“There’s Not Really Much Consideration Given to the Effect of the Climate on NCDs”—Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados
Abstract
:1. Introduction
1.1. Study Context
1.2. Objective
1.3. Theoretical Framework
2. Methods
2.1. Research Design
2.2. Participant Recruitment
2.3. Data Collection
2.4. Analysis
3. Results
3.1. Current Burden on Non-Communicable Diseases in Barbados
“Well right now I think that the number one problem in Barbados in terms of health issues are chronic non-communicable diseases.”—HP3, Doctor
Issues Associated with the Burden of Non-Communicable Diseases
“Four chronic diseases were identified as the chronic diseases of importance: cardiovascular disease, cancer, diabetes and chronic lung disease. And these four were identified for essentially two reasons. First of all, they accounted for some 80% of all of the deaths in the Caribbean. And also, they all for the most part, shared the same risk factors for their development … Even though we recognize that there are many, many other chronic diseases.”—HP6, Head of the Board of Directors of the Civil Society Health Non-governmental organization (NGO)
“I’m not concerned about one NCD over another, because usually you don’t have one alone. You have diabetes and more likely, not controlled is going to lead to retinopathy or poor circulation so, it progressively leads to other things.”—HP1, Pharmacist
“We need a change in our culture. We have become too materialistic. Looking at the American culture, the BET lifestyle …I think we need to get back to our old ways of living, living more contented. Park the vehicle, ride more, swim more … We like glitz and glam. I got a better car, I got a better house than you. It’s more about the perception out there.”—HP1, Pharmacist
“There are socioeconomic impacts with food choices as well. It’s quicker, cheaper to purchase, starchy foods. Just to get by your day, essentially feed your kids foods like hot dogs, that type of thing, but ultimately, it’s a huge impact on the health of the greater population.”—HP10, Retired nurse
“Diabetes is one of the biggest silent killers in Barbados. Diabetes is also preventable through good diet and physical activity. Diabetes also has the highest disability factor from problems with microcirculation. It is the main cause of blindness, the main cause of kidney disease, the main cause of amputation.”—HP7, Pan American Health Organization (PAHO) representative
“I think that what makes hypertension a little more dangerous is because people don’t feel hypertension so it’s very easy for them to take the same free medication and just not use it. Sometimes you will forget to take it, and it’s not like diabetes where you might start to feel sluggish, or you might start to feel ill because you’ve not taken your medication. With high blood pressure you could be going along with pre-stroke high blood pressures and not feel it, you won’t get headache, you won’t get any problems until it’s too late.”—HP4, Doctor
“That stigma has been a big problem and has also often impeded the relationship between doctors and patients because there are some patients who already come with the mindset that this person wants to take my foot … I’m someone who is interested in general surgery, and from what I’ve seen there are far too many people that end up with amputations. And it’s not because they come to the hospital and we’re surgeons and we’re trying to cut off their foot, it’s because they have come to the point where, to save their life, we have to take their foot.”—HP3, Doctor
3.2. Future Burden of NCDs in Barbados
“When it comes to reducing the burden of NCDs, unfortunately very few of the Caribbean countries, Barbados included, have managed to reduce the burden of NCDs. In fact, the burden of NCDs is increasing and not decreasing …The burden has been increasing exponentially and the burden is now at a stage where it’s crippling. If you look at Queen Elizabeth Hospital, if you look at the health centers, the majority of their patient load is for NCDs.”—HP7, PAHO representative
“I remember one of the discussions we had was about the kind of patient that’s coming in, and we’re noticing the chronic illnesses a lot earlier. So, it’s not that you are seeing people that are 50 and up coming in for the first time with high blood pressure and diabetes; you see it in their 30s and 40s and sometimes even in the younger people. There’s a lot, more pediatric cases of diabetes type 2. You’re seeing more of the pediatric onset of what we thought was an adult illness.”—HP4, Doctor
3.3. Climate Change—Non-Communicable Diseases Connections
3.3.1. Disparities in Knowledge of Climate Change and Health Impacts
“You know there’s not really much consideration given to the effect of the climate on NCDs, not at the places I have worked.”—HP4, Doctor
3.3.2. Overlap between Social Determinants of Health and Determinants of Vulnerability
“We speak of chronic disease being lifestyle driven, but if you go further upstream, they are really first driven by what we call the social determinants: where you live, where you play, whether you are empowered as a person, your stress levels and so on … These adverse social determinants are far more common in social class four. This is the social class more likely to get chronic diseases, and it’s also the class that is most significantly impacted by hurricanes.”—HP6, Head of Board of Directors of civil society health NGO
3.3.3. Climate Change Impacts Could Affect NCD Prevention and Management
“We’re telling people to eat fresh fruits and vegetables but then how many fresh fruits and vegetables can you find on the market? And how much is available across the island or is it in specific areas? So, availability is limited, and affordability is even more limited.”—HP7, PAHO representative
Food Security/Sustainability
“We already have a difficulty in getting affordable fresh fruits and vegetables on the market. Now if climate change effects, or weather effects are going to continue to damage our produce, it’s going to get even worse.”—HP7, PAHO representative
“If we are going to have a further increase in our sea water temperatures, the whole issue of the sustainability of fishing. We saw a few years ago the whole issue of the Sargassum weed, and how that affected the whole food chain with regards to the fishing industry. Fishing has already declined as an economically viable industry in the region, so we’re relying on imported products, imported frozen fish from other sides of the world with the additional processing.”—HP7, PAHO representative
“People are staying away from the outdoors in terms of farming and doing stuff that could probably produce foods that would be more, what we would call healthy to use.”—HP8, Nutritionist
Physical Inactivity
“We don’t have a lot of active lifestyles because everyone wants to be in their car with the AC on, because they say it’s hot.”—HP8, Nutritionist
“We had practically a whole month where it rained every day. Totally unusual for Barbados. You couldn’t tell your children to walk to school because you didn’t know if in the afternoon it will rain. I mean yesterday, case in point. It was a beautiful day in the beginning of the day. Hot, nice, sunny. By lunch time, torrential rain till the night.”—HP7, PAHO representative
Vulnerable Populations
“We already don’t have enough dialysis facilities for the public to accommodate the number of persons that are going into kidney failure. Imagine, if we do have a natural disaster that affects these facilities, those people honestly and unfortunately they will probably die.”—HP5, Doctor
“One of the consequences of weather events is people being cut off. People might have a week’s supply of medication and if the communication and the connectivity with the town or with the nearest health center is not there, how do they get access to their medications?”—HP7, PAHO representative
3.3.4. Physiological and Psychosocial Impacts of Climate Change
“There is the increased use of vehicles which then impacts physical activity, and there are also the carbon emissions from these vehicles that also has an impact then on the chronic lung diseases.”—HP6, Head of Board of Directors of civil society health NGO
“The stress of having a weather event. Think about how that affects your blood pressure and how that affects your blood glucose and how that affects all your complications arising from the NCD which you are living with.”—HP7, PAHO representative
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgements
Conflicts of Interest
Appendix A
Purpose: To gather insight from key health stakeholders about their perceptions and experiences with NCDs (current and future concerns); To provide an insight into the awareness and consideration of linkages between climate change and NCDs | ||
---|---|---|
Construct | Primary Question | Secondary Question/Probe |
Context | What is the full name of your organisation? Can you tell me about the formation/history of your organisation? Can you tell me about yourself? What are [has been] some of the biggest health challenges you have observed over the years? | What is its mandate? Has it changed over time? Can you describe your role in your role in your organisation? How long? What brought you to this position? How have these changed over time?Which ones have changed? |
Perception and experiences of climate change, health and NCDs | How has the burden of NCDs on the health care system changed over time? Are they any specific NCDs that you are concerned about? | What do you think is accounting for these changes? Why/Why not? |
Do you think climate change is a problem? Are you aware of health impacts of climate change? Are you aware of any linkages between NCDs and climate change? | When you hear climate change impacts in Barbados, what comes to mind? What are they? | |
Do you that climate change would affect NCD sufferers and persons at risk of developing NCDs? | ||
General/Concluding thoughts | Is there anything else you would like to add that we have not already discussed? Is there anyone else you think we should talk to NCDs or climate change and health? |
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Participant ID | Profession | Level of Operation of Organization | Description of Role |
---|---|---|---|
Health professional (HP) 1 | Pharmacist | Community | Management of NCDs |
HP 2 | Pharmacist | Community | Management of NCDs |
HP 3 | Doctor | Community, national | Management and prevention of NCDS |
HP 4 | Doctor | Community | Management of NCDs |
HP 5 | Doctor | Community, national | Management and prevention of NCDS |
HP 6 | Head of Board of Directors of civil society health non-governmental organization NGO | National, regional | Prevention of NCDs, Health Literacy |
HP 7 | Representative from Pan American Health Organization (PAHO) | Community, national, regional | Technical assistance, Management and prevention of NCDS |
HP 8 | Nutritionist | Community, national | Management and prevention of NCDS |
HP 9 | Fitness instructor/personal trainer | Community | Prevention of NCDs |
HP 10 | Retired nurse | Community | Management and Prevention of NCDS, Health Literacy |
Health Challenges | Specific Diseases/Issues | # of Participants Mentioning n/10 (%) | # of Mentions |
---|---|---|---|
Chronic non-communicable diseases | Diabetes | 10 (100) | 25 |
Cardiovascular diseases | 8 (80) | 8 | |
Other NCDs (cancers, lung diseases, etc.) | 2 (20) | 3 | |
Behavioral risk factors (unhealthy diets, physical inactivity) | 8 (80) | 11 | |
Metabolic risk factors (overweight/obesity, hypertension) | 10 (100) | 20 | |
Complications from undiagnosed/untreated/poorly managed diseases (e.g., amputations “diabetic foot”, kidney diseases, blindness) | 5 (50) | 8 | |
Cost to state and society | 8 (80) | 11 | |
Mental health illnesses | 4 (40) | 5 | |
Infectious diseases | Zika, Chikungunya, Ebola | 1 (10) | 2 |
Extreme weather events/natural disasters | Post-disaster access to care | 2 (20) | 3 |
Determinants | Factors |
---|---|
Economic | Overburdened healthcare system Limited resources (financial and human) for response to the NCD crisis Competing goals from the private sector Fiscal austerity measures |
Social | Income Access to health services Health Education |
Cultural | Shift from traditional to “westernized” diets Different priorities for a “good life” |
Individual behaviors | Noncompliance with medication regimes Health care avoidance |
Profession | Level of Organization | Climate Change & Health Impacts | Connection between Climate Stresses & NCDS |
---|---|---|---|
Pharmacist | Community | No | No |
Pharmacist | Community | No | No |
Doctor | Community, national | Yes | Yes |
Doctor | Community | Yes | No |
Doctor | Community, national | Yes | Yes (with prompting) |
Board of Director of health NGO | National, regional | Yes | Yes |
Representative from PAHO | National, regional | Yes | Yes |
Fitness instructor/personal trainer | Community | Yes | No |
Retired nurse | Community | No | No |
Nutritionist | Community, national | Yes | Yes |
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Springer, R.A.; Elliott, S.J. “There’s Not Really Much Consideration Given to the Effect of the Climate on NCDs”—Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados. Int. J. Environ. Res. Public Health 2020, 17, 198. https://doi.org/10.3390/ijerph17010198
Springer RA, Elliott SJ. “There’s Not Really Much Consideration Given to the Effect of the Climate on NCDs”—Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados. International Journal of Environmental Research and Public Health. 2020; 17(1):198. https://doi.org/10.3390/ijerph17010198
Chicago/Turabian StyleSpringer, Roxanne A., and Susan J. Elliott. 2020. "“There’s Not Really Much Consideration Given to the Effect of the Climate on NCDs”—Exploration of Knowledge and Attitudes of Health Professionals on a Climate Change-NCD Connection in Barbados" International Journal of Environmental Research and Public Health 17, no. 1: 198. https://doi.org/10.3390/ijerph17010198