Regarding Henry Fraser's article, "Health and Wealth in the Caribbean" [Vol. 9, No. 2], we feel it fitting to mention the pioneering work of the Caribbean Epidemiology Center (CAREC) in the field of HIV/AIDS prevention and control. The history of the Caribbean response to the epidemic will bear out the fact that it was CAREC that undertook to establish a special program in 1987, quite early in the onset of HIV/AIDS in this part of the world, to lead the charge against the epidemic.
The work of this special unit, known today as the Special Program on Sexually Transmitted Infections (SPSTI), inspired partnerships with and mobilization of governments, the private sector and civil society in general, including the media, the University of the West Indies (UWI), and a range of international donor agencies, for an expanded response to the epidemic. As a direct result of the work of SPSTI, we today have national AIDS programs throughout the Caribbean as well as regional bodies such as the Caribbean Regional Network of Persons Living with HIV/AIDS and the Caribbean Coalition of National AIDS Program Coordinators, and a host of international agencies as part of the response.
Professor Fraser, who heads CAREC's Scientific Advisory Council, will recall that UWI came on board with the Caribbean regional response to HIV/AIDS in September 2000, following a meeting convened by Prime Minister Owen Arthur of Barbados. Even before that, however, CAREC-SPSTI was in partnership with the Health Economics Unit of UWI, drawing attention to the economic impact of HIV/AIDS on the region. Indeed, this led to the paradigm shift that HIV/AIDS in the Caribbean was not merely a health issue but a major developmental one.
James Hospedales
Director, Caribbean Epidemiology Center
Port-of-Spain, Trinidad
In her article "A New Agenda for Health," [Vol. 9, No. 2] Ilona Kickbusch writes of the critical importance of citizen participation and partnerships in efforts to achieve the Millennium Development Goals. I would like to suggest that faith-based organizations be included among the groups that promote both.
In late 2002, the Catholic Medical Mission Board (CMMB) joined the Pan American Health Organization (PAHO) in Action for Family Health/Acción por la Salud Familiar, an initiative that works to reduce mortality and morbidity rates of children under 5. With this alliance, CMMB added the access and trust provided by faith-based networks to the work already begun by PAHO and government ministries in five countries in Latin America and the Caribbean. This was the first time PAHO, the ministries, and a faith-based organization had teamed up. The results to date have been impressive. Since the initiative became operational in 2003, more than 1,100 healthcare workers have been trained in the Integrated Management of Childhood Illnesses (IMCI) strategy, and 61,074 children have received care. Recently, the Bristol-Myers Squibb Foundation joined the partnership, providing funding and operational expertise. This partnership could serve as a role model for countries striving to achieve the millennium goals.
As Kickbusch points out, three of the eight Millennium Development Goals and seven of the 18 specific targets fall directly within the responsibility of the health sector. Health plays a key role in the achievement of many of the other goals, such as the elimination of extreme poverty, universal primary education, promoting gender equality and empowering women. Those of us who recognize health care as a universal human right have been given a powerful incentive to work together as never before. The rewards offered by the Millennium Development Goals dictate that we do.
Barbara Wright
Director of Communications
Catholic Medical Mission Board
New York, New York, USA
Congratulations on your excellent issue of Perspectives in Health [Vol. 9, No.1]. The articles covered important topics in a manner that would interest health professionals as well as a general audience.
The cover story, "Health for One and All: Latinos in the USA," had a minor mix-up of colors in the graph on life expectancy, giving the impression that women have shorter life expectancy than men. The reverse, of course, is true. Your professional readers would recognize this as a graphical error; the general public might not.
More puzzling is the apparently greater life expectancy of Hispanics than non-Hispanic whites, despite Hispanics having higher diabetes death rates, incidence of tuberculosis, rates of cervical cancer, and incidence of overweight and obesity.
The paradox may reflect problems with racial group reporting in census and vital statistics data. The National Center for Health Statistics report Health, United States 2003 notes that death rates by race and Hispanic origin are based on information from death certificates (the numerators of the rates) and on population estimates from the Census Bureau (the denominators). Studies have shown that individuals reported as Hispanic on census and survey records may sometimes be reported as white or non-Hispanic on their death certificates. This results in an underestimation of deaths and death rates for Hispanics. Moreover, young black and white males and the elderly are undercounted in census data. This results in an overestimation of death rates for whites. As a result of this misclassification and undercounting, death rates for whites and blacks are overstated by an estimated 1 percent and 5 percent, respectively, while death rates for Hispanics are understated by 2 percent.
In conclusion, we should not be complacent about the need for improved health for Hispanics in the United States.
Timothy D. Baker
Professor, International Health & Health Policy
Bloomberg School of Public Health
Johns Hopkins University
Baltimore, Maryland, USA
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