Jamaica’s Current Fight against Obesity

Editorial

Synopsis: The Heart Foundation of Jamaica, using a 15 month grant from the Global Health Advocacy Incubator, and collaborating with the Ministry of Health Jamaica and Jamaica Moves, launched a campaign against obesity using dynamic advertising techniques with the main message: “Are you and your children drinking yourselves sick? Drink water instead”.

Background

In Jamaica, a small Caribbean island nation with a population of 2.7 million, 78% of all deaths are caused by non-communicable diseases (NCDs) [1]. Obesity has reached epidemic proportions globally, and according to the WHO (2016), excess calories from sugar sweetened beverages (SSBs) contribute significantly to the global rise in obesity [2]. The 2008 Jamaica Health and Lifestyle Survey showed that 75% of Jamaicans consume more than one SSB per day [3]. The prevalence of overweight and obesity is 65% in women and 38% in men3. In school aged children aged 11-13 yrs. It is 27% for boys and 33% for girls2. Jamaica’s economy is projected to lose 77.1 billion JMD (2017- 2032) in terms of direct treatment costs due to cardiovascular disease (CVDs) and diabetes complications [1]. In November, 2017, a new public opinion survey, conducted by the Heart Foundation of Jamaica (HFJ) and Vital Strategies reported that obesity-related diseases such as hypertension (89%), diabetes (86%) and cancer (84%) were the three main illnesses most often identified as major health problems in Jamaica. Fifty-one percent of children who consume sugary drinks multiple times daily, consume 3-5 servings or more at least once a day. Eighty per cent of Jamaican parents of children under 16yrs are concerned about the effects of sugary drinks on their children’s health, 60% of Jamaican adults are concerned about sugary drinks on their own health. The same proportions are extremely concerned about their child’s access to sugary drinks at school [4].

Intervention

The Heart Foundation of Jamaica, promoting policy change for proper nutrition, in 2017 received a 15 month grant from the Global Health Advocacy Incubator, a program of the Campaign for Tobacco Free Kids as part of the Bloomberg Philanthropies’ efforts to tackle the obesity epidemic, raising public awareness of the problem and supporting policies to prevent the rise of obesity [5]. In January 2018, the Heart Foundation of Jamaica (HFJ), in collaboration with Jamaica’s Ministry of Health (MOH) and its Jamaica Moves program declared “war” on sugar and obesity in Jamaica, with a dynamic publicity move with colorful and bold advertisements appearing in all forms of media. Well-illustrated and focused advertisements (some full page newspaper ads) started appearing in all forms of public media with the theme: “You could be drinking yourself sick: drink water instead”; “Sugary drinks can lead to heart attack.”; “Your children could be drinking themselves sick. Just because they’re active, doesn’t mean sugary drinks aren’t damaging their health”; “Sugary drinks are a big reason for the obesity crisis in Jamaica. Drinking too many sugary drinks can bring on type 2

diabetes, high blood pressure and tooth decay. Drink water instead.” The press soon picked up the theme with such bold headlines as:“Frank dialogue on the national bulge”; “Parents say schools serving too much sugar: bitter lesson”; “Give children water instead of sugary drinks”; “Digging graves with knives and forks”; “Taxation can influence sugar consumption”; “Is Gov’t doing enough to fight lifestyle diseases?”; “Curbing sweet tooth” And many others. The Minister of Health Dr. Christopher Tufton, currently leading by creative example, along with the Prime Minister the Hon. Andrew Holness, publicly attend and promote fitness exercise and nutrition sessions. The key findings of the Obesity Public Opinion Survey Jamaica (2017), showed strong public support for Government action on obesity including support for a SSB tax. It was important that the Government be involved in helping to solve the problem of obesity (92%) and that quick action be taken to implement policies (90%). The public would also support Government action to pass and enforce policies that discourage the consumption of sugary drinks and unhealthy foods (72%). Sixty-four percent of persons surveyed supported a tax on SSBs and 78% of adults were in support of the SSB tax, if part of the revenue generated was spent in reducing obesity among children [5]. These results were presented by Dr Christopher Tufton and discussed at a stakeholders’ conference on March 07, 2018 [6, 7].

The Way Forward

The Survey confirmed that the public was supportive of the MOH. Further actions proposed by Dr Christopher Tufton included: 1. Create policies to implement change. 2. Start with schools i.e. nutrition policy for schools.

Collaborate with the Ministry of Education. Monitor what is provided in schools. 3. Jamaica Moves. Adult public exercise program started.

Reintroduction of physical education in schools. 4. Free medical checks. 5. Restructuring of SSBs by manufacturers. 6. SUGAR TAX. This would follow the successful example of about 25 other countries. 7. Use of marketing and continuation of advertisements in all forms of media. Bold effective messages to continue to sensitize public opinion. 8. Food task force to promote nutritional balance. 9. Public education for informal food venders. 10. Mandate 4-H Clubs to support school gardens.

11. Mobilize the Ministry of Agriculture to increase production of “healthy” foods [7].

Discussion

The Jamaican public seems to have generally accepted the need for reduction in consumption of SSBs. However, there may still be covert cultural barriers to weight control in Jamaica. Duff, et al. [8] reported relationships between waist circumferences, BMI, self-care practice scores, sugar intake and blood glucose in diabetics attending a specialist clinic in Jamaica. “The high sugar intake may be due to a cultural preference for highly sweetened beverages and may have been under- reported…there is a cultural acceptance of obesity especially in women” [8]. Professor Fitzroy Henry (2016) reported that although concerned, 50% of Jamaicans were unwilling to do anything to improve their health. For “Caribbean women, ‘having size ‘and ‘being solid’ were preferred states…” “The media, especially cable television, has much impact on…lifestyles of the region’s consumers…” [9]. Manufacturers of SSBs are now becoming sensitized to altering the sugar content of drinks (e.g. “Caribbean Flavors woos manufacturers to cut sugar content.”The Gleaner, March 21, 2017.)

Conclusion

Much has been accomplished by the Global Advocacy Project in sensitizing the Jamaican public to the consequences of obesity and its effect on adults and children. “Drink water instead” is frequently a topic of local discussion. It is hoped that the way forward will continue the progress that has been made to date. Public policy regarding the imposing of a tax on sugar will soon be implemented.

Acknowledgement

The Author thanks Mrs. Deborah Chen, Executive Director, and Ms. Barbara McGaw, Project Manager of the heart Foundation of Jamaica, for providing important information. Further information regarding the Global Advocacy Project may be obtained by email: advocacyofficer@heartfoundationja.org