COVID-19: A sustainable development approach to stabilization and recovery

The objectives of this study are to explore the impacts of COVID-19 on economic, social and environmental systems among CARICOM countries and to propose guidelines for stabilisation using the sustainomics framework.

Gender-based violence: don’t ask, don’t tell, don’t care

OBJECTIVE: Our goal was to highlight the ongoing disparity, promote discussion, and advocate for further funding to examine the factors associated with sexual violence to target prevention rather than intervention. DESIGN AND METHODS: We compared prevalence, incidence, and economic burden of sexual violence to other major public health issues in the US: cardiovascular disease, cancer, and diabetes. We compared the public funding allocated to an issue as a proxy of the social priority of addressing the issue. Finally, we calculated the ratio of public funding to economic disease burden. RESULTS: [Table]. CONCLUSION: Public funds allocated to sexual violence were a fraction of those allocated to other major public health issues such as cardiovascular disease, cancer, and diabetes despite similar incidence, prevalence, and economic burden between them. While sexual violence was similarly prevalent and costly to these other major public health issues, it received a fraction of public funds.

Implications of the Central America-Dominican Republic-Free Trade Agreement for the nutrition transition in Central America

OBJECTIVES: To identify potential impacts of the Central America-Dominican Republic-Free Trade Agreement (CAFTA-DR) on food consumption patterns associated with the nutrition transition, obesity, and diet-related chronic diseases. METHODS: Examination of CAFTA-DR agreement to identify measures that have the potential to affect food availability and retail prices. RESULTS: CAFTA-DR includes agreements on tariffs, tariff-rate quotas (TRQs), and sanitary and phytosanitary regulations with direct implications for the availability and prices of various foods. Agreements on investment, services, and intellectual property rights (IPR) are also relevant because they create a business climate more conducive to long-term investment by the transnational food industry. Trade liberalization under CAFTA-DR is likely to increase availability and lower relative prices of two food groups associated with the nutrition transition: meat and processed foods. These outcomes are expected to occur as the direct result of increased imports from the United States and increased production by U.S. companies based in Central America, and the indirect result of increased domestic meat production (due to increased availability of cheaper animal feed) and increased production of processed foods by domestic companies (due to a more competitive market environment). CONCLUSIONS: CAFTA-DR is likely to further the nutrition transition in Central America by increasing the consumption of meat; highly processed foods; and new, non-traditional foods. The public health community should be more aware of the implications of trade agreements for dietary health. Governments and related stakeholders should assess the coherence between changes fostered by specific trade agreements with national policies on diet and nutrition.

Policy tools for achieving more equitable financing of and access to health care services in Latin America and the Caribbean

This paper reviews policy tools or instruments for achieving more equitable financing of and access to health care services. The paper summarizes the economic rationale for public policies and the types of tools that governments can use in addressing resource allocation efficiency issues and equity objectives in order to reduce inequalities in the financing of national health systems and to improve equity in the access to health care services. Estimates are presented on the patterns of government expenditures and financing in countries of Latin America and the Caribbean. Estimates are also included on the level of government expenditures, the composition of revenues, the importance of government social and health expenditures, and the distribution of the benefits of government expenditures on health for different income groups. The last section of the paper presents policy challenges faced by the governments of Latin America and the Caribbean as they try to achieve more equitable financing of and access to health care services (AU)

Food saftey: an examination of the potential impact on the economies of countries of the Caribbean Community [abstract]

Food safety pertains to the prevention, reduction or elimination of the risk of ill-health as a result of the consumption of foods whether fresh or processed, obtained through the domestic market or by international trade. Food saftey issues therefore impact on agricultural production and trade, as well as on the manufacture of processed foods and on the preparation and service of meals, whether these be in a hotel/restaurant environment or by itinerant street vendors. Agricultural production, trade and tourism are together significant contributors to the output of the open economies of the countries of the Caribbean Community. The discussion examines the findings of a recent assessment of the food safety status of Caribbean Community (CARICOM) Member States, which focussed on food safety in respect of plant, animal and human health systems in the various countries. The economic structure of selected countries is highlighted together with an indication of the trends in trade. The findings of the food safety assessment are then reviewed in the context of their possible impact on the economic output of the countries. The analysis showed that agricultural production and trade play a critical role in the economic output of many CARICOM States, Through their contribution to export earnings as well as employment. Tourism is also important in this regard. Inadequate attention to food safety issues can result in loss of market share either through a shift in purchasing patterns as experienced by other countries, or through detention by the regulatory agency of the importing country. Weak food safety policies could also jeopardize the tourism sector. Improvements in the food safety system and its infrastructure would serve to enhance the earning potential of the agricultural and tourism sectors and this should lead to greater economic output from those sectors. (AU)

The IMF, structural adjustment and health in the Caribbean: policy change in health care in Trinidad and Tobago

In this study, an assessment of the impact of structural adjustment policies in the 1980s on the health status of people in the Caribbean is undertaken through observation of the effects of these policies on the living conditions of employment, income education, nutrition, housing and water supply. The data show distinct patterns of decline in living conditions in the Caribbean. Reference is made to the fact that while nutrition has the greatest impact on health, all other living conditions identified significantly affect the health status of the people. Other factors point to real declines in health status through increases in morbidity among specific groups in the Caribbean. In the context of declining health status, I examine the recent changes in health policy being implemented by the government of Trinidad and Tobago to effect a virtual privatization of health services. I comment on the possible outcome of these policies in relation to access to health care using evidence from the region, and suggest modifications to these policies in order to ensure that health is enhances in the Caribbean region (AU)

Situation analysis of women and children in the Commonwealth of Dominica

Examines the situation of women and children in Dominica. Overviews the social and economic situation in the country. Considers, the health status of children by looking at health and nutrition; the health status of women by looking at health, reproduction and nutrition; the environment; the health sector; the education sector; and the legal status of women and children. (AU)

Situation analysis of children and women in the British Virgin Islands

Examines the situation of women and children in the British Virgin Islands. Overviews the demography, political and economic situation of the country. Considers, the health situation of children by looking at health and nutrition; the health situation of women which looks at reproduction, health and nutrition; the environment; the health sector; the education sector; the legal status of women; the government services for women and children; the media; and the structural causes. (AU)

Situation analysis of children and women in Montserrat

Examines the status of children and women in Montserrat. Looks at the land, demography, political, social, and economic conditions. Looks at the health situation of children by considering infant and child mortality, health and nutrition. Looks at the health situation of women by considering reproduction, health, and nutrition. Other factors considered include the environment; the health sector; the education sector; community services programmes; non-governmental organisations working with women and children; the situation of women; and the legal status of women and children.(AU)

The economic crisis and its impact on health and health care in Latin America and the Caribbean

The economic crisis that struck most Latin American and Caribbean countries beginning in 1982 has caused sharp reductions in domestic investments and in imports; domestic consumption has been less affected, while public sector spending has responded in different degrees in countries. In general, public spending on health decreased, sometimes quite dramatically, but some countries were able to maintain the real value of noninvestment spending for health by central governments. It is much harder to tell what may have happened to output of health services, and still harder to know how health status has been affected. Scattered evidence suggests two conclusions. First, worsened economic conditions can seriously damage health status, with effects on infant mortality and on the patterns of disease and death, especially for children. Second, these reprcussion do not have to occur, and public programs designed specifically to maintain basic health services and to assure adeqauate nutrition are effective in offsetting the worse consequences of economic hardship. (AU)

Improving financial management of health care in the Caribbean: conceptual and empirical issues

Structural adjustment is reducing the traditional dominant role of the state in the financing and provision of health care. Issues of equity, allocative efficiency, sustainability and clinical freedom are brought into question. This paper examines two models of escalating health costs and discusses the possibilities and limitations of cost sharing mainly health insurance), cost recovery (user fees) and cost containment (privatisation and decentalisation) measures in the health sector. It also explores additional measures to improve financial management in the health sector -- this must be seen as a moral oblication by all rather than a managerial imperative by a few (AU)

From Ganja to crack: Caribbean participation in the underground economy in Brooklyn, 1976-1986. Part 1. Establishment of the marijuana economy

The involvement of Caribbean youth in drug distribution (marijuana from the mid-1960s to 1981; cocaine hydrochloride powder and crack from 1981 to 1987, the time of writing) throughout the Circum-Caribbean area and in North America is described. Social, economic, and cultural outcomes of these engagements are highlighted, and the relationship between the underground economy of drugs and the corporate, capitalist economy is explored. Responding to high rates of unemployment and to other problems of migrant adaptation, young Caribbean African males established a mutlimillion dollar marijuana (ganja) trading network which linked cultivators on the islands with exporters/importers and street-level distributors in North American cities. By 1976, its participants had become Rastafarians, or followers of an ideology of self-reliance and indigenous development. Following its precepts, they reinvested marijuana revenues to revive cottage industry and agriculture. In Caribbean or minority neighbourhoods, therefore, marijuana was a "positive vibration" and its distribution were lionized.(AU)

Government's expenditure on the health services, Jamaica: 1977-1986

Statistics show a modest increase in both total real per capita expenditure and real per capita recurrent expenditure on public health services respectively by 15 percent and 14.6 percent with the highest average annual expenditure in Kingston and Montego Bay areas. The share of allocations to personal emoluments fell from 61 percent to 44 percent in the budget for general administration while the share of other expenditure-mainly food, drink, drugs and medical supplies has increased. The decline in allocation to personal emoluments led to a reduction in numbers of most categories of health personnel employed in public health sector. Data also suggest the growth of population and utilisation outstripped the rate of growth of employment of health personnel, thus affecting the quality of health care offered (AU)