Development of primary health care in Jamaica

The development of primary health care in Jamaica is explored, tracing its early roots to the abolition of the slave trade, the collapse of estate-based services after emancipation and the subsequent establishment of the Island Medical Services in 1875. Most developments in the health sector occurred after World War I in response to the high infectious disease mortality rates. The Rockefeller Foundation was asked to assist with the control of hookworm, tuberculosis, malaria and yaws. Its recommendation led to the growth of public health programmes (eg environmental health, public health nursing, community midwifery) alongside community-based curative services run by hospitals. The most significant period of development occurred in the 1970s when the various vertical programmes were integrated into the current primary care system. Jamaica was integral in the development of the World Health Organization's Alma Ata Declaration on Primary Health Care, tabling the "Jamaican Perspective on Primary Health Care" which set out its goal that all citizens should be within 10 miles walking distance of a primary health care facility. At the close of the twentieth century, the health reform process led to the development of regional health authorities aimed at integrating the management of primary and secondary care under four Regional Boards of Health. This has led to a change in the role of the central Ministry of Health to one of policy-making, health promotion, setting standards, monitoring and evaluation of the quality of health care. (AU)

Los escenarios sociales en America Latina y el Caribe / The social setting in Latin America and the Caribbean

A wide range of sources have pointed out the magnitude and depth of the social problems that trouble Latin America and the Caribbean and the risks that these problems pose for democracy. Although there are other issues that merit consideration, this article briefly outlines nine key social problems: 1) the increase in poverty, 2) the impact of poverty, 3) unemployment and informal employment, 4) deficiencies in public health, 5) problems in education, 6) the newly poor, 7) the erosion of the family, 8) increasing crime, and 9) the perverse cycle of socioeconomic exclusion. Solving these problems must not be delayed. It is urgent to move to a comprehensive view of development that achieves a different balance between economic and social policies, and that recognizes the indispensable role of these policies in achieving truly sustainable development. At stake are problems that not only concern resources, but also priorities, levels of equity, and the organization of society. Facing up to this poverty and inequity requires an in-depth assessment of these economic policies' social consequences, of the crucial subject of Latin American inequity-the greatest in the world-and of the role of social and public policies (AU)

The Caribbean AIDS epidemic

The Caribbean AIDS Epidemic assesses the impact of the epidemic in the region, and does it in a manner that serves to counter the overtones of sensationalism that characterize much of the reporting on the disease to date. Its topic are wide-ranging - from an overview of the current situation in the Caribbean to commentary on regional policy development and formulation, from a discussion of discourses on AIDS through the region's music to a review of legal and ethical issues. It includes chapters on public health aspects such as the teaching of AIDS prevention and the treatment and care of those who contract the disease. THe book will inform public health workers, medical practitioners, policy makers and the general public about HIV/AIDS in the Caribbean (AU)

Ethics, medicine and society: imperatives for the future

Historically, medicine has been a caring profession and social factors have directly and indirectly affected clinical practice, yet the social roots of disease and suffering in patients and the ethics of patient care have often been left out of medical teaching and discussions at medical conferences. As health and social problems are inseparable, ethically, medicine and medical teaching need to respond to social suffering, and should help to solve the economic problems in health care. Further, since all intervention in the lives of human beings carries ethical content through the nature of care, ethical competence involving ethical analysis, critical thinking, and problem-solving should be developed in medical students and doctors simultaneously with clinical judgement and expertise.(AU)

Suicide in Trinidad and Tobago: associations with measures of social distress

Using national statistics for the period 1978-1992, associations were examined between suicide rates and measures of social distress in Trinidad and Tobago. The latter included unemployment, serious crimes, emigration rates and admissions to the country's psychiatric hospital. There was a 319 percent increase in male suicide rates, from 4.96/100,000 in 1978 to 20.76/100,000 in male suicide in 1992. Although there were fluctuations in the rate for females, it remained below 8/100,000. Over the 15 year period examined, there was a 51 percent increase in serious crime while male and female unemployment increase by 89 percent and 33 percent respectively. There was a 63 percent fall in the rate of permanent emigration while male and female admissions to the psychiatric hospital fell by 28 percent and 19 percent respectively. There were significant positive associations between male suicide and serious crimes as well as with male and female employment (p < 0.01). Male suicide rates were also negatively associated with male admissions to the psychiatric hospital (p < 0.01). Female suicide rates were positively associated with serious crime and male unemployment (p < 0.01). Although it is not possible to determine whether the observed associations were causal, the results suggest that social distress may be an important contributor to the suicide rate in Trinidad and Tobago, particularly among men. The organisation of preventive strategies for suicidal behaviour must therefore include measures to counter the experience of social distress in this setting(AU)

Peacekeeping and peacemaking: the conceptual foundations of a plan to reduce violence and improve the quality of life in a midsized community in Jamaica

Thomas Jefferson noted that socials ills breed economic ills and vice versa. Every community in the world has its own thresholds and patterns of violence, and communities experience varied levels of deterioration of safety with a reciprocal increase in violence. The United States, having undergone 200 years of social evolution as an independent nation, has a spiraling problem with violence. Jamaica, with only recent independence from British sovereignty, is an ideal crucible for the study of evolution of violence in a very young demogracy and, hopefully, to identify problems and provide some solutions. Having gained independence from British rule in 1962, Jamaica immediately demonstrated a facile experimentation with forms of government that differed dramatically from what had been previously experienced under the rather rigid, autocratic British administration. In its 33 years of independence, this country has gone through some extraordinary shifts. An initial courtship with communist theory led to a destructive liason with Fidel Castro's version of Marxism. During this brief interlude, the intellectual ideals of equality and peace came into direct contrast with facts of a failing Communist regime. During this period, there was a steady exodus of wealthy Jamaican families for whom heavy taxation threatened financial ruin. The prime minister, the Honorable Michael Manley, a highly sophisticated left-wing intellectual liberal, soon realized the political cost of the alliance with his Caribbean neighbor, Fidel Castro, who was then and is now dedicated to old-fashioned, state-controlled Communism. He attempted to return to a free-market democracy with financial foundations that were, by then, very shaky. To succeed in a project to reduce violence and improve the quality of life, the entire community needs to be involved. From our work in countries where community projects were primarily financed by federal and state agencies, we were aware that the participation of private citizens in projects was essential for success. Commitment has an added intensity when personal time and funding is involved. Prime Minister Manley enthusiastically embraced and inspired this project, believing that it embodied the fundamental principles of democratic involvement to which he was committed. When the authors personally presented their plan to him, he accepted it immediately and with an obvious personal sense of urgency.(AU)

Child abuse: a Caribbean regional perspective

Contends that in the Caribbean context the definition of `child abuse and neglect' is important because of child rearing practices and the widespread use of corporal punishment. Defines neglect in terms of the jeopardy of the child's physical, emotional and intellectual needs. Comments on some forms of abuses and offers reasons for their practice. Discusses the measures of legislative reform, also the Educational outreach and counselling services formulated in Barbados to combat the growing incidence of child abuse. Presents statistics of the various forms of child abuse and contends that the 0-4 and 5-12 age groups are at the greatest risk of being abused. Some of the major regional concerns as reflected here are: child abuse in every class and ethnic groups placed against social services which cater mainly for the poorer classes; the high correlation found between early pregnancy and child abuse; the increasing evidence of children being diagnosed HIV positive and developing AIDS as a result of sexual molestation; findings that the natural rather than the step-father more frequently being the abusers; reported cases being just the tip of the iceberg; and the need to include economic abuse in the legal definition of child abuse. Details the conferences request for a comprehensive prevention strategy viz: legal, educational, therapeutic, community-based and culturally appropriate. (AU)

The elderly in Barbados: problems and policies

Empirical data on conditions affecting elderly people in the Caribbean are very limited. To help deal with this lack of information in the specific case of Barbados, in 1982 a survey was conducted of 525 randomly selected people 65 years of age or older. This article summarises data derived from that survey in order to provide an overview of the social and economic circumstances affecting Barbados' elderly population. While it is true that these circumstances do not necessarily mirror those found elsewhere, they clearly have elements in common; and it seems likely that the survey approach applied in this instance could prove useful elsewhere in obtaining worthwhile information. (AU)

Analysis of food assistance programmes in Jamaica

Paper brings together information from several studies in a review of the elements of the Food Assistance Programme (FAP) in Jamaica, their impact on vulnerable groups, and suggests guidelines for reorganizing and financing the programme. The Food Assistance Programme comprises the Food Stamp Programme, instituted in 1984, the General Food Subsidies and the School Feeding Programme. This paper is part of a project - The "Jamaican Poverty Line Project" sponsored by the Planning Institute of Jamaica (PIOJ). This project is a collaborative undertaking between PIOJ staff and a research team from the UWI. The first phase of the project is directed towards the development of the Poverty Line, and the analysis of food support programmes. In this exercise, the project was able to draw upon data from the newly instituted series of Survey of Living Conditions (SLC) undertaken jointly by the PIOJ and the Statistical Institute of Jamaica(AU)

A position paper on the social development policy of the Draft Medium Term Macro Planning Framework 1989 - 1995

Social development must take its rightful place in the overall development strategy, and therefore in the national planning framework. It must not be an after-thought. It must not play second fiddle to economic development. Additionally, the media must be seen as a positive and powerful instrument in the social development. Additionally, the media must be seen as a positive and powerful instrument in the social development process. This was the message of Mr. Marcelle's paper. He submitted specific comments/recommendations regarding Government's Draft Social Development Policy; viz:- i Professional training of Social Workers at the University of the West Indies, St. Augustine must be a top priority in the thrust toward social development. ii The policies and programmes of the N.G.O's should be linked with the national policies and programmes. iii Government's rallying cry of self-reliance can be served by the proposed National Charitable Foundation, only of its operations are decentralized. There is need to identify: - a bench mark poverty line; - an approximate rate of population growth which is realistically related to the carrying capacity of the economy; - an acceptable unemployment level, and spell out how it would be done; v. The establishment of day-care facilities at industrial enterprises as a source of motivation to workers. vi. Rehabilitation of prisoners; re-training of prison/probation/police officers; re-vitalizing of poverty-striken neighbourhoods. v. The Family Services System must be geared to provide individual, family and community counselling, and also to provide a network of alliances in support of the family. Mr. Marcelle reiterated his admonition that we must not allow our awareness of existing social needs (severe as they are) to blind us to the equally pressing need for a proactive approach to Social Development, i.e. one which actively promotes social development before there is a need to react to social disturbance

Strategies and recommendations for drug abuse prevention in Saint Lucia

Reviews the establishment of a national task force on drug abuse whose function is to develop prevention plans and implementation strategies. Includes a project proposal for training community leaders for drug abuse prevention (AU)