The Bahamas has been identified among the countries in the Americas with the highest probability of dying too young from a non-communicable disease (NCD), according to volume one of the Bahamas STEPS 2019 report, which warns that The Bahamas is "not only off course, but is headed in the wrong direction relative to its health and well-being".
"Not only are more Bahamians dying today from NCDs than any other disease category, they are dying at younger ages," according to the report, subtitled, "2019 Bahamas NCD Risk Factor" report.
"There is a 20 percent chance of a Bahamian dying early or prematurely from an NCD.
"In fact, for 2019, The Bahamas was identified among the countries in the region of the Americas with the highest probability of dying too young from an NCD. The probability in The Bahamas is 19.9 percent compared to the regional probability average of 14 percent (Costa Rica, 9.5 percent at low end and Haiti, 31.3 percent at the high end)."
The report, which Minister of Health and Wellness Dr. Michael Darville tabled in the House of Assembly yesterday, highlights the massive burden of NCDs on The Bahamas and calls for bold and urgent action at the highest political levels and at the grass roots level to bridge the gap from promise to priority to progress.
"A singular message from the STEPS 2019 data is that The Bahamas is headed in the wrong direction in its NCD trajectory," the report read.
"Additionally, in the study year, the adjusted rate of potentially avoidable premature mortality in The Bahamas was 324.5 deaths per 100,000 population, a decrease of 26.9 percent from a rate of 443.9 in 2000.
"This meant that in 2019, the avoidable mortality in the country was 43.1 percent higher than the average rate reported for the region of the Americas as a whole.
"Among potentially avoidable premature mortality, the rate for preventable causes was 171.5 per 100,000 population in 2019, which is 25.1 percent higher than the regional average rate; and the rate for treatable causes was 153 per 100,000 population, above the regional average of 89.6. These data reflect the ultimate toll of NCDs, death. There are, however, other tolls that NCDs exert."
The report noted that over time, NCDs reduce the quality and quantity of a country's labor force, which lowers the national income.
"Gross domestic products (GDP) do not go untouched," the report continued.
"Global studies reveal that NCDs comprise a significant proportion of a country's GDP.
"In 2010, that projection was calculated at 48 percent of the global GDP. Simply put, NCDs are growth-retarding factors."
Findings
Addressing the report in the House of Assembly, Darville said, "The findings were startling and highlighted individual risk, major gaps in our public healthcare system, which has failed to adequately address health inequities."
The study was executed in 2019 and published in 2022. This delay was the result of shifting priorities due to Hurricane Dorian and the COVID-19 pandemic, the minister said.
Darville said the survey found that 29.3 percent of respondents were diagnosed with hypertension and seven percent never had their blood pressure checked.
"The survey revealed that less than 60 percent that were hypertensive were actually taking medication as prescribed," the minister said.
He added that 40 percent of the participants who were noncompliant with medication had elevated blood pressure readings at the time of the survey.
Also, about nine percent of respondents with elevated readings denied having a diagnosis of hypertension.
Turning to diabetes, the minister said 12.8 percent reported that they were diabetic and 22.7 percent reported that they had never had blood sugar checked.
He said less than 45 percent reported that they were taking medications for diabetes.
"About 12 percent of participants diagnosed with diabetes had elevated fasting blood sugar readings at the time of the survey," Darville continued.
Based on the body mass index, the survey found that 23.8 percent of participants had normal weight, 25.4 percent were classified as overweight and 43.4 percent were classified as being obese with a BMI of over 40.
"The rate of physical inactivity was such that three in 10 persons did not meet the minimum global recommendations for sufficient movement when totaling their daily movements at home, at work and recreationally," Darville continued.
"We must reduce the incidence of non-communicable diseases and reduce the disease burden across the country."
The report also noted the prevalence of those who do not take their prescribed medication.
"A revelation of concern was that among previously diagnosed diabetics and hypertensives, an average of 60 percent sometimes substitute their prescribed medication for bush/herbal remedies," the report read.
"This may contribute to the low control rates for hypertension - less than 20 percent of known hypertensives on medication are controlled.
"With the STEPS 2019 findings, The Bahamas now exceeds the regional prevalence (Region of the Americas) for overweight and obesity prevalence (71.1 percent versus 62.4 percent), and hypertension prevalence (38.2 percent versus 18 percent). The national prevalence of diabetes is 11.5 percent, but an additional 6.8 percent are pre-diabetic," according to the report.
"Although tobacco use trends are decreasing in 150 countries around the globe, in The Bahamas, tobacco use is an increasing trend - rising by 145 percent over the almost 20-year period from 2000 (7.1 percent) to 2019 (17.4 percent).
"This current tobacco smoking prevalence also exceeds the regional average of 16.8 percent."
Diet
"STEPS 2019 showed that the Bahamian diet is driving the population towards more unhealthy states, consuming too little fiber, and too much sugar and salt. Concretely, 85.3 percent of the population does not meet the minimum daily intake/consumption of fruits and vegetables.
"There are high rates of fried food consumption, with more than 50 percent of the population eating fried foods up to three times each week, and another 13 percent eating four or more days each week. There is a three-times higher frequency in the daily consumption of fried foods for males compared to females.
"The consumption of free (added) sugars is alarming, with 60 percent of the population drinking at least two cans/bottles of a sugary beverage each day.
"This is compounded by the practice of adding sugar to tea and/or coffee. Specifically, 53 percent of the population add between two to three spoonfuls of sugar.
"And on average, Bahamians consume double (10.5 grams) the daily recommended (five grams) amount of salt.
"In addition to consuming diets that are more harmful to health, STEPS 2019 revealed that a sizable share (44 percent) of the population engages in the use of alcohol to the point of being harmful to health and well-being.
"Of added interest, females were two times more likely to engage in the harmful use of alcohol, while males were more likely to engage in heavy episodic drinking."
The report also highlighted the risks of cardiovascular events among Bahamians.
"Based on risk calculation from the STEPS 2019 data, nearly 10 percent of the Bahamian population between ages 40 to 69 years have a 30 percent or higher chance of a cardiovascular event (heart attack or stroke) in the next 10 years," the report estimates.
"This, coupled with the NCD risk factor profile and trends, makes clear that the health of the nation is off course and headed in the wrong direction."
The report read, "Taken together, there is significant co-occurrence of NCD risk factors within the Bahamian population. Specifically, 60.6 percent have between one to two NCD risk factors and an alarming 38.8 percent have three to five NCD risk factors."
The report read, "The co-occurrence of risk factors for NCDs is more harmful to health than the presence of an individual risk factor. These data lend to The Bahamas' population ranking high among countries whose population have a greater probability of dying too young from NCDs."
Looking at the wider picture, the report added, "The image emerging is that a healthy Bahamas remains a conceptual ideal with only 0.7 percent having no NCD risk factors."
The report also found that the presence of three or more lifestyle risk factors was more frequent in women, older age groups (45-69 years), the unemployed and those with a secondary education or less.
"Regarding females, it is important to note that the single most prevalent risk factor was overweight/obesity. This is particularly alarming as obesity has been observed as a strong risk factor for multi-morbidity," the report continued.
Costs
"Using current-state disease prevalence rates, preliminary cost scenarios estimate a conservative lifetime price tag of $8.6 billion to manage NCDs and their downstream complications," according to the report.
"This price tag, along with the indirect costs, mortality and reduced quality of life associated with NCDs, represent real threats to national development.
"The STEPS 2019 survey findings give the evidentiary footing to prioritize upstream strategies to prevent the onset of NCDs.
"Prevention through bold and targeted policies and interventions is a more cost-effective and sustainable approach to disrupt the trajectory of NCDs in The Bahamas."
In response to the report, Darville said among other things, the Ministry of Health and Wellness will lead a comprehensive response to findings of the survey, strengthen healthcare infrastructure, purchase medications to treat common medical conditions and establish a non-communicable disease registry to track those with applicable conditions.
Darville added that policies will be put in place to reduce the consumption of salt, sugar, alcohol and tobacco.
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