Remarks Delivered By The Honourable John Boyce, Minister Of Health, On The Occasion Of The 39th Sir Winston Scott Memorial Lecture

It is a distinct privilege for me to address you on the occasion of this 39th Sir Winston Scott Memorial Lecture which honours the memory of our first native Governor General and an illustrious medical practitioner.

I am especially pleased to welcome Professor Ashcroft from the University of Oxford. I am certain that all of us are eager to hear your presentation on “Diabetes: A Tale of Genes and Sugar”, a topic which is of immense interest to us here in Barbados.

Sir Winston Scott dedicated his life to service to his country and community. His contributions in medicine, politics and social development have been recognised in several ways, including the naming of the Winston Scott Polyclinic at Ladymeade Gardens, in 1985.

This polyclinic is the flagship of our primary health care system, serving a catchment of 26,500 premises with a diverse mix of commercial, recreational and residential properties. This polyclinic is a certified International Vaccine Centre. It also has a FastTrack/urgent care service, which was designed to alleviate the pressure on the Accident & Emergency Department of the Queen Elizabeth Hospital.

Over the years many ground-breaking research studies have been conducted at the Winston Scott Polyclinic including the Barbados Eye Studies and more recently the Global Standardised Hypertension Treatment Project which has the potential to revolutionize the treatment of hypertension, not only here in Barbados, but across the world. A recent innovation in patient care has been the introduction of a NCD clinic to streamline the provision of clinical service to patients with such conditions.

Successive governments have been and continue to be committed to investing resources in health to the greatest extent possible. This is often accomplished in the face of competing demands, all with worthy objectives.

This policy commitment has led to the implementation of policies in health care, which make a comprehensive range of services accessible to the population. Together with policy actions in associated sectors of education, housing, labour, social care and economic development, Barbadians have attained a high standard of living and have been able to realize many of their dreams and aspirations.

However, one may argue that this same success has contributed to changes in lifestyle giving rise to the growth in non-communicable diseases that now threaten the very quality of life we have come to treasure.

Along with social and economic development, there has been a corresponding exposure to a wide range of external influences which have altered the demand on our health services and have also placed a heavy burden on the service.

Data from the soon to be released “Health of the Nation Study” confirms our observation that, as a nation, we are not as weight conscious as we should be and thus body weight is increasing among the population. For instance, 56.6% of men and 68.8% of women are obese or overweight. 17.9% of adults have diabetes and up to 35% are hypertensive. All of these figures represent increases over the findings of the 2007 Risk Factor Survey. A more worrying trend is the rise in over-weight and obesity among children, which in 2012, was reported to be 30%.

Ladies and gentlemen, non-communicable diseases, such as diabetes, continue to challenge our capacity to provide quality health care services to Barbadians at a cost we can afford. While our data on the economic burden of NCDs is limited, a study conducted in 2001 showed that the direct and indirect costs of managing diabetes in Barbados amounted to approximately Bds$75 million or 1.83% of GDP, at that time. Another study on diabetes in Latin America and the Caribbean estimated a productivity loss of US$65 billion dollars.

It is clear that managing diabetes and other NCDs impose a high economic cost. Of course, these are accompanied by correspondingly high social and emotional burden on families in terms of increased care taking responsibilities and changes in roles in the household.

Addressing NCDs is not a simple matter, but involves a set of complex relationships that must be managed in a comprehensive manner. For instance, many of the actions which are required must be implemented in sectors such as agriculture, trade and education. However, the health sector is required to lead the response, in collaboration with its key strategic partners.

Of critical importance, also, is the realisation that the individual citizen is unable to create many of the fundamental conditions that are required in order to improve their health choices. Matters related to the price and availability of food or access to safe recreational spaces in communities are largely outside of the control of the average citizen and are best negotiated and implemented by the state on behalf of the citizen.

These two fundamental points, the need for effective inter-sectoral collaboration and the vulnerability of the citizen to poor health options, make it imperative for the state to create an environment which is conducive to healthy choices and healthy living.

To this end, the Cabinet of Barbados has agreed to the establishment of an Inter-Ministerial Committee which will coordinate all NCD policies. This new committee will be guided by policy recommendations from the Ministry of Health and other civil organizations. It is envisioned that this inter-ministerial committee will raise the NCD agenda to the highest level of government and provide the political force to push the NCD agenda forward with an even greater sense of urgency.

Over the years, our efforts to reduce non-communicable diseases have led us to adopt many of the international best practices which are available, including the establishment of the National NCD Commission under the distinguished Chairmanship of Professor Sir Trevor Hassell.

Furthermore, Barbados is one of few developing countries which can boast of having a national registry that documents and records case of cancers, stroke and heart disease. In an effort to improve diabetes management at the individual level, and national levels, the Ministry of Health has entered into a contractual arrangement with the Diabetes Foundation of Barbados for the provision of specialists services to public sector clients who are living with diabetes. Barbadians may also access these services privately by entering a direct relationship with the Diabetes Foundation of Barbados.

Much has been done and much has been achieved, however, at times we ask ourselves what else can or should be done? What other options should be explored? I am therefore grateful to the Central Bank of Barbados for providing this opportunity for us to hear from Professor Ashcroft through the avenue of this lecture.

Our experiences in diabetes prevention and control have taught us that behaviour change is challenging. Policy interventions may or may not work. Could the answer be in the genes? We are aware that risk factors by themselves do not tell the complete story of NCDs. The prevalence of diabetes in our population has a strong familiar relationship. We are, therefore, pleased that this lecture will explore the genetic contribution to the burden of NCDs, especially in Diabetes. It, therefore, gives me great pleasure to invite Professor Frances Ashcroft to address us at this time.

Thank you.

November 24, 2014