Accessible healthcare needed for all

By Lindsey Turnbull

Speaking at this year’s Cardiovascular Conference organised by Cayman Heart Fund held last week at the Kimpton Seafire, Chief Medical Officer Dr Nick Gent spoke to the theme of ‘Improving Cardiovascular Health for All’ and said that it was vitally important that everyone in Cayman had access to adequate healthcare, not just the wealthiest.

“…we have a society, that, whilst superficially wealthy, has marked divisions, and we must help those that are most disadvantaged by poverty, or the way our insurance and health care systems work, to manage diseases that will affect their future cardiovascular health,” he said.

Talking on the state of cardiovascular health today. Dr Gent elaborated:

“…before we congratulate ourselves, the Cayman Islands being an apparently affluent country, we should also look at the fallacies underlying the superficial concept that we should, being apparently rich, at least by international standards, therefore, be healthy too. The fallacy is, of course, that societies are heterogeneous, and within our population there are significant elements of low, and middle income groups, together with people of wealth,” he said.

He went on to explain that various indexes which measure the evenness of distribution of wealth amongst a country’s population and which measure the movement of wealth from rich to poor within that country suggested that the low income population of the Cayman Islands was “of a significant size”.

“I observe that we have a general appearance of a middle income, or even a wealthy society,” he said. “The investment and development that we see in the Cayman Islands brings with it those things that eliminate the premature causes of death that we see in the poorest societies, such as clean water, sanitation, and immunisation. And these are a relatively universal benefit to most of the population of the Cayman Islands. But poverty is also significant in the Cayman Islands, and affects a surprisingly large proportion of the population.”

Dr Gent said that this produced a strange mix of middle income and wealthy people who will worry most about dying of cancer, and a large group of the population whose health experience may be more equivalent to lower income societies, and their propensity to suffer, and die, from cardiovascular disease.

He went on to talk about the “ingrained nature of this risk”, detailing statistics that revealed 70% of people were overweight and 33% obese.

“…when we summarise risk factors, such as smoking, diet, physical activity, weight, and hypertension, we see that 24% of 18 to 44 year olds have three or more risk factors for heart disease, rising to 47% in people aged 45 to 69 years,” he cautioned.

Dr Gent said that Cayman therefore was a society, whilst it could be assumed universally benefited from its apparent wealth, in practice it was very divided and the life chances of many were seriously impaired.

The divide in society was further exacerbated by issues of access to health care, he believed, in particular, the unintended consequences of the structure of Cayman’s insurance system, which was weighted towards secondary and tertiary care and the inevitable development of a health care service system dominated by secondary and tertiary health care, which he called a “self-fulfilling prophecy.”

“Worryingly, primary health care services, devoted to chronic disease management, are, for many, not accessible and not affordable. Nor have we explored how such care services can be made affordable,” he stated.

As an example, he spoke about the way in which a person with symptoms of hypertension (high blood pressure) had to undergo 24-hour blood pressure recording, a number of blood tests, and an ECG that would easily exceed the insurance allowance and be unaffordable even before potential treatment costs were taken into account. He then worried about whether the care plan for treatment ever took the patient’s ability to pay into consideration.

“I believe that it is not beyond our whit to devise low-cost investigational plans and cost effective care pathways for the most important predeterminants of future debilitating disease – diabetes and hypertension,” he said. “Not forgetting that even affordable care will not deliver a healthier population unless it is accessible care.”

He called for new delivery models using a wider range of clinicians. To that end, he said he was pleased to see how well supported the fledgling resuscitation council for the Cayman Islands was progressing.

“We aim to standardise and regulate training and accreditation. To build on the excellent work of local charities to build first responder networks equipped with automated defibrillators. Integrate the response of those first responders with the standing health care and emergency services, and both give the best resuscitative care at the scene of an acute cardiac event, and reduce the time from onset of such an event to definitive revascularisation intervention,” he confirmed.

The resuscitation council would be a forum to fit these pieces together, he said.

Dr Gent ended his presentation by stating that Cayman needed to realise that some care services could not be left to market forces as they required the planning and partnership of a range of people from volunteer backgrounds, the emergency services, and specialised service providers working as one to manage the commonest critical medical emergencies - acute coronary events, and stroke.