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When finance overshadows health


“The newly proposed special excise on sweetened beverages, included in the Financial Statement and Budgetary Proposals for the year 2015 is here to reduce the social and economic impact of the non-communicable diseases (NCDs). And if this measure still does not translate to a decline in NCDs, a stiffer penalty may be coming for those who continue to engage in unhealthy practices.” This was part of the contribution by our Hon. Minister of Health to the recent ‘Budget’ debate.

We await further clarification from the Minister and/or senior health officials on the details of the “stiffer penalties”. It is also unclear whether sports persons who aspire to improve their athletic performances, by using sports drinks, will also be “further penalized”.

Is participation in sport to be discouraged? The small number of babies born to mothers, who are unable to access breast milk for a variety of medical reasons, will face “stiffer penalties” in raising their children.

Sir George Alleyne, director emeritus of PAHO, in July 2005 noted that it is “bad practice to ask people to make healthy choices when there is a lack of agricultural policies and other initiatives to help them do so”.

Nonetheless, the present Government still finds it necessary to threaten penalties, taking health here in a new and uncharted direction.

I will also state at the onset that I support any measures that have the potential to reduce the impact of the NCDs. However, more information is needed on the measures outlined during the Budget debate to determine whether the proposed excise tax on sweetened drinks is likely to reduce the prevalence of NCDs. The strategies, and the implementation, will be interesting.

Since we have no recent data on the exact number of persons inflicted with NCDs, we expect that the Ministry of Health will soon commence on a national enumeration programme (prevalence study), and put in place an ongoing surveillance programme, so we can see exactly how many people are affected prior to the introduction of the special excise tax.

The ongoing surveillance will allow us to determine whether the excise tax is being translated into a decline in NCDs, or determine whether it is time to move on to the “stiffer penalties” which are yet to be announced.

At this time any individual who develops one or more of NCDs are offered free visits to any of our polyclinics and Government promises that yet another polyclinic is soon to be opened to the public.

They are then offered free medications from the Barbados National Formulary (BNF) for the treatment of their NCDs, at least while the diminishing stocks last. (Is this another way of penalizing them, by restricting their access to needed medications?)

And if he or she develops a complication, such as heart disease, a stroke or even chronic kidney disease requiring dialysis, then the Government offers free tertiary care at the Queen Elizabeth Hospital.

The new excise tax on sweetened drinks will penalize all those who utilize these free services. Making them pay a few cents more for each sweetened drink is not too much to ask in exchange for hundreds or thousands of dollars worth of free medical attention and supplies offered by the Government. [“Something for something”, one popular calypso describes this.]

There are probably very few places on this planet where, in exchange for drinking a few sweetened drinks, one is “penalized” by a Government policy that offers free medical attention in primary care, free medications, subsidized high-costs high-tech investigations if needed in tertiary care, and free treatment. As our invitational brochures say: “Barbados, just beyond your imagination!”

For most countries this is way beyond their imagination, and certainly beyond government finances.  Our Government says that they hope to ‘invest’ in the future health of Barbadians by “penalizing” them with excise taxes from sweetened drinks.

Public health officials may choose to point out to the Minister that special taxes put on cigarettes and alcohol in the past have failed to reduce consumption.

Wards at the free Psychiatric Hospital and the free QEH have been blessed with individuals who have been “penalized”
for their consumption. The evidence that suggests a tax on sweetened drinks will be successful in reducing the incidence and prevalence of NCDS has not been presented.

CARICOM ministers responsible for health promised, at the Declaration of Port-of-Spain in September 2007, that member countries will put in place programmes for screening of NCDs and risk factors by the middle of 2008.

Perhaps this Ministry of Health is about to unveil a belated but welcome start of an NCDs surveillance programme here.

Another option available to the Minister was to reduce the allowable quantity of sugar in each sweetened drink, and to penalize the soft drink manufacturers if a particular quantity was exceeded. We have seen, in recent years, the appearance of ‘low-salt’ salt bread and low-salt corned beef, for example, but many more policies need to be rolled out before we can impact on NCDs. As Sir George Alleyne also noted back in 2005, “urgent and sustained response is needed to deal with the
alarming increase in chronic non-communicable disease”.

The Government’s stated objective of reducing the social impact of the NCDs is admirable.

We certainly have no shortage of speeches reminding us how important NCDs are. In fact, the focus has shifted so far that health care financing totally overshadows health, so the concerns are coming more from the Ministry of Finance than the Ministry of Health.

A single strategy of imposing an excise tax on sweetened drinks is likely to please the Ministry of Finance, but would have little impact on our deteriorating health situation.

We need a comprehensive, formally documented, sustainable programme to be actually implemented immediately.

(Dr Colin Alert, MB BS, DM.)

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