We've all been there... it's lunch time, we're hungry, we don't have much time to wait, don't want to spend too much money, but want to make healthy choices. So, what are our options? Well, on a recent mission in the Caribbean the choices were fried chicken or stew with fried chicken, not many other choices.
We felt guilty because we were the health team on mission in the Caribbean conducting studies on the impact of non-communicable diseases (NCDs) and we are extremely conscious that fried chicken contains a lot of saturated fat --a contributing factor in obesity, heart disease and diabetes, which top the list of NCDs.
We ended up swallowing our guilt and snacking on the crispy morsels of chicken anyway.
This simple encounter brought to light the challenges countries and individuals face in addressing NCDs which as a group represent the leading causes of morbidity and mortality worldwide --two thirds of global deaths are the result of chronic diseases. In the Caribbean, the burden of NCDs has escalated to the point that five times as many people are dying from chronic diseases than from all other illnesses combined.
Much of the rise in NCDs in the Caribbean can be traced to individual risk factors such as unhealthy diets (the fried chicken experience), lack of physical activity, smoking and excessive alcohol consumption. Particularly at risk are women who are more overweight or obese and more inactive than men; young adults who begin smoking and consuming alcohol as early as 12 years of age; and the poor who find themselves paying a larger proportion of their out-of-pocket expenditures on NCD care than the better off population.
One of the most stunning facts is that more than 60 percent of women aged 35-54 years in Jamaica are either overweight or obese. The trend is very similar in other Caribbean countries. Is this related to what we put in our mouths? While it may seem that the risk factors driving NCDs are largely under the control of each individual --eating healthier, getting more exercise, making better choices-, is this really the case? Just look at our experience in trying to eat healthy. Much like our team, many people, not only in the Caribbean, but across the world face similar dilemmas. People are busy, want something to eat quickly, and don’t want to spend too much money.
So what are the choices? Fast food, fast food, and fast food! So, how do we address this fried chicken epidemic? Challenges always present opportunities. Can we make the food industry provide food with less trans-fat and less salt through regulations and monitoring? Can we give farmers the incentives to produce more veggies and fruit? What is evident is that we need to work closely with the private sector to reduce the risk factors fueling NCDs.
In our consultation meeting for risk factors, we were told one of the reasons why Jamaican women are likely to be overweight or obese is that full figures are considered beautiful in the Caribbean.
So, it appears we also have to work on cultural norms and habits too. In the twin reports that our team just completed, Non-Communicable Diseases in Jamaica: Moving from Prescription to Prevention  and The Growing Burden of Non-Communicable Diseases in the Eastern Caribbean , we document the situation in selected countries in the Caribbean, analyzed countries response to non-communicable diseases and provide policy recommendations for moving forward in controlling them.
Some of the recommendations include:
- Prevention as an integral part of any initiative to address the NCD epidemic, such as policies that encourage physical activity, promote a healthy diet and reduce the harmful use of alcohol and tobacco.
- Engaging actors outside the public realm such as non-health ministries, NGOs and the private sector in NCD prevention and control. Actions can include encouraging the food industry to manufacture, distribute, and market healthier products.
- Boost surveillance, monitoring and data collection for NCDs so policymakers can more accurately target high risk groups.
- Introduce legislation of tobacco, alcohol, food and essential medicines to better coordinate pricing and taxation initiatives, establish smoke-free work and public environments, and restrict the sale of alcohol to appropriate age groups.
Only this comprehensive approach could break the “fried chicken curse” and help people in the Caribbean make healthy choices as the best response to beat non-communicable diseases.