• Dr Shernice Johnson

The Role of Medicine in Sustainable Development

In this article we will explore the role of medicine in sustainable development. To do this we must first understand what sustainable development is. The Oxford dictionary defines sustainable development as:

“Economic development that is conducted without depletion of natural resources.”

The Brundtland Report says that

“Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs."

One might ask, how does healthcare play into this? Consider that humans are the main focus of sustainable development. We are one of the biggest beneficiaries of this concept and the only conscious vector of change. From an economic perspective, the physical, mental and emotional health of a county's citizens are paramount to its development. Illness leads to decreased school and work attendance, performance, and loss of man-hours. Lower school performance then gives rise to less educated and skilled workers for the future. Premature death also has a significant impact on a country's ability to sustainably develop. Together with illness, it leads to a shrunken workforce which reduces earning potential.


It is impossible to consider sustainable development without mentioning the impact of health. There are several indicators to measure the impact of healthcare policy such as life expectancy, prevalence of communicable and chronic non-communicable diseases, vaccine and essential drug availability, infant mortality and maternal mortality. Below we will examine how Trinidad and Tobago has performed over the years as it relates to three key indicators, life expectancy, infant mortality and maternal mortality. Then, we will briefly introduce the UN's sustainable development goals.




Key Indicators of Sustainable Development in Trinidad and Tobago



Life Expectancy


Definition: the average number of years that a newborn is expected to live, taking current mortality rates into account [1].


Life expectancy has increased dramatically in the past 200 years due to the combined efforts of public health and medicine. Improved sanitation, sewage management, water treatment, garbage collection and food inspection have done much to curb the spread of infectious disease. Medical advances such as vaccines, antibiotics, improved detection and surgical innovations, have also contributed to this rise. New technologies and drugs are being rapidly developed to improve not only the length of an individual’s life, but the quality of it.


Life expectancy is a multi-factorial indicator, it acts as a proxy when measuring development. The more a country develops in terms of health, economics, crime reduction etc, the higher it rises.


For Trinidad and Tobago, life expectancy has been on a slow but steady rise as seen in the line graph below.



Graph Showing Life Expectancy in Trinidad and Tobago, data source: WHO [2]

We see a small dip in life expectancy in 2008. This can be partially accounted for by a surge in murders in that year to 550, representing a 39% increase from 2007 [3]. Men have steadily maintained a lower life expectancy than women. Many factors contribute to this including violence, accidental deaths and poor health seeking behaviour.


Infant Mortality


Definition: the infant mortality rate is the probability that a child under the age of one year will die. it is expressed as the number of deaths per 1,000 live births occurring among the population of a given geographical area in a given year [4].

As discussed before, increasing the health of a population and decreasing mortality is essential to sustainable development. While infant mortality has been decreasing in Trinidad and Tobago, it is still somewhat high compared to other countries. Currently we have the 72nd highest infant mortality rate in the world and the 4th highest rate in the Caribbean [5]. Below is a graph depicting the trend in infant mortality in Trinidad and Tobago. The green line represents the vital statistics reported by T&T which stops at 2011 and the teal line represents the UN Inter Agency Group for Child Mortality Estimation (IGME).



Infant Mortality Graph
Line Graph Depicting Infant Mortality in Trinidad and Tobago, data source: IGME [6]

There are many causes of infant mortality including infections(blood-borne, respiratory, diarrheal), birth trauma and complications of preterm birth. Several interventions are put in place to avoid these deaths including vaccination programmes, training programmes for point of care staff, increasing Neonatal Intensive Care Unit (NICU) availability, staffing, and NICU staff training.


Higher infant mortality is seen in socially and economically vulnerable populations. Therefore, the measures mentioned above need to be complemented by social interventions. Mothers and families need to be educated on the causes of infant mortality and what they can do to aid prevention. Social programmes which allow adequate access to food, sanitation and healthcare also go a long way in preventing infant mortality.


In Trinidad and Tobago, several measures have been put in place to fight high infant mortality. There is a nationwide, free vaccination programme which is mandatory to enter the public school system. Healthcare is free of charge at the nation's public hospitals and health centres and there are NICU services available at 4 of the nation's public hospitals.



Maternal Mortality


Definition:


"Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes." -WHO [7]

To put it simply, maternal mortality is the number of non-accidental maternal deaths, per 100,000 live births.


This is a particularly important indicator of sustainable development as maternal mortality affects overall life expectancy and economic growth, especially with women making up a significant portion of the workforce in many countries. The most recent maternal mortality statistic available for Trinidad and Tobago is from 2015. At 63, it puts T&T as having the 88th highest maternal mortality rate in the world and the 6th highest in the Caribbean [8]. While data beyond 2015 isn't currently available, it was reported that there were no direct maternal deaths for the first half of 2018 [9].


Now it is important to examine some more definitions related to maternal mortality:


Direct obstetric death: deaths which result from complications of the pregnancy state from either interventions, omissions, incorrect treatment or a combination of these events. The pregnancy state includes pregnancy, labour and the 6 week period after pregnancy [10].


Indirect obstetric death: deaths which result from:

  1. Pre-existing disease

  2. Diseases which develop during pregnancy which were

i. Aggravated by the effects of pregnancy

ii. Not pregnancy-induced [10]


Below is a graph depicting the trend in maternal mortality in Trinidad and Tobago using available data from 1990-2015. We see that while the rate has decreased significantly from 1990, it has remained steady since 2000 with no decreases.




Graph showing maternal mortality in Trinidad and Tobago, data source: UNICEF [11]



The UN and Sustainable Development


Background


In 2015, world leaders agreed on a 15-year plan involving 17 goals to address some of the most pressing issues worldwide. The 2030 agenda for sustainable development provides a blueprint which is geared towards achieving peace and prosperity in developing and developed nations alike. The goals address ending poverty, reducing inequality, improving health and education, spurring economic growth, preserving the environment and addressing climate change [12].


Health


The third sustainable development goal focuses on health [13]. The goal itself is simply stated as:


“Ensure healthy lives and promote well-being for all at all ages”


This goal is further broken down into 13 target goals:



An examination of the UN's 13 target goals reveals a clear linkage between sustainable development and health. While going into each of the 13 goals is out of the scope of this introductory article, we can see that goal 3.1 focuses on maternal mortality and 3.2 includes infant mortality. Also, most of the goals aim to improve life expectancy. These goals are geared toward ensuring a healthy and sustainable workforce which in turn ensures that a country has limitless potential for sustainable development.



Conclusion


Effective healthcare policy is essential to a sustainable future. The human workforce is a invaluable asset to any country's development but we must remember that it is a living breathing resource. When the health of this resource suffers so does development. As such, health care indicators such as life expectancy, infant mortality and maternal mortality must be improved worldwide. Policies based on a framework such as the UN's third sustainable development goal will further reduce illness and premature death.



References

  1. Whostat2006DefinitionsAndMetadata. (n.d.). Retrieved April 13, 2019, from https://www.who.int/whosis/whostat2006DefinitionsAndMetadata.pdf

  2. GHO | By category | Life tables by country - Trinidad and Tobago. (n.d.). Retrieved April 13, 2019, from http://apps.who.int/gho/data/?theme=main&vid=61690

  3. Crime Statistics. (n.d.). Retrieved April 13, 2019, from https://www.ttcrime.com/crime-statistics/

  4. Infant Mortality Rate. (n.d.). Retrieved April 13, 2019, from https://www.who.int/healthinfo/indicators/2015/chi_2015_27_mortality_infant.pdf?ua=1

  5. Infant Mortality Rate - Country Comparison. (n.d.). Retrieved April 13, 2019, from https://www.indexmundi.com/g/r.aspx?c=td&v=29

  6. CME Info - Child Mortality Estimates. (n.d.). Retrieved April 13, 2019, from https://childmortality.org/data

  7. Maternal mortality ratio (per 100 000 live births). (2014, March 11). Retrieved April 13, 2019, from https://www.who.int/healthinfo/statistics/indmaternalmortality/en/

  8. Country Comparison Maternal mortality rate. (n.d.). Retrieved April 13, 2019, from https://www.indexmundi.com/g/r.aspx?v=2223

  9. Porro, R. (2018, July 19). PAHO/WHO CLAP - In 2018 there has been no direct maternal deaths in Trinidad and Tobago | PAHO/WHO. Retrieved April 13, 2019, from https://www.paho.org/clap/index.php?option=com_content&view=article&id=499:in-2018-there-has-been-no-direct-maternal-deaths-in-trinidad-and-tobago&Itemid=215&lang=en

  10. The WHO Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD-MM. (2012). Retrieved April 13, 2019, from https://apps.who.int/iris/bitstream/handle/10665/70929/9789241548458_eng.pdf;jsessionid=D82F1AD215330455E11CEFB7D5F9D5C9?sequence=1

  11. Maternal mortality. (n.d.). Retrieved April 13, 2019, from https://data.unicef.org/topic/maternal-health/maternal-mortality/

  12. Sustainable Development Goals .:. Sustainable Development Knowledge Platform. (n.d.). Retrieved April 13, 2019, from https://sustainabledevelopment.un.org/?menu=1300

  13. Goal 3 .:. Sustainable Development Knowledge Platform. (n.d.). Retrieved April 13, 2019, from https://sustainabledevelopment.un.org/SDG3




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