Dr Alfred Dawes | Looking below the surface of crime and sugar
A generation ago, the Jamaican healthcare system struggled with and defeated the scourge of infectious diseases.
With one of the most efficient vaccination and public-health programmes the world has ever seen, this tiny nation eradicated polio, malaria, and other infectious diseases that, to this day, affect developed countries.
But now, Jamaica faces new challenges. With an ageing population and the rise in violent crime, we now have to contend with intentional injuries and chronic non-communicable diseases (CNCDs) such as diabetes and hypertension as the greatest burdens on the healthcare system.
Only this time around, there is no Rockefeller Foundation to fund public-health campaigns. We are left to solve our problems ourselves, as no country has the formula as to how to solve the CNCDs problem, and violent crime is a symptom of a sick society.
Unfortunately, the response to both issues leaves much to be desired.
TO FIX HEALTH, WE MUST FIX CRIME
Crime costs the country billions of dollars annually in lost productivity, deterred investments, as well as in the treatment of the victims of violent crime and those denied treatment because of the prioritising of these victims.
The solution of the crime problem is the business of anyone concerned about the state of healthcare. If we don't, and we continue along this path, then all our gains will be wiped out and the healthcare system will never develop. All the talk of medical tourism will be moot. Waiting-time initiatives will fail, and surgery waiting lists will stretch into the next decade.
Unless the decline in values and morals is addressed, we will never see the end of the attacks on medical personnel and the low morale they carry with them to work daily. To fix health, we must fix crime.
As with every reaction, the go-to plan for crime is a surge in operational activity of the Jamaica Constabulary Force. Not a focus on intelligence to find out who is sending the guns and who is receiving them, but to issue a press release as soon as the guns are found with not one arrest made.
We are used to hearing of curfews, searches and raids, and now the removal of tints from taxis, but nothing about strengthening the judicial system so those caught have a better chance of being tried expeditiously and brought to justice.
We continue to debate the successes of the Independent Commission of Investigations, while police officers are afraid to tackle criminals, lest they be caught up in a five-year investigation with no chance of promotion, and out-of-pocket legal fees until a decision is made on their fate. We simply cannot focus our energies on the roots of the issues but are content with approaches to the symptoms.
AS IT IS WITH CRIME, SO IT IS WITH CNCDS
The root of the chronic non-communicable diseases epidemic is obesity. Diseases such as diabetes, hypertension, and their endpoints of heart attacks, kidney failure, and strokes are linked to obesity. To solve these problems we must solve the obesity crisis.
If you asked me why someone is wealthy and I told you he earns more money than he spends, you would probably label me an idiot. So why is it that when you are told that people are overweight and obese because they consume more calories than they burn, you don't question it further?
That armchair logic at first makes sense. But if this is so, then all you have to do is to cut back on calories and walk a little more and reverse the caloric balance and the pounds will magically disappear.
For those who are struggling to lose weight, sometimes eating less than skinny persons, they know this logic is clearly false. Yet, we still tell obese persons to eat less and exercise more and they will lose weight.
We have not looked at why persons are not getting in more physical activity and where they're getting their calories from. That is why we have an obesity epidemic.
SAME UNSCIENTIFIC ARMCHAIR LOGIC
The leaders of the Caribbean recently held high-level talks on combating obesity and lifestyle diseases. Unfortunately, all that came out of the meeting was the same unscientific armchair logic that called for taxes on sugary drinks. Where is the evidence that sugary drinks are the cause of the obesity epidemic? And if they are, where was it ever demonstrated that a tax on sugary drinks will cut consumption and lead to a reversal of the epidemic?
Instead of probing deeply why persons end up with caloric imbalance and consume more than they burn, thus getting to a point where reversing their habits alone cannot help, the commitments coming out of the meetings reinforced the thinking that fat equals more calories in than calories burnt.
Why do persons eat more than they burn? How do they eat more than they burn? What are the sources of these excess calories?
Many of my patients ate no junk food or drank sodas, but they reached a point where they need surgery for weight loss. Approximately 18 per cent of Jamaicans live below the poverty line. Yet there are the poor who suffer from obesity. Did they get that way by eating out too much, or is it our traditional high-carbohydrate diet?
Until we start to look at these issues below the surface and ask the right questions, we will never solve the problems of crime and chronic diseases.
A paradigm shift is needed in how we, as a nation, address the threats to our society. If we don't, then the downward spiral will not only affect health and security, but will bring this country to her knees.