It is very difficult to follow in the footsteps of two outstanding sons of the Region in the persons of the Hon. Owen Arthur, former Prime Minister of Barbados and Dwight Nelson, himself a giant in the trade union movement and now Minister without Portfolio in the Ministry of Finance and the Public Service, both whom gave the first two Hugh Lawson Shearer Memorial Lectures.
Hugh Lawson Shearer had a vision for humanity that was not constrained by geography, race, politics, class or nationality. He simply loved people. He was known to have great affection for the elderly. And being the consummate trade unionist he proceeded to register and organise them. Toady, our senior citizens can speak from an organised position that confers on them a strong and credible voice.
Indeed, it is difficult for me to define the boundaries of my presentation as the late Most Honourable Hugh Lawson Shearer defied boundaries. Quite frankly, I could not settle on the capacity in which I should speak- whether as Politician or more precisely, as the Minister of Health and Environment, Trade Unionist or Friend.
Ladies and gentlemen, in the words of the great writer Charles Dickens, we are in the best of times and the worst of times. This paradox is not unique to Jamaica. Advances in human well-being co-exist with extreme human deprivation around the world.
While we applaud the advances made as a result of technological transfer and new medicines, we are disturbed by unprecedented reversals in areas such as health and environment.
The world is contending with the HIV/AIDS pandemic which has reduced life expectancy in some African countries.
Rapid changes in diets and lifestyles have occurred with modernity-industrialisation, urbanization, economic development, international travel and marketisation. The combined impact of these on the health and environment status of populations in developing countries has introduced new challenges and shifted paradigms and boundaries in the health and environment sectors.
On the one hand, standards of living improved, food availability expanded and access to services improved.
On the other hand, inappropriate dietary patterns emerged, physical activities decreased and there is an increase in diet related chronic diseases especially among poor people.
Yet, at the heart of this painful contradiction, there is hope and marvelous possibility. Hugh Lawson Shearer was a man who would have looked beyond the challenges. His boundless love for the weak and dispossessed and his abiding faith in the Jamaican People would have inspired us to re-define the boundaries of our discourse, re-draw the lines of public policy spaces and re-design a new social architecture that is anchored in laws and practices that protect the weak and vulnerable from domination, exploitation and neglect.
New Challenges for Health and Environment The Third Annual Memorial Hugh Lawson Shearer Lecture is being given within the context of this 14th. International Diabetes Conference. It is a most fitting backdrop for this lecture because Hugh Lawson lived for thirty years with diabetes. HL (as we affectionately called him), was a man who walked the talk. He was as passionate about healthy lifestyle as he was about the rights of workers. He demonstrated that passion through daily exercise and proper nutrition.
My friend and mentor lived for thirty years with this disease but it did not change his quality of life. Hugh Shearer’s triumph should inspire millions of persons worldwide who are living with this disease. It should inspire millions more who are at risk. It is projected that the number of persons with the disease will reach the 228 million mark in the developing world alone.
On this, the penultimate day of the Conference, you may wish to reflect on what I know were excellent sessions and recommit to an agenda that will advance the quest for human security for the world’s people.
It is an opportune time to explore a new social paradigm that relocates the health and environment sectors as great levers of the economy and not as squatters on the periphery of the broad and significant economic policy spaces. As practitioners and respected members of academe, you must be passionate advocates in the halls of the international community for a repositioning of the health and environment sectors. This repositioning must be reflected in policies that are formulated and the financing that is provided to support the policies.
Jamaica has a great history as a leader in health. Health development was the pride and joy of Jamaica in the 70s and 80s. We boasted a good health care system. Our health indices mirrored that of developed countries.
Communicable diseases were well controlled and some, such as Malaria, Yaws and Yellow Fever were events of the past. The country enjoyed a high immunization status – measles was eliminated and polio eradicated.
But things and times have changed in the global health community.
Between 1973 and 2000, 39 infectious agents capable of causing diseases were newly identified. HIV/AIDS became a new disease and a new challenge that has increased poverty, reduced life expectancy and has led to a decline of the Gross Domestic Product of several countries.
SARS cost the Asian countries US$60 billion of gross expenditure and business losses in the second quarter of 2003 alone even though it had fewer than 10,000 cases.
Malaria, a re-emerging disease, threatens more than 3 billion people. Every year more than one million people die from this disease.
Globally, in 2005, over 1 billion people were overweight, including 850 million women. Three hundred million were obese.
The societal costs of diabetes in the Latin American and Caribbean Region were estimated at US$65 Billion in the year 2000 or 3.5% of the GDP of the Region.
The challenges in the environment sector have been no less formidable. More than 60,000 people have died from climate related natural disasters in recent years. In 2006 alone, 134.6 million people have been affected by natural disasters worldwide.
As far as the Latin American and Caribbean Region is concerned, 150 million people have been affected by natural disasters in the last three decades.
Hurricane Ivan created damage to the equivalent of 8% of Jamaica’s GDP and caused damage to Grenada in excess of twice the value of that country’s 2003 GDP figure.
Air pollution affects more than 80 million people in the Latin American and Caribbean Region and results in a yearly loss of approximately 65 million working days.
The costs of disease and environmental degradation on society involve not only level and growth of per capita GDP but also how they affect lifespan, lifetime earnings and disrupt sustainable livelihoods.
It is an irrefutable fact that small developing nations and countries in transition are more vulnerable to diseases and the impacts of environmental degradation. These countries are often plagued by poor infrastructure, weak public institutions and overcrowding in cities and urban towns.
Approximately 75% of total population of the Latin American Region lives in urban areas resulting in the proliferation of shanty towns, shacks and ghettoes and the attendant health and environment challenges.
Health and Environment as central planks of development
This new global era of health and environment demands a different social infrastructure on which the essential planks of the economy must be built.
There is an inescapable link between well being and development. When there is good health and sustainable livelihoods, we protect wage earners, improve productivity, safeguard attendance at school and preserve children’s learning capacity.
In a global survey commissioned by former Secretary General of the United Nations, Kofi Anan, good health consistently ranked as the number one desire of men and women around the world. It is the basis of every single person’s economic productivity.
It is accepted in the annals of history that some of the great economic leaps that have been taken were supported by important breakthroughs in public health, disease control and improved nutritional intake. The growth of Britain during the Industrial Revolution, and the rapid growth of Japan in the early 20th. Century are two such examples.
High prevalence of diseases such as HIV/AIDS and malaria are associated with large reductions of economic growth rates. The burden of disease is linked to Africa’s poor economic performance rather than to traditional variables of macro-economic policy and political governance.
The development agenda of countries must therefore embrace a perspective that embodies an integral concept of development which regards human rights-civil, political, economic, social and cultural rights- as constituting the ethical framework for the formulation of development policies. Therein lies the fundamental principle on which the new social architecture must be built. It must be embedded in the fundamental rights of individuals.
This concept of development demands that policy makers, and indeed practitioners, reject the old notions of a uniform and linear vision of development. Human capital, social well-being, sustainable development and citizenship should be regarded as embodying the core meaning of development.
Re-drawing the boundaries of economic and development policy requires disrupting the settled pattern of thinking that has framed our discourse and informed the rigid boundaries across our policy spaces.
We are now challenged to:. Reject some old concepts and notions of health;. Embrace a holistic view of health and wellness;. Appreciate the global dynamics of health and the environment; and, . Appreciate the inextricable linkages between social, economic, environment and behavioural determinants.
The following graph shows the health and environment interlinkages. It seeks to reposition health and environment from the periphery to the centre of the economic and development policy agenda. The important levers of the economy such as education, productivity, investment all depend on the central planks of health and environment. The New Social Architecture and Vision 2030.
There is need for a new social paradigm to confront the challenges of 21st. century health care and global environmental issues. Many of these challenges are inescapable in a borderless world.
The Government of Jamaica, will as of April 1, 2008, begin to absorb some of the out of pocket expenditure that the Jamaican people are required to make at the point of service delivery. We understand that while that policy intervention will increase access to health care, it cannot on its own, guarantee sustainable access to quality health care.
We in the Ministry of Health and Environment have begun the transformation of the public health sector to ensure that we can continue to provide good quality health care at low cost to Jamaicans.
Some of the important planks of the transformation include:1. An aggressive programme of quality improvement at all levels including policy and service delivery;2. The systematic rehabilitation of our plants; and,3. The re-positioning of Primary Health Care as the indisputable foundation of a good health system.
I must confess that the third plank is very dear to my heart. The core elements of a strong Primary Health Care System must include:
1. Strengthening links at the local and departmental levels and with other sectors involved in development;
2. Strong and effective health committees at the local and sector levels involving local civil, political and faith based authorities; and,
3. Community participation in defining policies, health sector management and monitoring and evaluation mechanisms.
The transformation of the health sector cannot be accomplished in isolation. The overarching social context must be redefined and re-established on different notions and concepts. This is an imperative for the achievement of Vision 2030: Jamaica a place of choice to live, raise families and do business.”
It is impossible to achieve first world status without first world citizens- people who are healthy, educated, productive, aware, informed and law abiding.
Government must enter into a formal contract with the people of Jamaica that defines the level of service that will be provided across the broad range of policy and service delivery areas. This compact would provide a guarantee to every Jamaican that basic social services would be made accessible to all and in a manner that shows respect for their dignity.
This new paradigm would define the principles of social cooperation that exist between government and people. It removes the provision of public services from being done merely out of a sense of duty on the part of government to a moral and ethical imperative that is shared by policy makers, technocrats and other civil service mandarins.
This compact with the Jamaican people would bring the poor and powerless, the disabled, children and the elderly into a service delivery paradigm that gives them equal access. To quote from a World Health Organization Publication, “a society that treats its most vulnerable members with compassion is a more just and caring society for all”.
Embedded in this new social architecture is the recognition that poverty is structured and is rooted in the economic and political systems that influence people’s livelihoods. It follows therefore that the sustainable creation of livelihoods must be predicated on the notion that development of people’s ability to change their conditions is an inescapable imperative.
A contract involves two or more parties agreeing to certain conditions. The Jamaican people must recognize their role as citizens of Jamaica and a global village. We must begin to help the Jamaican people to appreciate the link between their conduct, values and behaviour and the general social and economic performance of the country.
To illustrate, we could save some 2 billion dollars in the health sector this year if Jamaicans resolve to settle their differences in a peaceful manner, obey the rules of the road and reduce motor vehicle crashes.
There could be a significant reduction in health expenditure on chronic diseases if people commit to give up smoking, alcohol and walk for even half an hour each day.
Think of all the things that we could do with US$170.4M which represents the direct cost of diabetes to the Jamaican economy.
Around the world, there is a death every second from diabetes. An amputation occurs every 30 seconds. Diabetes is the leading cause of blindness and the leading cause of kidney failure.
Here in Jamaica, government and people must come together to craft a new social engagement that will help us to achieve health and human security.
Together we can save lives every day. We can roll back many diseases that plague us and we can mitigate the impacts of climate change.
The future presents many challenges but opportunities abound. We can choose to slavishly abide by traditional notions and continue to establish lines of demarcation to secure old boundaries. Or we can choose to create new policy spaces and re-design a new social architecture with its fundamental tenet embodied in the concepts of human rights and respect for the dignity of all.
As we ponder on the choices before us, I would like to bring us back to the essential goodness of a man in whose honour I am presenting this lecture tonight.
I do so by recalling a statement that he made when he was Prime Minister and I quote “The interest of this Government and the nation is one and indivisible, and we intend to apply ourselves to cementing this interest so that our voice will be your voice, our actions, your actions and our successes, the successes of all the people of Jamaica.”
HL could speak with a credible voice about inclusive governance. He is the only Jamaican to have worked at all levels of the political process up to the rank of Prime Minister. He was a Councillor, Member of the Privy Council, Senator, Minister, Deputy Prime Minister and Prime Minister.
If Hugh Lawson Shearer could have chosen for us tonight, he would have chosen the path that would lift his people out of the darkness of ignorance, the pain of sickness and the misery of poverty. He would have been guided by the voice of the people, and the dreams and aspirations of Jamaicans. He would have gone where even angels fear to tread if that road would have led to a new and brighter day for the Jamaican people.
He would have moved the boundaries and re-designed a new social architecture to push our people and country forward. And so must we.
Our history will judge us harshly.