Middle income countries like those in the
Caribbean can feel proud of their
achievements in
health care. There has been a dramatic fall-off in
infant mortality and
crude mortality rates along with significant improvements in
life expectancy at birth. However, these countries now find themselves grappling with the burden of chronic
non-communicable diseases such as
heart disease,
stroke,
hypertension,
diabetes mellitus and
cancer. There are good data to support the view that some of these
diseases, in particular
diabetes mellitus, have assumed
epidemic proportions and there is concern that this fact may have been missed by many because of the surreptitious onset, as is the
nature of the
chronic diseases. The impact of this
epidemic may have suffered because of the higher profile of more tropical issues like
HIV/
AIDS even though the former makes a larger contribution to
morbidity and
mortality statistics. It is now obvious that despite the impact of other factors,
lifestyles changes are the major contributors to the
epidemic. In
populations of
similar genetic stock, living in significantly different socio-economic circumstances, the impact of increased dietary
salt, increasing
obesity and decreased
physical activity on the
prevalence of
hypertension,
diabetes mellitus and
lipid disorders is unequivocal. Data from the developed world, which has already been through this
epidemic of
chronic diseases, have shown that increasing technological advances in
medical care is an efficient way to respond to the situation. A multi-sectoral approach is required to tackle this
epidemic, including the
provision of
incentives for
healthy eating and widespread opportunities for increased
exercise and other
physical activities. Continued
research into the evolution of the
epidemic, including reliable estimates via
surveillance methods is a necessary component of our response. The problems and the
solutions are not only the responsibilities of the
health officials but must involve
education,
agriculture and other sectors of the economy. (AU)