Food Security In The Context Of The Fight Against Chronic Diseases In The Caribbean”

Summary:
Food security and chronic diseases are separate entities, but are related in many ways. Food security is defined as having sufficient qualities of food in the right proportions and nutritional composition at all times to ensure a complete state of physical, mental and social well being. Chronic non-communicable diseases are defined as diseases that are related to lifestyles and are influenced by environmental and genetic factors. The incidence, prevalence and the economic burden of chronic diseases are becoming a growing public health concern for the Caribbean. Lack of resources, inadequate infrastructure, and lack of concrete, well thought out policies and practices are now beginning to take a toll on the Caribbean economies. Recognizing this fact the Caribbean governments through CARICOM have met and discussed means of dealing with the growing epidemic of food security and chronic non-communicable diseases. The present paper addresses the issue of food security and chronic non-communicable diseases in the Caribbean, providing recommendations to this growing problem as a means of protecting the public’s health and by extension the Health of the Caribbean Region. Key Words: Food security, chronic non-communicable diseases, public health.

Introduction: The Problem
Chronic non-communicable diseases are the main cause of premature death and morbidity in Latin America and in the Caribbean. Chronic diseases are not only devastating to individuals, families, communities, societies and countries, but place severe burden on fragile health care facilities and economies thus perpetuating the cycle of poverty and desperation.

It is estimated that there will be tripling of the incidence of ischemic heart disease and strokes. The poor and the underprivileged will be the most likely to be afflicted with and die from chronic diseases.

The societal effects of chronic diseases are difficult to determine. But, the annual cost associated with diabetes alone is estimated to be US$ 65 billion in 2000 for Latin America and the Caribbean. It is therefore imperative for clear decisive, comprehensive and integrated action to be taken to reverse the deadly epidemic of chronic non- communicable diseases to prevent the further loss of millions of lives and
unrecoverable damage to economies.

The epidemic of chronic non-communicable diseases threatens not only economies, but also the social development as well. Mortality resulting from chronic non-communicable diseases far exceeds mortality arising from infectious communicable diseases. It is estimated that 35 million people worldwide died from chronic disease, in 2005, a figure that indicates doubling of people died from communicable diseases.

The chronic non-communicable disease burden may be even greater than these statistics indicate, given the large proportion of underreporting in mortality data in the Region. The most commonly occurring chronic diseases and those of greatest public health importance in the Region are: cardiovascular disease including hypertension, cancer, chronic respiratory diseases, and diabetes.

It is predicted that during the first decade of the 21st century, cardiovascular diseases are expected to claim 20.7 million lives in Latin America and the Caribbean. The World health organization (WHO) estimates that by 2020, there will be 833,800 deaths due to cancer and an increase to 64 million people afflicted with diabetes in Latin America and the Caribbean. These chronic non-communicable diseases may have been partially caused by “nutrition transition” that is currently being observed in the Caribbean Region.

The “nutrition transition” in the Caribbean is characterized by a low consumption of fruits, vegetables, whole grains, cereals, and legumes. This is coupled with a relatively
high consumption of foods rich in saturated fat, sugars and salt, among them milk, meats, refined cereals, preserved and processed foods. This dietary pattern is a key factor leading to a rise in the prevalent overweight and obesity.

For adolescents, this lack of physical activity is particularly disturbing as the development of healthy habits is formed at this stage and tends to stay throughout life. As occupations shift from manual labor and agriculture to the service sector, physical activity levels have declined.

Food Security:
Food security in the context of the fight against chronic disease in the Caribbean is the current theme this year discussed among the Caribbean Community (CARICOM) as they began a special one-day summit on September 16th, 2007 on developing strategies to deal with non-communicable diseases that were taking a toll on the socio-economic development of the region.

Food security is often described as a situation where people do not live in hunger or fear of starvation. In the context of the fight against chronic diseases food security may incorporate in addition to having sufficient food, enabling informed healthy choices to be made, thus preventing, reducing or eliminating chronic non-communicable diseases.

The Food and Agriculture Organization (FAO) and the United States Department of Agriculture (USDA) have put forward commonly used definitions of food security. These definitions are:
 Food security according to the FAO means that all people at all times have access to sufficient, safe and nutritious food to meet their dietary requirements and food preferences for an active and healthy life.

 Food security according to the USDA means access by all people at all times to enough food for an active, healthy life. Food security includes at a minimum:
(1) The ready availability of nutritionally adequate and safe foods.
(2) An assured ability to acquire acceptable foods in socially acceptable ways without resorting to emergency food supplies, scavenging, stealing or other coping strategies.

Both FAO and USDA definitions may be applicable to food security and the fight against chronic diseases in the Caribbean. Food security may be one of the ways to address the fight against chronic diseases, but it is not the only way. Having sufficient food and the right mix of nutrients may reduce the onset of chronic diseases but may not prevent the manifestation of chronic diseases in susceptible individuals. It must be noted, however that chronic diseases may be caused be both genetic and/or environmental factors. Food security represents a controllable environmental factor that may possibly bring about some positive results in the fight against chronic diseases.

In the Caribbean region, food availability may be a problem since the Caribbean region is dependent on external imports to satisfy its needs. Delayed transport of food to the Caribbean region due to natural or man made occurrences, delayed or increased container congestion at the ports of entry, increased taxes on containers delayed at the ports and an increased inspection fees results in decreased availability and affordability of food, resulting in increased food prices to the consumer.

Since, roughly one third of the population of 1.3 million in Trinidad lives below the poverty line, it would be difficult if not impossible for these people to get sufficient food with all the necessary nutrients. The resultant effect is the increased incidence and prevalence of chronic diseases such as stunted growth, malnutrition, diabetes, heart disease, strokes, hypertension, and cancer among the lower income sections of the population.

There is another problem of “sufficiency without proper nutritional content” can lead to the development of chronic diseases. The middle and upper class sectors of the population who have sufficient food, but because of poor dietary choices tend to select sugary, salty and fatty foods over healthy foods. These calories rich foods when consumed over a period of time can lead to the development of chronic diseases such as obesity, heart diseases, cancer, and diabetes.

Timely delivery of health care is another problem in the fight against chronic diseases. The poor and the underprivileged in society in the Caribbean are unable to access appropriate health care facilities and treatment in a timely manner. The poor who are unable to get sufficient nutrient rich foods and to access health care institutions and get timely treatment are the most vulnerable to the ravages of chronic diseases. Additionally, the high cost of drugs and treatment has made health care for chronic diseases patients extremely difficult.

Economic impact of non-communicable disease in the Caribbean:
Determination of the economic impact of non-communicable chronic diseases in the Caribbean is a very difficult task, because of the direct and indirect cost associated with such diseases. According to the WHO, obesity is a disease of important public health concern and is a particular risk factor for other chronic diseases such as heart disease, hypertension, diabetes, cancer and gall bladder diseases. In the Caribbean, men and women ages 20 and older have a high incidence of obesity. That is, their body mass index (BMI) is equal or greater than 30. The prevalence of obesity in the Caribbean may range from 10 % to 30 % in some high income countries. Additionally, lifestyle habits and income per capita are factors directly correlated with obesity and other chronic diseases.

Direct costs associated with chronic diseases in particular diabetes, in the Caribbean may vary from US$ 300 to US$ 900 annually and may include:
 Consultations.
 Hospitalizations.
 Physician services.
 Medications and treatment programs.

Indirect cost associated with chronic diseases in the Caribbean may be on average US$ 9.3 billions per year:
 The value of productive years lost due to early mortality.
 Days of productive life lost due to disability.

Deaths associated with chronic diseases may be reduced, eliminated or prevented using the following initiatives:
 Develop and implement public policy and advocacy on chronic non-communicable diseases, their risk factors and their determinants.
 Establish and improve effective surveillance to strengthen the impact of public health interventions.
 Develop and promote health through health promotion strategies and disease prevention such as:
• The promotion and adoption of healthy habits, active lifestyles and control of obesity and nutrition-related chronic non-communicable diseases.
• The development of policies, practices and guidelines, institutional changes, communication strategies and research related to diet and physical activity.
• The development of a life course perspective that takes into account health starting with fetal development and continuing into old age.
• The development of an integrated approach through the concerted efforts of multiple stake holders from health and health-related sectors.
 Develop and implement integrated management of chronic diseases and risk factors.
• To facilitate and support the strengthening of the infrastructure and competencies of the health system for the integrated management of chronic non-communicable diseases.
• Replacement of the ineffective current “Chronic Acute Health Care Model with a model that incorporates prevention and management of chronic conditions through an intersectoral approach and reorientation of the health care system. That serves to improve the accessibility and availability of services and access to essential medicines and treatment regimes by all, regardless of social, economic and cultural factors, thereby improving social protection for the vulnerable populations in the Caribbean. The Proactive Chronic Health Care Model should include the following: (1) self-management support for people with chronic non-communicable disease, (2) improved clinical information system and data base, (3) competent and well trained health work force, (4) technical assistance including both local and foreign for chronic non-communicable disease programme, (5) reorientation of the health care services towards chronic non-communicable diseases and improved access to essential medicines and technologies and (6) access to medicine and other health supplies.

 Allocate sufficient resources for the proper management of chronic non-communicable diseases.
 Increased taxation on alcohol and tobacco to provide funding for people suffering with chronic diseases.
 Ban smoking in public places.
 Mandatory introduction of physical education and health education in schools.
 Tax relief for businesses that encourage and provide recreation facilities for the social, physical and mental well being of their staff.
 Ban on tobacco advertising targeting children and women.
 Developing effective strategies that dispel myths about chronic diseases such as chronic diseases affect rich countries.
 Strengthen institutional capacity and infrastructure of health care providers.
 Develop partnerships between regional and international private and public health care providers for greater management of chronic diseases.
 Develop and adopt cost effective prevention and management practices. Some cardiovascular diseases, cancers and diabetes may be prevented or delayed by
changes in diet and lifestyle.
• Screening for risk factors and early manifestation of diseases.
• Treatment of early symptoms and conditions and introduce pharmacological interventions.
• Routine preventive health exams and the measurement of blood pressure, body-mass index, lipid profile, blood glucose testing, pap smear and mammography for women.

Conclusion:
Food security not only results from having adequate amounts of foods. But, foods consumed must contain the right mix of nutrients to promote and maintain growth, repair and maintenance of bodily functions. Every country, regardless of the level of resources should make significant improvements in chronic non-communicable disease prevention and control. The major causes of chronic non-communicable diseases are known, and if these risk factors were eliminated or controlled, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented.
The Regional CARICOM Summit held recently aims to prevent and reduce the burden of chronic non-communicable diseases. It therefore serves to make the case for urgent action and is intended to guide regional governments through technical cooperation and collaboration on chronic non-communicable diseases and to develop chronic non-communicable disease national plans, policies and programmes that deal with diet, physical activity and access to health care institutions and timely treatment.

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