In Genesis, the first book of the Bible, God stated “it was good” five times as the Earth, seas, plants, animals and humans were created. Yet, we are not being good stewards over what we have been given charge. Climate change and non-communicable diseases (NCDs) are symptoms of the inherent failures in our development paradigms. Small island and low-lying developing states (SIDS) are the most vulnerable to the impacts of both climate change and NCDs, as reflected in the Samoa pathway. The unprecedented hurricanes in the Caribbean in 2017 were planetary alarm bells sounding that climate change is real and accelerating. These challenges in SIDS are a litmus test for the international development community. Their responses demand dogged attention, resource mobilisation and a paradigm shift among all levels of leadership within our jurisdictions and beyond.
SIDS comprise mostly small, open economies that are vulnerable to natural and human-made shocks – the most formidable of which appear to be our escalating problem of NCDs. Every year, tens of thousands of people lose their lives, legs, kidney function and sight due to NCDs such as diabetes and hypertension, with a high and unsustainable price tag. This level of social and economic impact cannot be maintained in SIDS. We cannot spend our way out of this, as our economies overall are not growing fast enough.
The heads of government of the Caribbean Community (CARICOM) saw this 10 years ago, when they issued the historic Declaration of Port of Spain: Uniting to Stop the Epidemic of Chronic NCDs in September 2007 with 26 commitments, which have been monitored annually.
Turning the tide
There are effective public policies and programmes that can help turn the tide on this NCD epidemic. Measures to improve regulatory capacity for tobacco, alcohol, food and medicines are needed to reduce population risk levels and to increase access to treatment.
Both climate change and NCDs are typified by over-consumption: of food, fossil fuel, tobacco and alcohol. Climate change in the Caribbean means hotter, drier weather, with more category 4 or 5 storms, and inundation by above-average rainfall that leads to loss of life, property, agricultural crops and infrastructure. The social, economic and environmental implications are profound. We therefore welcome the World Health Organization’s (WHO) initiative on climate and SIDS.
One link between climate and NCDs is the excessively large number of deaths among people with NCDs in the weeks and months after a large storm, given the disruption to services and reduced availability of medicines. Another link is food and nutrition security. We are witnessing the erosion of agriculture as more frequent storms, drought episodes and damage to coral reefs undermine food and nutrition security in SIDS. This leads to more consumption of cheap, low-quality imported food, leading to obesity and attendant NCDs.
The massive agriculture industry in the world – especially for meat – uses huge amounts of gas and oil to make fertilisers and support mechanised agriculture. If we shift to a more plant-based diet there would be benefits to health from reduced risk of NCDs, and benefits to the planet from reduced greenhouse gas emissions.
Another link is that of air quality, as heat and drought lead to more fires and smoke, and pollution from vehicle emissions can trigger asthma and chronic respiratory disease.
Regarding physical activity: people living in SIDS are increasingly inactive, driving up the incidence of heart attacks, strokes and cancers. Transportation is largely by motorised vehicles using fossil fuels. Initiatives to increase alternative transport such as biking and walking and rapid mass transport, which utilise the existing built environment, have potential co-benefits to health, energy security, tourism and the planet. This is in line with the conclusions of the recent G7 meeting of environment ministers in Halifax, Nova Scotia.
The range of health and other social and economic sectors that need to be involved in tackling the NCD challenge is broad and deep. Thus, we welcome the new Defeat-NCD Partnership as a ‘big tent’ to bring together public and private-sector agencies and civil-society organisations to share information and identify good practices in funding, service delivery, positive behaviour change and community engagement so that all of these facets can be scaled up. The urgency today demands that we develop and foster such mutually beneficial and demonstrative partnerships without delay. There is no luxury of time when lives are at stake, livelihoods are in jeopardy, national competitiveness is under threat, our collective labour force is in crisis and our SIDS economies become even more fragile under the crushing weight of the formidable challenges of climate change and NCDs.