(CARICOM Secretariat, Turkeyen, Greater Georgetown, Guyana) I welcome all of you to Guyana and trust you will have a fruitful and enjoyable time in Guyana. I am grateful that you have honoured us with your presence and allowing us in Guyana to host COSHOD at a very important time.

I wanted to start this meeting with words that always resonate with me, from the great Mahatma Gandhi and when I cannot ascribe the words, I have always credited them to Confucius.

To know what is right and not to do it is the worst cowardice – Confucius told us this many centuries ago.

The great Indian Freedom Fighter, the Mahatma Gandhi put it this way: To believe in something, and not to live it, is dishonest.

This meeting comes exactly on the 10th anniversary of the Nassau Declaration, the landmark Declaration that concretized the regional commitment to the notion that there can be no development without health: Health is Wealth. We made a deliberate decision to strengthen our functional cooperation through the vehicle of health.

As we meet, one of the outcomes of the Nassau Declaration, PANCAP, has celebrated its 10th anniversary and has been recognized as a global best practice in the fight against HIV. This meeting will consider proposals to transform PANCAP into a more formal partnership and will consider how PANCAP can better serve the partnership against HIV in an environment where the flow of financial support is likely to dwindle.

Globally, we are observing the 10th anniversary of the landmark UNGASS for HIV that led to the establishment of the Global Fund. We have made significant inroads in the fight against HIV, and we in CARICOM are poised to pursue elimination of mother-to-child transmission of HIV by 2015, of achieving universal access to prevention, treatment and care by 2015. Our Region consistently ranks high in meeting the obligations established by UNGASS 2001.

And we are meeting on the cusp of another landmark UNGASS, one that we have chartered, to address the issue of NCDs. Between 60% and 80% of all deaths in our Region are accounted for by the NCDs. All of our countries have made the transition to an epidemiological profile where only between 5 and 12% of all deaths are due to communicable diseases. The Port-of-Spain Declaration represented a bold step in functional cooperation and, in the tradition of the Nassau Declaration, established CARICOM in the forefront of the struggle to stop the destructive path of the NCDs. While the Port of Spain Declaration established a pathway for improved diagnosis and treatment, the Port-of-Spain Declaration recognized the NCDs as primarily lifestyle diseases. In that regard, the Port of Spain Declaration committed us to work for lifestyle changes which would reverse the growing trend of the NCDs.

It is on this score that I would like to highlight the fact that our progress towards meeting the obligations of the FCTC and towards the commitments in the Port of Spain Declaration regarding tobacco is slow at best. In the simple matter of pictorial messages as labelling requirement, the proposals supported by Ministries of Health have remained on the shelf of CROSQ and not moving. If we cannot move to adequately warn the public about a substance that is a killer and acknowledged even by the manufacturers that it is a killer, then the battle seem lost.

I heard this remarks during the week from one of the delegates at the CMO meeting: We are driven by the pocket, not by vision.

It is bold actions like the Port of Spain Declaration which have led to the High Level Meeting on NCDs at the UN in September 2011. We have played a pivotal role in bringing the world together to commit to global actions to stop the NCD Pandemic, one of the genuine calamities confronting humanity today. We must play a leadership role at the UN in September, but we must also endeavour to aggressively tackle the problem of NCDs at home.

The Caribbean must take action on the front of diet and nutrition. Good nutrition is necessary for maintaining and sustaining good health. But the dominance of fast food and food high in trans-fat and salt provide a visible risk for our populations. We must not delay any further

I remind us all that the Neuro-Psychiatric illnesses represent a particularly disabling problem.\ No one can deny that the neuro-psychiatric illnesses represent a major burden of disease area. But our collective response has been low profile and inadequate. The human resource issue when it comes to neuro-psychiatric illnesses is a particularly troublesome problem.

Like the MDGs, like the upcoming High Level Meeting on NCDs, our programs have shown a frightening disregard for the importance of programs to stop the neuro-psychiatric illnesses from impoverishing large numbers of people in our countries.

This COSHOD is meeting when the implementation of CCHIII, CARICOM’s functional cooperation in health, is now fully in place. The CMOs have been developing monitoring and evaluation tools to ensure CCHIII is fully implemented. This is our agreement on collective action. Yet too many persons are unaware of the CCH.

This COSHOD comes at a time when we are ready to begin the implementation of CARPHA. CARPHA is one of the most important development initiatives ever undertaken in our Region and this dream must happen this year. I am disappointed that the IGA has not been signed yet, but hopefully the adjustments recommended at this meeting should lead to a rapid signing of the IGA by the Attorneys General.

We meet today against the backdrop that health is a pre-requisite for development and that development is not possible without health. Therefore, investment in health is an imperative and the Caribbean Commission on Health and Development made a number of recommendations. CARICOM countries have an impressive record in health investment, but we need to revisit the recommendations in the Commission’s Report.

Each of our countries invests about 10% of our National Budgets towards health. Yet each of us is facing major challenges in meeting the cost of health care in our countries. Our countries are facing challenges of increasing demand for health care, an increasing demand that outpaces the increase in budgetary allocations for health. In Guyana we have increased budgetary allocations every year for the last 15 years. We have moved from an investment of $US6 per capita in 1991 to almost $US100 per capita this year. Even though this represents a huge burden for Guyana, we must still invest more. In spite of this constraint, we continue to provide free health care in the public health sector to everyone in Guyana. Almost 90% of all health services in Guyana are obtained through the public health sector. Free health care is accessible to anyone accessing health services in the public sector, even if the person is not a citizen of Guyana. Non-citizens and visitors access public sector services for free and Guyana is proud of this record, in spite of the fact that financing the public health sector is a severe challenge for the Government.

It is not surprising that every CARICOM country is encountering financial pressure as the demand for health escalates. But as we take actions to mitigate the increasing cost of health care in our various countries, we must preserve the human-rights basis of the Caribbean health care system. The recent news coming out of Barbados limiting access to health care for non-citizens, including those with work permits, raise certain concerns, if it is true. It shows the extent of the problem, as one of the better off countries seeks to meet the escalating cost for health.

As Chair of COSHOD I would urge that countries do not embark on a path whereby persons are deprived of health. It is a moral and human rights issue. We meet today as a partnership recognizing and embracing that the goal is to promote and protect people’s health as a fundamental human right and as a reaffirmation of our commitment to eliminate poverty and accelerate human development. Outside of the developed world, the CARICOM Region is outstanding in achieving a life expectancy where virtually all the countries have either gotten close to 70 or have exceeded 70.

In this recognition, we must accept, as I argued at the World Health Assembly in 2008 when I served as the President of the 61st World Health Assembly, that no country in the Americas should have a life expectancy of below 75 by 2025. We meet today understanding that to achieve these goals, to protect and promote Health for All provision of quality, safe and efficacious medicines and access to medical technology and other commodities is an essential component of any health system. Access to medicines and commodities, indeed, is an indispensable need to guarantee Health for All and the promotion of long, productive, disability free lives for our people, all of our people, everywhere. Proposals for a Caribbean Pharmaceutical policy are on the table. We must ensure that we do not fall into the trap of limiting our people from access to affordable, quality medicines. Generic medicines have provided an opportunity for our people to have access to quality, affordable medicines. Any policy we agree to must not limit our use of generic quality medicines.

In 1978, we all agreed to make a concerted effort as part of our pursuit of Health for All.

In 2000, as part of the MDGs, we recognized the importance of medicines when we included as part of Goal 8, Target 8e:

Target 8e: In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries.

And we included as an indicator for Target 8e, Indicator 8.13: Proportion of population with access to affordable, essential drugs on a sustainable basis.

 Guyana spends now over $US26 per capita on medicines and supplies. This is a vast improvement of the less than $US1.50 spent in 1990 in Guyana. In developed countries, this expenditure is between $US27 to over $US500 per capita and in the least developed countries, this expenditure varies between $0.04 and $US16.

It will not be easy. But let me remind you that in 1962 faced with many difficulties and wanting to go to the moon, the American President, John Kennedy, explained to his people: We chose to go to the moon in this decade and do other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and others, too.

We can make a difference

Contact: piu@caricom.org