Stronger Economy through Healthier People

When we think of the economy, we normally consider such things as the performance of Gross Domestic Product, rates of employment, trends in the business environment and in the case of Trinidad and Tobago, the performance of the energy sector. Indeed, when economic, financial and other commentators write, debate, bemoan policies or generate forecasts, they normally restrict their discourse to these phenomena with not enough mention of the human condition. It is sometimes surprising that the most important resource any country, company or informal group can possess, the principal impetus behind profits, growth and transformation, can capture so little attention. Undeniably, human resource is the most important asset. Consequently, the capacity of a country’s people is of utmost importance to its current and future economic fortunes. On this basis, it is imperative to monitor the health of every nation, to caution and to take decisive action to mitigate threats to the current and future labour force. This article seeks to highlight some of the health perils facing the people of the Caribbean, and their implications.

As is the case for most regions in the world, a significant proportion of the maladies now plaguing Caribbean people can be attributed to poor lifestyles choices. For instance, poor diets, aided by the proliferation of fast food restaurants and little exercise has resulted in sizeable proportion of Caribbean people being overweight. According to the World Health Organization’s (WHO), in 2016, the prevalence of overweight adults ranged from 46 percent in Trinidad and Tobago to 60.3 percent in Dominica. During the same year, the prevalence of obesity ranged from 18.6 percent in Trinidad and Tobago to 31.6 percent in The Bahamas. The survey considers individuals 18 years and over and is based on Body Mass Index (BMI) calculations. This method has its shortcomings but is still a good gauge of the ideal weight for most individuals. The increasing prevalence of overweight and obese adults has switched from being a problem mainly associated with high income countries, to a global challenge, with dramatic increases in low and middle-income countries. This trend by itself has proven to be a significant catalyst for the upsurge in chronic diseases. When alcohol and tobacco consumption are added to expanding waistlines, the incidence of these lifestyle diseases is only exacerbated.

According to the World Health Organization, heart disease and stroke account for a third or 17 million of all deaths worldwide annually. In the Caribbean, the trend is similar and death rates in this category are projected to rise. In Trinidad and Tobago, they accounted a third of all deaths between 1998 and 2016 (CSO). Disturbingly, younger people are increasingly being struck down by heart disease and strokes. Although cardiovascular diseases can be hereditary, a significant proportion of cases can be traced to poor lifestyle choices. For instance, smoking increases the risk of dying from heart disease and stroke, two to three-fold. Physical inactivity and unhealthy diets are other main risk factors which increase an individual’s chances of developing cardiovascular diseases. In addition to taking more lives than any other ailments, heart disease and stroke require expensive treatments which impose significant economic hardship on families and burden the health system and ultimately the economy.

Diabetes is another chronic disease experiencing dramatic explosion throughout the world. There were approximately 62 million people in the Americas living with the disease in 2014 (WHO). According to the WHO, 80 percent of all diabetes-related deaths occur in low and middle-income countries. This disease increases the chance of death by cardiovascular disease and stroke by 50 percent and causes significant damage to the body’s internal organs. Many countries struggle to satisfy the organ transplant needs of their diabetics, who normally find themselves on long waiting lists. Amputations and other costly procedures and treatments are normally necessary to allow diabetics to survive. In fact, a diabetic’s medical bills can be easily three times that of someone without the disease. In a study titled “The Cost of Diabetes in Latin America and the Caribbean in 2015: Evidence for Decision and Policy Makers” published by the Journal of Global Health, it was estimated that just over 820,000 people in the English-speaking Caribbean had the disease in 2015. The study’s conservative estimate for the total direct and indirect costs (including lost man hours) to the region arising out of diabetes related treatment and deaths for 2015 was US$2.8 billion. However, its estimate of US$3.8 billion, which assumes broader coverage of medication and services may be more realistic. If we take factors such as the rise in the price of medicines and treatments, and lost productivity, and amalgamate them with projections for the occurrence of diabetes, the cost of the disease to the region in 20 years would be astronomical.

The Caribbean has an HIV prevalence rate that is second only to Sub-Saharan Africa. The number of people living with the disease in the region was estimated at 340 thousand 2018 by UNAIDS. On the positive side, the rate of infection in the region slowed over the last 12 years, with an estimated 16,000 new cases in 2018 compared to 27,000 in 2006. Additionally, wider access to anti-retroviral treatment has helped to extend the lives of many infected persons around the region. The number of AIDS-related deaths fell to 6,700 in 2018 from 19,000 in 2006. A very disconcerting trend of HIV is that its greatest impact is felt on the most productive and economically active section of the population. In fact, it has become one of the leading causes of death among adults of ages 15 to 44 years. In the region, the spread of the disease has been aided by several factors, chief among these being cavalier sexual habits, stigmatisation, gender inequalities and the sex trade. The disease continues to disrupt family life throughout the Caribbean and attacks economic progress on two fronts. It first erodes the labour force by striking down productive members and future members. Additionally, it diverts valuable resources away from productive activity.

Even though we focused on a few diseases, there are several other lifestyle ailments that plague our region. For instance, cancer of all types is a leading cause of death in the Caribbean and worldwide. Hypertension is also a very common disease that affects thousands of people in many nations. Other ailments include mental disorders and chronic liver disease among a list of several.

All the diseases mentioned above are similar to the extent that they are all preventable, except for some versions of diseases like heart disease that are hereditary. Individuals can take specific steps and adopt lifestyles than can significantly reduce their vulnerability to these ailments. These steps include, but are not limited to, proper diet, regular physical activity and responsible sexual practices. Individuals must recognize that they are principally responsible for their own health and must adopt preventative measures, not only for their sake, but for the sake of the wider society. There is also a critical role for the policy makers of the region which can be broken down into three components. The first area is related to government’s expenditure, which is needed not only to provide treatment and medicines to the afflicted, but to fund the other two components (legislation and education). Government can use its legislative arm to support the reversal of the decline in national health. For instance, regional governments can espouse legislation such as one adopted by some states in the United States to place an outright ban on the use of Trans Fats to prepare food. This will be an excellent complement to the move by some regional states to ban or reduce sugar sweetened beverages in schools. Another example is the criminalisation of the act of knowingly transmitting HIV. Such measures may involve establishing new organizations to monitor activities. The third component relates to promotion and education strategies designed to afford as much knowledge as possible to the public and to bring about change in undesirable behaviour. Admittedly, many regional states have directed a reasonable level of resources to programmes encouraging healthy lifestyle choices and the available evidence suggests these have been effective to some extent. Nevertheless, there is always room for improvement and such programmes should be constantly enhanced if they are to achieve their main objectives.

Without going into the details, it must be noted that non-government agencies and businesses play vitals roles in the fight against these terrible diseases by supporting education, prevention and treatment initiatives. In most cases, these diseases represent avoidable peril. However, their increasing prevalence dictates that all stakeholders play a role in reversing the deleterious effects on human capital. It is also important to synergise and enhance the efficacy of the various programmes. This will ultimately help to increase productivity and GDP growth.