Health Minister, Pablo Marin: “…if we chose to behave differently, then we can all improve our health and quality of our lives.”
With the murder rate increasing over the past three years, Belize’s death rate has shown a simultaneous increase, reflecting lives lost through violent trauma, but what many Belizean’s don’t know is that there is a serious and silent killer in our midst – it goes by the name DIABETES.
“More than 60% of our population over 20 is overweight. More than 30% is hypertensive, and more than 13% is already diabetic,” said Health Minister, Pablo Marin, delivering very timely and relevant remarks on Monday morning, September 15, at a formal ceremony for the signing of an agreement for Belize’s Health Information System.
According to statistics Amandala independently requested from the Epidemiology Unit of the Ministry of Health on Friday, September 12, the #1 killer in Belize for 2007 was diabetes mellitus – known widely in Belize as “sugar,” or high sugar levels in the blood. In effect, a person’s body loses the ability to properly regulate the blood sugar, sometimes due to problems with either insulin secretion or the function of the hormone. It is a pervasive problem in Belize, but more so among older Belizean women.
Even though diabetes has been registered as the single biggest killer between 2005 and 2007, competing for that top spot are homicide and injury, transport accidents, HIV/AIDS, heart disease, and hypertensive disease (locally known as “pressure”).
Heart disease and cancer are the leading killers among women, but official statistics confirm that violence and associated trauma is the single biggest killer of Belizean men. The number one killer of males in 2007 was classified as “injury undetermined whether accidentally or purposefully inflicted” – 69 cases or 8.6%. Together with the cases of homicide and purposefully inflicted injuries, the number of deaths due to traumatic injury escalates to 100 for 2007. The second killer was HIV/AIDS – 55 cases or 6.8%, and third was transport accidents, accounting for 51 cases or 6.3% of deaths in males.
What kills the young is generally very different from what kills the old. For 2007, injury (whether accidentally or purposefully inflicted) was the leading cause of death for the 15-19 age group and the 20 to 29 age group, and next in line was transport accidents. HIV/AIDS was the number one killer in the 30 to 39 age group and the 40 to 49 age group, followed by injury and then by transport accidents. Diabetes emerged as the number one killer among people over 50. Generally, diabetes-related deaths became significant for people over 40.
It is interesting to also review the statistics based on the location in the country from where the deaths are reported. In Toledo, transport accidents were the leading cause of death in 2007, while intestinal infectious diseases were the second leading cause of death there. 91 people died in that district in 2007.
In Stann Creek, 171 deaths were reported and heart disease was the number one killer. Likewise, heart disease claimed most of the lives in Cayo, where 215 deaths were registered.
In the Belize District, the death toll was the largest – 561, with 12% (68 cases) of the deaths being due to injury and homicide.
Of the 177 people who died in Orange Walk, the top killers – diabetes and heart disease – claimed an equal number of lives, totaling 41. An almost similar pattern was seen in Corozal, where diabetes was the #1 killer, followed very closely by heart disease, together responsible for 35 of the district’s 173 deaths.
All in all, 805 men reportedly died in 2007 compared to 584 women, and the trend has been similar over the past five years, where generally, over 200 more men die each year than women. Over half of the people who died in 2007 were 60 and over. A total of 121 babies under a year old died in 2007, mostly due to respiratory conditions.
Addressing these very telling statistics, Dr. Peter Allen, Chief Executive Officer in the Ministry of Health, emphasizes that, “The young productive sector of our society is at risk, particularly to HIV, road traffic incidents, and violence and homicide.”
He went on to say that, “These conditions are going to lead to greater complications, particularly heart disease and stroke, which is the commonest cause of death in the general population. HIV and AIDS affect a more specific population, I believe in the 15 to 45 categories, and road traffic incidents specifically affect young males, and we don’t even call them accidents any more because they are not accidents. Violence as well – it particularly affects young males.”
He maintains that whatever the causes of death, they are generally linked to the way people behave – the way they live.
“We know we’re not supposed to drive too fast. We know we should use our seat belts. We know that we shouldn’t drink and drive. We know that our vehicles should have proper lights and proper brakes, yet how many of us, follow the information to actually behave in an appropriate manner which makes it safer?” asks Dr. Allen.
“It’s difficult of course to ask the society to change their behavior, but that is actually what we need to do,” he emphasized.
On Monday morning, the Health Minister sounded that call for change: “We have again called on all Belizeans to consider that the main health problems that affect our people are largely preventable. We have once again called our people to consider that diabetes, hypertension, road traffic accidents, HIV, smoking-related illness, and even many cancers…they are strongly related to our behaviors and if we chose to behave differently, then we can all improve our health and quality of our lives.”
“We have once again called on our people to consider better nutrition, more exercise and safe sexual practices – we have once again called our people to consider the danger of driving too fast or when under the influence of drugs and alcohol… to consider the danger of smoking… this is the right thing to do. Yet we have made this call before.
“It’s not new advice when we tell our people that better nutrition and more exercise is good for our health. It is not new advice when we say that smoking causes cancer, heart disease and stroke, or when we say that road traffic incidents and HIV can be prevented if we just slow down and take precaution.”
The continued health challenges Belize faces are not so much due to a lack of information as to a resistance to behavioral change, Dr. Peter Allen emphasized.
“There is a wealth of information out there on HIV, yet people still contract HIV,” said Allen. “I think people know that it’s good to have healthy nutrition – to eat your fruits and vegetables – and yet we still go and eat our fried chicken. We still have sweets and soft drinks instead of juice, we still don’t do enough exercise. And so what is needed is for us to find the triggers that would persuade people that it is time to change our behaviors to a healthier lifestyle.”
One strategy he identified to compensate for the fact that many people don’t voluntarily go for health check ups, is for doctors to use the opportunity whenever they can to extend more holistic or more comprehensive care to patients.
“If a 40-year-old male goes to clinic to see the doctor because he has headache or has hurt his ankle, the care provider can suggest, when was the last time was he checked for sugar, pressure, prostate cancer or disease risk factors?”
Allen admits that even though it is an inconvenient time to be asking such questions, it is perhaps the best opportunity for the doctor’s intervention.
“We would prefer annual checkups, but the real truth is people only encounter the health system when there is a problem,” he elaborated.
How does Belize measure up compared to our neighbors? Are there similar trends around us?
Allen told Amandala that in the Caribbean, the incidences of diabetes and hypertension are also high, and in some cases even higher than Belize. In Central America, he said, incidences of diabetes and hypertension are also increasing, and so are deaths due to violence and road traffic incidents.
The deferral of good health care costs both individuals and the nation.
Allen elaborates that, “The social, financial and emotional costs of the problems that cause so much death and injury in our country are increasing every day, and we have to fix not just the symptoms but the cause – the behavioral components of those diseases.”