First of all, let me say how deeply honoured I feel to have been selected as a prime celebrant for this event.

My sentiments arise obviously because of the significance of this occasion in the evolution of the Caribbean Epidemiology Centre - CAREC - as, undoubtedly, one of the premiere public health institutions in the region, and, indeed, the hemisphere.

But I am gratified additionally, and perhaps even more importantly, because this event, on the basis of your historical account, Mr. Director, is also a tribute to the vision, the enterprise and the initiative of our own people, as well as an opportunity to hail an example of the excellence of which they are capable.

What is quite important to understand and even celebrate is that this excellence is borne out of that unrelenting quest our people for self-determination. It is quest that has fired our march and progress towards integration and independence over the last four decades.

But given the tremendous contribution of the many international alliances CAREC has been able to attract and nurture over the years and specially alluded to in your narrative this morning, Mr. Director, it is also noteworthy that in their desire for self-determination, our people were never too proud nor arrogant to dismiss, nor to not recognize the value of interdependence.

Accordingly, today CAREC continues to reap the benefits of this type of co-operation which, in turn, can only be to the advantage and redound to the benefit of the people at the heart of your mission as a public health institution.

Mr. Director and members of the CAREC family, since your celebrations challenge us to celebrate the past and imagine the future, I, in turn, would want to challenge you to accept that the past in not that distant, and that the future is UPON US. In other words, you have the advantage of relatively fresh memories of your experiences including your successes and your shortcomings. But conversely you also share the disadvantage of having to act fairly quickly if the lessons you have learned from those experiences are to be translated and adequately applied to the demands that immediately confront you. That is an imperative if you are to deliver on your mission to improve the health status of the peoples of the Caribbean.

Your mission complements and, in a way, extends into a regional framework the mission we have set ourselves at the Ministry of Health. But improving the health status of our peoples is evolutionary and demands so many pre-requisites. It is in this context that I see a shorter and more medium-term vision. It is a vision that requires a re-orientation of all of our peoples in their thinking and attitude towards the question of their health.

It remains a fallacy for people to envision wellness in the exclusive context of hospitals, doctors and nurses, surgery, treatment, medicine and so on. We need to step back a bit, and initiate that process of good health to the point of when we are in fact not ill, and what we do and how we do it to remain being well, and to know how to act when in fact we do become ill.

In effect, the paradigm shift is for a dramatic change in behaviour, and sometimes I wonder why is it that people cannot understand that underlying most of the causes of PREVENTABLE ILL-HEALTH AND DISEASE is the issue of their own behaviour.

Consider the demands that are made on our institutions, particularly our emergency services. Most of these are for conditions that are preventable and treatable. And if people assume are more intimately in the process of staying well, our institutions will not be subject or reeling to the type of strain and continuous crisis that pervade their operations.

If we are more responsible in our driving habits: if we wear our seatbelts, if we do not drink and drive, injury and other trauma, not to mention death, from vehicular accidents will not be such a prominent feature of the routine of the casualty at our hospitals. If we consider the debilitating impact of alcohol and tobacco on both our physical and mental faculties, then we will be less concerned with treating non communicable and chronic illnesses like diabetes, heart and liver disease, not to mention the fall out of domestic violence which has now reached proportions so phenomenal and disturbing in Trinidad and Tobago, that it is not only breaking up families but physically annihilating them. If we do not indulge in careless sexual practices, the seemingly inexorable upward spiral of HIV incidence and death from AIDS will be halted and another generation of healthy and productive Trinidadians and Tobagonians, and consequently, a most viable state would be assured.

Do not get me wrong. I am not at all suggesting a de-linking of the government and the state in providing the resources and leadership, and creating the policies for effectively improving the health status of our people.

That is why as a government we are on the verge of finalizing a policy document for the ratification of cabinet which is intended to ensure the most stringent control on domestic advertising and promotion of smoking, including banning the sale of cigarettes to minors, and restricting the type of activity that could be sponsored by tobacco selling companies.

That is why we now have a bill before the Parliament that would prohibit the sale of alcohol to minors, having already instructed our schools to desist from making alcohol available in functions.

That is why we have launched very successful pilots in Tobago and in the North West region to make anti-retroviral DRUG TREATMENT to HIV positive pregnant women in order to reduce mother to child transmission of HIV.

That is why we are giving the most careful consideration to all of the ethical issues involved in the search for a vaccine to combat HIV, and by the end of this month, we will be receiving from a specially government appointed committee relevant recommendations to further guide our thoughts and action on this issue.

But no amount of governmental policy and/or legislation and other statutory action will be effective by themselves or with exclusive government policing.

That is why my shorter-term vision is to have our people, and I mean our people at all levels, become more intimately connected with the overall responsibility of a healthier and happier nation.

I fear that in seeking a time frame to achieve this, from what I have been reading in the newspapers, June will be too soon. That is why I will need more than one term as Minister of Health… maybe I will need a term that spans a generation.

However, giving it a shot I will, and come April, we at the Ministry will want to mobilize the entire national community in this particular regard. Our health promotion month will wish to demonstrate that collective action in health is what is required if we are to successfully lift the burdens that are now so unnecessarily weighing down on the health sector, and if, also, we are to make people more productive to the obvious economic advantage of Trinidad and Tobago in the long run.

That is why I want to stress, Mr. Director, CAREC's welcome role in the type of work that is required in dealing with non-communicable and chronic illnesses. Your sterling performance in the elimination of such threats like polio AND measles and yellow fever must be among the milestones of Caribbean achievements in health and are more than worthy of celebration. But this new era we have entered demands fresher outlooks to propel more dynamic action on those other fronts that are rooted in the behaviour of people.

In this context I wish to hail your relatively new incursions into areas like the health and tourism area. I am sure we in Trinidad and Tobago will find tremendous benefits from this particular project as we redirect energies into the tourism thrust, including the whole area of food safety. But such efforts must not be seen merely as support for healthy tourists as a plank of our aspiration towards the creation of a vibrant and rewarding tourism industry, which is among those pillars we are laying for a solid economy. They must result in policies for the health and safety of all of our people around whom, we must remember, the entire economy is dependent, shaped and constructed.

All that I have outlined, I hope, assumes special appropriateness to my charge at one of your meetings a couple years ago, that if CAREC was to remain relevant, the institution needed to provide information for public health action that was informed by an understanding of the costs and benefits to the peoples the Centre is charged with serving.

The significance of my assertion remains underlined by the fact that the future we have now entered is an age or an era, if you will, in which information is truly power. What is more, is the technology that is driving information has been quite successful in eliminating time and distance, and has truly transformed this world into a global village. It reminds me of a headline in the prestigious and credible British Medical Journal IN 1997, which said simply: "Distance is dead. The world will change."

And just in case you do not take this as seriously as I do, consider that just a little more than a week ago, we were able to remain in our living rooms here in Trinidad and Tobago on the eve of the New Year and witness the first dawn of the new millennium immediately as the rays of sun embraced the distant beaches of Kiribati thousands of miles away in the far off Pacific. Frankly, would have desired that the arrival of 2000 over New Zealand would have meant new fortunes for the West Indies cricket team, but from all appearances that is not to be. Nevertheless, we will continue our rally around the West Indies and I am confident that the hoisting of the flags of our West Indian brothers and sisters here today is also symbolic of CAREC's renewed pledge to rally around the wider West Indies for the better health of the populations.

In appraising the extent to which information technology has transformed the world into that global village, what I want to emphasize is that Trinidad and Tobago, and, indeed, the Caribbean, cannot afford to be on the periphery of that village. We must aspire to take our place centrally if we are to successfully exist in this era, and I do not think I am being selfish as the Minister directly concerned when I say our attention to the good health of all of our peoples must be paramount in our efforts to compete and deliver in this new and challenging environment.

CAREC must therefore be congratulated for its initiatives to invest in the latest information technology to ensure timely and qualitative diffusion of its work to inspire the soundest public health policies by governments and other decision makers. As governments, we too must be prepared to embrace the technology so as to ensure that the information flow is not one way.

Let me repeat something I said to you a couple of years ago.

"If CAREC did not exist today, we in the region would have to invent it, as no surveillance and early warning system can be mounted by one country, no matter how well resourced it is.

The creation of a Council for Social and Economic Development helped in enabling us to further redefine our approach to health in the Caribbean.

It has enable us to come up with the Caribbean Co-operation in Health which promotes health as that state of well being which goes beyond the absence of disease, and includes mental, spiritual and emotional health. The recently published CCH vision "recognizes also that the factors effecting health go far beyond the ambit of the health sector and encompass the physical and social environment, and the individual's genetic makeup and lifestyle."

It suggests that interventions for improved health must include education for healthy life choices and skills, food security, satisfactory housing, access to potable water supplies and proper disposal of waste.

From my examples this morning, I trust you will have understood that we in Trinidad and Tobago are firmly behind that approach and that vision which seeks, in the new millennium an era in which Caribbean people will be happier, healthier and more productive, each respected for his or her individuality and creativity and living more harmoniously with cleaner and greener environments… with Caribbean countries helping themselves and one another to improve opportunities and systems for health in the region… with a goal to improve and sustain the health of the people of the Caribbean… adding years to life and life to years for all.

With this outlook, how could an institution like CAREC not command an indispensable place in the Caribbean?

It all reaffirms my suggestion to you as I visit the past once again, that the complex regional health situation, with new emerging and re-emerging health and disease problems that threaten the health of local populations and the tourism industry, re-affirms the underlying need for a Caribbean public health institution, as foreseen by the visionary leaders of this region, led by Trinidad and Tobago, when they proposed its creation in the early 1970’s.

As these flags flutter gaily behind me this morning, I, along with all of you salute with pride how many new horizons that vision has now embraced through the work of CAREC - more than justification for you to celebrate the past - and I now look forward, Mr. Director and the CAREC family, imagining the future with you.

Thank you very much.

Caribbean Epidemiology Centre
16-18 Jamaica Boulevard, Federation Park
P.O. Box 164, Port of Spain
Republic of Trinidad and Tobago
Tel: (868) 622-4261, Fax: (868) 622-2792
E-mail: postmaster@carec.paho.org

Page last modified 14 February, 2000