The State of Health Care in Jamaica

Basil Waine Kong, Ph.D., JD

Gary Spaulding, Senior Gleaner Writer , wrote in his Oct. 17, 2010 Column that: “…human-rights groups would do well to focus their attention on the health sector. I suspect that the treatment at hospital is worse than police excesses, if less spectacular.,, Over the years, the RHAs and senior positions in the public-hospital system have been administered by persons who are clearly motivated by the need to protect their jobs and status instead of advancing the Government's vision of a cost-effective, sustainable health-care delivery system… Can one, therefore, blame persons who rush abroad to seek medical treatment as they feel that a minor bellyache is coming on?”

It would appear that we have assassins in uniform on the one hand as well as a health care system that hastens the demise of those seeking acute medical care on the other. Underfunding, lack of appropriate planning and organization result in the inhumane treatment of our citizens. The shortages of essential medicines, supplies and equipment is a crime against those needing medical care. Given that lack of resources and organization is not a problem with a foreseeable solution, we need to change our focus from acute care to prevention. Obesity and inactivity exerts a heavy burden on our resources.

It is difficult to imagine that with all the sunshine, ocean, open spaces, and such a strong sports tradition, 20% of our children are overweight. All aesthetics aside, being fat ought not to be perceived as anything other than unhealthy.

Obesity has reached troubling proportions in Jamaica. Since 1980, we have seen a 50% increase in the incidence of obesity every decade. This dramatic rise in obesity is inevitably accompanied by an equally critical rise in diabetes, resulting in over 20% of Jamaican adults suffering from this awful disease. Diabetes is particularly nasty as it impairs eyesight, causes impotence, and may result in the amputation of toes and legs. How did a society where people walked miles each day, succumb to this plague of inactivity, diabetes and obesity? An unhealthy country is a country without a future.

The United States has taught the world that there isn’t enough money to pay for all the disease caused by obesity, lack of exercise, cholesterol, smoking and diabetes. However, the United States spends 20 cents of each dollar collected as revenue on health care. Still, the life expectancy of an average African American men is less than Jamaican men. The United States has a so-called ‘state-of-the-art’ health care system, yet they are way behind the rest of the world in promoting health and well-being. When a patient has a disease, treat the disease; similarly, when a large segment of a population has a disease, treat the country. If you want to reduce violence, crime and unwanted pregnancies in Jamaica, let children have the opportunity to know their grandparents.

Jamaica needs a system that promotes health and not an expensive “health care system” that only treats disease. In a country where the average household income is less than US$4,000 per year, Jamaica can ill afford to provide invasive and expensive medical services to treat illnesses that should have been prevented. A “System of Health” emphasizes prevention, while a “health care system” places emphasis on the treatment. By being proactive instead of reactive, we can inspire people to take health promotion and disease prevention seriously.

Jamaicans live on an island of sunshine and cool breeze and most of us must live and eat by the sweat of our brow. Europeans and Americans come to our island to lose weight through exercise and heart healthy eating, so why can’t we take advantage of these home grown remedies? If we consider the fact that most of the disease that plague us and cost so much can be prevented, it becomes apparent that promotion of heart health and exercise would allow enormous savings for the health care system. In fact, just about all the heart attacks, heart failure, strokes, diabetes, kidney failure (diseases that kill 50% of us) could be prevented by making simple adjustments to our lifestyles. Being proactive in health can add 10 more years to enjoy the company of our grandchildren and guide them to a happy, healthy and productive life.

I grew up reciting the nursery rhyme about Humpty Dumpty who was lazily sitting on a wall, had a great fall and nothing could put him together again. If Humpty was not sitting on the wall, his risk of falling would be far less. We can take an important message from this nursery rhyme by understanding that no matter how good our reactive plans in medicine and surgery may be, it will never be as good as prevention. An ounce of prevention is always going to be worth more than a pound of cure.

While our government struggles daily with how to allocate our limited resources, it should be recognized that it would be a good investment to spend more on prevention. At present, the Government spends less than 5% on prevention of diseases and we need to increase our spending here to at least 25%. In a Gleaner article dated 13/8/2008, Prime Minister Bruce Golding, in identifying this problem addressed 750 delegates from 80 countries at the opening ceremony of the 57th August General Assembly of the International Federation of Medical Students’ Associations disclosing the fact that the Government is planning to launch an island wide program aimed at getting people to adopt healthy lifestyle practices. In outlining the Government’s plan, Prime Minister Golding emphasized the need to sensitize the public of the benefits of a healthy lifestyle, letting them know that “you can eat yourself to death in the same way that you can smoke yourself to death.” However, other than this speech, not much has been done in this arena.

Comparable to the above mentioned program, The Heart Institute of the Caribbean has developed a plan which involves an island wide tour aimed at training “Community Health Advocates” in various parishes. This plan also involves cardiac screening and group counseling thus effectively identifying the healthiest and most at risk communities in Jamaica. This way, we can educate and motivate our citizens up close and personal to maintain good health.

Just as it would be unconscionable not to have an infectious disease program, it is unacceptable not to have a prevention program. Every citizen must recognize that if they do not take time to exercise and eat well, they will prematurely succumb to disease. God made us to be strong and physically fit, and by choosing to be “fat and lazy”, we will have to pay a price that our government can ill afford.