Non-communicable diseases put a strain on GDP

Non-communicable diseases. Lifestyle diseases. Co-morbidities. These aren’t just words; covid19 has put these serious, sometimes deadly issues on the front burner. Epidemiologist Dr Avery Hinds recently confirmed that hypertension and diabetes are the most common co-morbidities observed in people who have died of covid19.

Researchers have, on several occasions, noted the correlation between NCDs and poor lifestyle habits. Tobacco and alcohol consumption, unhealthy eating and inactivity, can lead to several conditions, including obesity which contributes notably heart disease and diabetes and others.

In the 1970s the Caribbean was the envy of the western hemisphere when it came to health and healthy eating. Studies showed that in the 70s the Caribbean people were among the healthiest in the world, with an obesity level of less than ten per cent and low prevalence of non-communicable diseases (NCDs).

But in the 1990’s the prevalence of non-communicable diseases skyrocketed. For example, diabetes went from a prevalence of 1.3 per cent in the 1970s to 13 per cent in, the 1990s.

The region went from infections being the leading cause of death at that time to non-communicable diseases being the leading cause of mortality, with diabetes being listed in the top three causes in most countries in the region.

Locally the picture is similar. A study done in 2017 by the Ministry of Health indicated that NCDs were the leading cause of death for people in Trinidad and Tobago.

At a national food system webinar hosted by the United Nations, participants were told that NCDs do not only impact on lives, they also put a strain on the nation’s gross domestic product, costing the country billions of dollars

According to the Ministry of Health’s national strategic plan for prevention of NCDs, heart disease, diabetes and cancer are the three leading causes of death in TT. NCDs accounted for 62 per cent of all deaths in TT for 2015. While crime claimed 410 lives in 2015, heart disease killed 2,673 people, accounting for 25 per cent of all deaths in TT that year. Diabetes accounted for 14 per cent, and cancer 13 per cent. Overall, 6,629 people died from NCDs in 2015.

During the webinar, health economist Karl Theodore described obesity as “rampant” in TT.

“What you have is an obesity problem that has an exponential increase and that is something that we have to be concerned about,” Theodore said.

The ministry’s strategic plan noted that approximately 55 per cent of people in TT are either overweight, with a body mass index of 25 to 29.9, or obese, with a BMI of over 30. The ideal BMI is between 18.5 and 24.9.

The strategic plan noted that obesity disproportionately affects women, with a 32 per cent prevalence of being overweight and a 32 per cent prevalence of obesity, as compared to 40 per cent prevalence in men for being overweight and a 19 per cent prevalence of obesity. The action plan also indicated that 24 per cent of the school-aged children were also either obese or overweight.

Other contributing factors also attributed to the spike in NCDs. The ministry’s action plan indicated that lack of physical activity was also disproportionate in women and 90 per cent of TT citizens have less than the prescribed amount of vegetables daily. Additionally there is a high prevalence of alcohol and tobacco consumption at 21 and 40 per cent respectively.

Unhealthy people, unhealthy economy

The cost of healthcare services in 2017 according to the Ministry’s action plan amounted to about $8.7 billion – with diabetes costing $3.5 billion, hypertension costing $3.3 billion and cancer, $2 billion because of the fewer cases compared to hypertension and diabetes.

Indirect costs accounted 58 per cent of the hypertension costs, and 65 per cent of the diabetes cost. Indirect costs accounted for a large portion of the costs to the economy, with 58 per cent of the cost of hypertension being indirect and 65 per cent of the diabetes cost. The highest proportion was estimated for cancer at 90 per cent.

Theodore linked the food system, with the health of the population and ultimately the health of the economy. He said the cost of treating NCDs accounts for a loss of between five and 10 percent of TT’s average global domestic product each year.

“The food system is contributing to the ill health of the population and that is not how it should be,” Theodore said. “The health of the population is not only costing the economy in treatment and prevention, but in losses and the losses are significant.”

“As if that is not bad enough when you do the calculations as to the impact of NCD’s on an annual basis, the loss in GDP from having to deal with NCDS and having to deal with the sick and dead, we are talking between $8 billion and $16 billion each year. These are huge losses and when you think about a small economy like ours that is trying to grow.”

Last year in her contribution to the 2021 Appropriation Bill, Trade Minister Paula Gopee-Scoon quoted Central Statistical Office statistics which said food imports amounted to $5.67 billion in 2019. Of that, $1.1 billion was spent on cereals, fruits and vegetables.

Govind Seepersad, lecturer in the Department of Agricultural Economics at the University of the West Indies, said the food system is highly supplemented by imports despite the increase in quantities

“Animal protein imports have been increasing, your fats and oil imports have been increasing. Preserved foods have been increasing. Imports of soft drink and beer has been increasing,” Seepersad said.

He said the seasonality of fresh fruits and vegetables have contributed to the desire, or lack thereof to consume healthy foods. Affluence and lifestyle have also changed, which increases the facilitation for consumption of highly processed foods. Bush fires, pressure on the land bank and pollution also affects local food production, thus leading consumers to imported products.

According to foodexport.org, the United States is one of the largest exporters to TT, with a 44 per cent share of the market in 2016. That year, the US exported food to TT to the tune of US$349 million dollars.

“Exposure to US media as well as language, cultural and commercial ties with the US all contribute to consumers having a positive attitude toward US products.”

Prevention better than cure?

President of the Pharmaceutical Association Andrew Rahaman argued that regardless of how healthy people eat and how many healthy practices they follow, people still get sick.

He said pharmacies still carry a range of supplements and other products that could help prevent NCDs but none of these medications can guarantee that people would no longer contract and NCD.

“We still promote these things to see if they get relief, but we also counsel them in terms of the lifestyle changes that they need to make to lessen the risk of NCDs. But you can do what you want, for a large number of people it is impossible to prevent because it is hereditary.”

But in his address at last week’s food system webinar, Rambharat once again lobbied for healthy consumption of food to reduce the strain on the nation’s GDP.

“I have said over and over the reduction in the food import bill, changes in the ravages that we face with NCDs, that is only going to change if you as an individual makes the healthy food choices that would give you wellness and improve your productivity. This is not about agriculture; this is about food as fuel.”

Making note of the link between healthy eating and the reduction of risk factors to NCDs, Rambharat said if people watched their health on an individual level the aggregate effects could change not only the cost of treatment, but what is imported as well.

“What we eat is going to determine how we perform and for how long we live. It is going to determine the healthcare cost of our household and it will determine our national healthcare cost,” Rambharat said. “We have to make the decision at the household level to do the things that are right for us.”

Theodore called for the Ministry of Health to have a greater impact on the food system. He called for a national nutrition council to be formed, which would have different ministries, producers and importers of food involved.

“We need to move from an informal set of discussions among people to a more structured approach where we could start monitoring and mending the impact on our health.”