Overburdened by non-communicable diseases (NCDs) and threatened by climate change, health ministers of Small Islands Developing States (SIDS) met in Barbados over the past few days and adopted the  Bridgetown Declaration on NCDs and Mental Health. 

The declaration commits the SIDS to a number of actions including implementing the World Health Organization’s (WHO) recommended “Best Buys”, a menu of policy options to prevent and control of NCDs and mental health. These include regulation and taxation of harmful products such as tobacco, alcohol and junk food.

The SIDS comprise 39 countries and 18 associate members of the UN situated in the Caribbean, the Pacific, and the Atlantic, Indian Ocean and South China Sea (AIS), and have a combined population of around 65 million.

A new WHO report shows that eight of the 15 countries with more than a 30% risk of premature death from cardiovascular disease, cancer, diabetes, or chronic respiratory disease are SIDS. The 10 countries with the highest obesity rates globally are all SIDS in the Pacific, where over 45% of adults live with obesity.

Cry for help

While the Bridgetown Declaration is a call to action, it is also a cry for help as it lays bare the problems facing these small nations – one percent of the world – that rely primarily on tourism and workers’ remittances for survival. 

Over half of the deaths in SIDS are premature and from NCDs, including cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, and mental health conditions, according to the declaration. 

Nauru, Cook Islands and Palau have the highest rates of obesity in the world, while childhood obesity in all SIDS is increasing exponentially. 

The highest prevalence of adult diabetes is also projected to be in SIDS, with prevalence in the Caribbean double the global average. Meanwhile, over 30% of adults have hypertension. 

In Guyana, premature mortality from cardiovascular disease is the highest in the region of the Americas. Rates of mental health conditions reach as high as 15% in the Caribbean and the Pacific. 

The SIDS attribute the drivers of these problems to “disproportionate commercial influence and trade-related challenges. Negative commercial influences are driving high rates of smoking, obesity and sedentary behaviour across these countries.”

The islands are a captive audience for these commercial forces. They’re reliant on imported food, which is often ultra-processed and high in sugar, salt and fat – and comes wrapped in plastic that pollutes the environment. 

With climate change negatively affecting local fishing and agriculture, this dependence is likely to increase.

The declaration also speaks of  “the disproportionate and repetitive impact of disasters, whose frequency and intensity are further exacerbated by climate change”. This causes economic losses and drives people away from the islands.

Funding to mitigate challenges

One of the reasons for the meeting, which was hosted by the World Health Organization (WHO), its regional counterpart, the Pan-American Health Organization (PAHO) and the Barbados government, is to prepare for the UN General Assembly high-level meeting on universal health coverage in September.

The intention is to engage governments, international agencies and donors to assist SIDS to address their unique problems.

“Bold action for our climate, good health, and wellbeing relies on redressing and reorganising global financing to unlock billions in investment while making it less punishing for developing countries to pay their debts,” said Mia Mottley, Prime Minister of Barbados, at a media briefing on Thursday. 

“Funding for climate change adaptation and mitigation in the most vulnerable countries is also key, with noncommunicable diseases and mental health accounted for.”

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the SIDS for showing “remarkable resilience, despite their limited resources and geographical constraints”.

He pledged that WHO would work to mobilize financial resources to develop climate-resilient, environmentally sustainable healthcare facilities in the SIDS. WHO will also continue to advocate for “loss and damage” funding for climate change adaptation and mitigation investments in lower-income countries.

Image Credits: Rick Bajornas/ UN Photo.