The body of a nation

This Independence Day, Trinidad and Tobago turns 64. If the country were one of my patients, this would be about the age when I would become more interested in health.

I would ask about diabetes in the family, home blood pressure checks, cholesterol, sleep, smoking, alcohol, waist circumference and whether anything unusual happens while climbing stairs. I might also enquire gently about stress, because the patient has been through quite a lot lately.

Then I would probably say something doctors often tell people in middle age.

“You are doing many things well. But there are a few things we need to work on.”

That may not be a bad way to think about Independence Day.

There will be flags, ceremonies, patriotic music and the familiar surge of emotion that comes with seeing the red, white and black flying against a Caribbean sky. Independence was an extraordinary achievement.

But birthdays are useful occasions for reflection too.

How healthy are we?

A fascinating international study published last year in the New England Journal of Medicine examined five familiar cardiovascular risk factors: high blood pressure, abnormal cholesterol, diabetes, smoking and excess body weight. People who reached 50 without these had more than a decade of additional life expectancy compared with those who had all five. Treating hypertension in midlife was associated with the greatest gain in years free from cardiovascular disease while quitting smoking was associated with the greatest gain in overall survival.

There was nothing miraculous, exotic or futuristic about the list. The old “silent killers” remain. That is what makes the research so important for T&T. We know a great deal about preventing and treating them.

A person can have dangerously high blood pressure and feel entirely well. There may be no headache, dizziness or warning bell. The first dramatic symptom can be a stroke or heart attack. Blood glucose can rise gradually while a patient continues working, driving, cooking and living normally. Years later, the dreaded toll may arrive in the form of kidney disease, impaired vision, nerve damage, heart disease or an amputation.

This year, we need independence from the idea that chronic disease is inevitable. Genetics matter and some people genuinely carry much greater biological risk than others. A family history of diabetes, hypertension or heart issues should be a reason to act earlier. However, many chronic illnesses are influenced by biology, diet, physical activity, sleep, stress, smoking, alcohol, social circumstances and the environment in which people spend their lives.

You cannot prescribe walking to a community where crime is rampant or the pavement disappears into a drain. Fresh food has to be affordable. Children need places to play and working people need enough time to cook, sleep and exercise. School meals, food advertising, transport, recreation and urban planning may sound far removed from a doctor’s office but they eventually arrive there as blood pressure readings, glucose results or bulging waistlines.

Of course, food is memory, culture and family. Pelau or doubles mean more than the carbohydrate content. Sunday lunch with loved ones cannot be reduced to a nutritional label. The problem comes when portions steadily grow and sugary drinks become almost invisible because they are so normal. Drink more water, eat vegetables because your grandmother was right about some things and move regularly in the great outdoors.

There is another independence worth pursuing: independence from waiting until catastrophe before taking health seriously.

“Prevention” has one major disadvantage. Its victories are invisible. A dramatic operation has a patient, a surgeon and perhaps a photograph. The stroke prevented by twenty years of good blood-pressure treatment has no social media coverage. An Emperor does not cut a ribbon for the heart attack that never happened. That is why a blood pressure cuff, bathroom scale, running shoes or a screening visit may be more important than many people realise.

At 64, our national health check should include mental health. We have become more comfortable discussing the hidden pandemics of depression, anxiety, burnout, addiction and loneliness, but not comfortable enough. A healthy nation cannot be measured only by how long its citizens live. It matters how they live.

There is much to be proud of. Our country has produced exceptional doctors, nurses, pharmacists and other health professionals. We have built services that previous generations could scarcely have imagined. Children survive illnesses that once killed. Our immunization programme is a national treasure as people live for decades with diseases that were previously devastating.

That takes us back to independence.

When Eric Williams addressed the new nation in 1962, he reminded citizens that independence brought responsibility.

Freedom was not simply something bestowed at midnight. It had to be used wisely.

Health carries much the same bargain and enters the home, the supermarket trolley, school lunchbox, the decision to walk rather than remain seated and the bedroom at midnight when we should probably put down the phone.

This August 31, I will give thanks for the extraordinary privilege of belonging to Trinidad and Tobago. Many of its citizens are living longer than their parents and grandparents did, yet too many are carrying chronic non-communicable diseases that steal healthy years before they steal life itself.

What kind of country do we want to grow old in? Political independence gave us ownership of our future but health independence asks what we intend to do with it.

Happy Independence Day, Trinidad and Tobago. There is still a great deal of living to do.