1. TOWARDS SUSTAINABLE DEVELOPMENT Ministry of Health Perspective Patrick Martin Chief Medical Officer 04/12 Voice & Experience of St. Kitts & Nevis

2. KNOWN: Development at all costs without regard for equity and the carrying capacity of the environment is unsustainable – a prescription for social strife and disaster. Ott, K 2Patrick Martin CMO, SKN

3.  People in small islands are acutely aware of limits/boundaries.  Lives and livelihoods depend on the interaction between the "three pillars" of social, environmental and economic sustainability. Adams, W.M 3Patrick Martin CMO, SKN

4. RE SUSTAINABLE DEVELOPMENT Salient Question How best can the gifts of Providence be used to satisfy daily needs and future aspirations, while leaving a beneficial legacy for generations to come? 4Patrick Martin CMO, SKN

5. ABOUT ST. KITTS & NEVIS Patrick Martin CMO, SKN5 Pop: 52,000 Land Area: 269 km 2

6. STRENGHTS Clean Air Potable water universally accessible Fertile soil Sun (12/24 hours) Democratic Governance Universal health and education Per Capita Income – “Middle” Poverty (2008) – 22% 6Patrick Martin CMO, SKN

7. CHALLENGES Susceptibility & Vulnerability – Geographical: Hit by Cyclones, Tectonic Activity, Climate Change – “Open Economy”: Hurt by global fuel, food, finance market vicissitudes High rates of cardiovascular disorders and diabetes – Over-reliance on imported food Prevalence of substance use and abuse – A driver of mental illness and violence 7Patrick Martin CMO, SKN

8. CHALLENGES Excessive expenditure for imported fossil fuel energy Porous Borders – 60 miles of coastline. Marine Space 5x Land Area. – A national security and public health concern – Relative ease of trafficking in illicit drugs and humans causing ongoing gang violence – Relative ease of entry of new and reemerging infections 8Patrick Martin CMO, SKN

9. OPPORTUNITIES Government Leadership – Prime Minister is Minister of Sustainable Development – Planned development Young, ICT-aware population Significant tracts of agriculture-ready land High interest in exploiting renewable energy – Solar; Wind; Biomass 9Patrick Martin CMO, SKN

10. THREATS High Indebtedness: Forced to borrow at market rates – For human and infrastructural capital improvement – To repair/restore damages caused by natural phenomenon including Climate Change Prolonged global recession – Inimical to tourism earnings (#1 GDP pillar) & FDI (construction # 2 GDP pillar) Land Use/Coastal Zone Tension – Agriculture/Reefs/Green Spaces vs. Housing/Hotels/Golf Courses – Plastic and chemical pollution 10Patrick Martin CMO, SKN

11. PRESENT NEEDS – FUTURE NEEDS Health Sector Contribution Cross-cutting: Continuous advocacy for health in all public policy – Balance concerns for Viability - Carrying Capacity - Equity Equity & Sustainability: Measures of success – MDGs attained before 2000. Need to be sustained i.e. $$$ – High HDI rating. To sustain requires $$$ = Increase investment in government health sector from 2.8 to 5.0% GDP 11Patrick Martin CMO, SKN

12. PRESENT NEEDS – FUTURE NEEDS Questions for RIO+20 How can a small island developing state like St. Kitts and Nevis sustain progress in the circumstances of a prolonged global recession and already felt Climate Change impacts? 12Patrick Martin CMO, SKN

13. PRESENT NEEDS – FUTURE NEEDS Questions for RIO+20 Is it fair that island states with infinitesimally small carbon footprints are victims of others ecological indiscretions? How can a global forum transform empathy to meaningful development partnership? 13Patrick Martin CMO, SKN

14. PRESENT NEEDS – FUTURE NEEDS Expected Outcomes of RIO+20 1.Performance M & E Framework – Commitments to assist countries to develop robust surveillance and information systems, and evidence-informed, response strategies 2.Commitment to Fairness in Development Assistance – Vulnerability indicators trump macroeconomic indicators. “Middle Income” status can be reduced or destroyed by a single cyclone or earthquake. Sustainable Development = Equity, Protection, Solidarity, Partnership, Investment, Performance Metrics, “Good Governance” 14Patrick Martin CMO, SKN