Mr Chairman
Honorable Heads of Government
Distinguished Delegates
Ladies and Gentlemen

I am honored to have been invited to this special Summit of CARICOM Heads of Government. Let me congratulate you for the leadership and strategic vision you are demonstrating in uniting to stop the chronic disease epidemic that is undermining human and economic development prospects of economies which can ill afford them. It is clear that for the Caribbean, the Millennium Development Goals (MDGs) need to include NCDs, since the current epidemic also needs to be curbed before 2015.

In convening this Summit, you are showing leadership again, as you did in being the first region of the world to declare and to achieve polio, measles, and rubella elimination, framed within the Caribbean Cooperation in Health. You should be proud, but cannot rest on your laurels, as new threats have emerged, such as the chronic diseases, caused by socially-determined risk factors of unhealthy diet, physical inactivity, tobacco and alcohol. And the fight against NCDs is qualitatively different from that against vaccine preventable diseases, as we are fighting to change the conditions that give rise to these diseases.

I am very happy to be in Trinidad, where I started my public health career with PAHO as an epidemiologist at CAREC in 1984. And I got familiar with the world-class St James Cardiovascular disease study, which more than 20 years ago showed the enormous burden of NCDs. So the NCD epidemic has been creeping up on us for a long time and is now exploding because the protective measures were not seriously considered in the past.

In addressing you, I would like to thank very specially and very warmly, Sir George Alleyne, for the catalytic role he has been playing, beginning with his role as Chairman of the Caribbean Commission on Health and Development, and then in taking the findings to the Cabinets in the Region. I thank all the Commissioners present.

I would like to briefly reinforce certain points made by Prime Minister Douglas in his comprehensive presentation, and outline what PAHO/WHO will do in support of your policy decisions at this Summit.

The Caribbean is facing a triple burden of NCDs, injuries, and infectious and environmental threats undermining social and economic development. And the NCD burden in the Caribbean is the worse in the Americas.

Yet, I am most encouraged at the tangible progress in reducing preventable loss of life from HIV/AIDS - 27% over a 4-year period; a fruit of the vision and leadership you as CARICOM Heads demonstrated when you had a Summit on HIV/AIDS in 2000. The challenge is to do the same or better for chronic non communicable diseases and their risk factors, through actions in the purview of Heads of State.

NCDs are the highest priority in PAHO’s Caribbean regional health agenda, both in country programs supported by PWR offices, and in CAREC and CFNI. And it is the Caribbean situation repeated throughout the hemisphere that stimulated the development of a “strategy and plan of action for an integrated approach to the prevention and control of chronic diseases, including diet and physical activity for the Americas”. This presents a comprehensive approach and provides an excellent framework for Caribbean countries for intensified action against NCDs. This strategy is contained in the packages prepared for all the delegations.

Today, you have taken some strategic, catalytic decisions. I PLEDGE THE SUPPORT OF PAHO in the follow up actions, in collaboration with CARICOM secretariat. Some of these actions you have decided will be universal in all countries. Some will be collectively implemented through the RHIs, PAHO/WHO, the Regional Negotiation Machinery, to engage trade. In addition, I would encourage a wider engagement with the tourism industry, the agriculture and agri-business sector, the insurance companies, consumer awareness and education.

From my point of view, I see three universal actions you have decided upon that will be critical:

First is to Mobilize for action and establish inter-sectoral national commissions which have to engage other government sectors, the private sector and civil society to promote awareness and create public support for the creation of enabling policies and legislation that are comprehensive and multi factorial.

Second is the improvement of financing NCD prevention and control, and the use of fiscal incentives and disincentives to modify lifestyles and risk behaviors. Taxes can be increased to discourage consumption and also to make resources available for funding health promotion activities.

And thirdly, the development of a plan for improving coverage and quality of care for people with chronic diseases, and ensuring that the right components are incorporated in the national and regional insurance schemes. In this we will certainly work with you via our country offices, RHIs and Washington units. Let us aim by 2012, five years from now, for 80% of the population of people with chronic disease being adequately managed including the involvement of patients and families and communities.

A related action is the need to strengthen the public health leadership and workforce capacity to respond to epidemic of NCDs and risk factors. And PAHO would be willing to work with the UWI and CARICOM Secretariat in making such a program a reality. This is a strategic, catalytic action that is needed for effectively responding to NCDs, or to other threats, and for effectively managing the health services.

These types of action are pillars of a comprehensive approach, which has been the approach of all countries that have had significant success in reducing NCDs and risk factors.

And I see you will need an unprecedented communication campaign using all channels to inform and educate people about the risks and what they can do to prevent and control NCDs, and in which the Heads themselves will need to show the way by precept and example.

The challenge is to provide an environment which helps make the healthy choice the easy choice. And that is where the role of Government is so pivotal and the decisions you are taking on improving diet, physical activity, and controlling tobacco and alcohol use are so important.

What will PAHO do to support the CARICOM countries to implement the directions of the Summit? Let me leave you with some of the concrete actions we will take:

• Training and capacity building of countries and RHIs to monitor the epidemic and the risk factors and to plan appropriate responses, using internationally recognized tools and instruments. (e.g., training in policy for OECS countries, October; training in STEPs via CAREC);

• Assist preparation of a revised Caribbean regional plan for NCD prevention (November 4-8 tech meeting in POS.)

• Engage with sister agencies incorporating your mandates and recommendations, for example, IICA is convening the meeting of senior officials of Agriculture October 9 in Jamaica and CFNI will present the case of obesity and NCDs to shape Agriculture and Food policies. PAHO and IICA will introduce this matter in the coming Inter Ministerial meeting of health and agriculture in April 2008.

• Mobilisation of resources and partners to aid the fight, jointly with the CCS. In that regard, PAHO would offer to work with the Secretariat to convene a meeting early in 2008 of donors and partners, including private sector.

• A year from now, we will convene an inter-disciplinary group to evaluate the impact of the Summit, as part of the Monitoring and Evaluation and follow up to the Summit.

In closing, I would like to thank and recognize the joint staff work between PAHO and the CARICOM Secretariat.

I also thank and recognize the Government of Canada through CIDA and PHAC in providing funding to support technical aspects of preparation for the Summit and follow-up policy dialogues, and M&E.

Honorable Heads of Government will recall that at their recent Conference they accepted a recommendation for the establishment of a Caribbean Public Health Agency, to include the existing regional health institutions. The creation of such an Agency will not only strengthen the response to the NCD challenge, but will enable us to more effectively address the wider public health priorities of CCH. PAHO is working assiduously with the CARICOM Secretariat and other partners to ensure that this new institution is in place within the next two years and that it is technically and financially stronger to respond to the needs of the countries.