Introduction

On October 2, 2023, the Trinidad and Tobago House of Representatives presented the budget for the 2023-2024 financial year. One aspect that has always piqued my interest is the allocation of funds for health and agriculture. These financial commitments shed some light on the government’s priorities, particularly in addressing the concerning prevalence of non-communicable diseases (NCDs) in Trinidad and Tobago. This blog post explores the government’s approach to healthcare, the importance of the environment in health outcomes, and a compelling case for investing in environmental change to promote healthier living.

The Government’s Approach to Healthcare

The budget allocated a substantial TTD 7.409 billion to the health sector, marking it as the second-largest allocation for the 2024 financial year. In addressing NCDs, Mr. Colm Imbert, the Minister of Finance, emphasized a multi-disciplinary approach aimed at preventing, managing, and controlling the burden of NCDs. The goal is to ensure the population attains the highest standards of physical and mental health, quality of life, and productivity across all age groups.

Mr Imbert’s Budget presentation can be found below (It’s a very long speech, just so you know)

For those of us who prefer to read the statement, here is the link to the written statement.

Key Programs and Initiatives

Mr. Terrence Deyalsingh, the Minister of Health, outlined several initiatives, with a focus on hypertension and diabetes:

1. Diabetes Transition Clinic: A specialized clinic targeting young adults aged 16-24, encouraging lifestyle changes to combat diabetes.
2. Diabetes Wellness Clinics: Established to reduce limb amputations by 20% within 2-3 years by promoting lifestyle changes.
3. HEARTS Program: Launched in collaboration with the Pan American Health Organization (PAHO) to combat hypertension and cardiovascular disease.

These programs have achieved some success, with several patients improving their HbA1C readings to a healthier level.

However, a more profound concern arises from two of Mr Deyalsingh’s passing comments –

“…we hope the habit sticks”

and

“…but we don’t release you to go back home to the same bad habits. You go back now to your primary health care clinics that I spoke about earlier.”

In my opinion, lifestyle changes should not rely on hope but require an environment that supports and sustains these changes.

A report of Mr Deyalsingh’s Budget contribution can be found here¹

The Importance of the Environment

The people whom the Health Minister talks about in the wellness centres etc; wouldn’t be staying in the wellness and health centres for 24 hours a day.

The environment in which individuals live, work and make daily choices plays even more of a pivotal role in health outcomes than the habits we learn and develop in wellness centres.

In Trinidad and Tobago, the prevailing food environment is a significant contributor to the high rates of NCDs². The readily available unhealthy foods and the design of the built environment that encourages being sedentary have created a health crisis in the population

Trinidad & Tobago’s Health Crisis

Andrew Dhanoo, President of the Diabetes Association of Trinidad and Tobago, emphasized the impact of the food environment on health in this article³. The availability of cheap, high-calorie foods and the ubiquity of fast-food restaurants have contributed to the alarming rates of NCDs in the country. This ‘obesogenic environment’ promotes unhealthy lifestyles, resulting in the rise of NCDs.

(This is why I’m not a fan of ‘personal responsibility’ when it comes to diet and lifestyle. In fact, I think that term should be lost in the dark mists of history. But that’s for another day)

A Path to Real Change

To address the NCD crisis effectively, the focus must not be on individual responsibility, but on systematic change in the environment. The success of the North Karelia project in Finland serves as a compelling example⁴. Here is a quote from The Blue Zones Solution^{(affiliate link)} which is one of the lessons learnt from the North Karelia Project:

Pekka Puska’s team didn’t waste anybody’s time by lecturing them about individual responsibility. Instead, they put their resources into making long-lasting changes to the local environment.

Pekka Puska was the individual who spearheaded the health transformation of North Karelia.

By transforming the local environment to make healthy choices more accessible and convenient, North Karelia witnessed remarkable health improvements. This encompassed reductions in heart attack and lung cancer rates, along with a general increase in life expectancy.

Changing the Environment for Healthier Living

To conclude, improving healthcare infrastructure, while essential, may not yield the desired population-level health impact. The most prudent investment would be to allocate resources to change the environment, making healthy choices more accessible and appealing to the people of Trinidad and Tobago. Such changes can include promoting healthier food options, facilitating exercise, making outdoor spaces safer and creating a culture of well-being. By doing so, we can pave the way for a healthier, more vibrant Trinidad and Tobago, with a population that can enjoy a higher quality of life and well-being.

References:

1. https://newsday.co.tt/2023/10/09/deyalsingh-patients-must-act-to-curb-diabetes/ ↩︎
2. https://trinidadexpress.com/business/local/more-kfc-outlets-per-person-in-t-t-compared-to-any-other-country/article_f32e2304-2b4b-11ee-a47a-7723ab521ffc.html?utm_campaign=blox&utm_source=facebook&utm_medium=social&fbclid=IwAR2QQT2aKHdcU2E578CmSVesbw5fKKQLPIk72n3-mZmLw-KQoY3iAE112pQ ↩︎
3. https://trinidadexpress.com/news/local/ncds-causing-more-covid-deaths-in-t-t/article_6b616822-1366-11ec-906a-a3822b11d036.html ↩︎
4. https://www.bluezones.com/2018/05/finlands-unhealthiest-town-went-on-diet/ ↩︎