Correspondence Submissions should be made via our electronic submission system at http://ees.elsevier.com/ thelancet/ www.thelancet.com Vol 394 October 19, 2019 1409 A perfect storm in the Caribbean requires a concerted response The countries of the Caribbean are facing a perfect storm of events that pose a severe threat to the health of their people. 2018 was the third consecutive year of above average meteorological activity, with several countries, including Anguilla and the British Virgin Islands, devastated by major hurricanes. The effects of climate change mean the situation can only get worse. In addition, the high toll of prema- ture deaths from non-communicable diseases (NCDs) in this region contin- ues. The 2007 Port of Spain Declaration, signed by the Caribbean Community heads of government, paved the way for the 2011 UN High Level Meeting on NCDs, 1 but little progress has been made in these countries to date. The region also faces continuing threats from infectious diseases, especially HIV and AIDS, and from violence. Although some countries in the region are extremely safe, others have among the highest homicide rates in the world. 2 Together, these threats would be sufficient to justify governments placing health high on the political agenda, but we must also consider the threats to the economies of these small countries from events elsewhere. Most experienced severe declines in tourism after the 2008 global financial crisis. 3 Now, two of the most impor- tant nations for Caribbean tourism face particular threats, with the USA engaged in a damaging global trade war and the UK in turmoil with Brexit. Although less economically important, the risks to trade in agricultural products must also be considered, given continuing confusion about future trading arrangements. Finally, the crisis in Venezuela is also affecting the Caribbean. More than 100 000 Venezuelan people have already fled to Caribbean countries, with expectations of many more. 4 The health system in Venezuela has largely broken down; the prevalence of HIV, malaria, and tuberculosis has increased to levels not seen for decades, and outbreaks of vaccine- preventable diseases are now affecting neighbouring countries. 5 Extraordinary situations demand extraordinary responses. The countries of the Caribbean cannot tackle these problems individually. As they did in Port of Spain in 2007, we call upon the political leaders in this region to renew their commitment to tackle the threats to the health of the people of this region, but this time to work together to develop a comprehensive approach to these shared challenges. We declare no competing interests. *Sandeep Maharaj, Terence Seemungal, Martin McKee sandeep.maharaj@sta.uwi.edu Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, St Augustine, Trinidad and Tobago (SM, TS); and London School of Hygiene & Tropical Medicine, London, UK (MM) 1 Samuels TA, Hospedales CJ. From Port-of-Spain summit to United Nations High Level Meeting CARICOM and the global non-communicable disease agenda. West Indian Med J 2011; 60: 387–91. 2 Verstraeten SP, van Oers HA, Mackenbach JP. Health policy performance in 16 Caribbean states, 2010–2015. Am J Public Health 2019; 109: 626–32. 3 Laframboise N, Mwase N, Park J, Zhou Y. Revisiting tourism flows to the Caribbean: what is driving arrivals? Washington, DC: International Monetary Fund, 2014. 4 Labrador RC. The Venezuelan exodus. July, 2019. https://www.cfr.org/article/ venezuelan-exodus (accessed May 4, 2019). 5 Page KR, Doocy S, Reyna Ganteaume F, Castro JS, Spiegel P, Beyrer C. Venezuela’s public health crisis: a regional emergency. Lancet 2019; 393: 1254–60. Published Online September 17, 2019 http://dx.doi.org/10.1016/ S0140-6736(19)31822-7 Jose Jimenez/Stringer/Getty Images The collective pushback on women’s health and rights The Editors urge advocates to “produce a stronger, more visible, and unified approach against the conservatism that is slowly eroding women’s rights”. 1 Women’s movements have historically taken this exact approach, and continue to do so, forming alliances globally to resist attacks on our rights. Collective action is needed to fight pervasive threats to girls’ and women’s health and rights; many groups have long led such action. The newly formed Alliance for Gender Equality and Universal Health Coverage (UHC) comprises more than 100 civil society organisations from more than 43 countries. The Alliance stresses the centrality of gender equality and girls’ and women’s rights in UHC policy and decision making. In preparation for the UN high-level meeting on UHC on Sept 23, 2019, we urged the UHC2030 group to recognise gender and to continue to mainstream gender throughout their six key asks from the UHC movement. 2 We also asked UHC2030 to include a seventh ask for gender equality and women’s rights. This could be a key moment to assert and safeguard girl’s and women’s health and rights, especially sexual and reproductive rights, as a cornerstone of sustainable development. UHC has the potential to greatly benefit girls and women, in all their diversity, by addressing their needs. We call on governments to put rights and gender equality at the centre of UHC, to include sexual and reproductive health and rights, to consider gender determinants of health for all genders, and to recognise women’s role in the health workforce, including unpaid care work. At this pivotal moment, we must keep our voices aligned and loud, or we risk reversing decades of progress. Join us. We declare no competing interests. Katja Iversen, Francoise Girard, Roopa Dhatt, *Courtney Carson ccarson@womendeliver.org Women Deliver, New York, NY 10021, USA (KI, CC); International Women’s Health Coalition, New York, NY, USA (FG); and Women in Global Health, Fremont, CA, USA (RD) 1 The Lancet. The erosion of women’s sexual and reproductive rights. Lancet 2019; 393: 1773. For UHC2030 see https://www. uhc2030.org/ Published Online September 20, 2019 https://doi.org/10.1016/ S0140-6736(19)31824-0