Garth Rattray | Rich people’s disease, poor people’s burden

Nowadays, the burden of lifestyle-related diseases falls heavily on people who can least afford them. Once upon a time, it was the rich who ended up being sedentary and eating calorie-dense foods that led to their suffering from metabolic disorders and cardiovascular diseases. They were the ones with hypertension, diabetes, hyperlipidaemia, excess weight, joint problems, and dying prematurely from strokes, heart attacks, heart failure, and kidney disease.

Because of modernisation, many poor people end up leading sedentary lives and, because of economic restrictions, their diet is tailored according to the depth of their pockets. Consequently, they eat what they can afford, and that means less expensive food.

Poor folk tend to eat high-calorie foods that are not necessarily nutritious. The poor dietary quality is called qualitative malnutrition. It is a deficiency of food composition and the mechanism behind “hidden hunger”. This puts them at increased risk for non-communicable diseases (NCDs).

Obesity, diabetes, hypertension, and hyperlipidaemia should not be discussed as though they were merely the consequences of personal irresponsibility. Eat better, eat less, exercise more, are good pieces of advice, but our social and economic circumstances severely limit our choices because the foods that offer the most calories for the least money are the ones that poor people can afford. It comes down to survival.

The weekly food budget is a constant exercise in compromise, especially for poorer Jamaicans. Fresh fruit, vegetables, lean animal products, and other nutritious foods must compete with the demands of rent, transportation, school expenses, and utility bills. When the budget is tight, people must choose foods that fill hungry stomachs at the lowest cost. Cheap, energy-dense products can provide quick satisfaction.

This is not to suggest that nutritious food is always more expensive than unhealthy food. The reality is more complicated. Some healthy staples can be economical, but the cost, availability, and convenience of a balanced diet matter enormously.

A UN report asserted that approximately 1.8 million Jamaicans (about 62.6 per cent of the population) were unable to afford a healthy diet in 2021. Education alone cannot compensate for inadequate purchasing power or an environment in which unhealthy products are far less expensive, more widely available, aggressively promoted, and convenient to consume.

Our changing lifestyle is another nail in our coffin. Many adults spend hours sitting behind desks and counters, in offices and/or in vehicles. Work pressures and long commutes leave less time and energy for preparing meals, walking, exercising, or engaging in recreational activities.

Children face a related challenge. The days when outdoor games, running around the yard and playing with neighbourhood friends occupied much of a child’s free time are increasingly competing with screens. Computers, laptops, tablets and smartphones provide entertainment, education and opportunities for communication. But, when hours of screen time replace physical activity, the consequences can extend well beyond childhood.

At the same time, children are growing up in a commercial food environment that encourages frequent consumption of sugary drinks, packaged snacks, sweetened cereals, fast foods and other highly processed products. These products are designed to be extremely convenient and appealing. Their branding, packaging and advertising can make them especially attractive to young consumers, who may have little understanding of the long-term health implications.

When companies spend heavily to promote products high in sugar, salt and unhealthy fats, governments must consider whether families and children are being given a fair opportunity to make informed choices ... hence the dire need for proper nutrition labelling.

Transport is a health risk in and of itself. Traffic congestion can turn even a relatively short journey into a lengthy period of inactivity. People must usually travel long distances to work, school, shopping areas, and so on. They either use private or public transport to commute. The peak-hour delays that we are experiencing force citizens to remain sedentary for many hours while inhaling harmful exhaust fumes from the sea of vehicles around them.

Health surveys reveal that, from adolescence onwards, about 33 per cent of our adults live with hypertension. Approximately 12.5 per cent are living with diabetes. And 24.6 per cent have hyperlipidaemia, while 54 per cent of Jamaican adults are classified as overweight or obese. Those numbers are scary.

For poorer households, the financial consequences can be devastating. A chronic illness may mean additional transport costs, money spent on medication, and time lost from work. When a breadwinner becomes seriously ill, the entire household may suffer. Meanwhile, the public health system must absorb the cost of treating conditions that could often be prevented or delayed.

This is why the burden is disproportionately harsh on people with limited resources. Wealthier households may have greater access to nutritious food, safe recreational facilities, private healthcare and the time or means to pursue healthier lifestyles. Poorer households may face several obstacles simultaneously. The result is a vicious cycle in which poverty increases exposure to risk, illness deepens financial hardship, and hardship makes recovery and prevention more difficult.

The National School Nutrition Policy is a step in the right direction. Schools should provide healthier food choices and make recreational, rather than competitive, physical activity a normal part of the school day.

We need mitigation against inactivity for children and adults. Along with several key agricultural products, the prices for vegetables, tubers, plantains, cooking bananas and pulses (dried beans, peas, and lentils) rose sharply by 10.5 per cent this year. The government should examine how to make nutritious foods more affordable and more available, because every price increase also increases our NCDs.

Garth Rattray is a medical doctor with a family practice, and author of ‘The Long and Short of Thick and Thin’. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.