Provides support to the Ministries of Health in developing comprehensive mental health systems. The process is done in collaboration with regional and international institutions, Universities, NGOs and the private sector whenever feasible, emphasizing the development of:
Mental health is identified by the Caribbean Cooperation in Health initiative as one of the eight priorities for the region. During the September 2006 Caucus of CARICOM Ministers Responsible for Health, mental health was once more recognized as one the three main areas of concern needing immediate action.
A Mental Health Policy Framework for the Caribbean was developed and endorsed by the Ministers of Health during the October 2007Caucus of CARICOM. The document defines the main concerns and the key strategic areas to be developed at sub-regional and country levels.
Despite the efforts and progress made over the last years, the general situation of mental health in the sub-region lies behind many other areas. There is no comprehensive assessment of existing resources and possible barriers for the development of mental health systems that will respond to the needs of the population of the sub-region. Substance abuse, particularly alcohol abuse, is another area of concern and there is a lack of epidemiological research on alcohol consumption and its consequences. In general, gaps in information on the status of mental health and substance abuse in the sub-region needs to be better identified for a proper implementation of effective policies and plans.
Many initiatives have been undertaken at country and sub-regional level during the last few years. Legislation, policies and plans were developed by many countries; however, implementation continues to be a problem for most. One possible reason for the difficulty in implementing reforms is the absence, in most of the countries, of a mental health official or focal point in the Ministries of Health who could move the agenda forward.
In order to overcome part of the information gap, most of the countries have initiated the implementation of the WHO Assessment Instrument for Mental Health Systems (WHO - AIMS), a comprehensive mental health systems assessment tool developed by WHO to facilitate identification of gaps and promote appropriate planning. The results will help countries in their efforts to improve the current situation. A few countries have already finalized the process (country reports are available at the PAHO and WHO mental health WebPages).
It is important to emphasize that there are in the sub-region very good examples of mental health practices that are being promoted within and outside the Caribbean.
Sub-regional meeting of mental health stakeholders - Countries represented: Antigua & Barbuda, Bahamas, Barbados, Belize, Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, St. Kitts & Nevis, Saint Lucia, St. Vincent & the Grenadines, Trinidad & Tobago, Turks and Caicos.
The United Nations Framework Convention on Climate Change (UNFCCC) defines climate change as “change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods.” The United Nations (UN) and the Intergovernmental Panel on Climate Change (IPCC) have devoted considerable time to analyzing the issue of climate change.
Climate change is not new to the health sector. The first scientific report on climate change and health was released by World Health Organization in 1990. In 1995, PAHO presented the issue at the National Academy of Sciences during a conference on climate change and human health. Since then, PAHO has worked to increase awareness, information and initiate risk assessments in the Member States. Nowadays, these actions must be scaled up. Climate change is a more serious threat than anticipated in the early 90s, affecting mostly vulnerable populations with the worst health conditions, and those threatened by multiple environmental risk factors. The impact of climate change on health could seriously challenge the public health advances made, and thus calls for heightened awareness and preparation to face emerging threats. This fact is reflected in the agreements made during the 61st World Health Assembly in its Resolution WHA61.19 (2008).
Globally, people at greatest risk include the very young, the elderly, the infirm, migrant populations, indigenous populations, poor communities, and poor women in particular. Low-income countries and areas where under-nutrition is widespread, education is poor and infrastructure is weak, will have the most difficulty in adapting to climate change and the related health consequences. Vulnerability is also determined by geography, and is higher in areas with a high endemicity of climate-sensitive diseases, water scarcity, low food production and isolated populations. Moreover, populations considered to be at greatest risk are those living in small-island developing states, mountainous regions, water-stressed areas, mega cities and coastal areas in developing countries, as well as the poor in urban and rural areas and those lacking access to health services.
The adverse health impacts of climate change can be both direct and indirect. Direct impacts result from climatic extremes such as thermal stress and weather disasters. Indirect impacts result from climatic influences on vector-borne disease transmission, water- and food-borne disease transmission, and food and water security. Indirect impacts also include the consequences of social and economic dislocation, including population displacement. Current population vulnerability influences the capacity to respond to the impact of climate change. Effective adaptation strategies should identify population groups that are unable to cope with the effects of climate variability and extremes. At risk populations live in areas prone to floods, droughts, and heat waves. The most vulnerable groups include children under five, pregnant and lactating women, older adults, marginalized, rural, urban, indigenous populations, and displaced populations. Vulnerability can further be exacerbated by other stress factors such as poverty, food insecurity, conflict, and disease.
The two ways in which societies can actively respond to climate change are through mitigation and adaptation. Mitigation aims to reduce, delay or avoid impact through interventions that reduce the sources of greenhouse gases or those that enhance gas-absorbing "sinks." In the sphere of public health, this involves primary prevention aimed at preventing the onset of injury or illness. Adaptation is defined as an adjustment in the natural or human system in response to changes produced by climatic stimuli. Mitigation and adaptation must be addressed by civil society, industry, government and other sectors, while taking into consideration the cultural diversity of the Region and the need to increase the awareness of many of our citizens.
PAHO and WHO are closely collaborating on the topic of climate change in the Americas and worldwide, in an effort to increase awareness of its health consequences, assess country-specific risks, strengthen health systems to ensure adequate protection from climate-related risks, and enhance the inclusion of a public health perspective on climate change decision-making in other sectors. The Organization developed a plan of action based on the regional country profiles reviewed during a Regional Workshop on Climate Change and its Effects on Health in the Americas, held in Brazil from 9 to 11 April 2008. This action plan was presented to Member States during the 48th Directing Council.
PAHO is currently piloting guidelines on vulnerability and adaptation assessment and during 2010-2011 will be providing technical cooperation to countries for carrying out these assessments, in addition to other activities on the Plan of Action.
An Environmental Health Indicator (EHI) is defined as one that provides data on environmental quality and its impact on public health (PAHO, 2000). It is a measure of health, environmental quality, or sociodemographics which is important for monitoring the overall health of the population. They provide information about a population's health status with respect to environmental factors, and can be used to assess health or a factor associated with health in a specified population through direct or indirect measures. They may be used to assess baseline status and trends, track program goals and objectives, and build core surveillance capacity in state and local agencies.
The best indicators are those that reliably predict the relationship between human health and the environment, are routinely collected, and have well-accepted definitions and data collection standards. Indicators may be particularly useful when clear measurable links are not available. As such, they can measure health or a factor associated with health in a specific population.
Environmental health indicators can be effective tools for understanding environmental health in specific geographic areas. They can help raise awareness of environmental health and inform policy making. Their creation will help to fill gaps between information on environment and information on health, putting into focus special vulnerabilities in order to help guide environmental, health, and development policy.
Models or frameworks of our comprehension of, for example, the link between water quality and human health, often represent the components in a linear fashion to more clearly articulate causal connections. With the understanding that the situation is often more complex in reality, models provides a framework for the organization and development of indicators at various points along the chain (Kjellstrom and Corvalan, 1996). One of the most recognized of these "frameworks" of understanding is that of the "Pressure - State - Response" model developed by the Organization for Economic Co-operation and Development (OECD). A model developed at the World Health Organization took a broader approach to include macro driving forces in the pressures on health and the environment. The model was called the "Driving Forces-Pressures-State-Exposure-Effects-Action (DPSEEA) framework". The DPSEAA model is useful as it covers the full spectrum of potential forces and resulting actions and brings together professionals, practitioners, and managers from both environmental and public health fields to help orient them in the larger scheme of the problem.
Environmental Health indicators are incorporated into the Caribbean Cooperation in Health Phase III, for measuring progress towards to Environmental Health goals.
At the Caribbean Caucus meeting held at the occasion of the 48th Directing Council (September 29 to October 3, 2008), the Ministers of Health of the Caribbean and CARICOM delegates expressed their anxiety to the Director of PAHO regarding the absence of a coherent PAHO health and tourism program in the Caribbean. Consequently, the Director instructed that the PAHO managers within the sub-region develop a harmonized strategy to use the resources of PAHO, earmarked for the execution of technical cooperation and impacting on tourism, in a non-fragmented manner. Therefore, on April 2 -3, 2009, the First PAHO Caribbean Sub-regional Working Group Meeting on Health and Tourism was held in Barbados, attended by 14 staff members from PAHO offices and centers that serve the Caribbean sub-region.
The Working Group took note of several reports and declarations related to tourism in general, but specifically to health and tourism. One such declaration was that declared by the Heads of State of Governments at the Association of Caribbean States (ACS) meeting on Trade, Tourism, and Transportation, held in Port-of-Spain, Trinidad and Tobago on August 14-18, 1995. There the Heads declared that "the tourism industry constitutes the major vehicle of development for many of the small states of the Caribbean region and that it is not only the single economic activity common to all ACS States but also a priority economic sector for all the states concerned". In April 1997, the Heads of State and Government, at the 17th Inter-American Travel Congress, had again acknowledged "the importance of tourism to the economies of the countries of the hemisphere and the valuable role it plays in promoting understanding among the people of the Americas".
An Action Plan was developed taking into account the progress made, and the conclusions of the Inter-American Advisory Committee Meeting on Health and Tourism that was held in Managua, Nicaragua on December 4 – 6, 2007. At that meeting, and based on the Travel and Tourism Competitiveness Index (TTCI) framework, PAHO and its strategic partners, agreed to follow a set of selected actions and policies, aimed at attaining the optimum conditions for a sustainable tourism development. The Action Plan was designed to allow the PAHO partners to work in a more harmonized and less-fragmented way. The role of the Office of Caribbean Program Coordination was deemed important in providing the required sub-regional leadership through the Plan for the attainment of a sub-regional strategy in which the respective country programs may be critically linked.
The Heads of Government have promoted the free movement of skilled professionals across the Caribbean Community since 1989. This is supported in the revised Treaty of Chaguaramas, Protocol 2, which deals with the establishment of goods and services and the establishment of equivalency of qualifications to support free movement (Article 35e). Several initiatives have already been set in train in the Region to address the issue of assessing equivalency, with a focus on harmonization of training programmes. The development of a Regional Accreditation Agency and National Accreditation agencies have been proposed and accepted by the Ministers of Education and the Meeting of the Council for Human and Social Development (COHSOD).
Meetings of Tertiary Level Institutions and Ministries of Health of CARICOM Member States in 1994, 1995, 2000 and 2002 have defined the skills and competencies of the Environmental Health Assistant (EHA), the Environmental Health Officer (EHO) and the Environmental Health Specialist (EHS). The Meetings also defined curricula and credit hours utilizing the Qualifications Framework accepted by the CARICOM Education Sector.
The range of responsibilities of the Environmental Health Practitioners has expanded considerably over the last two decades. This has been in response to the new challenges posed by expansion of the national food industries, the endemicity of the Aedes Aegypti mosquito and high transmission of the dengue fever and other vector-borne diseases, the global market economy (WTO), the rapid expansion of tourism, the transhipment of waste, and the emergence of new communicable diseases. These new challenges have thus created a demand for the refocusing of training programmes to deal with issues such as food safety, air quality, vector control, health education/promotion, solid waste management and environmental health impact assessment.
The "Three-Step Training Programme" is designed to firstly enhance the management of Environmental Health Programmes in CARICOM states. At the same time, it is expected to enhance the caliber of persons working in the Environmental Health field in CARICOM states.
The specific objectives were:
Other Agencies collaborating in environmental health
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