HEALTH AND NUTRITION IN THE CARIBBEAN BY M S. N. L EWIS

A RE YOU GETTING ENOUGH OF ……..

C URRENT TRENDS IN HEALTH AND NUTRITION IN THE C ARIBBEAN Malnutrition in children and infectious diseases, once the major public health problems, have considerably declined and have been replaced by obesity and chronic noncommunicable diseases such as diabetes, hypertension, stroke, coronary heart disease and cancers. Although very much reduced, the threat of undernutrition and infectious diseases is still lurking in the background and may erupt into epidemic proportions under the fragile economic systems.

MALNUTRITION

U NDERNUTRITION IN THE C ARIBBEAN Undernourishment Under-nutrition is a significant intervening factor in the levels of morbidity and mortality in the Caribbean subregion. The prevalence of obesity is also rapidly growing and is considered a potential threat to Caribbean development in terms of its impact on productivity, income, health and nutrition. Current statistics shows that about 6 million persons in Latin America and the Caribbean are undernourished.

Prevalence of undernourishment in total population Country 2.5 % - 4 % Cuba 5-19%Guyana, Jamaica, Trinidad and Tobago, Suriname %Dominican Republic 23 %Haiti

Available data show that the dietary energy supplies for the Caribbean countries areabove the minimum standard of 1800 Kcal a day. However, 6.7 million people in the Caribbean are undernourished. This accounts for 21 per cent of the Caribbean population in the year 2000 and 2002 (FAO 2004).

MALNUTRITION AND CHILDREN Despite the implementation of policies to address some of these problems and the impacts of poverty, many people remain hungry and one in three young children in developing countries still suffer from under-nutrition. In the Caribbean, the percentage of LBW ( low birth weight) babies is 10 per cent. Women who are malnourished are also less likely to be able to successfully breastfeed their children. In addition, their cognitive ability is often marred leading to inadequate care for their young children.

As figure 1.2 below demonstrates, the Dominican Republic, Guyana, Suriname and,notably, Haiti and Trinidad and Tobago have relatively high levels of LBW babies. Haiti (21 percent) and Trinidad and Tobago (23 per cent) score even higher than the Sub-Saharan Africa and the least developed countries, these having proportions of low birth weights of, respectively, 14and 18 percent. ( statistics since 2003) Malnourished children in the Caribbean for % Haiti; Guyana 10.8%; Jamaica 2.2% 3.9 % Cuba; Trinidad 2.2%

OBESITY IN THE CARIBBEAN

Obesity has become an epidemic in the caribbean. Currently about 25% of women in the caribbean are obese with ( BMI > 30), which is twice as much as their male counterparts. Of the many challenges confronting the Caribbean with respect to obesity are two which are directly linked to gender,nutrition and poverty, namely the epidemiological profile of age and gender and poverty, obesityand food economics.

CHILD OBESITY The Caribbean is also faced with the emerging problem of childhood obesity, which paradoxically coexists with undernutrition, where increasing levels of overweight and obesity are linked to diet-related chronic diseases. However, overweight or obese children, like adults, are at risk for serious health-related problems such as diabetes, hypertension, liver disease and respiratory problems, such as asthma and sleep apnea, as well as muscular- skeletal problems with hips and knee joints.

HIV/ AIDS

The statistics show that at the end of 2009, an estimated 240,000 people were living with HIV in the Caribbean. Some 17,000 people were newly infected during 2009, and 12,000 people died from AIDS.HIV in the CaribbeanAIDS In the Bahamas more than 3% of the adult population is living with HIV. Higher prevalence rates are found only in sub-Saharan Africa, making the Caribbean the second-most affected region in the world. Half of adults living with the virus are women.

Trends and transmission routes Overall, the main route of HIV transmission in the Caribbean is heterosexual sex, much of which is associated with commercial sex. Sex between men is also a major factor in some countries' epidemics. Cultural and behavioural patterns (such as early initiation of sexual acts, and taboos related to sex and sexuality), gender inequalities, lack of confidentiality, stigmatization and economic need are some of the factors influencing vulnerability to HIV and AIDS in the Caribbean.HIV

E STIMATED HIV PREVALENCE AND DEATHS DUE TO AIDS, END 2009 CountryAll people living with HIV/ AIDS Adults with Hiv/ Aids in % Death due to AIDS Bahamas6,6003.1<500 Barbados2,1001.4<100 Cuba7,1000.1<100 Dominican Republic 57, ,300 Haiti120, ,100 Jamaica32, ,200 Trinidad and Tobago 15, <1,000

ANTI RETROVIRAL DRUGS Countries in this region are making efforts to slow the epidemic and to limit its impact, most obviously through their efforts to provide antiretroviral drugs. In 2002, the Pan Caribbean Partnership against HIV/AIDS signed an agreement with six pharmaceutical companies to provide access to cheaper antiretroviral drugs. Progress since then has been uneven, partly due to wide differences in drug prices. antiretroviral drugs Access to antiretroviral therapy is provided to almost all those in need in Cuba. However in the Dominican Republic, Jamaica and Haiti, HIV treatment coverage reaches less than half those in need, at 47%, 46% and 43% respectively.

D IABETES It is estimated that diabetes affects 10-20% of adults. The International Diabetes Institute estimated that there were over one million cases of diabetes in the Caribbean since 1994( 105,000 type 1 and 913,000 type 11)