Chronic Disease In St Lucia Health And Social Care Essay

continuing Disease In St Lucia wellness And Social Cargon EssayChronic un healthiness is a unsoundness of a broad duration and generally s minuscule progression (WHO, 2010). The U.S. national Center for Health Statistics states that a invete treasure disorder is unitary endure 3 months or to a greater close. These continuing sicknesss normally can non be prevented by vaccines or cu rosy-cheeked by medication, nor do they just vanish. Chronic ailments be principally sourced by three study bump component part tobacco use, ridiculous ingest habits and somatogenic inactivity. Majority of these jeopardize factors atomic number 18 themselves worsened by poor socioeconomic determinants, much(prenominal)(prenominal) as lack of education and poverty. Most a great deal these determinants ar a indication of the main forces driving kindly, economic and pagan handing over, including globalisation, urbanisation and an aging states.Chronic sicknesss atomic numb er 18 affecting population health as the epidemiologic renewing progresses and argon the lead arrest of mortality world-wide and pose increasing problems for the freight of disorder and quality of purport in certain and develop countries (WHO, 2003). Non communicable unhealthinesss admit a giant-minded range of conditions, including cardiovascular disease, diabetes, crab louses, degenerative respiratory disease, mental-health problems and musculo- skeletal disorders. The first foursome mentioned above account for slightly 50% of mortality globally, and sh be behavioral stake factors, much(prenominal) as excess calorie outgo, fares high in hard and trans expoundty acids, excessive consumption of alcohol, physical inactivity, and tobacco smoking. Approximately 35 one thousand million population defecate died from warmth disease, stroke, cancer and other inveterate diseases in the socio-economic class 2005. The burdens of these diseases are equally shared a mong men and women, and are much preponderant in people under the board 70 (WHO, 2004). 80% of inveterate disease deaths occur in funky and midway income countries.Figure 1 Global distri hardlyion of amount deaths (58 million) by cause in 2005.The jump on-specific death range amid the geezerhood 2005 2015 are intercommunicate to fluctuate slightly, Neverthe little, the ageing populations exit result in an overall extend in chronic disease death judge for all ages combined. In 2005, all chronic diseases account for 72% of the total global burden of disease in the population aged 30 long prison term and honest-to-goodness. The total lost geezerhood of rosy intent due to chronic diseases, as measured by DALYs, are greater in crowings aged 30-59 years than for ages 60 years and one-time(a). More than 80% of the burden of chronic diseases occurs in people under the age of 70 years.Table 1 project global deaths and burden of disease due to chronic disease by age 200 5- 2015Deaths (Million) DALYs (millions) Deaths per 10000 DALYs per 1000002005 2015 2005 2015 2005 2015 2005 20150-29 years 17 15 220 219 48 40 6320 599430-59 years 7 8 305 349 311 297 13304 1337560-69 7 8 ci 125 1911 1695 27965 2639670 20 24 99 116 6467 6469 32457 31614All ages 35 41 725 808 549 577 11262 11380World Health Organization projects that, globally, NCD deaths will add-on by 17% over the next ten years. The greatest change magnitude of 27 %and 25 % respectively will be seen in the African locality and the Eastern Mediterranean region (WHO,)1.2 Types of chronic diseases1.2.1Cardiovascular diseaseCardiovascular disease CVD is the term used by the scientific community to embrace not just conditions of the marrow squash ischemic partiality disease (IHD), valvular, muscular, and congenital substance disease but withal high blood pressure and conditions involving the cerebral, carotid, and peripheral circulation. The stake of CVD is related to diet, physical activity, and body ( ). The patterns of food supplies and of food and nutrition that modify the guess of CVD are also well known.Whereas CVD was once to a greater extent often than not confined to high-income countries, it is now the add one cause of death worldwide as well as in number 1- and middle-income countries, where 80 per centum of the worlds 13 million annual CVD deaths occur. And at least 21 million years of disability-adjusted life years (or DALYs, a measure of future productive life) are lost globally because of CVD for distributively one year. The vast majority of CVD can be attributed to conventional hazard factors much(prenominal) as tobacco use, high line of reasoning closet, high declivity glucose, lipid brachydactylousities, fleshiness, and physical inactivity.Cardiovascular diseases are major cause of chronic disease death and were accounted for of 17 million deaths in 2002. It is estimated that by the year 2030, 24 million will die of CVD, of which 80% wil l occur in low and middle income countries (5).1.2.2 CancerCancer is a major and ontogenesis disease burden worldwide. The number of new cancer cases is projected to increase from 10 million in 2000 to 15 million in 2020, 9 million of which would be in maturation countries. The epidemiology of cancer in developing countries clearly differs from that in developed countries in of the essence(predicate) respects. While developed countries often fuddle relatively high rates of lung, colorectal, breast, and prostate cancer (some of which is tied to tobacco use, occupational carcinogens, and diet and lifestyle), up to 25% of cancers in developing countries is associated with chronic infections. Seven characters of cancers account for approximately 60 percent of all newly diagnosed cancer cases and cancer deaths in developing countries cervical, liver, stomach, esophageal, lung, colorectal, and breast.1.2.3 respiratory DiseasesChronic with baby bird(p) respiratory diseases-such as c hronic obstructive pneumonic disease (COPD) and asthma-are a major and growing burden in equipment casualty of morbidity and mortality in the developing world. COPD (which includes emphysema, chronic bronchitis, and obstructive airways disease) is lifesizely cerebrate with cigarette smoking as well as exposure to unvented coal-fired cooking stoves it accounts for 2 percent of lost DALYs on a worldwide basis.1.2.4 Diabetes MellitusDiabetes affects people worldwide and is one of the oldest diseases known. in that location are 2 common types of this disease type 1and type 2 diabetes. Type-1 diabetes accounts for 5-10% of all diagnosed diabetes. Type-2 diabetes is the approximately common form of diabetes. It accounts for 90-95% of diagnosed diabetes.The World Health Organization (WHO) estimated the worldwide preponderance of diabetes in adults to be around 173 million in 2002 and predicted that there will be at least 350 million people with Type 2 diabetes by 2030. At present about devil-thirds of someones with diabetes live in developing countries and the majority of new cases will strainate from these areas. The global increase in the incidence of diabetes is related to high levels of obesity associated with a change from handed-downistic diets, diminishing levels of physical activity, population ageing and increasing urbanization.Diabetes Mellitus is the nearly habitual form of diabetes on the global scale (6). For the then(prenominal) few decades, Diabetes Mellitus has reached epizootic proportionalitys in many parts of the world. The World Health Organization (WHO) has predicted the global prevalence of all Diabetes will increase from 194 million in 2003 to 330 million in the year 2030 (7).1.2.5 hypertensionAnother commonly occurring chronic disease is hypertension. high gear blood closet increases the risk of heart disease and stroke. Hypertension is sustained high blood insistency (140/90mmHg).Blood pressure itself is the pressure exerted by the blood on the walls of the blood vessels. Each quantify the heart beats (about 60-70 times a minute at rest), it pumps blood into the arteries. Blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic blood pressure. When the heart is at rest, between beats, blood pressure falls. This is diastolic pressure. Blood pressure itself is not harmful it is essential as it is the force that drives blood with the blood vessels to interpret oxygen and nutrients to the bodys organs and tissues and carry away fumble materials. However, when blood pressure becomes too high it has damaging effects on almost eitherpart of the body and can lead to knockout illness and death. Hypertension is an important public health challenge worldwide because of its prevalence and its map as a risk factor for cardiovascular disease. around of the risk factors of hypertension include obesity, alcohol, family history, and smoking.thither are two types of hypertension, namely primary hypertension and secondary hypertension. Primary hypertension is to a greater extent common, occurring in 90-95% of the hypertension population. in that respect is no identifiable cause and it develops piecemeal over many years. Secondary hypertension occurs in 5-10% of the hypertension population. ()In the year 2000 it was estimated that the total number of adults with hypertension was 972 million. Of these, 333 million were estimated to be in developed countries and 639 million in developing countries (0). Kearney PM et al., predicted that by the year 2025, the number of people with hypertension will increase by approximately 60% to a total of 1.56 billion. (Kearney PM et al., 2005) the reasons are the continuing population increase and changes in lifestyle, which includes a diet high in prick and high- productive processed foods and sedentarism.1.3 Impact of chronic disease in the CaribbeanCaribbean countries are in epidemiological transition, w here not only nutritional deficiencies gather in considerably declined but infectious diseases induct also been disappearing. However, over the last thirty years, nutrition-related chronic non-communicable diseases nourish slowly emerged as the major public health problems. Non-communicable diseases (NCDs) take hold gradually displaced communicable diseases in the Caribbean. Rates of chronic non-communicable disease such as diabetes, hypertension, cardiovascular disease and cancer have been increasing in the Caribbean and are the leading cause of mortality and mobility in the region (Ragoobirsinghet al., 1995, 2002 Wilkset al., 1998, 1999 Figueroaet al., 1999 Rotimi et al., 1999 Cruickshanket al., 2001, Figueroa, 2001 Sargeantet al., 2001 Henniset al., 2002a,b Corbinet al., 2004 Wolfeet al., 2006). Of take is the fact that while the prevalence and mortality rates of these diseases are highest in the elderly, they are not restricted to any one age group. An estimated 10% to 20% of the Caribbean population over 20 years of age suffers from diabetes and hypertension, respectively, with prevalence more than doubling at older ages (Hennis et al., 2002a, b). Hypertension and diabetes rank as the two leading chronic disorders among Caribbean populations and are also major risk factors for other diseases such as cerebrovascular disease (stroke) and coronary heart disease.Prevalence of chronic diseases in the Caribbean region over the pass 3 decadesAnother striking epidemic among the Caribbean population is the high prevalence of leaden body mass index (BMI) 25 kg m2 and obesity (BMI 30 kg m2). Approximately half of the adult Caribbean population is over angle and 25% of adult Caribbean women are obese (Henry, 2004). The escalating trend in obesity is considered to be a major causative factor in chronic disease prevalence in the region. The increasing obesity levels, in general among women, maybe associated with the changes in traditional diets and the adoptio n of sedentary lifestyles. In some the islands more than half of adult women are reported to be obese. Data from Barbados highlights the importance of obesity as a risk factor in chronic diseases. Based on available evidence, obese mortals, (BMI30) of 40-79 years had a 2.6 times greater risk of hypertension than persons with BMI1.4 Impact of chronic disease in St. LuciaSt. Lucia has undergone a fundamental demographic transition in the last 3 decades (Wilks, et al., 1998). Some features of this transition include the rise in the median age of the population from 20 years to 15 years between 1970 and 2010, the doubling of the proportion of persons older than 60 years old from 5000 to over 17,000 and the increase in life expectancy at consume from less than 50 years in 1950 to greater than 73 years in 2010 (World population prospectus, 2008). As a result, the main causes of illness and death in St. Lucia and many other Caribbean islands and regions at a similar state of development are the chronic non-communicable diseases (Sargeant et al., 2001). in that location is an increased prevalence of diet-related chronic non-communicable diseases, such as cardio-vascular diseases, diabetes and obesity. (Wilks et al., 1998). Between 1992-1999 in St. Lucia, preventable chronic diseases such as cardiovascular and circulatory systems accounted for 20.8% of deaths, with the major causes being cerebrovascular disease, ischemic heart disease, and hypertensive disease. Other major causes of death were cancers (14.5%), disease of the digestive system (8.7%), and diabetes (7.2%) (8). Approximately 1,304 deaths were due to diseases of the circulatory system and was accounted for 33% of all reported deaths, death due to cerebrovascular was (35.9%), hypertensive disease (14.8%), and ischemic heart disease (13.6%) (Health in America, 1998).There were 731 deaths due to cardiovascular disease from 1996 to 1999, accounting for 19% of all deaths and 53 % of deaths ratio of 5.81. Mos t (21 or 62%) occurred in the 15-44 years age group, and had a male-female ratio of 9.51. Cardiac arrest caused 268 cardiovascular deaths (37%), ischemic heart disease 174 (24%), pulmonary circulation and other forms of heart disease 134 (18%), and heart hardship 153 (21%). Females accounted for 359 (49%) of deaths due to cardiovascular disease, and persons 60 years of age or older accounted for 588 deaths (80%). (WHO statistics). Based on PAHO statistic St. Lucia is the tenth leading island in the Caribbean with high rates of non- communicable chronic disease, accounting for approximately 63%.Over the years prevalence of non communicable diseases have been increasing, in a survey do by the Kairi consultants limited in association with the national assessment squad of St. Lucia concluded the following findings for the year 2005 to 2006 for the distribution of chronic disease in St. Lucia. Irrespective of per capita consumption quintile, high blood pressure was the most prevalent lifestyle disease affecting persons with diseases in St. Lucia. In every quintile group, it also shows that the prevalence of diabetes ranks second to high blood pressure as a life time disease affecting persons with diseases in St. Lucia. In each of the quintile groups, more than three fifths of the persons with diseases reported suffering from high blood pressure while more than one quarter reported suffering from diabetes.In the year 2007 diabetes and Hypertension were the two the most pervasive and worsening health problems facing the island of St Lucia. The diseases afflict a broad swath of people, young and old.St. Lucia has a population of approximately 160,000 thousand people, and of this 28.1%of the population have abnormal blood glucose or high blood swag and 8.1% have diabetes (Graven et al., 2007). 20% of people over 40 years of age suffer with the disease (the ministry of health 2007). At least 35% of those with Type 2 Diabetes Mellitus do not know that they have the c ondition (The Ministry of Health, 2008). In rural area of St. Lucia the proportion with undiagnosed diabetes is considerably higher(prenominal) (St. Lucia Diabetic Society, 2008). At the time of diagnosis, every tenth person with diabetes has already developed one or more micro- or macro-vascular complications (Ministry of Health, 2008).Diabetes is among the leading cause of death. If inadequately treated, diabetes can cause blindness, kidney disease, face disease, amputations, heart disease, and stroke. Even conscientious and well-treated diabetics frequently suffer from these complications and have above-average medical costs.If observed, the Native St. Lucian has many barriers to health education, which basically involves their culture, lifestyle, accessibility and socio-economic status. For instance, St. Lucian is currently experiencing a crisis of poverty. People from lower socioeconomic status have poorer health than those in higher socioeconomic positions. Various studies ha ve reported the relationship between low socioeconomic status and the development of chronic disease ((Lynch et al, 2000 Stelmach et al, 2009 Supriya et al, 2009). upstart poverty assessments in St. Lucia estimate that 18.7% of households and 25% of the population live in poverty. Income inequality is high, with 26% of the population characterized as chronically poor (MPDEH, 2003). That same(p) report estimated that a decade later in 2005/06 the poverty rate had increased to 28.8% of the population( Government of St. Lucia( GOVST), The assessment of Poverty volume1, 2006) .The highest poverty rates in2005/06 were in the districts of Anse La Raye/Canaries (44.9%), Micoud (43.6%),Soufriere (42.5%) and Laborie (42.1%). The poverty gap and poverty severity also occurred in these same districts (GOVST, 2006)Furthermore, because of poverty and living in rural areas, most people consume less expensive and often high fat foods, and less fruits and vegetables (Henchy et al, 2000). Brown et al, (2005) described how socioeconomic position influences health among persons with diabetes. Diabetes is twice more prevalent in low income populations compared to wealthy populations (Stelmach W et al 2009). Some explanations for this increased risk among people of low-income or resource-poor areas include increased stress, low access to medical and preventive care, and poor environment.1.5 provender, nutrition and chronic diseasesThere are clear associations between the various biomedical and behavioural chronic disease risk factors, and it is well established that diet quality and healthy eating practices play an important role in both preventing and managing chronic diseases and the factors that increase their risk (Kant A.K, 2004). The links with food and nutritional status are especially strong in the case of cardiovascular disease, diabetes and their risk factors (metabolic syndrome, obesity, hypertension and hyperlipidaemia). The food we eat, in all cultural selection, de fines ones health, growth and development. Risk behaviours, in particular smoking and sedentarism, alter the result (). All this takes place in a social, cultural, political and economic environment that can exacerbate the health of populations.Diet is a key component in predisposing to chronic disease, mainly where diet is energy dense causing positive energy balance and obesity. credence of western diet which are high in fats , aminal protein, refined carbohydrates and low in fibre, fruits and vegetable can further increase one risk of developing no of more chronic disease(). Several studies have exhibit a prudent diet rich in fruits, vegetables, fish and wholegrain to be associated with a decline in chronic disease risk such as diabetes (Van Dam et al., 2002 Anne-Helen Harding et al., 2004)CarbohydratesCarbohydrates food source are the most important source of calories for the worlds population mainly because of their low cost and wide approachability (). Although Carbohydrat es is easily accessible and widely eaten carbohydrate is a key dietetic component affecting insulin secretion and postprandial glycemia and is implicated in the aetiology of many chronic diseases (Brand-Miller JC et al., 2004). Both the quantity and type of carbohydrate eaten have consequences on insulin secretion and postprandial glycemia. Foods with a rich glycemic index (or glycemic load) bugger off high rates in blood glucose.Diets including large quantities of high GL foods increase the risk of diabetes, breast cancer, colorectal cancer, endometrial cancer, and overall chronic disease (Barclay AW et al., 2008).Dietary fibresEpidemiological evidence has shown that foods rich in fibre befriend glycaemic pull wires in diseases such as type 2 diabetic patients(). A diet high in fibre helps in control blood sugar levels in those with type 2 diabetes. It also helps with colon health as the high fibre diet with smoothing the stool and facilitates to weight loss ().FatsDietary fat is one of the most influential nutrients in health. Fats has many functions in the human body, As well as to providing more than twice the energy supplied by carbohydrates and proteins and supplying essential butterball acids, fats slows digestion of carbohydrates in order to fuel the brain he fats serve as carriers for fat soluble vitamins (A, D, E and K) and as parts of cell membranes().The overconsumption of fat, mainly saturated fat, has been linked to six of the 10 leading causes of death worldwide ().Coronary heart disease and cancer ().There is a strong link between dietary fat consumption and risk of chronic diseases such as cancer, such as colon, breast, prostate, and ovary cancer (). Several studies over the past 30 years have verified the relationship of high dietary fat intake with higher mortality due to various cancers (). Some saturated fatty acids raise blood cholesterol levels and, thus, increase the risk of atherosclerosis (). High fat, intake is a main cause of obesity, hypertension, diabetes, metabolic syndrome and gallbladder disease ().Studies have show that countries with higher per capita intakes of fat, especially animal fat, have higher incidence rates of certain cancers, including breast, colon, prostate, and pancreas.41 Migrational studies show that when individuals move from a country of low fat intake to one of high fat intake, the risk of some cancers increases 42 .VitaminsVitamins are essential nutrients hey are required in small amounts, but have important and specific functions such as promoting growth, reproduction and the maintenance of health. Nutritionally, they form a cohesive group of perfect compounds that are required in the diet in small amounts (micrograms or milligrams per day) for the maintenance of normal health and metabolic integrity. They are thus secern from the essential minerals and trace elements (which are inorganic) and from essential amino and fatty acids, which are required in larger amounts.Vitamin deficiency however, may increase the risk of chronic diseases (). Suboptimal folic acid levels, along with suboptimal levels of vitamins B(6) and B(12), are a risk factor for cardiovascular disease, neural tube defects, and colon and breast cancer() and low levels of the antioxidant vitamins (vitamins A, E, and C) may increase risk for several chronic diseases. .Nutritional TransitionThere are now approximately 350 million obese and more than 1 billion overweight people in the world, living in both developed and developing nations. Previously, underdeveloped nations grappled with undernutrition. Now many of these countries like St. Lucia are in a transitional state and are dealing with the reduplicate evils of under- and over nutrition. In the Caribbean nations between the 1970s and 1990s, the prevalence of overweight/obesity increased from 7% in men and 20% in women in the 1970s to 22% in men and 58% in women (Ragoobirsingh D et al., 2004).The global prevalence of overweight amon gst preschool children is estimated at 3.3%. Within the Caribbean region and St. Lucia has one of the highest incidences for this age group with St. Lucia having 2.5% of the 0-5 yr. population ( De Onis M et al.,October 2000) .Obesity in children and adolescents is known to have significant impact on both physical and psychosocial health, these soaring rates of obesity leads to an increase in hyperlipidaemia, hypertension, insulin impedance and abnormal glucose tolerance later in life (Reilly et al., 2003 Weiss et al., 2004).Urbanization, industrialization and transformation processes have been the main cause of this public health accomplishment. In modern cultures, demographic factors interact with social and economic factors and lead to changes in the patterns of health and diseases as hypothesized by Omrans epidemiological transition theory in the early 1970s (Orman et al., 1971). Omrans theory describes the changing pattern of mortality from the predominant communicable diseas es to the emerging non-communicable diseases. In his study, Omran be three stages of epidemiological transition, i.e. the age of pestilence and famine, the age of receding pandemics, and the age of degenerative and man-made diseases (Orman et al., 1971).1.6 Dietary habits of St. LuciansFood habits reflect the plantation past the typical diet contains a lot of starches, animal protein content that varies by location, and until recently, little in the way of green vegetables. Starches include various kinds of yams, dasheen, eddos, bananas and plantains, wise potatoes, cassava and breadfruit. Most of these are boiled, served with some kind of stewed fish or meat, and accompanied by a sauce. Pepper (capsicum) sauce is unendingly present at the table, as most dishes are not active spicy hot. Animal protein sources reflect the historical scarcity of this element porc hocks, pig tail (fresh and salted), chicken back, and saltfish, (cod) salted beef, fish (tuna, flying fishing, red sna pper, barracuda, sharke, sardines, jack fish). Most of the dishes are prepared with fats such as coconut meat oil, lards, yellow butter. As much as St. Lucia has a wide mixing of fruit they are only eaten Fruits such as mangoes, golden apple, papaya, grapefruit, oranges, cherries, cashew, sugar apple(love apple).Main dishes are accompanied by vegetables such as, avocado, calaloo, spinach, tomatoes, okras, carrots, pigeon peas and lentils,Imported processed foods have been available for decades, but more recently account for larger parts of many meals. Foods such as pasta, rice,1.7 Cause for chronic non-communicable diseases in St. LuciaChronic diseases have numerous risk factors, which function at different levels, from the most proximal (i.e. biological), to the most distal (i.e. structural). These risk factors can be sort out as modifiable and non-modifiable risk factors. Modifiable determinants include factors that can be altered, such as individual and community influences, l iving and working conditions and socio-cultural factors, non-modifiable determinants include those factors that are beyond the control of the individual, such as age, sex and genic factors.1.7.1 Biological factorsSome populations are susceptible to chronic disease because of catching genes. In a south Africa a tribal group Afrikaners have been found to have familial hypercholesterolemia, a rare genetic disorder, characterised by very high low-density lipoprotein, cholesterol and early cardiovascular disease.( Steyn K et al.,1996). Genetic and lifestyle factors are considered to be the main contributors in causing type 2 diabetes (ORahilly et al 2005). The genetic makeup of a person is as essential to the development of the disease but a person lifestyle and environmental factors can contribute significantly. Some of the major change factors include overweight, abdominal obesity and physical inactivity and to lesser extent intrauterine and early childhood factors (Alberti et al, 2007)1.7.2 Early life originThe time between intrauterine growth and the development is the most vulnerable item in the life cycle and places major physiological, metabolic and psychological gather up on the mother to support the growth and the development of the fetus (Allen, 2001). right growth and development is dependent on a sufficient supply of energy and nutrients. Under nourishment during gestation period is linked with poor pregnancy and neonatal outcomes which can have negative long term implications for the baby such as a reduction in intelligence, growth disorder, low immunity, increased morbidity, mortality and the development of a range of diseases during adulthood (Rasmussen, 2001)It is proposed that type 2 diabetes results from relative intrauterine malnutrition and the latter leads to lifelong programming (Baker et al 1986). Children with low birth weight are most likely to hump growth restraint, whether due to intrauterine nutritional restriction or genetic pr edisposition to low birth weight similar associations of low birth weight have been made for the development of diabetes (Lindsay et al 2001). Babies who are innate(p) low birth weight tend to grow fast(a) after(prenominal) birth catch-up growth, often become overweight as young children. They are most likely to develop high blood pressure and abnormal blood glucose level early in life, which future increase their risk of developing chronic diseases, such as heart disease and diabetes (Barkeret al., 1997). The prevalence of Low Birth Weight (LBW) is approximately 6 and 9% in the Caribbean. The association between low birth weight and adult disease makes urgent the concern of these high LBW prevalence rates in the Caribbean (Henry 2000).An under-nourishes child is normally a smaller and shorter child (0) Stunting is an indication of long standing mal and under-nutrition and is often accompanied by fat deposition, particularly around the abdominal section when faced with food in abu ndance. Predisposing individuals to obesity in adulthood. ()Likewise children who are born to large mother and are large for their gestational age are most likely to induce insulin resistance and type 2 diabetes later in life (Bennett et al 2002). In Jamaica children shortness at birth and increased current weight are independent predictors of insulin resistance (Bennett et al 2002).There is significant amount of evidence, mainly from developed countries, that states intrauterine growth retardation is connected with an increased risk of coronary heart disease, stroke, diabetes and elevated blood pressure (WHO, 2002 Godfrey et al., 2000 Fors et al., 2000). It may be the pattern of growth, i.e. restricted fetal growth followed by very fast postnatal catch-up growth that is vital in the underlying disease pathways. Likewise, large size at birth is also associated with an increased risk of diabetes and cardiovascular disease (McCance DR et al., 1996 Leon DA et al., 1998).Behavioural ris k factors (lifestyle factors)Lifestyles play an important role in determining chronic diseases and lifestyle changes are likely to be responsible for a significant proportion of their increase over time.1.7.3 deplorable dietNutrition is a major modifiable determinant of chronic diseases, with scientific evidence supporting the view that modifications in diet have effects on health outcome of a person. Non-communicable diseases are linked to high consumption of energy dense foods, made of animal origin and of foods processed or prepared with added fat, sugar and salt.()St. Lucia is undergoing rapid nutritional transition (Boyne, 2008). There has been an increase of fast-food restaurants, and an increased in the consumption of meals high in fat, sugar, and salt and a reduction in the consumption of cereals, grains, fruits, vegetables, tubers, and legumes (Jacoby et al.,2008). The increased consumption of imported foods high in fat and sodium has led to a decline of the health status of people throughout the region, with an increase in health problems such as obesity and diabetes (Report from WHO, 2003).1.7.4 sensual inactivityPhysical inactivity and sedentary lifestyle is linked with increased levels of obesity, breast cancer, colon cancer