How many more must die?
PHYSICISTS HAVE LONG pondered the consequences of an unstoppable force coming into contact with an immovable force. This sequence of events, as regards the health situation in Barbados, is unfolding before our very eyes.
Senior health officials, in charge of data detailing specific health scenarios affecting Barbados, were supposed to provide the unstoppable force for improving the health of Barbadians. But each time the force came up against an immovable object, nothing seemed to happen.
• In 1981, Dr Frank Ramsey, director of the National Nutrition Unit, in the report of the National Health and Nutrition Surveys of 1969 and 1980, commented that “measures for obesity prevention and control need to be urgently implemented”. Thirty-four years later, we are still waiting.
Meanwhile, about two-thirds of our adult population continue to be overweight or obese, leading to our high prevalence of diabetes (the highest in Latin America and Caribbean countries) and hypertension. In turn, this is leading to an average of 20 deaths monthly from each of heart attacks and strokes. We may bow our heads in sympathy for those affected, but are seemingly putting no national effort in reversing this trend.
• In September 2007, following a special summit of Caribbean ministers responsible for health, these ministers pledged that “our ministries of health, in collaboration with other sectors, will establish by mid-2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80 per cent of people with NCDs would receive quality care and have access to preventive education based on regional guidelines”.
These deadlines have come and gone, but the comprehensive plans have remained one of the best- kept secrets. Eight years later, we are still waiting to see action on areas identified as needing immediate attention by Caricom health and finance ministers. In fact, we may have moved backwards since 2007.
• In 2010, our current Chief Medical Officer (CMO) Dr Joy St John wrote in her annual reports of 2004 to 2006, that “new evidence-based strategies for managing the non-communicable diseases should be implemented with utmost urgency”. The CMO did not specifically say, in her official capacity, that most believe she should be leading the way in facilitating a new approach towards the ncds, and no one seems to have accepted that responsibility.
• Dr Dexter James, chief executive officer of the Queen Elizabeth Hospital, at the 22nd annual Louis Lynch Lecture in April this year, noted that “strong policy decisions were urgently needed to fix the ever widening gap between demand and services” available from the public clinics. The more this gap opens, the more people fall through the cracks. He strongly suggested, in the face of massive budgetary cuts to health care, that a policy review is urgently needed.
We continue to see more and more people fall through the cracks, but we see no evidence of any urgency being put into reversing this phenomenon.
• In 2015, the Health Of The Nation (HotN) Survey, a collaboration between the University of the West Indies and the Ministry of Health, suggested that “urgent action is required to address the low levels of healthy behaviour and high levels of behavioural risk present in the adult Barbadian population”. While the Minister of Health, commenting on the data provided by the HotN, did concede that tackling the non-communicable diseases needed urgent attention, he also stated that changes suggested by his ministry earlier this year would not occur overnight, and it would probably take 20 years to see a change in attitude towards the ncd risk-factors.
• Health statistics apart, there is little evidence that national finances can wait for 20 years to see a turnaround in our approach to health. The “cut budget now, consider consequences later” approach by the Ministry of Finance to health will unfortunately lead to more deaths and suffering, but is the inevitable consequence of an exponential rise of health care expenditure over the last three decades without appropriate attention to the simultaneous deterioration in health.
• A couple of months ago there was an unfortunate incident where a ZR van turned over, injuring a number of schoolgirls and one unfortunately ended up losing her hand. There was “shock and awe”. Government ministers immediately appeared on the scene of the incident; emergency meetings of various transport authorities were called. The message: it should not be business as usual in the transport sector; even the injury to one girl can be prevented. Something needs to be changed immediately.
Contrast that with the release of the HotN report and data released by the National Chronic Disease Registries: we have a very high prevalence of diabetes, and over 60 per cent of diabetic patients may not be adequately managed. As a consequence, every day someone’s heart is damaged by a heart attack and two people’s brains are damaged by a stroke.
People are losing eyes through blindness, kidneys are being subjected to an expensive process called dialysis to keep their owners alive a little longer, people are losing limbs while we “boast” that we may have been overtaken as the “amputation capital of the world”, yet these are not a “call to action” in the Ministry of Health. An average of 20 heart attack patients and 20 stroke patients die every month – how many more must die?
• Can you imagine that many citizens believe that these senior health officials are actually being paid to do the things that they say need to be done urgently, and are not being done? We are living up to our tourism advertising slogan, Just Beyond Your Imagination.
We all have to die, but our landscape is dominated by persons who suffer terribly and die prematurely, while our health decision-makers repeatedly say “something must be done urgently”. Ultimately we cannot stop people from dying, but medical science suggests we can reduce the suffering and premature deaths.
Disease prevention, diagnosis and early intervention offer a cost-effective option of doing this. But our public health service continues a “business as usual” posture, even in the face of increasing suffering and deaths. Our health decision-makers are unmovable in implementing strategies, many of which they themselves have articulated, to reverse this unfortunate trend.
• Dr Colin Alert is a family physician.