Caribbean public health: achievements and future challenges
Authors: C James Hospedales
Journal: The Lancet Public Health (2019)

The Caribbean Public Health Agency (CARPHA), one of the three multinational public health agencies in the world, commenced operations on Jan 1, 2013, with the aim of delivering the functions of five previous regional health institutions (Caribbean Epidemiology Centre, Caribbean Environmental Health Institute, Caribbean Food and Nutrition Institute, Caribbean Health Research Council, and Caribbean Regional Drug Testing Laboratory) through one platform for greater synergy and cost-effectiveness and as the principal institutional expression of Caribbean Cooperation in Health.1Carrillo Roa A Santana JP Regional integration and south-south cooperation in health in Latin America and the Caribbean.Rev Panam Salud Publica. 2012; 32: 368-375Crossref PubMed Scopus (11) Google Scholar CARPHA provides public health surveillance, emergency response, laboratory, information, research, training, and policy development services that benefit a diverse population of 17 million people in 24 English, French, and Dutch-speaking member states and territories. The region also received 57 million visitors in 2018, mostly from North America, the UK, and Europe. CARPHA has had several key achievements. First, it coordinated regional health security in response to Chikungunya and Zika, including intensified surveillance and vector control, scaling up of testing through the Caribbean Public Health Laboratory Network, and public education.2Olowokure B Francis L Polson-Edwards K et al.The Caribbean response to chikungunya.Lancet Infect Dis. 2014; 14: 1039-1040Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar, 3Zika virus outbreak in 19 English- and Dutch-speaking Caribbean countries and territories, 2015–2016.Rev Panam Salud Publica. 2018; 42: e120PubMed Google Scholar Second, CARPHA involvement in research has included hosting the Annual Caribbean Health Research Conference (the longest-running health conference in Latin America and the Caribbean), building research capacity through training, establishment of a network of research ethics committee chairs, and a register of human trials. It also continues to advocate for legislation governing research on humans. Third, CARPHA has introduced new value-added services, such as the Field Epidemiology and Training Programme and the Tourism and Health Programme, aimed at improving health monitoring, food safety, and environmental management, which it did in partnership with the Caribbean hotel and tourism industry. It also launched the C3aribbean Regulatory System for pharmaceuticals, in partnership with the Pan American Health Organization and WHO.4Preston C Chahal HS Porrás A et al.Regionalization as an approach to regulatory systems strengthening: a case study in CARICOM member states.Rev Panam Salud Publica. 2016; 39: 262-268PubMed Google Scholar Finally, CARPHA has shown leadership and innovated by, for example, raising awareness of child obesity prevention related to the economic sector with a six-point policy package for healthier food environments.5Kirton J Knight WA Hospedales CJ Hippolyte D Kulik K Regional and global impacts of the 2007 Port-of-Spain Declaration on noncommunicable diseases.Rev Panam Salud Publica. 2018; 42: e194PubMed Google Scholar It has raised awareness of climate change as a major regional public health threat to small island developing states. In June, 2018, CARPHA launched the International Agency for Research on Cancer Caribbean Cancer Registry Hub for its member states. The Caribbean has made many gains in health, but it has an unsustainable burden of chronic non-communicable diseases and injuries, an ageing population, unprecedented disease, environmental, and climate challenges, and is not on track to meet the Sustainable Development Goals. However, cost-effective solutions exist, such as the WHO's Best Buys for non-communicable diseases6Allen LN Pullar J Wickramasinghe KK et al.Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015.BMJ Glob Health. 2018; 3e000535 Crossref PubMed Scopus (57) Google Scholar or the shared services that CARPHA provides in regional public health lab services, which require everyone to work together. In that regard, CARPHA is in a unique position to lead and encourage change in countries and political processes, regional institutions, academia, civil society, the private sector, and international partners, such as the Pan American Health Organization and WHO, which it can achieve in part by leveraging digital health and other technologies. With half of CARPHA's funding coming from member states and half from partners, it is a practical example of South-South-North cooperation. The EU, the USA, the UK, Canada, France, Germany, the Netherlands, and Latin American countries have particularly intertwined interests in the Caribbean. Other regional and international partners are invited to join this noble mission to make a difference to health and development within the Caribbean. I declare no competing interests. The Caribbean response to chikungunyaAs of Oct 6, 2014, the Caribbean Public Health Agency (CARPHA) has reported 7981 confirmed cases of chikungunya since December, 2013, when the first cases were reported from the French Caribbean island of Saint Martin.1 These are the first occurrences of autochthonously transmitted chikungunya to be identified in the region. As with several other viruses that have spread as a result of human behaviour and globalisation, local spread was probably originated in a traveller returning from an affected area overseas. Full-Text PDF