By A. T. Freeman
As we enter the 3rd decade of the 21st century, millions of people across the Caribbean continue to be deprived of their fundamental human right of access to modern health care. After hundreds of years of colonialism and over 60 years of nominal independence in most countries, the health care systems across the region, with the notable exception of Cuba, are incapable of providing Caribbean citizens with access to 21st century health care. In most countries, a two-tier private/public health care system exists. Those who can afford it use the private sector and those who cannot have to rely on the under-resourced public sector. This latter group includes the majority of the population. The non-viability of these arrangements have been highlighted by the double public health challenges of Covid 19 and the dengue fever outbreak which is currently affecting the region, particularly the islands of the eastern Caribbean.
According to data from the Pan-American Health Organisation (PAHO), the World Health Organisation’s [WHO] regional agency, so far in the Caribbean there have been over 270, 000 cases of Covid 19 resulting in nearly 5000 deaths and over 70,000 cases of dengue fever resulting in 62 deaths. However, this broad picture glosses over quite significant differences in how the two outbreaks are affecting individual countries within the region. For example, in the member states of the Organisation of Eastern Caribbean States (Antigua and Barbuda, Commonwealth of Dominica, Grenada, Montserrat, St. Kitts and Nevis, Saint Lucia and St. Vincent and the Grenadines) the picture is quite different with 2756 dengue cases resulting in 11 deaths compared to 543 cases of Covid 19 which has resulted in 7 deaths. The situation in individual countries is even more varied. To date St Vincent and the Grenadines has reported 83 cases of Covid 19 with no deaths and 1185 cases of dengue fever with 8 deaths. The health care challenges posed by Covid19 and dengue fever are dwarfed by the scale of what PAHO describes as an ‘epidemic of non-communicable diseases (NCDs)’, including cardio-vascular disease, diabetes and cancer. Based on data from 2016, which is the most recent data published by PAHO, there were 223,000 deaths from NCDs that year in the countries of the Caribbean. This represents 72% of all deaths in the region and PAHO calculated that over 95,000 of these were premature or could have been prevented if appropriate measure had been taken. This is a severe indictment of the lack of adequate health care in the region which is causing the unnecessary deaths of thousands of people each year.
It is clear that governments across the region are failing their citizens with regard to providing healthcare. Underpinning this lack is the fact that many regional governments pay out more in debt servicing than they invest in developing the healthcare systems. This means that they are left holding out a begging bowl when confronted by health care challenges. However, as the saying goes, ‘beggars can’t be choosers’ and those who hold the purse strings set the agenda. This reality is brought home by a statement made by Dr Yitades Gebre, the PAHO/WHO regional representative to Barbados and the Eastern Caribbean countries, while recently addressing a webinar entitled “Dengue Response in the midst of the COVID-19 Pandemic”. He explained that in response to PAHO’s efforts to raise funding to support eastern Caribbean governments facing the twin challenges of Covid 19 and Dengue fever, the organisation had raised US$9 million from its Covid19 appeal and
US$345,000 from its dengue fever appeal. These amounts reflect the priorities of the donors and not those that exist in the Caribbean.
That the health of people in the Caribbean is dependent on charitable donations is an indictment of the current state of affairs. It’s time to change it so that people in the region can have access to modern health care recognised and guaranteed as a fundamental human right.