This week we conclude our discussion of the social challenges that have emerged in the wake of the tremendous social gains, which most CARICOM countries were able to attain in the decades of the 1980s and 1990s.

In this article I want to pay particular attention to health. However, before turning to this topic, I shall make a few concluding comments on gender issues in education, a topic referred to in the two previous articles.

Gender crisis in education

Recently, the view has been widely expressed that there is a gender crisis in education. One that has crept up on the Region, with barely any notice paid to its formation over the past two decades. This is sometimes crudely put as "girls are outperforming boys academically because studying is seen as effeminate." The linkage of boys studying seriously to perceptions of effeminacy, with all its attendant psychological implications for young Caribbean males, does not by itself tell us which is supposed to be the cause and which effect.

As some writers have observed, this claim of a linkage between the two is not new. Moreover, the data we currently have available on it are not really conclusive in their support of this claim. Thus, for example, we find that while male enrolment at certain tertiary institutions may be lower than females, it is not true for all. It has been reported that, at the University of Technology in Jamaica, male enrolment significantly exceeds female enrolment.

Such an occurrence may well reflect a bias of males towards certain science and technology subjects, where the data also suggest that they generally outperform girls. These concerns therefore, have to be added to the blanket observation noted above.

Concern has also been expressed that at the primary level of the educational system, girls outperform boys by the wide margins. Indeed it is claimed that a lower standard is usually set for boys than girls at the Common Entrance level examinations!

While reliable gender data on all aspects of the educational system are not generally available, enough exist to support the view that the social challenges posed by gender in education are enormous.

Particularly as it appears that these problems are linked to such concerns as: family situations and the roles of parents; community attitudes and responses; opportunities in the job market for providing sustainable livelihoods to young persons, male and females; and, the transfer of values through the media and entertainment.

Health

Turning to health, it will be recalled that we had lauded the "health transition", which had taken place in the Region. This is exemplified in such data as regional life expectancy at birth at 70+ years; smaller families (the average family size is just over 4 persons); reduced deaths from communicable diseases; increased vaccination and immunization coverage (a 100 per cent coverage in some countries for most of these); better nutrition; reduced birth and death rates; and, better health care products and services, along with much improved access to these for the broad mass of the population.

Changing life styles

The challenges currently facing the health sector are, however, enormous. There is first of all the challenge posed by "changing life styles". These changing life styles affect such basic areas as physical activity, diet, substance abuse, and sexual behaviour.

This has now reached alarming levels as recorded in cases of drug abuse, obesity, and sexually transmitted infections, especially HIV and AIDS. We have already noticed in this series that the Caribbean stands next to Africa, as having the highest infection rate for HIV and AIDS.

Preventable conditions and special problems

Linked to this is the comparatively recent emergence of health challenges to young persons arising from "preventable conditions". While there is some overlap here with behavioural conditions, as in the case of sexually transmitted infections and HIV and AIDS, this category also includes accidents, murder, and suicide. The grave situation is that, among young persons, these are currently the leading causes of death.

There is also the health challenge emerging out of "special problem areas." This include health problems in the areas of mental illnesses, disabilities, and care of the elderly.

The data we have, suggest that these are growing concerns in the Region, especially as detection and reporting for treatment has expanded with increased health awareness.

Health promotion and linkages

Health awareness is directly linked to health promotion and health education. Because so many of the health challenges identified relate to behaviour, preventable practices, and the lack of information, health education and health promotion play important roles in improved health outcomes in the Region.

To provide this, however, calls for resources, particularly if these efforts are to be sustained. Unfortunately, these resources have not always been available within the Region, and consequently dependence on external assistance for health promotion and health education has been very high.

Health education and health promotion highlight the links between health and other sectors of the society. This linkage calls for broad multi-dimensional approaches in offering solutions. One particular area where the challenges of linkage are mounting, is in regard to the legislative/institutional framework for the provision of health care and the delivery of health products.

Several experts point to the absence of effective health information systems in the Region. They also point to outdated legislation, as well as significant regulatory gaps in important areas like the distribution of pharmaceuticals by the private sector; pesticides; and, the provision of "allied" health services. Other experts also stress the weak institutional coordination, which exists within the health sector. They also go on to point out that there exists as well weak institutional coordination between health and such health-related sectors as water, sanitation, transportation, and education as mentioned before.