

Graph 1

Average Rate of Population Change (%) in the Caribbean (United Nations 2017)

Graph 2

Leading Causes of Mortality in the Nations in the Caribbean (WHO Data 2016)

Graph 3

Prevalence (% of Population) of Overweight Adults (BMI ≥ 25, both sexes, 18+ years old) in Caribbean Nations (World Health Organization Data)

Graph 4

Incidence of Tuberculosis (cases / 100,000 people) in Mid and High Incidence Countries (>15 cases / 100,000 people) in the Caribbean (WHO Country Profiles)

Graph 5

Death Rate of HIV/AIDS (deaths / 100,000 people) in the Caribbean Region (Including data for severely affected MS) (UNAIDS)