The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

DISEASES linked to unhealthy eating will "destroy" the Bahamian economy if left unchecked, a Cabinet Minister has warned, admitting that planned 'breadbasket' food reforms may be viewed as "blasphemy".

Dr Duane Sands, minister of health, told Tribune Business that the proposed changes were designed to "dramatically alter the trajectory" of lost productivity, worker absenteeism and increased healthcare costs that result from poor Bahamian dietary habits.

He added that this was "a significant part" of the explanation for why the Bahamian people were getting "terrible results" and poor value for money from the $800 million this nation spent annually on healthcare, with the country ranked between 120th-130th in the world for care outcomes. Disclosing that the total overhaul of the breadbasket food item line-up, proposed for the 2018-2019 Budget year, will form a key part of National Health Insurance (NHI) or whatever healthcare model the Bahamas chooses, Dr Sands said the economic implications were "ominous" if this nation failed to change its habits. "We'll put them on," he told Tribune Business of healthier foods, "with the hope this allows the diffusion of the belief that's too expensive to eat healthy. "We spend $800 million a year on healthcare which means the Bahamas is in the top 30 on expenditure per capita, yet on healthcare outcomes it's between 120-130th in terms of results.

"We're spending huge amounts of money and getting terrible results, and a significant part of that is what we put in our bodies."

Tribune Business revealed last week that the Government is proposing a total transformation of the so-called 'breadbasket' food list, which is comprised of price-controlled products whose costs are kept artificially low by state regulation.

Dr Sands conceded that, through these subsidies, successive administrations have effectively incentivised Bahamians to 'poison themselves' by purchasing low-cost unhealthy foods that contribute to the high level of chronic non-communicable diseases (NCDs) in this nation.

By reforming the contents of the 'breadbasket', the Minnis administration is thus attempting to align tax and economic policies with the Bahamas' dietary health needs for the first time since the 1970s.

"This is more than an academic exercise," Dr Sands reiterated to Tribune Business. "This is intended to dramatically alter the trajectory we're on.

"Look at the communique from the 2007 CARICOM meeting in Trinidad. They made it very clear that NCDs will destroy most of the economies of CARICOM if the trend continues. No economy would be robust enough to accommodate the increased cost of the NCDs.

"In 2007, it was predicted that between 2007 and 2027 that the CARICOM countries would see a 300 per cent increase in deaths from cardiovascular diseases. That's just deaths, it doesn't include complaints, morbidity."

Describing the findings as "ominous", Dr Sands said the spread of NCDs in the Bahamas had proceeded "at such a clip that no matter how robust your economic growth, you could never have enough surplus to pay for what you were creating with the rise in NCDs".

The Minister's warning of spiralling healthcare, economic and social costs if the increase in NCDs is not arrested was backed by a recently-released Inter-American Development Bank (IDB) report, which found that such illnesses typically impose an "economic impact" of up to 8 per cent of gross domestic product (GDP) on Caribbean countries.

In the Bahamian context, that could mean NCDs are costing this country between $640 million to $880 million per year, depending on whether $8 billion or the new $11 billion GDP - as measured by the Department of Statistics - is used as the calculation base.

"The Bahamas currently faces critical challenges due to an increase in chronic diseases (CD)," the IDB report warned. "Epidemiological figures illustrate the magnitude of the problem. The prevalence of overweight and obesity is high in all age groups: 13 per cent of school children; 45 per cent and 21 per cent of adolescents; 72 per cent and 43 per cent of women; and 66 per cent and 27 per cent of men, respectively.

"Several factors contribute to this epidemic, including poor dietary practices constituted by irregular feeding patterns and high caloric intake due to the consumption of food with high caloric density and low nutritional value, which is widely available and more expensive in comparison with local food. Furthermore, sedentary behaviour is generalised, with 72 per cent of adults aged 24 to 64 reporting that they do not engage in physical activity."

The IDB report, titled 'Associated factors of healthy lifestyle in the Bahamas', added that NCDs account for 45 per cent of all deaths in this country. It added that the economic and demographic consequences represented "a complex problem for the Government".

"The top three leading causes of years of life lost (YLL) due to premature deaths - ischaemic heart disease, cerebrovascular disease, and diabetes - are related to NCDs, and these three causes of YLL have been steadily growing over the past 20 years," the IDB report said.

"Though life expectancy has been consistently increasing, if the prevalence of NCDs continues to rise, it will reduce these gains in the short run. The probability of dying from an NCD between the ages of 30 and 70 is 18 per cent in non-Latin Caribbean countries, the highest in the Americas."

Dr Sands and his Ministry of Health team will meet this Wednesday with their counterparts from the Ministry of Labour and Price Control Commission to further develop the proposed 'breadbasket' list reforms prior to seeking Cabinet approval and issuing them for further public consultation.

Dion Foulkes, minister of labour, confirmed that he and his officials were strong supporters of the initiative led by Dr Sands. "One of the main concerns we have is the majority of the items on the price-controlled list are, generally speaking, foods not as healthy as they can be, such as fruits and vegetables, which are not on the list," he said.

"We're in the preliminary stages. Everything is subject to Cabinet approval. The main thing is he and I [Dr Sands] are very serious about it. The chair of the Price Control Commission, Syndia Dorsett, this is something she feels very strongly about and is agitating for it."

Mr Foulkes said the recommended reforms, if adopted, would have "multiple effects" including a healthier, better life for many Bahamians which would allow them to be more productive in the workforce. There would also be a reduced burden and cost for the healthcare system.

"The main thing is for Bahamians to live a healthier life and enjoy life," he told Tribune Business. "There are a lot of social and economic benefits."

Dr Sands, meanwhile, told Tribune Business that the proposed 'breadbasket' food reforms will be critical to the Government's preventative medicine strategy and whatever form of healthcare is adopted by this nation.

"Whatever model we adopt for healthcare, an integral and essential part of it is prevention, prevention, prevention," he added. "We believe we have to start with what we have, look at it critically, blow it up and start over.

"If we take the approach that the breadbasket is an evidence-based basket that looks at nutrition, looks at health rather than just providing a meal, perhaps we can start to turn the tide."

Dr Sands identified some of the foods proposed for inclusion in the new 'breadbasket' line-up as fruits, whole wheat bread, "certain healthy grains", fish in water "as opposed to fish in oil", and beans.

"I'm sure one of the criticisms will be 'My favourite food is not on the list' or 'I'm allergic to what's on the list'," the Minister added. "We'll accept that.

"The concept is that the 'breadbasket', at least the one we're recommending, according to the evidence as we understand it will be beneficial in terms of health as opposed to harmful. When you look at a number of the items people consider staples, it's little wonder we have the challenges we do."

Among the so-called 'staples' likely to be ditched from the 'breadbasket' list are the likes of corn beef and sugar, which Dr Sands acknowledged was "almost like blasphemy".

"You can tell a Bahamian that corn beef is not good for you," he told Tribune Business. "That's an easy intelligent discussion, but from an emotional point of view that's like saying 'there's no apple pie'.

"We're not saying you can't eat it. We're saying we're not going to be in the business of subsidising the cost."