The burgeoning health issues of small island developing states – which are on the front lines of climate change, but also awash in handguns and ultra-processed food imports – is the focus of a high level ministerial meeting taking place in the Caribbean island of Barbados today and tomorrow. 

The SIDS Ministerial Conference on NCDs and Mental Health, co-sponsored by the World Health Organization, has brought together more than three dozen small island states that face not only climate precarity, but also globally high levels of hypertension and obesity as well as mental health disorders – in a complex web of issues that is both unique but also representative of broader global trends in unhealthy foods, environments and lifestyles.

The conference also represents a first attempt by WHO to more squarely confront what it calls the “commercial determinants of health” – such as the enormous dependence of small and isolated states on big food imports that are leading to more and more chronic diseases.

“We are not just the canaries in the mines for the climate crisis,” asserted Prime Minister Mia Amor Mottley at the opening session Tuesday evening.  She asserted that her “Bridgetown Agenda” for financial reform aimed at low- and middle-income countries was also critical to reforming development policies, agriculture and trade so as to allow SIDS countries to become more healthy, sustainable and self-sufficient.

“The world has to summon the political will to be able to put the structures in place that will allow us to be able to finance global public goods, not with short term capital. But with long term capital that makes sense. And that allows us to have the elbow room still to meet the other challenges that we face,” Mottley said.

Geographically remote and vulnerable to global markets

“I think we really need to absorb the geographical remoteness, the domestic market and the diverse economies that is happening in the SIDS,” said Bente Mikkelsen, WHO’s head of noncommunicable diseases. 

“We have three threats coming together here, mental health,  NCDs and climate change,” she observed, “and also to add to the the experience from COVID-19 and the need for better preparedness.” 

She noted that small island states – scattered from the Pacific to the Caribbean – “are highly depending on international relationships” and that dependence has made them particularly vulnerable to cheap, ultra-processed food imports. 

“What you will see is a lot of nutrition related diseases in the SIDS countries… and we have already heard mention of the commercial  determinants of health,” she added. “The prevalence of hypertension exceeds 30% in all SIDS countries. The prevalence of diabetes is among the highest in the world. And very remarkably and very scary, I would say is the high obesity rates.” 

She called for stronger regulatory measures, such as higher taxes on unhealthy foods, along with measures “supporting the healthy forms of trade” that incentivize local production and imports of healthier alternatives.  

Economic and commercial drivers of health in the spotlight

NCDS – primarily cardiovascular diseases, cancer, diabetes and chronic respiratory diseases – cause 74% of premature deaths in the world (before the age of 70), including 8 million deaths linked to unhealthy diets, points out a WHO briefing paper on the intertwined challenges of climate change and NCDs in the small island nations, published at the start of the conference.

“The NCD epidemic has grown earlier and faster in SIDS than elsewhere in the world due to commercial influences and trade challenges, which undermine access to fresh, nutritional food,” the brief points out.

Now, climate change is making things even trends worse:

“Heat-related mortality from NCDs such as cardiovascular and kidney diseases in SIDS is projected to increase with higher temperatures. The elderly, children, pregnant women, outdoor workers, the poor and marginalized and people living with NCDs and obesity are among the worst affected,” the paper points out.

Not only that, but  “damage to crops and livestock from rising sea levels and extreme weather events and reduced fish catches because of higher ocean temperatures and acidity,” could increase food insecurity as well as the already heavy reliance on unhealthy imported foods.

Another WHO “discussion” paper on the economic drivers of the NCD epidemic in the SIDS provides further detail on how food imports have swamped the SIDS, which tend to be debt-ridden and vulnerable trading partners.

“Obesity rates in SIDS continue to increase, in part due to the over-availability, widespread marketing, reliance and entrenchment of importing foods and non-alcoholic beverages that are high in saturated fatty acids, trans-fatty acids, free sugars and/or sodium, and typically highly processed (HFSS foods), and their relatively high consumption,” the WHO paper notes.

“Five of the top 10 countries with the highest overweight and obesity rates in the world in 2016, and seven of the 10 countries with the highest rates of diabetes, are Pacific Island countries and areas.” Over 60% of adults in the Caribbean, and up to 80% in some Pacific Island states are obese, the paper adds, referring to the two regions that together, comprise most small island developing states.

Colonialism, climate change and unsustainable fishing combined

It wasn’t always that way. Traditional diets were fibre-rich, with plenty of seasonal fruits, legumes, nuts, seeds and other indigenous plants, the WHO notes. But current obesity trends are being driven by a “change in the diets of local populations from traditional, locally grown staples to imported, energy-dense, HFSS foods and beverages.

“This shift away from agricultural production has been shaped by economic and commercial factors… , including the colonial legacy of land ownership and land division, land loss and pressures, as well as increasing migration and urbanization,” states the WHO paper on economic determinants. “It is also impacted by climate change and increasing droughts within the countries, as well as prohibitive inter-SIDS trade provision and shipping costs and other barriers, when compared to importing food internationally.

“As noted in a regional UN Conference on Trade and Development (UNCTAD) meeting, fishing remains a mainstay of economic activity, but remains challenged by issues such as illegal fishing. Unsustainable fishing or fishing insufficiently regulated to protect local fisheries and local consumption has direct impacts on health, as depleted stocks require island fishermen to work longer hours, farther from shore, in less safe conditions.”

“In contrast to the urban populations, people in rural areas of Pacific SIDS have a more varied diet which is more likely to meet WHO recommendations of consuming more than 400 grams of non-starchy fruits and vegetables daily,” the paper notes.  Government policies are historically weak: “In 2021, only 13 of the 38 Member States SIDS had food based dietary guidelines (FBDGs) to inform and guide policy work along the food system, and no FBDGs explicitly incorporated environmental sustainability elements.”

Reducing taxes and duties on fresh foods and promoting healthy school lunches

“I anticipate that in a few years time, we’re going to see premature mortality increase and it’s going to have a negative impact, I believe on the labor force and on the quality of life,” said Christopher Tufton – Minister of Health and Wellness, of Jamaica in a panel discussion on Wednesday. “What do we need to reduce this trend?  I think we have to target all stakeholders and not just the converted.. From an economic modeling perspective and from a quality of life perspective. 

“Particularly in terms of nutrition, we are import-dependent,” he noted, asking “how do we impact the global commodity chains to influence behavioural change?”  Schools offer one point of focus, Tufton said.

“We are starting at the level of schools to influence behavioural change..We are pursuing nutrition policy  because our children are our future. They’re a captive audience,” Tufton.  Another panel member Ellis Webster, Minister of Health of Anguilla, agreed that school feeding programmes are a good starting point.

A key aim of the conference is to consolidate SIDS inputs into a upcoming high level UN meeting on Universal Health Coverage,  scheduled for September, WHO says.  Traditionally, NCDs and mental health have been poorly represented within countries’ UHC plans, with inadequate attention to prevention as well as to diagnosis and treatment.

The conference also follows on from the SIDS High-level technical meeting on NCDs and mental health held in January 2023, where representatives from SIDS countries discussed the progress and challenges to meet the Sustainable Development Goal 3.4 related to NCDs and mental health.

An outcome document to be issued at the close of the conference aims to reafirm SIDS political commitments to putting NCDs and mental health front and center, stimulating both increased domestic action and more international cooperation.

Image Credits: WHO.