According to the World Health Organization (WHO), non-communicable diseases (NCDs) are the leading cause of premature death in the Caribbean– significantly higher than the global average of 70 per cent– with 80 per cent of deaths in Jamaica, 81 per cent of deaths in Trinidad & Tobago, 82 per cent of deaths in Antigua & Barbuda and 83 per cent of deaths in Barbados arising from non-communicable diseases such as cardiovascular diseases, cancer, diabetes and chronic respiratory diseases.
The elevated prevalence of NCDs has resulted in a multitude of negative public health, economic and social effects, which have exacerbated the effects of the COVID-19 pandemic on the region and have hindered progress towards achieving sustainable development.
According to the Economic Commission for Latin America and the Caribbean (ECLAC), in 2001, the economic cost of diabetes and hypertension to the region was estimated to be the equivalent of 5.34 per cent of the Gross Domestic Product (GDP) of Barbados; 5.87 per cent of the GDP of Jamaica; and 8 per cent of the GDP of Trinidad and Tobago.
But these costs could have been avoided.
NCDs share common modifiable behavioral risk factors, the four most prevalent (tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets) of which are the leading causes of mortality, morbidity, and disability in the Caribbean.
Risk factors result in high levels of overweight, with a prevalence of obesity among children that is two to three times higher than the world average. Twenty-four per cent of children in Bermuda, 23 per cent of children in Bahamas and Dominica and 22 per cent of children in Barbados, Jamaica and Saint Kitts & Nevis (ages 5 to 19) are expected to be obese by 2030.
Among adults, 48 per cent of the female population of Bermuda, 46 per cent of the female population of the Bahamas, 45 per cent of the female population of Dominica and 43 per cent of the female population of Jamaica is expected to be obese by 2030.
And by 2030, 37 per cent of Bermudian men and 33 per cent of Bahamian men is expected to be obese.
According to Maisha Hutton, Executive Director of the Healthy Caribbean Coalition, a regional alliance of over 100 NCD-focused civil society organizations, rising rates of obesity in the Caribbean have been fueled by increases in marketing and consumption of sugary drinks and ultra-processed foods that are high in added sugar, salt, and fat.
The Caribbean is one of the most obese sub-regions in the world
Physical inactivity, another risk factor for obesity and disease, is also prevalent in the region. According to the Inter-American Development Bank (IADB) one of three adults in Latin America and the Caribbean qualifies as physically inactive, as compared to the global average of one in four.
Obesity results in elevated blood pressure, raised cholesterol, and ultimately NCDs and premature death.
According to the Pan American Health Organization, in 2019, heart disease was the leading cause of death in the Caribbean (90.7 per 100,000), followed by stroke (83.5 per 100,000) and diabetes mellitus (70.4 per 100,000). Kidney disease, prostate cancer and hypertension were in 5th, 6th and 7th positions respectively.
Diabetes, in particular, places a high demand on health care resources in the region, and is a major cause of blindness, kidney failure, heart attack and stroke, with age-adjusted mortality from diabetes in the Caribbean estimated at 35 per cent higher than in the United States. According to the International Diabetes Federation, more than 13 per cent of the population in the Cayman Islands and Bermuda and more than 14 per cent of the population of Barbados has diabetes, with the latter recording a 10 per cent lower limb amputation rate for diabetics– one of the highest in the world.
The UN Sustainable Development Goals call for Member States to reduce premature mortality from non-communicable diseases (NCDs) by a third between 2015 and 2030, and according to a March 2022 Health Policy paper released as part of the Lancet NCD Countdown 2030, the cost of NCD inaction would be $320 billion to the region.
A 2021 report by The Lancet that ranked countries by implementation of 18 core NCD policies across 194 countries between 2015 and 2020, with the highest score of 17 going to Norway, found that Guyana scored the highest in the region for NCD policy implementation, with a score of 9. Trinidad & Tobago and Saint Lucia were found to have the second strongest NCD policy implementation track records in the English-speaking Caribbean, both with a score of 8, while Barbados received a score of 7.5, equivalent to Jamaica and Suriname, and Antigua & Barbuda received a score of 7 for its efforts. Belize and Saint Vincent & the Grenadines received a score of 6 while the Bahamas received a score of 5.5, Dominica and Saint Kitts & Nevis received a score of 5.5, Grenada scored 4.5 and Haiti received the lowest score in the region of 1.5.
In November 2021, the Caribbean Public Health Association (CARPHA), in partnership with the Pan American Health Organization (PAHO) and Agence Francaise de Developpement (AFD) convened a virtual Regional Stakeholders Consultation on the formulation of a Regional Non-Communicable Disease (NCDs) Surveillance System for the Caribbean, which CARPHA Executive Director, Dr. Joy St. John said “is a critical component of any comprehensive NCD prevention and control response,” as a source of “information for action.”
But in addition to information gaps, there are policy, infrastructural and socio-cultural gaps that still need to be overcome to encourage and support healthy eating and physical activity at the population level.
Over-reliance on food imports and shifting tastes towards processed foods, which have been encouraged through the marketing of unhealthy foods, coupled with the pushback of the food industry against front of package warning labels that would inform consumers about the levels of sugar, salt and fat content in food, have created barriers towards overcoming rising rates of obesity and NCDs.
Meanwhile, the Caribbean continues to suffer with premature loss of life, productivity losses and spiraling health care costs driven by suboptimal decisions primarily related to food consumption, physical inactivity and alcohol and tobacco use– all of which have been compounded by the impact of COVID-19, which has elevated the need for urgent and meaningful NCD policy action within the region.