Introduction
It’s often said a nation’s health is its wealth. This is true, whether viewed in the context of the health of citizens, or in the broader social and economic context of health, that includes education, housing, transportation, diet/nutrition, food security, environmental health, and community safety. However, if we were to peruse Saint Lucia’s 2022 Social and Economic Review, we would conclude that the health of Saint Lucians has no bearing on their country’s wealth, as that document contains no data or information on the performance of the health sector.
Be that as it may, in this commentary, I posit that it is highly unlikely Saint Lucia will become a “wealthy nation” if health literacy is not addressed with all the urgency and resolve we can muster.
A Definition
The Centers for Disease Control (CDC) defines health literacy as “…the degree to which individuals are able to find, understand, and use information and services to make early and sound health-related decisions and actions, for themselves and others.” This definition conveys the following important messages: (1) that as an objective, progress towards the attainment of health literacy can and must be measured; (2) citizens must have easy access to relevant and trustworthy data and information and must be able to understand such information; (3) health literacy is a shared responsibility that can help build a “resilient citizen,” who is able to withstand and quickly recover from health shocks. Before we zoom in on some of these elements, a quick review of the health status of our country would be useful.
Our Nation’s Health Profile
If we go by the statistics, it cannot be said Saint Lucia is a nation of healthy people. Granted, our people are living longer, due mainly to advances in medical technology that are enabling early detection and treatment of cancers, among other ailments. It’s estimated that in 2100, life expectancy will be 80 years for men and 84 years women. It’s left to be seen whether this estimate holds true in the face of Saint Lucia’s declining health profile and its heavy burden of diseases, particularly non-communicable diseases (NCDs). Our Ministry of Health says that NCDs, such as cardiovascular diseases (CVDs), cancer, diabetes, and chronic respiratory diseases (CRDs), account for 82% of all deaths in Saint Lucia. Advances in screening and treatment have helped to improve survival rates in some of those afflicted with NCDs. However, the COVID-19 pandemic clearly showed that whenever there’s a shock to the health system of the individual, household and country, things can go downhill rather quickly. Most of those who died from the virus suffered with at least one NCD.
Another major threat to life expectancy is public acceptance of vaccines. I worry that the continuing negative public reaction to COVID-19 vaccines might affect infant mortality. The early evidence is that skepticism and cynicism surrounding the use of Covid-19 vaccines, has spread to vaccines that used to be routinely administered to children almost at birth and helped to reduce the infant mortality rates, caused by diseases like measles, mumps, rubella, diphtheria, tetanus and pertussis. I fear that if these diseases return and infant mortality rates rise, Saint Lucia’s population growth rate will take a big hit. Already, the country’s Total Fertility Rate, that is the average number of children a woman delivers over her lifetime, is dipping. It’s estimated that by 2100, this rate will drop to 1.3%. This compares unfavorably with Latin America and the Caribbean (1.6%) and the world (1.7%).
What’s at Stake?
The ramifications of poor health ought to be well appreciated by citizens. Uninsured workers should know well that if they’re too ill to work, they will not be paid. They should also know a long-term illness like kidney disease, will likely dent their savings and put them at risk of slipping into debt or poverty, thus making it difficult, if not impossible for them to care for their children and give them a proper education. If this appreciation is there, it’s not reflected in the lifestyles and/or diets of many of our people. According to Statistica, in 2019, Saint Lucians and Barbadians aged 15 years and older, consumed the most alcohol in Latin America and the Caribbean (LAC), at around 9.5 liters of pure alcohol, per person per year. Saint Lucia also leads the LAC in sugar consumption. According to the Global Dietary Database, the average Lucian consumes over 1250 grammes of sugar per day. That’s nearly 30 times the maximum recommended daily average of 50 grammes per day. In 2020, Saint Lucia ranked among the top ten meat eating countries in the world, with an average meat consumption of 90 kilograms per person.
These are disturbing statistics. When viewed alongside growing evidence of reduced physical activity by citizens of all ages, they help explain our poor national health profile (NHP). Within the Ministry of Health, there would be a strong appreciation of the many ways in which our NHP is impacting the health sector. But there are many reasons to doubt whether the general population appreciates how this profile is retarding national development. The following examples should suffice. First, there is the impact on productivity. Granted this has never been treated as a huge national concern, except in the private sector where, even a temporary decline in output can lead to the death of a business. During the pandemic, a solar water heating company had to close for about 10 days because its entire production crew was hit by the virus. Second, our poor NHP can weaken the financial viability of National Insurance Corporation (NIC) as it must pay out more money to settle claims for sickness and invalidity benefits. Third, it can affect our country’s foreign exchange reserves, as more medicines and medical supplies must be imported. Fourth-as we also witnessed during the pandemic-a poor NHP can wreak havoc on the public purse, by forcing the government to spend more on healthcare.
Elements of a Response
In my view, the public policy response to the challenges cited above, has at best been tentative and weak. How can we turn this situation around and build the requisite national awareness of the importance of good physical and mental health, for the benefit of us all? How can we help our people to accept greater responsibility for managing their health?
The clear truth is that we cannot expect to make any headway on a national health literacy agenda, if we do not dramatically improve the functional literacy of our people, that is, their reading, writing comprehension, and communication capabilities. It’s difficult to factually say whether our literacy rate is improving. There are varying definitions of literacy and different ways of measuring it. I have not been able to establish how literacy is defined in Saint Lucia, nor how it is measured. UNESCO estimates 90% of Saint Lucians are literate. However, if we go by education participation rates – that is, the percentage of our population who should be in school but are not- we have reason for concern. According to UNESCO, 17% of boys and 17% of girls of official primary school age are out of school. That’s nearly 1 out of every 5 of our primary school age population.
If understanding basic human biology is challenging for the literate and educated among us, consider how difficult it must be for the illiterate and/or uneducated. The whole idea behind getting regular health checks is to better understand how one’s body IS working, against benchmarks of how it SHOULD work. Every doctor’s visit should be used to learn more about the workings of one’s body. Also, there are online medical resources like WebMD that can be used to fill any gaps in one’s understanding of a health condition. Whenever I’m prescribed medication, I try to ascertain from my doctor and/or pharmacist what side effects I should look out for, and/or whether a prescribed drug will interact badly with any other drug, vitamin, or food that I’m consuming. Over time, I’ve found that pharmacists know more about the drugs they dispense, than the doctors who prescribe these drugs. It was a pharmacist who cautioned me about the harmful effects of drinking fruit juices while taking certain medication.
Those of us who can manage our health in these ways, are empowered to do so through education. But I worry very much about those who are not so empowered and how they fare in situations where they are fully reliant on a medical practitioner (MP). Rarely, if ever does a death certificate show practitioner-error, whether through a misdiagnosis, or a wrongly prescribed or administered drug, as the cause of death. The point here is that the less empowered a client is, the higher the degree of trust and responsibility that is transferred to his/her MP.
A Shared Responsibility
This brings me to my earlier point about health literacy being a shared responsibility. Citizens can play their part best in managing their health, IF they’re helped to understand what is going on with their bodies. I question how much “understanding” can occur during a 5-minute interaction between a client and a medical practitioner. I had a dear friend who, after such a visit was prescribed DICA for a condition that a month later, turned out to be stomach cancer. Are practitioners capable of communicating effectively in the language or dialect of their clients? Do they take the time to explain things to their clients and to confirm their understanding of the health information being shared with them? Do they use illustrations to break down complicated health issues?
Here, I must commend Dr. Almus Mc Dowall and Dr. Merle Clarke for making a genuine and sustained effort to bridge the communications gap between health practitioners and clients through their bilingual TV programmes. But much more needs to be done to “reach” most of our people who speak and understand only kwéyol. For starters, all MPs recruited to work in the public service should be able to speak kwéyol. I see an opportunity for the Sir Arthur Lewis Community College (SALCC), the Folk Research Centre (FRC), and the Medical and Dental Association (MDA) to collaborate on improving the ability of MPs to speak and understand kwéyol as well as the culture in which the language is used.
The Bush Medicine Culture
Clients should also be helped to understand their role in enabling a doctor or nurse to make an early and accurate diagnosis of a condition. Too often, medical attention is sought when it’s too late. The standard approach has been to first try alternative (bush) medicines and only when that fails to visit a health clinic. The widespread use of bush medicines is fanned by a belief system spanning many generations. These medicines have done much good for many people. Thanks to a turmeric-based poultice which my mother applied to my head every 2 days, I was able to make a miraculous recovery from a skull fracture in 1966. But I wonder about people whose health has been harmed by using the wrong bush medicines or the wrong dosage. How many people are aware that long-term use of turmeric and ginger can thin the blood and cause excessive bleeding after an injury?
The Mental Health Challenge
This has long been a neglected area of our country’s healthcare system and it is also one that will benefit from a health literacy programme. According to the World Bank, in 2019, Saint Lucia had a suicide rate of 14.3 per 100,000 people, when the average for the entire LAC region was 9.8 per 100,000. I reckon that about 1 in every 20 people, I know suffers with anxiety disorders. Panic disorder and post-traumatic stress syndrome (PTSD) are independently associated with suicide attempts. Still, few clinicians assess the risk of suicidal behavior in patients with anxiety problems.
Conclusion
Clearly there’s much to be done. Based on the concerns shared in this commentary, it’s my sincere hope that a “decent” part of the money raised through the Health and Security Levy will go towards funding the design and execution of a national health literacy programme.