Donna Christensen

Health as the Lynchpin to Society - Jan. 1, 2000

Donna Christensen
January 01, 2000
Health Forum
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Good evening and thank you for joining us at this Health Forum that focuses on health as the lynchpin to society. Here in the Caribbean, we have a saying that speaks volumes to the importance of wellness in everything that we do. "As long as I have my health," we tell each other when talking about whatever other challenges we may face. We instinctively know that all else will fall in place, if our health is good.

So we gather today to speak about those things that remain as a barrier to health, the threat of HIV/AIDS, the role poverty plays in our ability to be well and stay well and the role that indigenous remedies play in our attempts to be healthy.

I salute my co-presenters today and their work to promote wellness in this region, the Honorable Denzil Douglas, Harry Belafonte, and the Honorable Marcus Bethel.

This is a conference about those of us in the Diaspora—in the U.S. and the Caribbean, coming together to do business as a means to improving the economic status of the region, and in partnership, the individuals who live and work here, the companies that want to enhance their businesses, and the communities and countries that are affected by these all of these activities.

I would like to thank the CaribNews organization for once again recognizing the importance of health and the link between health and economic development.

I often say, and it is worth pointing out again, that the problems in health care experienced here in the Caribbean are not essentially different from those that we see in the US. The difference is in the resources available to address those problems, and the will to do so!

Even as we look to Sub-Saharan Africa, the difference is in the absolute magnitude of the health challenges, as well as the wide gap between that and the resources that are available to the people.

I hope that next year, we will include brothers and sisters from the continent because it is only when our family is together and strong and when we approach our challenges together that we prosper in a way that is sustainable, and immunized against the varied assaults on our integrity as nations and health and well-being as people.

Just last week I was asked to the National Center for Primary Care led by former Surgeon General, Dr. David Satcher in Atlanta to explore with other panelists the relationship of poverty, education, gender and geography to health outcomes.

It seems a very relevant discussion for us here today.

For while AIDS may be our central focus because of the severe impact it is having on us today and the awesome potential for devastation here, - AIDS cannot be addressed without also coming face to face with these other related challenges.

They must all be dealt with together. For example, poverty rates for blacks and Hispanics typically exceed the national average. In 2001, 22.7 percent of blacks and 21.4 percent of Hispanics were poor. By comparison, 9.9 percent of whites and 10.2 percent of Asians and Pacific Islanders lived in poverty in 2001.

In 2001, both black and Hispanic female-headed families had poverty rates exceeding 35 percent.

Children represent a disproportionate share of the poor in the United States; in 2001, 11.7 million children, or 16.3 percent, were poor. Poverty in the region averages roughly 38 percent of the total population, ranging from a high of 65 percent in Haiti to a low of 5 percent in the Bahamas.

Excluding Haiti, approximately 25 percent of the total population is poor. These estimates place the Caribbean close to a world aggregate average of poverty in developing countries. Income distribution is skewed, though slightly less so than the average for Latin America. The poor include the elderly, children, the disabled, small- scale farmers, unskilled workers, indigenous populations, and in some countries, female- headed households and the underemployed or unemployed, many of whom have not completed an education or who have few skills with which to enter the labor market.

The linkage between gender and poverty shows that subgroups among both women and men are vulnerable. In particular for women in some countries there are problems of discrimination in the labor market, limited rights to land and property ownership and high rates of teenage pregnancy. The male youth is also considered vulnerable because boys in the Caribbean have often lagged in school, lack male role models, and are confronted with high unemployment rates.

Common characteristics among poor households include large family size, low levels of education, overcrowded housing, and limited access to water and adequate sanitation facilities. In Haiti, issues related to food security are also of concern. Most of the poor in the region still live in rural areas, although with the rising rates of urbanization and high vulnerability of the urban poor to economic and social problems, urban poverty has become a major concern.

As an example while the U.S. economy grew at a record pace in the 1990s, contributing to the lowest child poverty rate in over 20 years, the economic conditions for children and families in the U.S. Virgin Islands deteriorated. Between 1989 and 2000, the percentage of children in families with incomes below the poverty line increased from 37 percent to 42 percent. In 2000, almost half of all families with children in the U.S. Virgin Islands (46 percent) were headed by a female householder. This represents a substantial increase over the share of female-headed families with children in 1990 (37 percent). Nationally, the share of families with children headed by a female householder increased from 20 percent to 22 percent.

In preparing for today, I came across the results of two studies from Berkeley and Harvard, which describe how income and poverty relate to health.

What they found has important implications for people of color and for us as your policy makers, especially in the current legislative environment. They reported that what matters most in determining the gaps in health care is not so much the absolute level of poverty but the size of the wealth and income gaps.

Overall, African Americans suffer most from the gap as well as from absolute levels of poverty. One in four African Americans live in poverty, and 1 in 5 Hispanics do.

What the researchers found is that the more unequal the distribution of wealth or income, the greater the death rate, the greater the infant mortality, and many of the other factors affecting the health of people of color, such as higher rates of unemployment, incarceration and higher numbers of people without medical insurance.

Currently, life expectancy at birth: 70 years and infant mortality is 30 per 1,000 births. The Caribbean's leading causes chronic non-communicable diseases are the main causes of death, disability and illness in the Caribbean. Data from the Caribbean Epidemiological Centre (CAREC) indicate that between 1990 and 2000, the leading causes of death in the region were: ischaemic heart disease (due to narrowing of blood vessels supplying the heart), cerebrovascular disease (stroke), cancer, diabetes mellitus, other heart disease and hypertension (high blood pressure), and HIV/AIDS.

In addition, diabetes and hypertension contribute significantly to heart disease and stroke, and diabetes is a major cause of admissions to hospital, kidney failure, blindness and limb amputations.

In our region, it has always been heterosexual sex that is the predominant mode of transmission, although this likely also masks a higher number of men who have sex with men than Caribbean people are willing to admit. The end result is that close to 50 percent of persons with HIV/AIDS are women. Our children, thus are also disproportionately affected.

It is a region where the latest AIDS fatality rate I could find was 63%. There AIDS is the leading cause of death in men 15 to 44. 83% of all AIDS cases are in that same age group., and it I estimated that if incidence rates continue at its present growth,, over 1 million people will be infected by 2010. This would represent a 6.2% prevalence rate for the Region.

Of the 40 million living with HIV or AIDS, almost half or 17.6 million are women, and another 2.7million are under 15. In the Caribbean, it is estimated that there are 420,000, by my calculations there are a similar number -- about 350,000 African Americans living with HIV/AIDS in this country.

But similar to the larger Caribbean countries where women make up close to 50% of those with HIV and/or AIDS, while in the US aggregate, 20 percent of infections are women, in the AA community it is closer to the 31% we see in the Virgin Islands.

There are an estimated 70,000 orphans in the U.S., and 80,000 in the Caribbean. Seven percent of HIV infections in African Americans are under the age of 13, and almost all of those are through prenatal transmission. Mother to child transmission now accounts for 6% of all reported AIDS cases in the Caribbean.

Nine out of the 12 countries with the highest HIV prevalence in the Americas are in the Caribbean basin. AIDS has become a major cause of death among men and women in the 15 to 44 age group in several countries.

An estimated 60,000 adults and children became infected during 2000 in the Caribbean island states. According to the most recent figures, over 7% of pregnant women in urban Guyana tested positive for HIV. Haiti is the worst-affected nation in the Caribbean. In some areas, 13% of anonymously tested pregnant women were found to be HIV-positive. Overall, around 8% of adults in urban areas and 4% in rural areas are infected. It is estimated that 74,000 Haitian children had lost their mothers to AIDS by the end of 1999.

In the Bahamas the adult prevalence rate is 4%. In the Dominican Republic, 1 adult in 40 is HIV-infected, while in Trinidad and Tobago the rate is 1 adult in 100. Heterosexual HIV transmission in the Caribbean is driven by the deadly combination of early sexual activity and frequent partner exchange by young people. For example, in Saint Vincent and the Grenadines, a quarter of men and women in a recent national survey said they had started having sex before the age of 14, and half of both men and women were sexually active at the age of 16.

In Trinidad and Tobago, in a large survey of men and women in their teens and early twenties, fewer than a fifth of the sexually active respondents said they always used condoms, and two-thirds did not use condoms at all. Age mixing, younger women having sex with older men, also drives the Caribbean epidemic. HIV rates are five times higher in girls than boys aged 15-19 in Trinidad and Tobago. At one surveillance center for pregnant women in Jamaica, girls in their late teens had almost twice the prevalence rate of older women.

Looking at the Caribbean, Haiti, the Bahamas, Barbados, the Dominican Republic and Guyana have the highest rates, but Haiti and the Dominican Republic reportedly bear 84% of the burden of the entire region.

There are reportedly 80,000 orphans in the Caribbean ages 14 and under. The vast majority of them are in Haiti.

The U.S. Caribbean territories of the Virgin Islands and Puerto Rico, are not spared. Both are in the top 5 of all states and territories for AIDS incidence rates.

In 2002, more African Americans were reported with AIDS than any other racial/ethnic group and race continues to be a strong predictor of who will receive drug therapy for AIDS, with African Americans 41% to 73% less likely than whites to receive particular drug therapies.

In addition, almost two-thirds (63%) of all women reported with AIDS were African American and African Americans are half of all new AIDS cases annually, and more than half of new HIV infections.

Given these numbers, and the vulnerabilities of the region, while this is a public health crisis of major proportions, it is also fast becoming an economic and security issue.

Already GDP's are being impacted and savings and investments are decreasing in countries where this has been studied. Estimates show that the cost of treating and preventing HIV/AIDS in the Caribbean would consume an average of 5.6% of GDP of many of our island nations.

Labor forces are shrinking, while pension plans are stressed and the current expenditures on HIV/AIDS is reportedly already as high as 35.7% in these schemes.

The urgency of this situation is underscored when we realize that even if the transmission of HIV were stopped today, we would still see this kind of impact continue for some years into the future, with obviously profound consequences for our economic and social development and national and regional prosperity.

It is quite noteworthy and laudatory that the nations and the people of the Caribbean have begun to take aggressive action. Across Latin America and the Caribbean social movements and people living with AIDS have demonstrated their determined leadership. Government have also provided leadership and forged an important force for change -- specifically the Pan-Caribbean Partnership Against AIDS led by CARICOM.

Through their work, access to anti-retroviral drugs has become a court guaranteed right in many of the region's countries. Region wide negotiations in Central American and by CARICOM has brought the prices of AIDS medication down by nearly 90%.

The wealth gap is important because inequality in the distribution of income and wealth has been increasing since the Reagan Era. While the gap began to narrow during the Clinton Administration, today, with tax cuts going to the wealthiest 1%, the poor economy, and the reported jobless recovery into which we are now entering, with higher and longer unemployment for Blacks and Hispanics, it is continuing to widen which bodes ill for our reaching our 2010 goals.

The one major challenge which all of you here today are very aware of is how to protect the small economies of the Caribbean for the economic displacement which is sure to occur with the implementation of the Free Trade of the Americas Agreement or FTAA. Small states by virtue of their size must depend heavily on international trade much more so than large states. However, if they are forced to reciprocally open their markets through the lowering of tariffs, thereby causing increased competition with formerly protected products, this will have devastating consequences for these small countries as opposed to their larger more developed partners which possess higher skilled workers, technology and productivity. But Caribbean officials also acknowledge, that there are long-term opportunities to be gained through the FTAA process as well, but "they insist that they need special and differential treatment if they are to survive among the sharks." Without special treatment for small economies for small economies the rising tide which lifts all boats which the FTAA is often referred as, could as pointed out by Belize's ambassador Lisa Shoman, "swamp" the smaller countries, "who are canoes compared to yachts."

My colleagues in the Congressional Black Caucus and I under the leadership of our Ways and Means Chairman, Charlie Rangel, who is here with us, have repeatedly and consistently insisted that the US support the position put forth my Ambassador Richard Bernal, the Chief Negotiator for the Caribbean Regional Negotiating Machinery, which among other things calls for a longer adjustment period for small economies on import tariffs for example as well as financial support for the cost of implementation of the agreement and assistance in the adjustment period.

Poverty and Health create a vicious cycle, because just as poverty is related to ill health, ill health perpetuates lower incomes and poorer quality of life.

Just to look at HIV/AIDS which is just the tip of the iceberg in terms of causes of death and disability:

Already GDP's are being impacted and savings and investments re decreasing in countries where this has been studied. Estimates are that the cost of treating and preventing HIV/AIDS in the Caribbean would consume an average of 5.6% of GDP of many of our island nations.

Labor forces are shrinking, while pension plans are stressed and the current expenditures on HIV/AIDS is reportedly already as high as 35.7% in these schemes.

There is another form of poverty that is important to this discussion, more insidious and more damaging. And that is poverty of compassion, poverty of fairness and equity and justice.

That is the poverty that presents the greatest barrier to us meeting our health care needs both as communities of color in the US, here in the region and in Sub-Saharan Africa.

And that is why the leadership and the determination to stand for what is right and important to our people, the eloquence of what our leaders are saying to those who wield power in this world is also important to our health.

Which brings me to my last point, which is that the remedy in the final analysis is political action.

The House and Senate Democrats minority health bill; The Healthcare Equality and Accountability Act of 2003 would eliminate health disparities and improve the quality of care for racial and ethnic minorities by: expanding health coverage. To reduce the number of minorities without health insurance, removing language and cultural barriers and improving workforce diversity because culturally competent providers are more likely to serve low-income, uninsured, and minority patients. This act will also fully funding programs to reduce health disparities by providing grants for community initiatives, funding programs to help patients with cancer and chronic diseases to navigate the health care system, and establishing health empowerment zones. Finally the act will improving data collection, promoting accountability strengthening health institutions that serve minority populations by establishing loan and grant programs as well as quality improvement initiatives for health institutions that provide substantial care to minority populations.

I think we are all on the same track, with the Pan Caribbean whatever on HIV/AIDS and our bill. The time has come for a comprehensive and collaborative approach.

But even this effort has been met with difficulty, among the more conservative elements in our party, and given our experience with the Republicans on issues concerning minorities, it faces an uphill battle.

I end where I began with the need for unity among the people of Africa wherever we live. This is critical to our progress.

The need today is for political unity, clarity of purpose and action. In the final analysis, the remedy to our plight as people of color in the U.S., as a Caribbean people, and as people in Africa is a political one.

This is one area that we have spoken about for a long time, but we are today in a critical juncture. We must either "seize the wave at its crest or forever lose the tide."