The Tribune

By Dr Monique Thompson

Here we are. Just two short weeks away from 2016 and the implementation of the much needed National Health Insurance (NHI).

With the current administration’s record of successfully planning, implementing and being accountable with the various aspects of large projects, I am honestly very concerned about this entire ordeal. As numerous questions regarding this mammoth task remain unanswered in the public domain, I have to put forth my one burning issue, as it is by far my biggest concern with this whole plan, because in the world of sustainable universal healthcare it is the most important factor, and that is disease prevention. Perhaps I am not looking hard enough, but I simply do not see a concerted effort being made in this regard.

“The majority of the country’s burden of disease comes from health risks that originated from an early age and are related to cultural and social determinants of health. Because of this, prevention and health promotion should be a key focus for the Bahamas’ primary healthcare plan.”

I didn’t say it, Sanigest International said it. I will echo it, however. Prevention is key. When it comes to primary health care plans, one size does not fit all. You have to take a thorough and critical look at what the people are dying from as well as the resources those conditions consume.

In our case – the Bahamas – we know that noncommunicable diseases (NCDs) make up our country’s burden of disease. NCDs are simply diseases that you cannot catch from someone, nor give to anyone else. They are noninfectious.

In 2014, the World Health Organisation (WHO) assigned the following mortality rates to our top four NCDs: cardiovascular disease (CVD) 33 per cent; cancer 17 per cent; diabetes seven per cent, and chronic respiratory disease one per cent.

These four diseases single-handedly killed 58 per cent of Bahamians. With 72 per cent of the total deaths per year being caused by NCDs – 58 per cent of them are due to the diseases I just mentioned. Furthermore, if you are a Bahamian between 30 to 70 years old, your chances of dying prematurely from one of those same four conditions are 14 per cent.

Are you as gobsmacked by all of this as I am? If not, take into account the fact that over 70 per cent of these NCDs are preventable.

At this point we know the diseases that are killing us off, but how much is it costing us?

It is estimated that the Bahamian government spends $2,000 per person per annum on healthcare. Do keep in mind that this figure takes into account all diseases such as those that are not NCDs, injuries, catastrophic events, etcetera. This places our healthcare costs among the highest in the Caribbean…just like our murder count. This is especially disturbing after it was recently made known to the public that some $100 million of our healthcare costs have been wasted.

Like so many Western nations, our current healthcare spending is generally represented on the following graph. We spend the bulk of the money essentially helping patients live with chronic diseases, followed by grand, expensive steps medically in an effort to stop them from dying, and then reduce spending a bit on palliative end-of-life care.

With an emphasis on prevention, the goals would be to prevent/delay onset of NCDs, reduce the severity and chronicity of the diseases if acquired, reduce healthcare costs over time, improve and extend the productivity of Bahamians, and not only lengthen our life-span but also improve the quality of life for Bahamians. Thus, adequate resources would also be spent on health promotion, health education, various health and wellness programs, and developing and implementing policies that would positively affect health in the public educational system as well as the work force, and communities. Over time, the amount of funds needed to support and treat patients with chronic NCDs should decline as the rate at which these diseases are acquired decrease, as well as their severity.

Now, I am no expert in economics. I am, however, among very few experts in this country on preventative health and holistic and integrative medicine – all key components of any successful universal health plan. I would much prefer that I toil and labour knowing that my efforts are going towards stopping a health crisis before it starts, rather than paying all these taxes to cover ridiculously expensive medical tests, treatments and procedures just so that at the end of the day, the masses still die from a condition that could have been prevented. This thing go with sense, man.

No, preventative health is not free. It is an investment; an investment on the part of the people and on the part of the government. It takes commitment from all parties involved. It requires stellar planning and significant community mobilisation. However, at the end of the day, it is worth every dime.

In regards to our particular health crises, we have to go beyond being intentional and almost become radical in our efforts to combat the poor health of our nation. For example, we know that childhood obesity is on the rise in this country. We also know that obesity is a significant risk factor for CVD, diabetes, and cancer – the diseases that are wiping us out. In general, to prevent these conditions, it is recommended that you do vigorous physical activity three to five times per week for around 45 minutes. I’m not even touching all the other health benefits of exercise by the way. But knowing all this, why do kids in public schools only have Physical Education once per week?

As I close, I want you to think on this – where is the logic in spending over $250,000 on educating a girl to the Master’s level, just for her to return home, work for five to 10 years in the public sector, only to have her die from breast cancer at the age of 37?

I say that to say that for any person, and by extension for any nation, your health remains your greatest wealth. It is by far your greatest investment and without it you are severely limited in what you can do.

To the current government and those to come: If you want National Health Insurance/universal healthcare to be a success in the long run and be sustainable, get very serious and intentional about prevention.

• Dr Monique Thompson is the founder of Cornerstone Healing Institute, an integrative family medicine clinic that focuses on educating patients on healthier lifestyles, preventing and treating chronic disease. Contact 356-0083 or visit www.chibahamas.com for more information.