PORT -OF –SPAIN, Trinidad – A major regional assault is about to be launched against chronic non-communicable life-style diseases. The historic first step will be made on September 15 when the Heads of Government of the Caribbean Community (CARICOM) meet in Port -of -Spain to start a campaign to galvanize the Region against the scourge of such disorders as obesity, high blood pressure, diabetes, stroke, heart attack and some kinds of cancer.
Life-style diseases have emerged as the principal public-health challenge in recent decades since great inroads were made in tackling infectious diseases that plagued the region. The chronic diseases result largely from bad food choices and low levels of physical activity. They come at a high cost to individuals and to the region’s nation states in terms of human suffering, expensive treatment and loss of production.
Economic Burden
Statistics on the cost of specific diseases in the CARICOM region are not always readily available, but it is reckoned that in 2001, the combined economic burden of diabetes and high blood pressure, in US dollar terms – if the diseases were properly treated – would be $89.4 million in Barbados, $419.3 million in Jamaica, and $496.7 million in Trinidad & Tobago, while the corresponding burden to the Bahamas in 2002 would be $58.4 million.”
These figures are very significant when compared with the health budgets and gross domestic product of the respective countries, and the economic burden of diabetes and high blood pressure is relatively high on the list of factors retarding the development of the countries of the region. Even more agonizing is the realization that most cases of chronic non-communicable diseases are avoidable, resulting as they do from poor lifestyle choices.
At the same time, there is an increasing awareness in the region that while individual responsibility and choice are crucial factors affecting the incidence of chronic diseases, public policy, public education, qualitative regulation of food imports, licensing laws to protect consumers and gearing the environment to support prevention of chronic diseases are also pre-requisites for combating this 21st century epidemic.
In its 2005 report, the Caribbean Commission on Health and Development (CCHD), under its mandate from the CARICOM Heads of Government, identified chronic non-communicable diseases as the major contributors to overall death and sickness in the Caribbean in the closing years of the 20th century. According to the report, cardiovascular diseases (high blood pressure, coronary heart diseases and stroke), diabetes and cancer accounted for 51 per cent of the deaths in the region in the latter part of the 1990s.
Focus on obesity
In the spirit of the consistent affirmation of the Heads of Government that “the health of the region is the wealth of the region” and that health must be seen as an input of development as well as an output, the Commissioners called on the Governments of the region to move swiftly to meet the challenge of chronic diseases. They zeroed in on obesity – extreme fatness – which they identified as a leading cause of chronic non-communicable diseases. This results from such factors as the consumption of too much food, the consumption of too much of the wrong kinds of food, bad timing of food intake, and too little physical activity. Obese women – about 25 per cent of the adult female population – are almost twice as prevalent as their male counterparts.
Although obesity is generally associated with ageing, when the body has slowed down and stores more calories as fat than in younger days, there is an alarming trend in the region in a high incidence of obesity among young children and adolescents.
Data compiled by the Caribbean Food & Nutrition Institute (CFNI) show that fat and obese children account for as much as 15 per cent of their population group in various Caribbean countries.
Research has linked the rising obesity rates to corresponding increases in consumption of fatty foods, snacks, soft drinks and high-energy foods and drinks. Sugar and fat are implicated in this worrying trend.
Obesity has been identified as a risk factor or an “aggravating agent” for more than thirty medical conditions. It tops the risk factors for the chronic non-communicable diseases (NCDs) that accounted for more than half the deaths in the region in the late 1990s. Other factors were physical inactivity, itself a major cause of obesity; high cholesterol and tobacco use. The Caribbean Commission on Health and Development urged that obesity must be tackled seriously on all fronts, with emphasis on the twin pillars of weight control – eating right, or balanced eating – and exercise and those policies must be put in place to increase physical activity for all age groups.
Public policy issues
At the same time, the Commission advocated modulation of the environment to support policies that facilitate weight reduction or ideal weight maintenance at individual and group levels. In particular, it cited the need for closer regulation of foods, especially of the steadily increasing importation of foods with high fat content. It called for licensing laws to ensure that consumers know the content of the foods they eat and for agricultural policies that ensure that food security is pursued in the context of incentives or subsidies for local production of the fruits, vegetables and whole grains required for a healthy diet.
The CCHD also contended that weight reduction must begin in schools, focusing on nutrition and “the absolute necessity” to include physical education as a critical aspect of the curriculum, and to recognize it as important as the “academic” subjects.
Caribbean Governments have already shown considerable harmony and success in tackling some of the health challenges facing the region.
Breast-feeding, seat-belt legislation and regulations designed to reduce tobacco use are good examples.
A watershed initiative – the campaign against chronic diseases and their major causes – which will be launched in Port-of-Spain on September 15, will see decision-makers, opinion-leaders, health professionals, educators, workers, managers, leisure industry leaders and the general publics of the region declaring actions to curtail Chronic Non-Communicable diseases.
