One Little Country Facing Many Giant Evils: Disease, Illnesses and Health-related Issues

By S3S

In a series of Blogs thus far, I have painted The Bahamas as a ‘little’ country by virtually any measure and used Land area (161^st in the world); Population (167^th); and three Economic measures (e.g. Purchasing Power Parity (PPP), 152^nd; GDP growth, 181^st; and Exports, 162^nd) to demonstrate this point. I have argued also, that in sharp contrast to our patently Lilliputian stature, we face challenges of 'Gulliverian' proportions. Thus far, identified challenges have included crime and anti-social behaviour; economic dependency; education; food security; political indecision and lack of will; our skewed socio-political reality; and trade unionism.

One further such challenge is the general health and welfare of our citizens, particularly, diseases, illnesses and health-related issues that affect our social standing and have the potential to affect our economic standing as well. Ralph Waldo Emerson famously said “The first wealth is health”, which we seem content to ignore in The Bahamas. This ignorance is not without impunity, however. Topping our list of health issues are overweight and obesity, which the World Health Organisation (WHO) defines generally as “as abnormal or excessive fat accumulation that presents a risk to health”[1] and which the medical profession defines specifically as “a complex condition in which having too much body fat increases a person's risk for developing other health problems …. typically measured by body mass index (BMI), a calculation that shows weight in relation to height’[2]. A BMI of 30 or more[3] is considered obese, though athletes tend to be the exception to the rule.

In The Bahamas, our population is afflicted by obesity with increasing frequency and seriousness (‘Doctor says chronic diseases account for more than 70% of hospitalizations and premature deaths’[4]); heart disease; various forms of cancer (specifically, male prostate, cervical and bowel cancers); and diabetes, particularly, Type II (Diabetes Mellitus), which are all linked to premature death. Our current rate of hospitalisations related to obesity belies the International Association for the Study of Obesity (IASO) 23-year old data on percentage of adults who are ‘overweight or obese’. The survey[5] (1988-1989) of a sample of 1,771 respondents, aged 15-64, found that 29.1% of men were overweight; 13.9% of men were obese; 25.6% of women were overweight; and 28% of women were obese. This means that in 1989, approximately 34% of men and 52% of women in The Bahamas were overweight or obese.

Wherever we are in the country, we do not have to look long or hard for signs of obesity amongst every age group. So it is not unreasonable to infer that these proportions probably would have increased, perhaps to 1 in 2 men and 2 of 3 women, since that time? If proportions are near these estimations, then it is fair to characterise the situation as an ‘obesity epidemic’, as per the above referenced Nassau Guardian article. Consequently, we could infer a range of health-related issues, which may be specific manifestations of the above-mentioned because people who are obese have an increased risk of:

Benign Prostate Hyperplasia: “an increase in size of the prostate gland without malignancy present and so common as to be normal with advancing age”[6];

Cancers of the lungs; breast; colon and rectum; mouth and oropharynx; oesophagus; endometrium (uterus, womb); kidney; gallbladder; liver; and prostate;

Chronic Obstructive Pulmonary Disease, COPD: “the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease”[7]);

Complications in pregnancy and in surgery;

Deep Vein Thrombosis: “the formation of a blood clot in a deep vein, usually in a calf or thigh muscle; can partly or completely block blood flow, causing chronic pain and swelling ”[9];

Diabetes Mellitus;

Gallstones;

Gastroesophageal reflux disease (GERD): “a condition in which the acidified liquid content of the stomach backs up into the oesophagus” causing severe chest pains[10];

Hyperuricaemia/Gout: “an excess of uric acid in the blood” [11]; a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation”[12];

Ischaemic Heart Disease, IHD: “a condition in which atheroma (fatty deposits) builds up in the linings of the walls of the coronary arteries. This causes a narrow artery and reduced blood flow to the heart muscle”[8];

Lower back pain;

Metabolic syndrome: “the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. You can develop any one of these risk factors by itself, but they tend to occur together. A diagnosis is made if you have at least 3 of the following risk factors: a large waistline (‘abdominal obesity’); and/or a higher than normal triglyceride level; a lower than normal HDL cholesterol level; higher than normal blood pressure; higher than normal fasting blood sugar (or on medication to treat any of the above conditions)[13];

Non-alcoholic fatty liver disease/steatosis (fatty liver) – “liver disease related to alcohol consumption fits into 1 of 3 categories: fatty liver, alcoholic hepatitis, or cirrhosis”[14];

Osteoarthritis - “a condition that affects the joints”[15];

Polycystic ovary syndrome, PCOS: “a condition which can affect a woman’s menstrual cycle, fertility, hormones and aspects of her appearance. It can also affect long-term health.”[16]

Psychiatric disorders;

Pulmonary embolism: “a blood clot in the pulmonary artery, which is the blood vessel that transports blood from the heart to the lungs. It is a serious and potentially life-threatening condition as it can prevent the blood from reaching your lungs”[17]

Reproductive disorders/infertility;

Sleep apnea: a condition that causes interrupted breathing during sleep.

Stroke: “the rapid loss of brain function due to disturbance in the blood supply to the brain”[18].

Two troubling things about this list spring immediately to mind; first the list is not comprehensive and second, it contains a disturbingly wide range of ailments. You can probably tell by the many references attached to the conditions that I had to look many of them up, because I have no special knowledge of medical issues. What I do know, however, is that faced with a list this long and daunting (at least, to me), one would think that we deserved a national strategy to reverse this trend of overweight and obesity in the general population.

What is the response of the Ministry of Health? On the surface, the Healthy Lifestyles Initiative (HLI) seems eminently reasonable, with a clearly stated vision (‘All residents living healthy lifestyles throughout life’) and mission (‘To reduce illness, disability and death due to lifestyle related diseases’) and an overview that confirms the 1989 IASO Survey (‘Health statistics indicate high incidences of chronic non-communicable diseases such as diabetes, hypertension, chronic respiratory disease, heart disease and cancer’ [19]). A 2003 Ministry Survey also confirmed that 70% of respondents were overweight and 47% had high blood pressure, inter alia. Four obvious questions beg, however.

How many people are aware of this initiative, and are active participants?

Why does the scheme focus entirely on the individual and his/her lifestyle choices, rather than also on the food industries that contribute to this vexing problem? (a third of respondents ate ‘fast foods’ at least twice per week).

Why is exercise a seeming after-thought (when ~65% self-described as ‘sedentary’)?

Finally, almost one in two deaths (45%) in 2003 was ‘due to chronic non-communicable diseases’.

These findings, though merely descriptive, lead me to conclude that the HLI policy, whilst appearing well-intentioned, is yet another paper-borne policy with no teeth in the form of visible controls to ensure its effective implementation in practice. A ‘Healthy Lifestyle Secretariat’ was established in late 2005 ‘to provide administrative coordination of the activities of the Initiative’; what really has it done in the past 7 years? We are losing the battles to crime, education and sustained economic development, inter alia; let us not lose the battle to ill-health of our citizenry.

As Gandhi rightly reminded us, “it is health that is real wealth and not pieces of gold and silver![20]”

By S3S©

[1] http://www.who.int/topics/obesity/en/ 31.12.12

[2] http://www.webmd.com/hw-popup/obesity 26.12.12

[3] http://www.noo.org.uk/NOO_about_obesity/ 31.12.12

[4] http://www.thenassauguardian.com/index.php?option=com_content&view=article&id=35789&Itemid=56 Accessed 08.12.12

[5] http://www.iaso.org/resources/world-map-obesity/ 31.2.12

[6] http://www.patient.co.uk/doctor/benign-prostatic-hyperplasia 05.01.13

[7] http://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx 02.01.13

[8] http://www.dwp.gov.uk/publications/specialist-guides/medical-conditions/a-z-of-medical-conditions/ischaemic-heart-disease/ 02.01.13

[9] http://www.webmd.boots.com/a-to-z-guides/deep-vein-thrombosis-dvt-symptoms-diagnosis 05.01.13

[10] http://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm 05.01.13