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Intended contribution
(My intended contribution to the Town Hall Meeting of the Joint Select Committee on Social Services and Public Administration)
The point I want to make today is about the way the country as a whole is addressing and attempting to combat the burgeoning problem of NCDs and obesity.
In the CARICOM Heads of Government Port-of-Spain Declaration Evaluation and Implementation workshop in 2016, the Minister of Health, Mr Terrance Deyalsingh noted the need to “take personal responsibility to bring about healthier lifestyles.”
(And my thoughts about it are articulated by the 2nd speaker, Dan Buettner. Think of this as a sneak peak to my argument)
In the recent Carlton Philips Diabetes symposium, Mr Deyalsingh asked the question as to why diabetics are not willing to make the necessary lifestyle changes to manage their disease as he did.
When one looks at the flagship program of the Ministry of Health to address NCDs, TTMoves, it places the onus on the individual to make the lifestyle changes that it champions. Therefore the TTMoves program relies on the individual’s sense of personal responsibility in tackling NCDs.
However, I am here to say that when it comes to changing the health outcomes of a neighbourhood, community or nation, appealing to personal responsibility has never worked and will never work.
In short, I’m saying that the Ministry of Health and the Government by extension is taking the wrong approach.
Point Of Focus
What do we need to focus on that will help to have a meaningful impact on the NCD problem that we are experiencing?
To start to establish my context, I reference the words of Marion Nestle, a former senior nutrition policy advisor in the Department of Health and Human Services in the USA and was also the editor of The Surgeon General’s Report on Nutrition and Health.
She is quoted as in an interview:
“You can tell people that large portions have more calories, but they will still eat more when given a large portion. Everyone does. Education isn’t enough. You have to change the environment to make healthy choices the easy choices.”
Trinidad & Tobago's Dietary Environment
We should ask ourselves, are healthy choices easy in Trinidad & Tobago?
To answer that question, some more context
Allow me to draw attention to the Blue Zones, regions where people live remarkably long, healthy lives, as in people in their 80s, 90s and 100s full of life and vitality.
(By the way, watch this series on Netflix. Highly recommended)
What sets them apart? They thrive in environments that naturally guide them towards healthy choices. They don’t have to fight against their environment in order to stay healthy.
How do they do it?
- They lived in environments that encouraged healthy eating. Fresh fruits and vegetables were affordable and readily available year-round.
- Unhealthy food (e.g. processed food, sugar-sweetened beverages, fast food) was very hard to get.
- Marketing of unhealthy food and substances was practically non-existent.
- Their home environments made it easy to cook plant-based food at home.
- They had recipes on hand to make the plant-based meals tasty
- People in the Blue Zones had a lot of social support for healthy eating and living, so much so that it was what the people in the community had in common.
Now how does that compare with Trinidad & Tobago?
- In my frank opinion, Trinidad & Tobago’s dietary environment does not support and encourage healthy eating
- Whilst fresh fruits and vegetables are readily available year-round, affordability might be a different matter altogether.
- Unhealthy food (e.g. fried chicken, pizza, doubles, roti, gyros, burgers, BBQ, salty snacks, sweets, breakfast cereals etc) surrounds us and is usually more affordable and convenient than healthier food.
- Marketing of unhealthy food is ubiquitous
- In Trinidad & Tobago, whilst we do have plant-based recipes that taste good, a lot of the recipes tend to have high amounts of fat, salt or sugar. E.g. 1 lb pelau, depending on how it is made, can have over 1000 mg of sodium in it.
- There is a general lack of social support for healthy eating and living in Trinidad and Tobago as it is not a common way of life for most of the population.
An example of the marketing advertisements that appear on local screens daily.
Therefore, we find ourselves in this predicament due to what local experts term an “obesogenic environment,” a setting that encourages unhealthy eating habits and sedentary lifestyles. Our diet has shifted drastically over the years, transitioning from local, wholesome produce to an influx of convenient, high-calorie, processed foods that dominate our landscape.
The local experts include Dr Dhanoo, President of the Diabetes Association of Trinidad and Tobago; Dr Rohit Doon Advisor in the Ministry of Health and Dr Parasram, Chief Medical Officer of Trinidad and Tobago.
All 3 experts have talked about Trinidad & Tobago’s obesogenic environment
Conclusion
I want to close off my point by answering the question Mr Deylasingh asked at the Diabetes Symposium recently. The reason why it is difficult for diabetics in this country to make the necessary lifestyle changes is because:
- We humans are genetically hardwired to crave foods high in fat, salt and sugar.
- More importantly, Trinidad and Tobago has an environment where sugar, sugar-sweetened beverages, ice cream, cookies, cakes, candy and sweetened breakfast cereals are ubiquitous.
- As anyone who is recovering from an addiction can say, there’s only so much self-control one can muster in the midst of the addictive item(s).
Therefore, in short, if we want to reduce the incidence rate of diabetes and other NCDs, and reduce the downstream healthcare costs, the dietary environment in Trinidad and Tobago HAS TO CHANGE! The future development of this country depends on it.
