Barbados enjoys the best ranking among its Caribbean neighbours in seeking to halt the spread of chronic non-communicable diseases, but that should be no comfort as there is a long way to go.
University of the West Indies, Mona Campus deputy dean of research and postgraduate studies Dr Alaifa Samuels recently affirmed this standing during a presentation on NCDs to an audience in the Henry Fraser Lecture Theatre, Cave Hill, immediately pointing out afterwards to the group of students, academics and other interested persons, that this was nothing to gloat about in the fight against the silent killers.
“When you look across the 20 countries of the Caribbean, Barbados has done the best –– not enough; but, compared to the other countries, has done very well,” said the director of the Chronic Disease Research Centre.
Dr Samuel’s June lecture came against a backdrop of Barbados having a near-epidemic rate in a major NCD –– diabetes –– in which the island leads the region in mortality.
A 2011-2013 Health Of The Nation Survey, conducted by the Ministry of Health, found that 18.7 per cent, or one in five adults had diabetes. It is 46 per cent in persons above the age of 65.
And around one in five persons is walking around with diabetes, undetected, which means they don’t know of the killer in their bodies.
In 2009 that total figure for adults affected stood at 16.4 per cent, and since then Barbados was declared the leader in mortality rates in the region.
Nonetheless, Dr Samuels lists a number of reasons for Barbados being a leader in the NCD fight, which is perhaps an condemnation of the state of affairs of the rest of the region.
She spoke of a “high level of awareness among policymakers, and the public”, thanks in no small measure to the public pronouncements work of Professor Henry Fraser, Professor Anselm Inniss, Sir George Alleyne and Sir Trevor Hassell.
“There has been good leadership in the NCD area.”
She said Barbadian “politicians have been listening. There has been a lot of research. The Chronic Disease Research Centre, started in 1992. They have been putting out a lot of research about chronic diseases”.
Additionally, Government is in partnership with CDRC; did the Risk Factor Survey in 2007; and contracted with UWI to do the Health Of The Nation, another risk factor study.
Barbados Governments have been supporting the National Registry, which Samuels said was the only active surveillance registry of chronic diseases in the Caribbean.
Prescribed drugs are free for Barbadians, and the Ministry of Health contracts with the Heart & Stroke Foundation for cardiac rehabilitation work.
In implementing recommendations of a 2004 health study, the Ministry of Health created the posts of Senior Medical Officer for Chronic Diseases, and Senior Health Promotion Officer.
But there are the lingering cultural/social factors that continue to hinder the drive to relieve Barbados of its NCD burden.
“Alcohol is a problem,” Dr Samuels said, adding: “ We have a delay in alcohol-related policies because alcohol has an economic and social role in the country, employment.”
The National Council On Substance Abuse Report on its 2013 study of children at risk serves to question Government’s lethargy in clamping down on alcohol consumption.
“Approximately three-quarters (71.2) per cent of all students had used alcohol at some point in their lifetime. The one-year prevalence for alcohol use was 56.3 per cent, while the one-month prevalence rate was 32.8 per cent. Lifetime and one-year prevalence of alcohol use was found to be slightly higher among female students. Alternatively, one-month prevalence rate was marginally higher among male students.”
Another hindrance is smoking of cigarettes, on which, Dr Samuels says, Government appears reluctant to impose the full sin tax of 75 per cent recommended by the Pan-American Organization.
The charge here is about 42 per cent, which places Barbados on the middle ground in the Caribbean, with the St Lucia levy at 62 per cent at the leading end, and St Vincent and the Grenadines at the last at 17 per cent.
Yet Dr Samuels noted: “Half of the people who smoke cigarettes are going to die from tobacco-related diseases.”
She said the purpose of the PAHO-recommended taxation was not only to discourage smokers, but “to raise money so when you have your heart attack later you can pay for it . . . . You may as well start paying down on the hospital bill from now. Start to save little by little”.
Dr Samuels said sin taxes on tobacco products were an easy way to raise money for health services, “and hopefully for the money to come to the health sector, because it is one thing to raise the money; the other thing is [what is] the Minister of Finance going to let off to us. In Barbados so far, the Minister of Finance puts everything in one pot, then doles out money to different sectors”.
Barbados last year introduced an extra ten per cent tax on sugar-sweetened drinks, and the money from this, along with that of tobacco, could go into a national health fund, similar to what obtains in Jamaica, according to Dr Samuels.
In the Jamaica model, ten per cent of all tobacco taxes is pumped directly into health services. She said that practice made for better health services planning.
“You know that you have this amount of money that you can do your programmes with.”