The burden of non-communicable diseases (NCDs) on the Caribbean region has prompted leaders of the Caribbean Community to issue a declaration indicating their commitment to implement measures to reduce this burden. Individual citizens, as well as states, bear the cost of this group of diseases. Secretary General of CARICOM, Ambassador Irwin LaRocque refers to “estimates that suggest that NCDs cost our region anywhere between two and five per cent of GDP”. In addition, a sobering statistic is that NCDs such as diabetes and high blood pressure account for more than 60 per cent of deaths in the Caribbean. At the 4th July 2017 CARICOM summit in Grenada the leaders of the region decided to move forward collectively with a strong commitment to reach the goals of the Port of Spain declaration issued 10 years ago of “Uniting to stop the epidemic of Chronic Non-Communicable diseases.”
Caribbean countries have not been idle during those ten years. Individual states have implemented programmes to help reduce NCDs. They certainly have been treating the illnesses and focussing on education about and prevention of such diseases. I think most citizens of the region keep hearing the term non-communicable diseases on the media and know to what it refers. Even non- government organisations provide information and there are frequent opportunities in St Kitts and Nevis for testing of blood sugar and blood pressure and accompanying advice by health professionals. Church groups invite speakers and doctors visit the topics often enough on their radio programmes. However the region is apparently still struggling to make an impact in the fight against NCDs.
The Caribbean countries would prefer to be leading the world in more positive areas such as economic growth rather than poor health statistics. Dr. Alafia Samuels, Director of the George Alleyne Chronic Disease Research Centre, University of the West Indies, and head of a wide-ranging evaluation of the Port-of-Spain Declaration says “the statistics are quite shocking. Our soda consumption is the highest in the world. In some countries more than 30% of young people are overweight or obese. Our diabetes rates are double global rates and in some populations up to 50% of us are living with high blood pressure. It is clear that we need to accelerate our response.” No doubt the evaluation of our progress in fighting NCDs 10 years after we started in Port of Spain has prompted a need for a more robust response.
One aim of the newest declaration is for countries who have not yet done so to immediately introduce legislation to “limit or eliminate smoking in public places, ban the sale, advertising and promotion of tobacco products to children.” This legislation should also insist on proper labelling of tobacco products and encourage the use of taxes to reduce “accessibility of tobacco.” This is really in step with international measures taken to reduce harmful effects of tobacco on the health of smokers and non-smokers. Although some people hold the view that this type of legislation amounts to restrictions on personal choices others rebut that it is the same government that often has to bear the costs of healthcare for those affected by tobacco related and other non-communicable diseases. A further argument is that another person’s choice to smoke should not be allowed to create a health hazard for others who themselves have chosen not to smoke. That is a powerful response indeed and in any case a ban on smoking in public spaces does not remove the right or choice to smoke it just limits the locations available for such activity.
Other activities or physical activity on the whole is also being encouraged. It is unfortunate that we in the Caribbean have allowed ourselves to become so sedentary that governments have to consider developing policies to get citizens to become physically active. It is difficult to imagine that governments will have to “mandate the re-introduction of physical education in our schools where necessary”. This stems from the apparent increase in childhood obesity and the unfortunate occurrence of type 2 diabetes in children. Reports seem to indicate that childhood obesity is a global phenomenon. The obesity is blamed on unhealthy food choices and on lack of physical activity. Although my observation is that at recess time at some primary schools the grounds are filled with running, squealing children and a ball comes sailing over the fence often enough. The primary schools also have organised sports programmes and most of them have football, netball and cricket teams. This may not be the normal school programme in every CARICOM state however. It is still evident though that some children prefer their video games to actual sports. Some readers may well recall the endless activities they organised for themselves especially during these upcoming long school vacations; roaming the hillsides picking fruits, walking to the beach to go swimming, making toys, having long cricket matches. Children are still active but they definitely used to be more active.
Overall the food may be more to blame than the lack of activity especially in younger children. The Caribbean leaders are trying preventive measures from both angles – increasing physical activity and providing healthy food choices. They can make a difference on both fronts especially where school meals are served. Governments have declared their aim to ensure that their “education sectors promote programmes aimed at providing healthy school meals and promoting healthy eating.” The schools will need the cooperation and will have to educate parents as well to ensure that unhealthy eating at home does not negate the healthy eating in schools.
Social changes have contributed to changes in eating habits and in levels of physical activity. With the increase in crime and especially the introduction of gangs into our communities parents would be reluctant to allow long periods of self-organised and unsupervised outdoor play as used to occur in the past. As far as food is concerned the introduction of fast food outlets in the countries has created a demand and a source of unhealthy foods. Consumption of these global brands is sometimes a convenience and sometimes a means of showing that you have the means to purchase such branded food bearing the internationally recognised names. I suppose as we earn more we are able to spend more on fast foods and we are also able to afford the gadgets that may attract our children away from physical activity. However where food is concerned all the blame as regards unhealthy eating cannot be heaped on fast food outlets. Our Caribbean tastes somehow favour salty foods as well as sweet foods. The drive should be towards reduction of salt and sugar and moderation in general.
While schools will focus on physical education the CARICOM governments are intent on getting the entire population more active using different means including sport, activities “at work sites’ and even “mass activities”. For those who object to being told where to smoke I wonder how they would react if the government were to say that office workers have to come from behind their desks and into the parking lot for their daily 15 minute physical activity session. I doubt whether there would be such a mandatory session. That is just my imagination but it is an interesting picture. Activities would be voluntary but the workplace may provide a facility for exercise or may provide a fitness tutor for lunch break exercise. We have seen the images of workers en masse performing Tai chi. Some businesses offer such classes to their workers as businesses like governments have realised that physically active and healthy workers reduce costs and can improve productivity.
We can really accomplish most of these healthy goals on our own. We can exercise more, eat more healthy foods and reduce consumption of tobacco. The Caribbean leaders are not convinced that we will take such steps toward a healthier lifestyle so they are prepared to offer assistance to their populations to make changes to reduce the impact of non-communicable diseases. It is a big decision and it will take some time for habits to change although the concern and statistics declare some urgency.
By Terry Nisbett
