In an interview with The Borgen Project, native Jamaican Shamella Parker describes the dire consequences of a lack of access to quality health care in Jamaica. On an evening in February 2023 in Montego Bay, Jamaica, Parker’s aunt Mary, a live-in cook, shared a dish with her employer containing susumba, commonly known as gully bean, a type of green berry popular in Jamaica. Shortly after the meal, both Mary and her employer fell ill.

The man’s family took him to a nearby hospital. “The hospital that he went to, I believe they treated him on the spot because he was wealthy and I guess known in the neighborhood, but my aunt – not being as wealthy – went to another hospital in the area where she was from,” said Parker. In contrast, Mary went to a hospital in St. Catherine and spent a long time waiting to be attended to in the waiting room despite being an emergency case. Eventually, she lost consciousness and became unresponsive. Nurses and doctors attempted to revive her, but it was too late. Parker and Mary’s husband feel the hospital did not do all it could to save her.

According to Mary’s husband, the forensic pathologist was away at his wife’s time of death. For example, in 2015, the Jamaican government employed only two forensic pathologists who perform autopsies for everyone who does not have insurance. When Mary’s husband returned, the pathologist deemed Mary died of an accident – consumption of a poisonous seed. But, to Mary’s family, unequal access to prompt and quality health care in Jamaica stood as the true cause.

A Public Health Crisis

Jamaica’s iconic reggae and beaches backdrop a public health crisis. The legacy of the colonial slave-based economy birthed the traumatic, post-emancipation public health care system present in Jamaica today. Health care is a dimension of poverty on the island; the Multidisciplinary Poverty Index (MPI) of 2022 estimated that 78,000 Jamaicans lived in multidimensional poverty in 2020. The Index splits poverty into three dimensions – health, education and standard of living – and scales the intensity of deprivations for each. Compared to selected other Caribbean and Latin American countries at that time, health care deprivation was greatest in Jamaica, at 52.2%; the next highest was Trinidad and Tobago at 45.5%.

Insurance and Unequal Access to Quality Health Care in Jamaica

The National Health Plan estimates that 500,000 out of 2.7 million Jamaicans have insurance. This means roughly 80% of Jamaicans do not have it and have to rely on public hospitals. These hospitals do not have enough equipment to meet this demand, with World Data estimating that there are 1.32 primary care doctors per 1,000 civilians and 1.7 hospital beds.

Many Jamaicans do not have insurance due to inflated premiums, rendering insurance inaccessible. Even those who have it are discouraged from exceeding the lifetime maximum benefit. As a result of poor insurance or lack thereof, many reserve medical attention for emergencies.

Just taking her aunt to the hospital, Shamella Parker said, meant “it was a serious thing… we do not just go to the hospital for anything.”

Health Education

Non-communicable diseases (NCDs) comprise 79% of mortality in Jamaica. These include diseases such as diabetes, heart disease or cancer. Teaching healthy habits is one way to combat NCDs. Though there is a National School Feeding Programme, public schools increasingly apply the protocol with “unevenness,” according to the Ministry of Education and Youth (MOEY) report.

As it is, many schools are not mandated to provide nutritional food, exercise programs or health classes that destigmatize illness. According to the Jamaican Health and Wellness Minister Dr. Christopher Tufton: “…there is actually a lost generation around that crisis, a cohort of citizens who unfortunately will have to spend the rest of their lives trying to make themselves as comfortable as they can…”

Transportation Infrastructure

Hospitals are difficult to reach. People often live far away from health centers and hospitals. Reliable infrastructure is essential for continual access to health care in Jamaica. However, rural roads are often unpaved, secluded and vulnerable to climate damage. Bad weather resulting in landslides and flooding is common and may disrupt transportation by “cut[ting] off access to health care, education and other essential services,” according to a 2018 report. Blocked roads complicate transporting patients. Jamaica’s “limited funding” for transportation maintenance causes drawn-out repairs when roads erode and bridges collapse.

Ongoing Efforts

In 2020, the Jamaican government signed the Vision for Health 2030, a 10-year health improvement strategy to reorder Jamaica’s fragmented care. Alongside the Pan American Health Organization (PAHO), this plan tackles noncommunicable diseases and maternal health by increasing the number of hospitals on the island and modernizing services to boost equity and efficiency while delivering “higher technical quality.”

In 2019, the government introduced the National School Nutrition Policy. This legislation forms part of the government’s efforts to mandate healthy eating and exercise in young people. Its provisions include measures such as color-coding foods permitted in schools and providing competitions to incentivize healthy eating, according to the MOEY report.

Additionally, various efforts are underway to reform infrastructure, according to the National Development Plan (NDP). Goal 9 of the NDP includes the country’s largest infrastructure project worth up to $800 million to upgrade roads and access to water, sewage and internet.

In 2016, UNICEF began assisting the government in adopting regulated, cold-chain transport. It is a temperature-controlled supply chain essential for reducing waste and improving the integrity of goods necessary for health services.

Looking Ahead

Efforts to address the public health crisis and improve access to quality health care in Jamaica are underway. The government’s Vision for Health 2030 and collaboration with organizations like PAHO and UNICEF aim to modernize health care services, tackle noncommunicable diseases and enhance infrastructure. The introduction of the National School Nutrition Policy highlights efforts to promote healthy habits among young people. As these initiatives progress, there is hope for a more equitable healthcare system that prioritizes the well-being of all Jamaicans.

– Caroline Crider
Photo: Unsplash