JAMAICAS HEALTH and the CARIBBEAN SINGLE MARKET

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JAMAICAS HEALTHand theCARIBBEAN SINGLE MARKET
ECONOMY
Dr. John Hall MB, FRCP, FRCPE, FACP, FAAN
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Millennial Goals

• Health
• Wealth
• Development

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Stages Development Jamaica

• Plantation Period Spanish British occupation
• Post-Emancipation Era British Colonial Rule 1838
  to 1962
• Post-Independence Period 1962 to present

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Historic Personalities
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Milestones Federation to CSME
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Composition of CARICOM Land Mass
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POPULATION
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GDP per Capita
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HEALTH EXPENDITURE PER CAPITA
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Health Expenditure per Capita
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Physicans per 10,000 population
WHO Statistics, 2005
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Nurses per 10,000 population
WHO Statistics, 2005
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Commonwealth Medical Association Concerns

• All countries need adequate healthcare workforce.
• Many countries have an actual or potential
  shortage of health workers, e.g. by 2020 USA
  projected shortage of 200,000 doctors and 800,000
  nurses.
• Further loss by migration in countries already
  short of health workers especially in
  developing countries is very likely to create
• a) undue dislocation of health services
• b) unnecessary loss of life in the countries
  populations.
• Global Health Fund to address problems e.g.,
  HIV/AIDS, Malaria, TB will be constrained by
  lack of healthcare professionals

April 2005
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Commonwealth Heads of Government ConsensusMalta
November 2005

• All countries must strive to attain
  self-sufficiency in healthcare workforce without
  generating adverse consequences for other
  countries.
• Developed countries must assist developing
  countries to expand their capacity to
• a) train and retain physicians/nurses
• b) enable them to become self sufficient
• All countries must ensure that healthcare workers
  are
• - Educated
• - Funded
• - Enabled to meet the needs of their
  populations
• Action to combat skills drain in this area must
  balance the right to health of the population and
  other individual human rights.
• Universal Declaration of Human Rights (1948)
  Article 251

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Perceived Threats

• HIV/AIDS
• Flu Pandemic
• Pharmaceutical Security
• Food Security
• Obesity
• Diabetes
• Smoking
• Economic Migrants
• Violence Drug Trade

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Pharmaceutical Market

• 2003 Market for all pharmaceuticals
• US337.3 billion
• 2003 Market for all vaccines
• (polio, measles, influenza, etc.)
• - US5.4 billion 2 of original demand

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Vaccine Problems

• Vaccines USA makes 185 million vaccines per year
• USA real needs 300 million per year
• Flu Vaccines
• Difficult to produce
• Cant be stockpiled from year to year
• Strains vary season to season
• Northern developed countries meet their demands
  first
• 5 Billion people in undeveloped countries
• Immunocompromised (HIV/AIDS) Prime targets - flu
• TB global upsurge piggy-backing on AIDS
• Foreign Affairs June July 2005

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Pharmaceutical Security

• BBC TV 18/9/2005
• Retroviral drugs - dosage compromised
• - Production process compromised
• - Emergence of MDR/TB
• Antibiotics
• Hypotensives
• Dumping of substandard drugs in developing
  countries
• WTO Legislation re importation of generic drugs
• CSME Drug Testing Facility.

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Food Security (3 Domains)

• Fruit Ground Provisions (Natural/Man-made
  disasters)
• Milk Dairy Industry
• 14 million litres of milk 2007
• 2/3 production of 2002
• Imported milk powder hazards
• Opportunity coordinated plan Ja/CSME
• Grain
• 6 major producers Australia, America, Brazil,
  Canada, Ukraine, Kazadestan
• 30 diverted production biofuels
• Chicken/Beef production (feeds) . Prices 5 .

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Biofuels Policy

• Interface Conflict with food production
• Global shortage of food grains
• More expensive food grains beef/chicken prices
• Threat of hunger/Social upheaval

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Prioritizing Agriculture (Rationale)

• Vulnerability to food insecurity
• Population outstripping food supply
• Climate change already affecting crop yields
• Soaring world food prices

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Prioritizing Agriculture (Method)

• Financing for better farming inputs
• Extension services to advise farmers on-
• a) new technologies
• b) high yield seeds
• c) small scale irrigation
• Community Nurseries to diversify production
• Re-investment in infrastructure
• Market based techniques of financial management
• Weather-risk insurance for farm communities

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Prioritizing Agriculture (Results)

• Increase in harvests farm incomes
• Escape route from subsistence conditions
  poverty 1/3 population lives in rural areas.
• Boost in agricultural production
• Participate profitably in Market Economy

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Violence/Drugs Trade

• Challenging menaces to Caribbean way of life
  economic, cultural, political stability
• Multi-factorial causes in Jamaica
• Marginalised Male Prof. Errol Miller
• Endemic poor educational performance D. Ralph
  Thompson
• Economic decline over 20 years
• Rural urban drift unemployment
• Squatter or ghetto communities
• Deportee phenomenon guns/drugs trade
• Drugs trade 7.5 GDP in Jamaica
• Homicide rate 35/100,000 in OECS, 15 in 2003 19
  in 2008

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Thursday, September 15, 2005
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Development is Key

• Education
• Visionary Leadership empowering citizenry
• Investment
• That is socially responsible
• Promotes healthy living lifestyles
• Protects residential farming communities
• Protects air/water quality
• Does not destroy our beaches
• Does not destroy the burial grounds of our
  ancestors

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Future Challenges

• Direction of Migration population, professionals
  others
• Doctor-patient ratio/Nurse-patient ratio
• Training standards of doctors/Health
  professionals
• Unified Caribbean Medical Council
  licensing/discipline
• Unified policy re
• Preventing spread of epidemic diseases
• Pandemics of HIV/AIDS
• Societal violence
• Strengthening Faculty of Medical discouraging
  fragmentation

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References

• Declaration of Human Rights (1948) Article 251
• Foreign Affairs, June-July 2005
• Economist, 20/3/08
• Osler, Sir William (1889) Aequanimitas and
  other addresses
• Lancet (2005) Vol 365. p1122, Mayhew et al
• Professor Errol Miller Men At Risk
• Dr. Ralph Thompson Daily Gleaner contributor