Islamset - Discussion: Health Care in Jamaica

A study in Jamaica found that the main health problems suffered by people over 60 years of age were hypertension, osteoarthritis and diabetes (1). All three of these chronic diseases are related to nutrition and lifestyle. Women were found to be at higher risk from these diseases than men, and two thirds of the 34.2% who were overweight were women. Such findings reinforce the view that health promotion is important for all age groups, since eating habits are formed early in life, and subsequently health depends to a significant extent on how such habits are maintained or modified.

Caring for the "older elderly"

I agree with Dr Darnton-Hill that lifestyle changes, especially in the area of physical activity and nutritional practices, can reduce disability and improve quality of life,

In a country such as Jamaica, where 60% of the elderly live in rural areas, a certain amount of physical activity is usually unavoidable as walking is the only reliable means of transport.

especially for the "older elderly", namely those over 75. In a country such as Jamaica, where 60% of the elderly live in rural areas, a certain amount of physical activity is usually unavoidable as walking is the only reliable means of transport. In our community study, 78% of the respondents walked daily. Another very important concept for successful aging is self-care, which refers to everything individuals can do to prevent, diagnose and treat their own illnesses, and use the informal and formal support systems and medical services available.

To avoid or overcome the obstacles health promotion can encounter, careful attention must be given to the normal cultural practices of the population concerned. In Jamaica one such obstacle is found not among the elderly themselves but among their younger relatives who want to "look after" them and encourage them to be less active than is good for them. This underscores the need for health promotion for all age groups as a means of strengthening intergenerational relationships, especially for countries which depend mainly on informal systems of care - in this case the family.

In Jamaica the extended family is still cohesive, and is often headed by an elderly person. Caring for elderly family members is not usually seen as a burden, and in many cases is carried out not by the young but by people who are only 10 or so years younger than the patient. Women, although they live longer and are economically disadvantaged, usually live with the extended family and donot see loneliness as a major concern. This is related tothe traditional role of women in maintaining the home and raising the children.

Although Jamaica's per capita gross national product is significantly less than US$ 3000, average life expectancy is over 75 years. People aged 75 and above comprise the fastest growing age group, and already account for 39% of the elderly population (those aged 60 and above). As has frequently been pointed out, the "older elderly" require two to four times as much health care as the "younger elderly". Meeting this growing need is therefore a pressing concern. At the same time, keeping it to a minimum by means of early prevention programmes can yield substantial benefits. Not least among these are the advantages of increasing the ability of the old to remain physically self-sufficient, economically independent and socially involved.

Health promotion through the primary health care system

Like many other developing countries, Jamaica already has a well-established structure for carrying out health promotion programmes for the benefit of older people: the primary health care system. This level of health care includes all age groups, and as such favours the life-cycle approach to health promotion. In most cases beneficial changes in lifestyle take their most important effect over a number of years. For instance, control of hypertension in mid-life reduces the risk of cerebrovascular disease in later life; likewise, proper management of diabetes mellitus from the start reduces ill-health and disability in later life. Thus a modest investment in promoting healthy lifestyles among adults now will yield its most substantial savings when the same people are elderly.

The multiple causes of chronic diseases are still insufficiently understood, and ongoing research is needed to make the preventive activities more numerous and more effective. Already, many of the frailties of old age can be reduced or averted if they are detected in time and appropriate action is taken. This calls for a culturally appropriate system of care, providing not only for medical referral but for social and economic support as well.

Health promotion must be seen as part of an overall strategy rather than a self-sufficient activity. WHO has suggested that maintaining autonomy should be the basic objective of care for the elderly. Other important considerations closely related to this include preserving dignity, and ensuring access to necessities such as rehabilitative, educational, social, economic, and health services. Thus programmes for preventing disease and disability in old age have to be multidisciplinary and involve intersectoral cooperation and community participation. Public support is needed at all levels, from national governmnent to local community, and this means that health promotion activities must include efforts to change public opinion and attitudes towards aging.

Eldemire D. An epidemiological survey of the Jamaican elderly. Kingston, University of the West Indies, 1993 (unpublished Ph.D. thesis).