Patrick Martin, MD
Student and Citizen
November 2017
Imagine a small island nation where 20% of children are big. Big, as in upwards of 50 pounds of fat hanging from the midsection and extremities of young and delicate skeletal frames.
In the Federation, there are primary school children weighing nearly 200 pounds. No surprise there: parents, rich and poor, outdo each other with birthday party bags bursting with candy and box drinks. Schools, public and private, proudly organize more “hot dog days” than exercise hours.
Diabetes is the third leading cause of death in the Federation. Death is usually preceded by a protracted period of illness and disability due to disorders of the eyes, heart, blood vessels and kidneys. Suffering is exacerbated by the humiliation of personal bankruptcy due to out-of-pocket expenditure for exorbitant medical bills.
At Independence, a child with diabetes was a rare occurrence. Today, the number of diabetic children is approaching 30 and at least 20% of the adults have diabetes.
St. Kitts and Nevis has a diabetes problem because there is an obesity problem. Obesity is determined by two main factors – lack of physical activity (sedentariness) and over-consumption of factory-processed, energy-dense foods and sugar sweetened beverages.
Some parents are afraid to send children out to play because they might fall while running. Therefore, their children spend almost the entire day lying down and sitting down while crunching down on salty and sugary snacks.
Diabetic consequences, especially kidney failure and amputations, are very problematic for the minister responsible for national health insurance. This promised entitlement will be difficult to sustain in a micro nation where 45% of adults and 20% of children are obese.
A way forward is for the minister to propose an 8% tax on salaries and wages to underwrite national health insurance. A bold proposition but unlikely in a political climate devoid of bi-partisanship and issue-centered debate. Indeed, it is improbable that any tax increase can be tabled when election bells, local and general, are being dusted off.
A small population can ill-afford the loss of a single able-bodied person. Many young lives have been lost to gun violence; many more lives are negatively affected by premature illness, disability and death due to diabetes and other NCDs.
Stick a pin! Human resource gaps are filled by migrants and dual citizens.
Every problem is an opportunity. Research and experience teach that the burden of diabetes and NCDs can be reduced by whole of society approaches with political will, front and center. Only government has the authority and means to lead and coordinate the sectors.
Similar to addiction treatment, the first step in diabetes control is to admit there is a major problem – high levels of diabetes represents failure of food security.
The world trade system has been deliberately distorted to flood food markets with high-fat, high-salt, high-sugar and highly-chemicalized stuff. The paradox is that such unhealthy consumables tend to be cheaper.
Behaviour research is clear: price is a more powerful determinant of consumer buying than education. Another driving factor is the pursuit of the American dream. Thus, when the food market distortion started, it was quickly followed by predatory marketing using Cable TV and other media. Marketers and sellers know the lower the price the more consumption, so they create clever messages to exploit impressionable minds.
Three decades later, people in St. Kitts and Nevis are paying a heavy personal price with diabetes and other NCDs. The country has to be lifted out of food insecurity and protected from greedy marketers. Citizen security/protection is the prime responsibility of government.
Food security is achievable though fiscal policies that incentivize local farmers and fishers to produce more food at affordable prices. Food producers deserve more tax concessions than persons importing barrels of macaroni and fake cheese, sausage canned in 2016, and cereals manufactured with high fructose corn syrup and dyes.
Government and the telecommunications sector should agree to block junk food advertisements. Basic television packages should contain channels featuring environmental protection, marketable skills and respectful political discourse. These and kindred subjects are more in sync with the avowed “Prosperity Agenda” than housewives of everywhere, ice hockey and gun-toting cartoon characters.
To combat diabetogenic girths, the policy should also be that all schools and all communities have safe and well-managed green spaces for people of all ages to enjoy programs of physical activity and sports. The budget could be funded by a tax on junk food, sugar sweetened beverages, alcohol, and cigarettes – tobacco and, yes, marijuana.
Inattention to food security and physical activity is a threat to health and holistic development. Reducing diabetes and other NCDs is beyond the control of the health sector. Fundamentally, it is a matter of political will.