KENWYN NICHOLLS
IN TT, the major disease burden is chronic noncommunicable diseases (CNCDs): heart disease, stroke, cancer, diabetes and chronic lung disease, accounting for over 62 per cent of deaths each year, three quarters occurring in people under age 70.
Over half the country's population has three or more of the risk factors common to those four diseases: poor nutrition, physical inactivity and harmful use of alcohol and tobacco (WHO October 20, 2021: Empowering TT Communities to Prevent and Self-Manage NCDs).
By most accepted definitions, CNCD is TT's 21st century public health problem.
The above situation is aggravated by the fact that between 1990 and 2020, the population in the 65+ years age bracket went from 5.4 per cent to 11.5 per cent and is projected to more than double to 26.2 per cent by 2060. As people age, the likelihood of developing preventable CNCDs increases, this unfortunate situation signalling continued social and economic disaster not just for the individual and his/her household, but for TT.
Any doubts about the capacity of the current health system to provide the adequate, continuous care that patients with CNCDs need while simultaneously addressing the socioeconomic norms associated with an ageing population were put to rest by the recent pandemic.
The Ministry of Health's daily recitations that covid19 hospitalisation and deaths were mainly aged people with CNCDs serve as grim reminders of how inadequate access to quality healthcare impacts the quality of life, as well as life expectancy itself.
If universal health coverage (UHC) was in place, TT's pandemic hospitalisations and deaths experience would have been greatly mitigated; and that is not the whole story.
UHC, firmly endorsed by the World Health Assembly (WHA) in 2005, is defined as 'access to key promotive, preventive, curative and rehabilitative health interventions for all at affordable cost.' On December 12, 2012, the United Nations General Assembly endorsed UHC as a sustainable development goal (SDG).
In 2013 TT joined some 115 countries that signed on to the UHC Partnership, a wholly funded WHO initiative, to deliver support and technical expertise to member countries in advancing UHC with a primary healthcare (PHC) approach. A US UHC success story follows.
In the biennially published Diabetes Report Card 2021, the Centers for Disease Control (CDC) in Atlanta revealed that after almost two decades of continual increases, the incidence of newly diagnosed cases of diabetes in the US decreased from 9.3 per 1,000 adults in 2009 to 5.9 per 1,000 adults in 2019.
Even more interesting was the fact that even though the prevalence of diabetes remained steady in the time frame, notification of prediabetes status nearly tripled from 6.5 per cent to 17.4 per cent. According to the CDC, with a proper diet, weight loss and exercise, only 20 of the people designated as prediabetic go on to full-blown diabetes.
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