Poverty & Social Development: A Caribbean Perspective

THE MINISTER OF HEALTH in Barbados was reported earlier this month to have raised his own concerns about obesity among the country's school-children. Jerome Walcott said he wanted to push for a move which would see fewer soft drinks and junk food in lunch-kits.

Dr Walcott's concerns come, however, as a desolate and disconnected alarm, exactly one year after an urgent report from the high-level Caribbean Commission on Health and Development was released at last year's CARICOM Heads of Government Conference in St Lucia.

Obesity was identified as an epidemic in that report. That Walcott's expressed concerns one year later made no reference to this speaks loudly to the continuing lack of implementation and follow-through on critical issues of development in the region.

Among its major recommendations, the report called for swift action in dissemination of its findings. "This report is directed to the Heads of Government through the Council of Health and Social Development," its authors said, "but there must be a structured effort to disseminate the findings and conclusions widely so that the main social partners become convinced of the fact that health is indeed critical for the Caribbean's development."

In its preamble, the document had made much of the fact that the region's leaders had for the first time singled out health "as an essential factor for the region's development", hence the mandate for this commission to study and make recommendations on treating with this phenomenon.

The commission was headed by University of the West Indies Chancellor, Professor George Alleyne, an international consultant who formerly headed the Pan American Health Organisation.

"Death from stroke, heart disease, and hypertension, at least in Barbados and Trinidad and Tobago are three to four times more common than in North America. Death from coronary artery disease is particularly prevalent in Trinidad and Tobago, with rates double those in North America. Diabetes has emerged as a major problem and must now be regarded as an epidemic in the region.

In the past 30 years, there has been a tripling of the prevalence of overweight and obesity in both males and females. High rates are seen in every country examined. One of the more alarming features is the increase of overweight in children and it is no satisfaction that this trend is being observed globally.

"This epidemic must be addressed with urgency," the commissioners said a year ago, in the report that was adopted unanimously, without question, by the region's leaders.

What has been the upshot of that wholehearted endorsement of these dire findings and their call for urgent action, the isolated concern of the Barbados health minister reveals a depressing story.

No evidence exists that the region's health co-ordinating machinery has begun to address the issues involved. The commissioners had called for a strengthening of the Caribbean co-operation in health, as one of the mechanisms for carrying forward its recommendations.

They had called on the region's leaders to "face squarely the problem of obesity with its co-morbidities of non-communicable diseases". They identified obesity as "a common risk factor for chronic non-communicable diseases and regardless of its etiological significance, a public health approach to preventing obesity will support efforts to reduce the burden of the non-communicable diseases".

Saying these disorders ought to have been tackled "with a vigour that has so far been absent", they advocated more emphasis on individual behaviour change through environmental modification, they concluded that "the economic consequence of these diseases is huge".

Critically as well, the health commissioners tied their concerns about the region's health condition to its implications for the successful operation of the CARICOM Single Market and Economy.

Inextricably bound with this, is the finding by the commissioners of the equally urgent need to address a vital region-wide health insurance programme. In Trinidad and Tobago, this idea has been kicked around since 1989, when the then minister of health announced a Cabinet decision to scrap the existing health surcharge, introduced in 1984. Forming part of a three-plank Health Sector Reform Programme with institutional financing from the Inter-American Development Bank, this matter remains, however, under active consideration by the Cabinet.

Progress has been equally slow, to non-existent, on this front, with the commissioners having called on the leaders to "deal with the problem that health financing represents for all countries". It was their contention that user fees to supplement health budgets or to discourage use of services was regressive and likely to be particularly damaging to the very poor and others who need to use the services most.

Dr Denzil Douglas, Prime Minister of St Kitts and Nevis, is the head of government under whose assigned responsibilities is the issue of health and human development. He will be the host Prime Minister for next week's regular summit.

One year after this urgent report on health in the region, he should be in a position to say why no apparent progress has been made on the recommendations.