Sustainable Wellbeing in Belize-The Challenge of Diabetes

+ The University of Texas at Austin December 2016

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+ The University of Texas at Austin

Erinn Wright Bridging Disciplines Program

December 2016

Sustainable Wellbeing in Belize: The Challenge of Diabetes


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ACKNOWLEDGMENTS............................................................................................3

INTRODUCTION......................................................................................................3

DIABETESANALYSIS................................................................................................4Overview................................................................................................................................................................4DiabetesinBelize...............................................................................................................................................4WeightandObesityinBelize........................................................................................................................6DiabetesKnowledgeinBelize......................................................................................................................7

ROLEOFORGANIZATIONS......................................................................................9BelizeDiabetesAssociation...........................................................................................................................9HillsideHealthCareInternational...........................................................................................................10YouthWellnessAmbassadors...................................................................................................................11DiabetesSummit...............................................................................................................................................11

Summary.............................................................................................................................................................13ROLEOFGOVERNMENT.......................................................................................13HealthSystemandPolicies.........................................................................................................................13HealthandDevelopment.............................................................................................................................14

CONCLUSIONS......................................................................................................14Challenges..........................................................................................................................................................14SuggestionsGoingForward.......................................................................................................................15REFERENCES.........................................................................................................16

APPENDIX1..........................................................................................................18

APPENDIX2..........................................................................................................21


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ACKNOWLEDGMENTS

SpecialthankstoDr.DavidGibsonoftheInnovation,Creativity,andCapital(IC2)InstituteofAustinwhomadethisprojectpossible.IappreciateDr.Gibson’sguidance,generosity,andleadershipthathelpedshapethispaperanddevelopmentoftheproject.AnotherspecialthankstoSaraLupinioftheUniversityofTromsøinNorway,whoisthepassion,brains,andmentorshipbehindmanyaspectsoftheproject;andElinOftedaloftheUniversityofTromsø,forherinsight,generosity,andsupport.Thankstothiswelcomingandsupportiveteam,Ihavegainedincrediblyvaluablelearningexperiences.AdditionalthankstoallofthepeopleImetinBelizeandelsewherethatwerewillingtosharetheirstoriesandperspectiveswithme,aswellastheBridgingDisiciplinesprogramforprovidingmewiththesupporttofundthisproject.

INTRODUCTION

ThepurposeofthispaperistoexplorethedimensionsofdiabetesinBelizeanditsimpactonsustainablewellbeing.DiabetesistheleadingcauseofdeathinBelize,withmanycontributingfactors.ItisimportanttonotethatIdonothaveabackgroundinmedicine,nutrition,orgenetics.Thus,myanalysisoffactorsinvolvingthescienceofcausesandcorrelationsisstrictlyutilizedtoexplainhowimportantpiecesofdataandfactorsmayhaveaneffectondiabetesinBelize.

AlargeportionofthispaperisdedicatedtotheinsightslearnedwhileonafivedaytriptoBelize,visitingSanIgnacio,Belmopan,andBelizeCity.Throughthetrip,Iwasabletogetaveryenhancedunderstandingofthesocial,political,andeconomicstructuresofthecountry,andthepervasivenessofdiabetes.AnothersignificantportionofthereportwillbededicatedtoanalysisofhoworganizationscancollaboratetoeffectivelyreducetheprevalenceofthisdebilitatingdiseaseinBelize.

MyresearchaccompaniesworkbeingdoingbySaraLupiniinNorwayaspartofacurrentinitiativeofTheBelizeFoundatio,anon-profitledbyDr.Gibson.TounderstandBelizeasacountry,aswellasthechallengesitfaceswithdiabetes,Iconductedalargeamountofsecondaryresearchthroughonlinepublications,casestudies,blogs,andnewsreports.However,themostsignificantpartofthisprojectinvolvesprimaryresearchconductedthroughconversationswithlocalsandorganizationsduringmytriptoBelize,aswellasconversationswithotherstakeholderswhomhaveextensiveexperiencewiththecountry.


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DIABETES ANALYSIS

Overview

Insulinisahormonethathelpstransformglucose,orsugar,fromcarbohydratesintoenergy.Itregulatestheamountofsugarinthebloodstream,workingtokeepasustainablelevel.DiabetesMellitusisachronicdiseaseresultingfromthepancreasbeingunabletocreateinsulin,ortoeffectivelymanagetheinsulinitdoesproduce.Therearethreemaincategoriesofdiabetes:Type1,Type2,andGestational.Type1occurswhenthepancreasdoesnotproduceanyinsulinatall,whileType2occurswhenthepancreasdoesproduceinsulin,butitdoesnotproduceenoughorthebodyhastroubleprocessingit.Finally,gestationaldiabetesisarareformthatoccurswhenamotherhashighsugarlevelsduringpregnancy.Type2isthemostcommonform,representingaround90%ofcasesworldwide.Thisistheformthemajorityofthepaperwillfocuson,asType2diabetescanoftenbeprevented,whereasType1cannot.AlthoughgenescanaffectthedevelopmentofType2,withsomegroupsbeingmoresusceptiblethanothers,lifestyleandbehavioralcharacteristicsarethemostimportantriskfactors.ManywithType2diabetescaninitiallymanageitwithlifestyle,diet,andexercisechanges,buteventuallyneedoraldrugsorinsulintofurtherregulateglucoselevels.Worldwide,415millionpeoplebetweentheagesof20and79yearswereestimatedtohavediabetesin20151.Thisnumberispredictedtoincreaseto642millionby2040,makingit“oneofthelargestglobalhealthemergenciesofthe21stcentury,”(InternationalDiabetesFederation,2015).Diabetescanleadtomanycomplications,includingblindness,strokes,heartattacks,andkidneyfailure.Manyofthesecomplicationscanthenleadtodeath,withdiabeteskillingapproximately5.0millionin2015-morethanHIV/AIDs,tuberculosis,andmalariacombined.Diabetes in Belize

InBelize,diabetesistheleadingcauseofdeath.However,dataonmajorchronicdiseasessuchasdiabetesandhypertensioninCentralAmericawererelativelyunavailableuntila2009studyconductedbythePanAmericanHealthOrganization,aspartoftheCentralAmericaDiabetesInitiative(CAMDI).Thestudyutilizedstratifiedsamplingtechniquestodetermineapopulationsampleof10,822peoplefromsixkeyregions:urbanareasofSanJosé,CostaRica;SantaTecla,SanSalvador,ElSalvador;Villanueva,GuatemalaCity,Guatemala;Tegucigalpa,Honduras;Managua,Nicaragua;andthenationalpopulationofBelize.Thestudyfoundthatthetotalprevalenceofdiabetesintheseareaswas8.5%,butwashighestinBelizewith12.9%.2

1“IDFDiabetesAtlas,SeventhEdition.”InternationalDiabetesFederation,2015.2"TheCentralAmericaDiabetesInitiative(CAMDI)."PanAmericanHealthOrganization,2009. 2"TheCentralAmericaDiabetesInitiative(CAMDI)."PanAmericanHealthOrganization,2009.


AlthoughBelizewasgroupedintotheCentralAmericanregionforthepurposesofthestudyabove,theInternationalDiabetesFederationplacesBelizeaspartofthe24countriesoftheNorthAmericaandCaribbean(NAC)region.TheNACistheregionwiththehighestpercapitaprevalenceintheworld,with44.3milliondiabeticsin2015,whichisexpectedtoriseto60.5millionby2040.3ThenumberofdiabetesmortalitiesintheNACregionwas324,000during2015,with38%undertheageof60.Theaverageregionalprevalencewas12.9%in2015,butinBelize,withareported28,700totalcases,theprevalencewas14.2%inadultsages20to79Thisfiguregoesupto16.5%accordingtoage-adjustedcomparativeprevalence.BothofthesefiguresshowtheprevalenceofdiabetesinBelizeisthehighestofallothercountriesintheregion,withMexicofollowingatanage-adjustedprevalenceof15.8%.Belize’sprevalencerateisnotonlyhigherthantheregionalaverage,itissignificantlyhigherthantheworldaverage,evidentbyFigure1below.Figure1

Source:InternationalDiabetesFederation

3“IDFDiabetesAtlas,SeventhEdition.”InternationalDiabetesFederation,2015.


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Thisalignswiththeevidencethatshowsdiabetesprevalenceisincreasingmorequicklyinmiddleandlowincomenations.4AccordingtotheInternationalDiabetesFederation,“manymiddle-andlow-incomecountrieshavemorepeopleundertheageof60withdiabetescomparedtotheworldaverage.Meanwhile,forhigh-incomecountries,agrowingpopulationovertheageof60makesupthelargestproportionofdiabetesprevalence.”Thisdemonstratesthatmanylowerincomecountriesareexperiencingayoungeronsetofdiabetesascomparedwithhigherincomecountries.However,approximatelyhalfofalldiabeticsgloballyareundiagnosed.AccordingtoDr.EricBradley,theonlydiabetologistinthecountry,thereareareported9,700additionalpersonsinBelizethatarelikelyundiagnosed,bringingupthetotalnumberofcasesto38,400Belizeans.NotonlyaretheremanyundiagnosedBelizeans,butanestimated50%ofthosediagnosedaredesignatedwithdiabetesattheuncontrolledlevel.TheBelizeDiabetesAssociatesnotesthatalargereasonforthisislackofadherencetodiabetesmanagementandmedication,compoundedbylackofsufficientknowledgeofthedisease.5Finally,diabetesaccountedfor9%ofdeathsin2016(MinistryofHealth)andhasbeenoneoftheleadingcausesofdeathformanyyearsinBelize.Between2006and2009,thedeathsattributedtodiabetesrepresented8.5%ofallmortalities,an18%increasefromthepreviousperiod,2001to2005.6However,thediabetesmortalityrateishigherinfemales,representingaround50%ofdeaths.Ontheotherhand,theleadingcausesofdeathformalesarehomicide,HIV,andmotoraccidents. Weight and Obesity in Belize

AsnotedbytheDiabetesCarejournel,amajorityofType2diabeticsareobeseand“theglobalepidemicofobesitylargelyexplainsthedramaticincreaseintheincidenceandprevalenceofType2diabetesoverthepast20years,”(RobertEckel,2011).In2008,anestimated71%ofBelizeanswereoverweight,and34.9%ofthoseoverweightwereconsideredobese.However,accordingtothePanAmericanHealthOrganization,alargerpercentageofwomenwerefoundtobeobesewith45.4%comparedto20.4%ofmales,whichmayrepresentacorrelationwiththehigherpercentageofwomenthatareaffectedbydiabetesthanmen.Belizehasbeguntakingmeasurestopreventthisongoingepidemicofobesity,especiallyinchildren,inconjunctionwithoverallCaribbeanregionalefforts.TheCaribbeanPublicHealthAgency(CARPHA)createdaplanofaction“PromotingHealthyWeightsintheCaribbean:PreventionandControlofChildhoodObesity,2014-2019.”TheBelizeMinistryofHealthisalsotakingmeasurestopromote4"Diabetes:FactSheet."WorldHealthOrganization,2016.5AnthonyCastillo."President'sReport."BelizeDiabetesAssociation,2013.6“Belize."HealthintheAmericas,PanAmericanHealthOrganization,2012.


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awarenessandsupportproactivelyhealthylifestylesbydevelopingseveralbrochuresandhandouts,includingFood-BasedDietaryGuidelinesandanObesityFactsheet.However,despitethisefforttoencouragehealthyweightintheCaribbean,obesityandhighbodymassindexesremainhigh. Diabetes Knowledge in Belize

Despitethehighrateofdiabetes,awarenessofthediseaseisveryminimal,andthetoolsthatpeoplehavetocombatitarelimited.AccordingtotheInternationalDiabetesFederation,“manycountriesarestillunawareofthesocialandeconomicimpactofdiabetes.Thislackofunderstandingisthebiggestbarriertoeffectivepreventionstrategiesthatcouldhelphalttheinexorableriseoftype2diabetes.”WhileinBelize,Iconductedprimaryresearchbyinterviewinglocalswheneverpossibletounderstandpublicknowledgeofdiabetes.Thefirstdayofthetrip,IinterviewedamannamedGavin,wholivesnearBelizeCity.Hehasbeenpersonallyaffectedbydiabetes,withhismompassingawayfromType2.However,hewasnotentirelysureofthedifferencesbetweenType1andType2diabetes,mentioninghismothertookpillswhenshefeltsick.WhenIaskedhimwhathebelievedisneededtohelpincreaseawarenessandknowledge,henotedaneedforadvocacyandlocalnutritionists.Hestatedthatmostnutritionistsareforeign.Healsomentionedthatalthoughthegovernmentappearstobeworkingonspreadingtheknowledgeandthereisalotofinformationinhospitals,theinformationdoesn’tseemtogobeyondthewallsofthehospitals.Formodesofcommunication,henotedFacebookandradiostationsashugeinfluencersinpublicattention,inpartduetoalocalaffinityforgossip.Inadditiontoquestionsondiabetes,IalsoaskedhimaboutdietandfoodinBelize.GavinattributedthedietofBelizetobemainlybasedonriceandchicken,andmainlydomestic-basedduetothehighproductionofitemssuchasrice.WhenprobedaboutlevelsofexerciseinBelize,Gavinfurthernotedthatthereisalotofobesity,whichheattributedtogohandinhandwiththeamountofriceeatenandthushighlevelofstarchingestion,leadingtohighfat.AccordingtoGavin,thereusedtobealotmorevegetableproductionuntilaGuatemalansugarcompanyestablishedoperationsandutilizedpesticideswhichdamagedthesoilthatwassuitableforthosevegetables.Now,hesays,Belizehasbeenrelyingonmoregreenhousedevelopmenttohelpspurmorevegetableproduction.Thisnotestheimportantcontributingfactorofdomesticagriculture’seffectondietandnutrition,aswellastheeffectofforeigninfluenceinagriculture.AlthoughGavinwasratherknowledgeableondiabetes,Ialsometmanypeoplethatwerenot.Reuben,wholivesinSanIgnacio,butisfromthesouthnearPlacencia,admittedheisnotveryfamiliarwithdiabetes.WhenaskedifitisabigproblemforBelize,hesaidprobablynot,butalsonotedhedoesn’tknowwhatcausesit.Aftergivinghimabrief,superficialexplanationoverthefactorsleading


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todiabetes,hementionedthatperhapsitisnotasbigofanissueinSanIgnacioduetothehillycharacteristicsofthecity.ThisbroughtupanimportantgeographicconsiderationofdiabetesprevalenceinBelizeandtheimplicationsitmayhaveonlifestyleandexercisefactors.Overall,hewasnotawareofthescopeofdiabetes,thecauses,orthecomplicationsthatcangoalongwithit.ThisnarrativewascharacteristicofotherconversationsIhadwithlocalsthroughoutmyvisit,demonstratingthelackofbroadawareness.AwarenessiscriticalforreducingtheprevalenceofdiabetesinBelizebyensuringpeopleathighriskareawareofhowtospotthesignsquicklyforearlydiagnosisandmanagement.Tofurthergageawarenesslevelsandimportantsourcesofinformation,Icreatedanonlinesurvey,includedinAppendix2.ThesurveywasdistributedviasocialmediaandemailsfromBelizeansImetthroughoutmytrip.Thusfar,thesurveyhas19respondentsfromavarietyofagesandgeographicalareasinBelize.Althoughtheresponseratewasrelativelylow,itisstillausefulsamplingforfurtherunderstandingthelocalperspective.AccordingtoFigure2below,whenaskedinanopen-endedquestionwhererespondentsgetinformationondiabetes,themostreferencedsourcesweretheschoolandinternet. Figure2:OnlineSurveyResults

Question:Wheredoyougetinformationondiabetes?

Sources of Information Count School 5

Internet/Research 5 Reading 1 Doctors 1 Family 1

Pamphlets 1 Facebook Groups 1

Belize Diabetes Association 1 Youth for World Peace 1

Clinics 1


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TheimportanceoftheroleofschoolandonlineinformationwasfurtherconfirmedwhenaskedtoselectthemostimportantcommunicationmethodsforbuildingawarenessinBelize,shownbelow.Figure3:OnlineSurveyResults

Twelveofthe19respondents,or70.59%,chosesocialmediaandschool.ThisechoesthethoughtsthatGavinsharedontheincreasinginfluenceofsocialmedia,especiallyFacebook,inBelize.However,accordingtodatafromtheWorldBank,internetusersinBelizeonlyrepresents41.9%ofthepopulation,presentingalimitationintheeffectivenessandbreadthofsocialmediaawarenesscampaigns.Otherimportantinformationsourcesnotedincluderadio,publicadvertisements,andTV.WhilevisitingBelize,whatparticularlystoodouttomeisthepopularityofradiotalkshows.Inparticular,manypeoplenotedthattheylistentoLoveFMalmosteveryday,demonstratingtheopportunitythatfurtherutilizingthesepopularstationspresentasanespeciallyeffectivewaytosparkawareness.

ROLE OF ORGANIZATIONS

Anotherimportantforcenotedinthesurvey,aswellasconversationswithlocalsduringthetrip,istheroleoforganizations.Throughmyresearch,Iencounteredseveraldedicatedtorunningdiabetesfairs,seminars,diagnostictests,managementplans,andotherrelatedcampaignsinBelize. Belize Diabetes Association

ThisNGOwasfoundedin1991toeducatethepublic,advocatefordiabetics,providemanagementtools,andmore.TheorganizationhasbeenamemberoftheInternationalDiabetesFederation(IDF)since1994,andworkscloselywiththeMinistryofHealth,andamainfocusinvolvesoutreacheventssuchascamps


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andhealthfairs.ItalsohasjoinedforceswithvariousIDFchaptersacrosstheregionandhaspartneredonavarietyofprojects,includingtheTheManagementofDiabetesinYouth. Hillside Health Care International

TheHillsideFoundationoffersfreemedicalcaretoBelizeans,operatingaclinicintheSouthernBelizedistrictofToledoaswellasamobileclinicthattravelstooutsidecommunities.Theorganization’spublichealthprogramfocusesoneducatingthepopulationondiseasessuchasdiabetes.AccordingtonotesbyAdamBorger,aprogramvolunteer,ofaconversationwithChristinaVernon,apreviousDoctorofPublicHealthVolunteer:

“They[TheHillsideFoundation]didsomefocusgroupswithcommunityhealthworkersinthevillagestofindoutthegeneralunderstandingofthepopulation.Someofthemthoughtthatdiabeteswascuredaftertakingthemedicationforacycle.Someonethoughtitwassexuallytransmitted.Anotherthoughttheycouldgetitfrombeingwithfamilymembersthathaveit.Alotofthisiscomingfromthepeoplewhoareeducatedaboutitinthecommunities.Someofthepeoplehaveneverlefttheirvillage.Theyhaveabasicunderstandingthatitdealswithsugar,butthat'saboutit.Reallyhardtomanageintheareas,duetotheaccessoffruits,tortillas,etc.Lowcarbdietsarealmostaculturalchange.”(Borger)

FromthesesamplesoftheareatheclinicservesoutofEldridgeville,nearPuntaGorda,itisclearthatthereisalotofconfusionandlackoftrueknowledgeofdiabetescausesandmanagement,evenamongstthosewhoarehealthworkers.AlthoughIreachedouttoChristinaVernondirectlyforanenhancedperspective,Ihavenotreceivedaresponse.However,IwasabletogetintouchwiththePublicHealthCaredirector,MatthewNicasio.Heprovidedmewithastudyconductedbystudentsatthefoundationtoidentifychallengesandgapsindiabetescare,titled“CommunityHealthNeedsAssessmentforDiabetesandHypertensioninToledo.”Onechallenge,describedbyavolunteerphysicianassistant,involvesunderstandingtherealityofthechallengeslocaldiabeticsfaceeachday,andthebarrieritcreatestoprovidingeffectivelifestylemodificationcounseling:“Ithinkthebiggestbarrierisprobablythatasproviders,wereallyhavenoclueastowhatourpatients’livesarereallylike…IthinkI’monlyjustbeginningtounderstandhowharditistolivehere.” Otherobstaclesnotedincludedthelowuseofinsulinastreatment,withmorefocusonoralmedication.Fromconclusionsdrawnbythestudy,theydecidedtotacklethesechallengesbydevelopingdiabeteseducationcurriculumswithMayantranslations,improvedlifestylemodificationcounselingmethods,


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increasedimplementationofinsulintreatment,andbettertrainingforincomingvolunteersandworkersonlocalfoodculture.Asevidentbythisstudyandconversationswiththoseinvolvedintheorganization,theHillsideFoundationiscontinuingtofocusoneffortstobettereducatethepublic,aswellasutilizemoreeffectivetreatmentmethods. Youth Wellness Ambassadors

ThisorganizationisbasedoutofBelmopanandcomprisedof20youngkids,ages14-17,whoarevoluntarilydedicatinghourseachweektobewellnessambassadors,advocatingfordiabetesawarenessandprevention.Thisgroup,ledbyCEOMysteryFurtado,organizes5Kruns,trainingseminars,outreachevents,andprovides10diabeticpatientsinthemainBelmopanhospitalwithdiabetes-friendlymealseachmonth.Despitelimitedfinancialandtechnologicalresources,theYouthWellnessAmbassadorsarecommittedtodoingeverythingintheirpowertofightdiabetesandadvocateforbetterpreventionandmanagementtechniques.

Diabetes Summit

ForWorldDiabetesMonth,thegroupalsoorganizedaDiabetesSummit,invitingdoctorsandinfluentialpeoplefromotherorganizationstocomeandsharetheirknowledge.TheconferenceinvolvedDr.JeanneIsabel,fromNorthernIllinoisUniversity,andDr.EricBradley,thediabetologistoperatingoutofBelizeCity.OtherpresentersincludedCharmaineClarkeCastilloandRoseAndersonfromtheBelizeDiabetesAssociation,aswellasLysettePrenfromtheBelizeCouncilfortheVisuallyImpaired.

ImagebyMysteryFurtado


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ImagebySaraLupini

Iwasabletoattendthiseventandlearnfromtheseknowledgeablestakeholders,gainingvaluableinsightintoadditionallocalperspectives,aswellasanenhancedunderstandingofsomeoftheactivitiesoftheseorganizations.TheBelizeDiabetesAssociation,Idiscovered,coordinateseducationalprogramsinnearlycommunity,andtheBelizeCouncilfortheVisuallyImpairedimplementseyescreeningexams.Thecouncilhasscreenedaround2,000peoplethankstofundsfromtheLionsClubInternationalFoundationandtheQueenElizabethDiamondJubileeFund.Despitetheheadwaytheorganizationhasmade,Ms.Prennotedtheneedforannualscreeningsthroughoutthepopulation.Notonlydidthoseinattendancelearnfromtheseexperts,butDr.IsabelfromIllinoisalsoconductedfreeA1Ctests,whichsheidentifiedasthecheapestdiagnostictestthatcanmeasuretheaverageofglucosecirculatinginthebloodandeffectivelyidentifyprediabetes.Shewasabletotestasmallrandomsampleofpeoplepresentintheconferencecenter.Shefoundthataroundtwo-thirdsofthissamplewerediagnosedaspre-diabetic,indicatingjusthowrampantdiabetesisinBelize,andhowimportantitistotakeactionnow.Otherkeytakeawaysfromthesummitincluded: “Diabetesisineverycornerofthiscountrywhichiswhyweneedtostartwithyoungpeopleforprevention”“Don’twaituntilthedoctortellsyounottoeatbadly.”“Let’snolongerbeblindtodiabetes”“Anyonecangetit…afightforallofus.”


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Summary

AlloftheseorganizationsdemonstratetheimportantcontributionthatthosecommittedtofightingdiabetesinBelizecanhaveonthecommunity.However,theyarefacedwithlimitedlabor,financial,andtechnologicalresources.Theyneedthecomplementarysupportofthegovernment,largerlocalorganizations,andinternationalorganizationsthatcanhelpprovidethemwiththetoolstheyneedtomaximizetheinfluenceoftheirwork.

ROLE OF GOVERNMENT

Health System and Policies

Althoughnationalplansfordiabetesareindevelopment,7therehavebeennotbeenenoughmeasurableorsustainablestepstowardinstitutionalchangesinaddressingdiabetesinBelize.Thereisnoframeworkformonitoringorsurveillance,nopolicyforpreventativenutritionorphysicalactivity,andmanypeoplelacktheinformationtheyneed.Althoughthereisanationalhealthinsuranceinplace,fundingisinsufficientanditisnotaccessibleinpartsofthecountry.Despitethepresenceofseveralorganizationsdedicatedtodiabetesawarenessandpreventions,thenumberofcasescontinuestorise.Belizeneedsthesupportofcomplementarygovernmentactionbyimplementingpoliciesandhealthcarereformthatwillmoreeffectivelyaddressdiabetes.TheInternationalDiabetesFederationhasseveralpublicationsaddressinghowgovernmentscanimplementpoliciesandprograms,includingthe“GlobalDiabetesPlan”and“GuidetoNationalDiabetesProgrammes.”TheseareeffectivestartingguidesforthegovernmentofBelizetodevelopideasandstrategiesforwhatmayworkinBelize.Potentialpoliciescouldincludemandatesfordiabeteseducationintheworkplaceandschools,aswellasrequirementsforweeklyordailytimeofphysicalactivities.Furthermore,thegovernmentshouldtakeanactiveroleincreatinganationalawarenesscampaignthatwillbewidelydistributed.AfterameetingwithaleaderfromtheMinistryofHealth,welearnedthatacampaigntochangethemessageandperceptionofdiabetesistopofmindforthem,buttheyhaveyettoinitiatetheprocessofdevelopment.Thisisthefirststeptoactivegovernmentinterventionandneedstobeconsideredapriority.However,promotingdiabetesknowledgeandencouraginghealthylifestylesisnotenough.Thegovernmentneedstotakemeasurestomakehealthierfoodsmorewidelyavailableandproliferated.Thiscanbedone7"Belize Scorecard." Global Diabetes Scorecard, International Diabetes Federation, 2014.


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bypromotingdomesticagricultureofvegetablecommodities,placestaxedonsugarandhighcarbohydratefoods,orimplementingapackagingrequirementthatrequiresproducerstobetterdescribesugarlevelsonproducts.However,duetothedevelopingnatureofBelize’seconomy,itislikelythatgovernmentwillbeunwillingtoputmeasuresinplacethatwilldeterprofitablecompaniesorforeigninvestment.Health and Development

Ontheotherhand,researchhasshownthatinrelationtodevelopmentalgrowth,healthofapopulationisvital.AccordingtoUnitedNationsDevelopmentBoard,Belize’sHumanDevelopmentIndex(HDI)for2014is0.715.Thisisconsideredtobearelativelyhighindex.However,whenadjustingforinequalityinthedistributionofhumandevelopment,theHDIdecreasesto0.553.AsdescribedbyHansRosling,awell-renownedmedicaldoctor,statistician,andinternationalhealthprofessor:“Youcanmovemuchfasterifyouarehealthyfirstthenifyouarewealthyfirst.”ConsideringthepreventablenatureofType2diabetes,thisfurthersubstantiatesthereasonswhythegovernmentshouldtakeactiontoreducetheprevalenceofthediseasewithinBelizeaspartofagreaterdevelopmentalgoal.It’snotenoughtofocusonexpandingtheeconomythroughitsmainstays,suchastourism.Itneedstofocusonimprovingthehealthofitsorganizationinordertosupportitseffortstobecomemoregloballycompetitive.

CONCLUSIONS

Challenges

ThegreatestchallengesIhaveidentifiedfacingBelizeinitsfighttoreducediabetesprevalenceinclude:

• Lowawarenesslevels• Difficultyincreatingaculturalshift• Foodmainstaysthatarehighinsugarandcarbohydrates• Lackofsufficientnumberofnutritionistsanddiabetologists• Culturalcontributors• Noncommittalofpatientstoadheringtomanagementregimes• Insufficienthealthcareaccessandhighpoverty• Lackofgovernmentpoliciesandprogramsrelatedtodiabetes• Governmentbureaucracy


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Suggestions Going Forward

Belizeisnotaloneinthestruggletoenddiabetes.Itisaproblemfacingnationsacrosstheworld,andmanypeopleareincreasinglywillingtotakeactiontostopit.BelizeneedstoputafocusoncollaboratingwiththeInternationalDiabetesFederation,theWorldHealthOrganization,andothercountriesintheregiontogainthefunding,tools,strategies,andsupportitneeds.Thegovernmentshouldcreateataskteamthatcanimplementcampaigns,policies,andprogramsrelatedtodiabetestocomplementeffortsbeingdonebyNGOs.Belizeshouldalsofocusonimprovingaccesstoitshealthcareandinsuranceprograms,whileprovidingmorefundingtoeducationalinstitutionsthatcanbuildonmedicalandnutritionprograms.Byfurtherequippingthepopulationwithlocalnutritionistsanddiabetologists,Belizecanhelpimprovediabetesawarenessandaccesstoexpertise.Tacklingdiabetesiscomplicatedandtakestime,butthegovernmentneedstotakemoredefinitiveaction.Organizationalmovementisnotenough,especiallyduetothelimitedfinancialandpersonnelmeans,whichputsstrainonthescopeofsuchmovements.


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REFERENCES

“AGuidetoNationalDiabetesProgrammes.”InternationalDiabetesFederation.Web.2010.http://www.idf.org/webdata/Guide-to-NDP_web.pdf"Belize."Data.TheWorldBank,2016.Web.<http://data.worldbank.org/country/belize>."Belize."HealthintheAmericas,2012Edition:CountryVolume.PanAmericanHealthOrganization,2012.Web.<http://www.paho.org/salud-en-las-americas-2012/index.php?option=com_docman&task=doc_view&gid=115&Itemid=+>."Belize."HumanDevelopmentReport.UnitedNationsDevelopmentProgramme,2015.Web.<http://hdr.undp.org/sites/all/themes/hdr_theme/country-notes/BLZ.pdf+>."Belize."InternationalDiabetesFederation.N.p.,2015.Web.<http://www.idf.org/membership/nac/belize>."BelizeDiabetesScorecard."GlobalDiabetesScorecard(2014):80.InternationalDiabetesFederation.Web.<http://www.idf.org/global-diabetes-scorecard/assets/downloads/Scorecard-29-07-14.pdf>."BelizeHealthSectorStrategicPlan2014-2024."MinistryofHealth.GovernmentofBelize,2014.Web.<http://health.gov.bz/www/attachments/article/801/Belize%20Health%20Sector%20Strategic%20Plan%202014-2024-April%202014.pdf+>.Castillo,Anthony."President'sReport."BelizeDiabetesAssociation(n.d.):n.pag.May2013.Web."Diabetes:FactSheet."WorldHealthOrganization.N.p.,Nov.2016.Web.<http://www.who.int/mediacentre/factsheets/fs312/en/>.Eckel,RobertH.,MD,StevenE.Kahn,MB,CHB,EleFerrannini,MD,AlisonB.Goldfine,MD,DavidM.Nathan,MD,MichaelW.Schwartz,MD,RobertJ.Smith,MD,andStevenR.Smith,MD."ObesityandType2Diabetes:WhatCanBeUnifiedandWhatNeedstoBeIndividualized?|DiabetesCare."DiabetesCare.AmericanDiabetesAssociation,2011.Web.<http://care.diabetesjournals.org/content/34/6/1424>."FactsAboutType2."AmericanDiabetesAssociation.N.p.,2013.Web.<http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html>.


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“IllnessesandCausesofDeath.”BelizeMinistryofHealth.Web.<http://www.sib.org.bz/Portals/0/Docs/Statistics/Other/Health-Statistics/Illnesses-and-Causes-of-Deaths.xlsx>."InternetUsersasPercentageofPopulation."PublicData:WorldDevelopmentIndicators.Google,7Oct.2016.Web.<https://www.google.com/publicdata/explore?ds=d5bncppjof8f9_&met_y=it_net_user_p2&idim=country%3ABLZ%3AHND%3ACRI&hl=en&dl=en>."NorthAmericaandCaribbean.”IDFDiabetesAtlas,SeventhEdition(2015).82-85.InternationalDiabetesFederation.Web.<http://www.idf.org/global-diabetes-scorecard/assets/downloads/Scorecard-29-07-14.pdf>."Overview."HillsideHealthCareInternational.N.p.,n.d.Web.<http://www.hillsidebelize.org/mission/>."PlanofActionforPromotingHealthyWeightsintheCaribbean:PreventionandControlofChildhoodObesity."CaribbeanPublicHealthAgency(n.d.):n.pag.2014.Web."TheCentralAmericaDiabetesInitiative(CAMDI):SurveyofDiabetes,HypertensionandChronicDiseaseRiskFactors,Belize."PanAmericanHealthOrganization.WorldHealthOrganization,2009.Web.<http://iris.paho.org/xmlui/handle/123456789/7687>.


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APPENDIX 1

GeneralInterviewGuide

QuestionsforMysteryFurtado,CEOoftheYouthWellnessAmbassadors• Whatisyourexperiencewithdiabetes?• IsthereaprotocolfordiabetesmanagementandpreventioninBelize?• WhocanleadandsustaineffortsagainstdiabetesinBelize?• Doyouthinkthatpeoplefullyunderstandhowdangerousdiabetescan

be?• Doyouthinkthatthepublicunderestimatesdiabetes?• Whydidyoustartyourorganization,theYouthWellnessAmbassadors?• Whatisyourorganizationdoingwithregardstodiabetes?(i.e.training,

education,support,projects,programsetc...)• Whoamongalltheplayersdoyourelyuponinthehealthsystemwhen

youareinneed?• DoyouthinkBelizeanpeoplearewillingtoembraceaheathierlifestyleif

providedwiththeopportunityofdoingso?• Whatarethemainchallengesinshiftingtowardsahealthierlifestyle?• Howculturalnormsandtraditioninfluencethechoiceofembracinga

healthierlifestyle?QuestionsforexpertsDiabetesprotocol:

• IsthereaprotocolfordiabetesmanagementandpreventioninBelize?• Whodoyouthinkhastheprimaryresponsibilityintacklingdiabetestype

1andtype2inBelize?• WhocanleadandsustaineffortsagainstdiabetesinBelize?

DiabetesResponse:• Howdoesthepublicrespondtodiabetesawarenesscampaigns?

a)Doyouthinkthatpeoplefullyunderstandhowdangerousdiabetescanbe?

b)Doyouthinkthatthepublicunderestimatesdiabetes?• HastheGOBtakenactionstopreventthecommunityfromdeveloping

casesofdiabetes?Diabetesandhealthsystem:

• Whatarethediabetesmanagementproceduresavailablefortype1diabeticpatientsinBelize?

• Whatarethediabetesmanagementproceduresavailablefortype2diabeticpatientsinBelize?

• HowdoyouthinkdiabetesaffectsthehealthsysteminBelize?


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• InwhichareasdoyouthinktheBelizeanhealthsystemneedsthemost

improvement?• WhatarethestrengthsofthehealthsysteminBelize?

OrganizationalRole:• Whatisyourorganizationdoingwithregardstodiabetes?(i.e.training,

education,support,projects,programsetc...)• Howdoesyou/yourorganizationmonitortheimpactofyourinitiatives?• Howdoesitcheckiftheoutreachisworking?• Whatisthatyourorganizationwouldneedtomakeyourcontributionin

fightingdiabetesmoreeffective?• Whyareyouinvolved?Whatareyourmotivations?

DiabetesAssessment:• DoyouthinkBelizeisawareofdiabeteschallengesandrisks?• Whatismostimportantinpreventingthespreadofthiscondition?• DoyouthinkBelizeanpeoplearewillingtoembraceahealthierlifestyleif

providedwiththeopportunityofdoingso?• WhatarethemainchallengesinshiftingBelizeanstowardsahealthier

lifestyle?• Howculturalnormsandtraditioninfluencethechoiceofembracinga

healthierlifestyle?QuestionsforLocalsDiabetesKnowledgeandExperience

• Whatisyourexperiencewithdiabetes?• Whendidyoufirstfindoutaboutdiabetes?Whereandfromwhom?• Doyoufeellikeyouunderstandwhatcausesdiabetes?Whataresomeof

thosecauses?• What’sthedifferencebetweenType1andType2?• DoyouknowofwaystopreventType2diabetes?• Wheredoyougetinformationondiabetes?

DiabetesManagement• IsthereaprotocolfordiabetesmanagementandpreventioninBelize?• Whodoyouthinkhastheprimaryresponsibilityintacklingdiabetestype

1andtype2inBelize?• WhocanleadandsustaineffortsagainstdiabetesinBelize?

DiabetesResponse:• Howdoesthepublicrespondtodiabetesawarenesscampaigns?

a)Doyouthinkthatpeoplefullyunderstandhowdangerousdiabetescanbe?

b)Doyouthinkthatthepublicunderestimatesdiabetes?• Wheredoyougetinformationondiabetes?• Doyoufeelyouhaveenoughinformationondiabetes?


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• Aretherethingsthatconfuseyouaboutdiabetes?Whatarethey?• Hasthegovernmenttakenactionstopreventyourcommunityfrom

developingcasesofdiabetes?DiabetesandHealthSystem:

• WhatdiabetesmanagementproceduresareavailableinBelizeasfarasyouknow?

• Aremanagementtoolsaffordableandaccessible?• WhichareasoftheBelizeanhealthsystemdoyouthinkneedthemost

improvement?• WhatarethestrengthsofthehealthsysteminBelize?• Whointhehealthsystemdoyourelyonwhenyouareinneedof

support?DiabetesAssessment:

• DoyouthinkBelizeisawareofdiabeteschallengesandrisks?• DoyouthinkBelizeanpeoplearewillingtoembraceahealthierlifestyleif

providedwiththeopportunityofdoingso?• Whatarethemainchallengesinshiftingtowardsahealthierlifestyle?• Howdoculturalnormsandtraditioninfluencethechoiceofembracinga

healthierlifestyle?


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APPENDIX 2

OnlineSurvey


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Documents

Sustainable Wellbeing in Belize-The Challenge of Diabetes