Communicable disease control as a Caribbean public health priority.

The English-speaking Caribbean is in transition toward communicable disease health patterns seen in the more developed world. Structural adjustment policies in recent years have weakened control measures, such as water supply and sanitation, as illustrated by recent outbreaks of typhoid fever in Jamaica (1990-1991), increased malaria incidence in Suriname and Guyana (with temporary importation into southern Trinidad in 1991), an upswing in tuberculosis in some countries, and the occurrence of cholera outbreaks in Belize, Suriname, and Guyana. The emergence of epidemic cholera throughout most of Latin America in 1991, and Caribbean mainland countries in 1992, aroused concern. Deteriorating socioeconomic conditions and the consequent communicable disease risk underscored the absence of communicable disease control in the Caribbean Cooperation in Health (CCH) strategy which was adopted in 1986 by the countries of the Caribbean Community. The Caribbean Epidemiology Center (CAREC) offered the following analysis: At least four out of seven CCH priorities already directly address critical aspects of communicable disease control, and therefore the question arises whether communicable disease control should be recognized as an explicit CCH priority. Beyond cholera and the diseases already represented in the CCH strategy, there are only a few other communicable diseases that warrant specific attention at this time: tuberculosis; leprosy, which CAREC member countries may want to eradicate; and leptospirosis, a zoonosis (communicable disease of animals transmissible to humans) thought to be the most frequent disease of this type in the Caribbean. These three conditions are insufficient to justify a distinct communicable disease grouping within CCH. However, if all communicable diseases of public health importance were to be grouped together (AIDS/STD, vaccine-preventable diseases, food- and waterborne diseases, vector-borne diseases), such a group would be important enough to justify a distinct priority category, with several major subcategories.