CHANGING PATTERNS OF FOOD, NUTRITION AND HEALTH IN THE CARIBBEAN

Countries of English-speaking Caribbean in the last thirty years have experienced an unprecedented epidemiological transition. Malnutrition in children and infectious diseases, once the major public health problems, have considerably declined and have been replaced by obesity and chronic noncommunicable diseases such as diabetes, hypertension, stroke, coronary heart disease and cancers. Countries of the Caribbean are net importers of food. During this period of time total food availability has greatly improved but from health point of view this improvement is highly skewed. The increase in the availability of total calories has been almost entirely due to increase in total fat, most of which is from foods from animal sources. While cereals are adequately available, none of the countries meets the recommended population goals for fruits, vegetables, roots, tubers and legumes and they lack upwards of fifty per cent of their needs. Indeed, an ecological study of food availability and disease pattern clearly shows a significant positive relationship between the increase in total calories and diabetes, and between total fat and coronary heart disease and cancers of prostate, breast and colon. A significant inverse relationship can also be noticed between consumption of roots, tubers, fruits and vegetables and heart disease and colorectal cancer. An important feature of this rapid transition in the Caribbean is that the complex problem of obesity and chronic diseases has followed right on the heels of nutritional deficiencies and infectious diseases. During this period of time, economies have not improved much, and almost all countries have incurred massive external debt and are reeling under economic structural adjustment programs. Although very much reduced, the threat of undernutrition and infectious diseases is still lurking in the background and may erupt into epidemic proportions under the fragile economic systems. Thus these countries are finding themselves torn between holding the reins of nutritional deficiencies and infectious diseases from resurfacing and making a frontal attack on the so called ''diseases of affluence'' with the resources only of developing countries. While eating properly is an individual choice, a variety of factors influence the choice. This paper suggests a series of strategies for appropriate policy development, private sector involvement, health care restructuring and public education programs.