No more smoking in enclosed public spaces from Ash Wednesday

Minister of Health Jerry Narace

Permit me to use this forum to advise the national community that the Tobacco Control Act will be proclaimed in parts, starting with the enforcement of smoke free enclosed public spaces, which will be in effect on Ash Wednesday (February 17th 2010 ).

OPENING REMARKS BY SENATOR THE HONOURABLE JERRY NARACE THE MINISTER OF HEALTH OPENING OF SPECIAL MEETING OF COHSOD – HEALTH FEBRUARY 5TH, 2010, 2:00pm, HYATT REGENCY HOTEL

 Chairman, COHSOD and Minister of Health, Grenada – Senator the Honourable Ann Peters
 Minister of Health, Antigua and Barbuda – Senator the Honourable Willmoth Daniel
 Minister of Health, Barbados- Senator the Honourable Donville Inniss
 Minister of Health, Belize – Senator the Honourable Pablo Marin
 Minister of Health, Guyana – Senator the Honourable Dr. Leslie Ramsammy
 Minister of Health, St Lucia – Senator the Honourable Dr. Keith Mondesir
 Minister of Health, Suriname – Senator the Honourable Dr. Celsius Waterberg
 Assistant Secretary General, Human & social Development, CARICOM – Dr. Edward Green
 Sir George Alleyne – Member of the Advisory Board, CARPHA
 Dr Rudolph  Cummings – Programme Manager, Health Sector Development, CARICOM
 Mrs Sandra Jones, Permanent Secretary, MOH, TT
 Dr. Anton Cumberbatch, Chief Medical Officer, MOH, TT
 Members of the CARPHA Steering Committee and Advisory Group, Esteemed guests, media, Ladies and gentlemen

Welcome
It is with great pleasure that I welcome all of you CARICOM colleagues to the fourteenth (14th) special meeting of the Council for Human and Social Development (COHSOD) – Health being held here at the Hyatt Regency Hotel in Port of Spain.

Let me say from the onset that you have come at a very special time to Trinidad and Tobago; Carnival preparations are well under way and our people are already in the festive spirit. I encourage you to participate in some pre-Carnival activities and discover the explosion of colour, music, revelry, and creativity of Trinidad's Carnival, which has spawned similar celebrations around the world.

And even though I encourage you to find the time for all the fun activities, it is of course equally important to devote your attention in the next two days on this meeting’s agenda, promote the dialogue around the issues and focus on discussion outcomes.

This weekend’s COHSOD meeting follows on the heels of a very successful meeting of the bureau of CARICOM Ministers of Health which was also held in Port-of-Spain last December.

Haiti and disaster preparedness
As we come together today, we are in full cognizance that we must continue to show solidarity and provide support to our neighbours in Haiti. It goes without saying that one of the most shocking events in our region recently was the catastrophic earthquake in Haiti, which has caused unprecedented levels of loss, chaos, sorrow and human suffering.

As would be expected, therefore, the health status in Haiti since the earthquake was an important item on this weekend’s agenda [and it was discussed already this morning]. We all share a commitment towards assisting Haiti in this vulnerable time in recuperating from this unprecedented disaster. The Caribbean Community has already given assistance to our neighbours.

We are mindful of the immediate contributions made by CARICOM members following the news of the earthquake. Just to note a few countries that rushed to assistance, within twenty-four hours of the earthquake, Jamaica deployed medical personnel and security forces as a first response to Haiti. Jamaica is the sub-regional focal point for the member states - Haiti, the Bahamas and the nearby Associate Members, under the system established by the Caribbean Disaster Emergency Management Agency (CDEMA) for regional response to natural disasters.

Guyana immediately pledged 1 USD million, as did Trinidad and Tobago. Additionally, the Honourable Prime Minister of Trinidad and Tobago attended a high level meeting in the Dominican Republic organized by the EU to discuss Haiti relief plans. That meeting was also attended by the Haiti President, Rene Preval, and other representatives of international institutions and governments. The Prime Minister also announced that Trinidad and Tobago would be inclined to assist in other ways, too, depending on the requirements, and as the situation develops.

Ladies and gentlemen, the situation in Haiti serves as a reminder of the ominous risks of natural disasters to all of us. Ours is a region prone to hurricanes, floods and earthquakes and the need for disaster preparedness is paramount.

This becomes even more concerning, when we factor in climate change. As you know, this was the primary topic of international discussions, both at the Commonwealth Heads of Government Meeting last November and at the Copenhagen Climate Conference in 2009. By now, I hope we all understand the effects climate change can have on public health; it is our responsibility to carry this message through to all of our citizens.

Climate change can cause death and disease through natural disasters including floods, heat waves and droughts. In addition, many important diseases are highly sensitive to changing temperatures and precipitation. These include common vector borne diseases, such as malaria and dengue and other diseases, such as malnutrition and diarrhoea. A link has also been established between climate change and an increase in cancers, mental disorders and the exacerbation of asthma and other respiratory conditions.
Climate change is indeed a sobering phenomenon for CARICOM.  Its socio-economic impact will include negative effects on the agricultural industry with a decrease in exports, disruptions of trade and tourism and increased cost of production of goods and services. All of this, my dear friends, can lead to increased urbanisation and thus overpopulation of cities and increased poverty. This will also take a toll on health, causing increased pressure on our health systems, as the basic health challenges associated with food security, disasters, water and infectious diseases will increase, both in frequency and in severity.

Therefore, being prepared for such dire circumstances becomes now more important than ever. The Ministry of Health in Trinidad and Tobago has been quite proactive in the field of disaster preparedness.. An Emergency Operating Centre, the Emergency Services and Disaster Preparedness Coordinating Unit, was established in 2006 to prepare a Health Disaster Operational Plan for the mobilisation and response of national health services in case of disasters. A Disaster Management Committee, comprising members of different elements of the health sector meets regularly and the Plan is continuously reviewed and updated. In fact, we adapted our disaster preparedness and response plan to serve the fifth Summit of the Americas and CHOGM. These international events gave us the opportunity to review, update, test and implement our plans and we are now confident that in TT we are fairly well prepared. 

Having said that, we recognize that no one is ever fully prepared for disasters of the magnitude we’ve seen in Haiti and there is indeed an ongoing need for continued attention to disaster preparation at both the national and regional levels. 

Moreover, among our topics of discussion in the next couple of days will also be a report of the Regional Insurance Study and a proposal on Health Information Systems which will assist us in strengthening our collective capacity to safeguard the health and safety of our regional population.

Caribbean Cooperation in Health
At this juncture, I also wish to highlight the significance of the Caribbean Cooperation in Health (CCH). The CCH’s primary goal is to improve and sustain the health of the people of the Caribbean. This will result in:
• Adding years to life and life to years [that is, we are not only interested in ensuring that we live longer, but perhaps more importantly, that we age better];
• Increasing equity for health within and among countries; and
• Maintaining universal access to quality care for priority problems.
Thus, ladies and gentlemen, the key priorities of the CCH include: 
• Environmental Health;
• Strengthening Health Systems;
• Chronic Non-communicable Diseases;
• Mental Health, including Substance Abuse;
• Family Health;
• Prevention and Control of Communicable Diseases;
• Food and Nutrition;
• Human Resource Development.
These areas are particularly important as we face the rise in Chronic Non Communicable Diseases in the region and the issues surrounding climate change for the region.

CNCDs
Also up for discussion, therefore, is the regional strategic plan for chronic non-communicable diseases (CNCDs).
My dear friends, the threat of CNCDs on our region is not to be taken lightly. As you may be aware, the Caribbean is the region of the Americas most affected by the scourge of CNCDs.  Moreover, both globally and in the Caribbean, the chronic diseases of concern are heart disease, stroke, cancer, diabetes and chronic respiratory diseases. These are caused by biological factors, such as high blood pressure, obesity, high blood sugar, and high blood cholesterol.

In Latin America and the Caribbean (LAC), chronic diseases are now the leading cause of premature mortality, accounting for nearly half of the deaths of persons under 70 years, and for two out of three deaths overall. Heart diseases, stroke, cancer and diabetes are the main causes of death in Trinidad and Tobago and in the Caribbean at large and these diseases continue to exact a heavy human and economic cost on the nation.
Ladies and gentlemen, the Chronic Non Communicable Diseases (CNCD) epidemic is indeed a considerable health threat. In addition to significantly reducing life expectancy, quality of life and productivity, CNCDs also place growing pressures on our health systems and economies, thus posing a serious threat to sustainable growth and development.
In response to the heavy burden of CNCDs on our region, on September 14th 2007, the CARICOM Heads of Government held an historic summit on Chronic Non-Communicable Diseases here in Port of Spain, spearheaded by the Prime Minister, the Hon. Patrick Manning. The Declaration of Port of Spain adopted by the Heads of CARICOM, comprised fifteen (15) resolutions which outlined the key strategies to be implemented in different sectors and settings, to prevent, control and reduce the burden of Chronic Non-Communicable Diseases (CNCDs). 
As CARICOM states are making progress in implementing these strategies, in continuation of this initiative, at the Commonwealth Heads of Government Meeting held last November, Commonwealth Heads also adopted the Statement on Commonwealth Action to Combat Non-Communicable Diseases. This statement acknowledged that surveillance is critical to effectively warring against CNCDs. As such, they made commitments to supporting initiatives to include the monitoring of CNCDs and their risk factors in existing national health information systems.

Trinidad and Tobago also encouraged the adoption of a statement on CNCDs at the CHOGM which called for:
• The integration of Non Communicable Diseases (NCDs) progress indicators in the 2010 Millennium Development Goals (DMG) review.
• The support for the availability of essential medicines for people living with NCDs.
• A UN Summit on CNCDs in September 2011.
• Integration of NCD prevention into national health systems and the global development agenda.
Tobacco Control Act

Ladies and gentlemen, as we pursue to achieve the most positive outcomes in public health for our populations, it is important to remember the importance of healthy public policy in realizing our vision.
To that end, we believe that the government of Trinidad and Tobago achieved a significant milestone in the fight against CNCDs through the passing of the Tobacco Control Act last December. It is a well-known fact that tobacco is a contributing factor to many of the chronic non-communicable diseases that plague us, including diabetes, cancer, heart disease and hypertension or high blood pressure. I am very pleased that Trinidad and Tobago was able to play a pioneering role in this respect, being the first country in CARICOM to be passing such legislation to the Parliament.

Permit me to use this forum to advise the national community that the Tobacco Control Act will be proclaimed in parts, starting with the enforcement of smoke free enclosed public spaces, which will be in effect on Ash Wednesday (February 17th 2010 ).
Even though the Act was passed a couple of months ago, we made a commitment to undertake a public education initiative before enforcing all of the clauses of Act and to work on the specific regulations to support the Act, which are forthcoming in the not so distant future.
The Ministry of Health will now intensify its public education campaign regarding the Tobacco Control Act, the upcoming proclamation, and the health effects of tobacco use and second hand smoke in general. We shall also be launching a Tobacco Cessation Campaign, as well as other clinical and non clinical smoking cessation programmes to support the people who wish to quit smoking.
Permit me to thank member states for their support in the passing of this legislation and give the assurance of our own commitment to reciprocate that support for other member states when the time comes. .

Closing
In closing, I wish to reiterate the importance of public health to the human and social development of our region. We thus remain committed to finding solutions to public health issues and minimizing public health threats.

We take note of the fact that even though the H1N1 pandemic shows some decreasing trends, we are still in a pandemic phase at the global level and we should remain vigilant and alert. At the same time we take note of the Avian Influenza H5N1 cases that were recently reported in Egypt. Recognizing the potential public health threat of H5N1, we are closely following developments and remain on high alert and surveillance. I thus call on all citizens to continue practicing good hygiene and respiratory etiquette at all times.

Colleagues, we have our work cut out for us in the next two days but I am confident that our deliberations will prove fruitful. I warmly thank you all for your contributions in finding solutions to regional problems and collaborating to ensure health and wellness throughout the Caribbean.

Ladies and gentlemen, allow me the honour of welcoming you once again to Port-of-Spain and I wish us a successful meeting during the course of the next two days.

I thank you and may God richly bless you all.