This section is prefaced with an outline of the progress of dementia-related regional plans within the Latin America and Caribbean region, in which Jamaica is grouped. It is important to note that although Jamaica, along with many English-speaking Caribbean islands, is often grouped within the wider Latin America and Caribbean (LAC) region in international plans and policies, the regional plans and policies most likely to be relevant to Jamaica are likely to emanate from CARICOM (The Caribbean Community). This is because CARICOM countries speak the same language, share similar histories, are geographically connected, and are faced with similar socio-economic challenges. CARICOM is the oldest surviving regional integration movement in the developing world and consists of twenty countries: fifteen Member States and five Associate Members (all listed below). It is home to approximately sixteen million citizens and focuses on areas of economic integration, coordination of foreign policy, social and human development (including health and culture) as well as security (CARICOM, 2019).

CARICOM full member states:

• Antigua and Barbuda
• The Bahamas
• Barbados (founding member)
• Belize (official language: English)
• Dominica
• Grenada
• Guyana (founding member)
• Haiti
• Jamaica (founding member)
• Montserrat (official language: English)
• Saint Kitts and Nevis
• Saint Lucia
• Saint Vincent and the Grenadines
• Suriname
• Trinidad and Tobago (founding member).

CARICOM associate member states:

• Anguilla
• Bermuda
• British Virgin Islands
• Cayman Islands
• Turks and Caicos.

One key regional dementia-specific plan which exists for the Latin America and Caribbean region is the PAHO Regional Plan of Action on Dementia in Older Persons (2011-2015), coordinated by ADI. This plan aimed at encouraging countries within the region to develop national dementia plans, promote risk reduction strategies; ensure a rights-based approach to the provision of care and support for people living with dementia and better training for health professionals.

The key stakeholders of this plan included PAHO and ADI members. CARICOM members have low representation relative to non-CARICOM/non-English-speaking countries in the LAC region. Specifically, 4 CARICOM members or associate states are full ADI members, whereas there are 22 non- CARICOM/non- English-speaking countries in the LAC region which are full ADI member states. In  October 2015 in Washington DC, the plan was revisited and aligned with the wider PAHO Strategic Plan (2014-2019).

In December of 2015, the Caribbean conference on Ageing, Elder Abuse and the Rights of Older Persons was held in Dominica, a CARICOM country in collaboration with the Economic Commission for Latin America and the Caribbean (ECLAC) and was attended by representatives of CARICOM (including Antigua and Barbuda, Barbados, Dominica, Grenada, Jamaica, Saint Kitts and Nevis, Saint Lucia, and Trinidad and Tobago), Martinique, UNDP, UWI and OAS.

The conclusions of this conference included recommendations which focused on the need for increased priority and funding to be given to policies for older persons; promotion of physical and mental health of older persons, a call for legislation to protect the rights of older persons and to better regulate LTC institutions, pensions, and insurance (Conclusions of the Caribbean conference on Ageing, Elder Abuse and the Rights of Older Persons, 2015).

It also stated that there is an urgent need for improved pension coverage and policies addressing financial abuse of older persons. Universal health coverage was recognised as a key tool for the prevention and management of NCDs and the need to improve human resources in geriatric care, palliative care and LTC was recognised. The importance of inclusivity was also noted. However, there was no mention of dementia or of the PAHO Regional Plan of Action on Dementia in Older Persons.

There was, however, mention of the PAHO plan in 2017 at the Fourth Regional Intergovernmental Conference on Ageing and the Rights of Older Persons in Latin America and the Caribbean, held in Paraguay. Regional states represented included Argentina, Barbados, Brazil, Chile, Colombia, Costa Rica, Cuba, Curacao, Dominican Republic, Ecuador, Germany, Japan, Mexico, Paraguay, Peru, Bolivia, Saint Lucia, and Uruguay. Only two CARICOM member states were represented, likely due to the conference being conducted in Spanish. At this conference, some countries presented reports on the progress of their implementation of the PAHO plan, as they were included as stakeholders during its development (ECLAC, 2017).

These various reports over the past few years demonstrate the various pathways of progress being experienced by different clusters of countries within LAC. Many Spanish-speaking LAC countries which are larger, are full ADI members and have been previously involved with dementia-related research such as the 10/66 study, and today, they have made some progress with national dementia policies and plans, such as Mexico and the Dominican Republic.

However, CARICOM/English-speaking islands within the region appear to have not been as closely involved with the PAHO regional plan as one may expect due to barriers in language and variations in resources and preparedness available in smaller island states, for example, with regard to dementia-related research.

Nevertheless, CARICOM member states have pursued for many years various initiatives and plans in NCD prevention and management as well as the rights of older persons. It has been acknowledged  the importance of dementia in the Caribbean Cooperation in Health Phase IV Framework (2016-2025) which emphasises multi-sectoral action to address regional problems. Dementia has been identified as one such challenge facing member states, coupled with high levels of chronic disease. This is promising as, firstly, dementia has been categorised by this framework as a challenge similar to that of NCDs and, secondly, the framework outlines its committee’s goal of enabling policies and policy processes shaped by multi-sectoral input.

References:

Caribbean Community (CARICOM). (2019). Who We Are. Available from: https://caricom.org/our-community/who-we-are/#

Conclusions of the Caribbean conference on Ageing, Elder Abuse and the Rights of Older Persons. (2015). Available from: https://jamaicapoliticaleconomy.files.wordpress.com/2015/12/conclusions-of-the-caribbean-conference-on-ageing-elder-abuse-and-the-rights-of-older-persons_final.pdf

Economic Commission for Latin America and the Caribbean (ECLAC). (2017). Fourth Regional Intergovernmental Conference on Ageing and the Rights of Older Persons in Latin America and the Caribbean. Available from: https://repositorio.cepal.org/bitstream/handle/11362/42239/S1700920_en.pdf?sequence=1&isAllowed=y

Pan American Health Organisation (PAHO). (2015). Strategy and Plan of Action on Dementias in Older Persons. Available from: https://www.paho.org/en/documents/cd54r11-strategy-and-plan-action-dementias-older-persons-resolution-2015

Pan American Health Organization (PAHO). (2014). Strategic Plan of the Pan American Health Organization 2014-2019. Available from: https://www3.paho.org/hq/dmdocuments/2017/paho-strategic-plan-eng-2014-2019.pdf