By the UNAIDS Caribbean Regional Support Team THIS week, more than 120 heads of state and governments meet in Rio de Janeiro to secure renewed political commitment for sustainable development. The original Rio conference 20 years ago spurred a heavy focus on the environment. But while that theme remains critical, some stakeholders make the case for a broader social focus. Director of the UNAIDS Caribbean Regional Support Team, Dr Ernest Massiah, wonders how the region will define its development agenda. "Sustainability is not just economic or environmental. It is also social development," said Dr Massiah. "The focus is primarily on one angle but in reality the social, economic and environmental commitments must all be there. A key message for the Caribbean must be that there can be no sustainable development without health, human rights and gender equality." Poverty, environmental degradation, gender inequality, stigma, discrimination and social exclusion are all insidious threats to sustainability. For Pierre Somse, UNAIDS country co-ordinator for Jamaica, the Bahamas and Belize, one type of revolution relies on another. "All those sustainability issues have one connector and it is social change. It has to do with what people think and value as well as how they do things differently. Poverty and environmental degradation increase people's vulnerability and expose them even more to HIV. This is especially true of women and girls. The commitments and efforts have to be connected," Mr Somse insisted. "There is no other way." Social protection and human rights go to the heart of the well-being of individuals, families and communities. Continuing the agenda for more just and equitable societies improves and safeguards productivity and human security. Health fundamentally matters. In the Americas, the Caribbean is most affected by the epidemic of chronic diseases. Almost half of the years our countries collectively lose due to ill health, disability and early death are linked to heart diseases, stroke, cancer and diabetes. AIDS remains the leading cause of death for men and women for precisely the span of a working life--ages 20 to 59. And although more people who need treatment are able to access it, in 2010 there were 12,000 new HIV infections. The region's disease burden and bill aren't getting smaller. "The economic cost of these conditions is not sustainable. It undermines development and incurs a huge opportunity cost. Think of how much more we could do for education and infrastructure if there was a more solid commitment to assuring the health of Caribbean people," Dr Massiah said. During a plenary at the Caribbean HIV Conference held in the Bahamas last November, Professor Karl Theodore of the Centre for Health Economics at the University of the West Indies in St Augustine stressed the potential of disease to undermine regional sustainability. He proposed that the non-communicable disease and AIDS movements jointly lobby governments for a one per cent budget allocation. "If we believe in the seriousness of what is facing us that is not a big amount," he said. "If something threatens your very survival you must invest to protect yourself." Caribbean leaders have a direct stake in ensuring that the Rio+20 Declaration reflects a solid commitment to rights to health, gender equality and non-discrimination. It should include access to health care as an essential element of sustainable development policy and as a measure of development progress. "It is also critical that they reaffirm their commitments to achieving an AIDS-free generation given the fact that there are broader implications of this investment on sustainable development," noted Dr Massiah. The global economic downturn has intensified the mandate for countries to exercise increased responsibility for their own development agendas while at the same time remaining accountable and responsible to one another. It is essential that no country is left behind, regardless of wealth or size. In our cash-strapped context it is imperative that donors commit to long-term investment in global health and sustainable development. On the other hand, countries must invest an appropriate share of domestic resources. We must measure and report on their progress, keeping in mind that the ultimate determinants of success are the outcomes for people. Rio+20 should reflect the existing international systems of accountability, including treaties and standards on human rights, the environment and development. "There are many competing priorities within the limited time and agenda of the meeting and we know that the focus will be on the environment," said Ruben del Prado, UNAIDS country co-ordinator for Guyana and Suriname. "But these initiatives can be anchored in and linked with broader health and well-being promotion including the prevention of HIV and mitigation of its impact." An economist might discuss savings to consumption ratios. An environmentalist could go on about green energy or forest conservation. But the true scope of our modern sustainability challenge isn't only about money and nature. It is fundamentally about the well-being of people and shared accountability of states. Rio+20 provides a unique chance to settle upon a fresh consensus about the course of global development. It should be underpinned by the understanding that without health, human rights and gender equality there can be no sustainable development. The Caribbean is well placed to issue this reminder.