|Type of paper:||Research paper|
|Categories:||Healthcare Community health|
Since the beginning of the 20th century, the Bahamas health sector has undergone rapid development. Dr. Harold Munnings, a consultant gastroenterologist at the Princess Margaret Hospital, has done a lot of research concerning the Bahamian medical history. He asserts that, during the early years of the twentieth-century, the government never paid much attention to the issue of public health. The general state of health of much of the Bahamian population was characterized by poor sanitation and prevalence of disease epidemics. Densely populated areas like the New Providence experienced health-related diseases such as cholera and typhoid. Hence, because of such adverse health conditions, the imperial government of the British Empire was prompted in 1936 to accept responsibility for the state of health in the Bahamas. The period following 1936 saw significant changes in the country's healthcare system. For example, by 1953, the government had constructed operational standpipes which serviced about 70% of the households in the New Providence alone. That said, the primary aim of this paper is to discuss the state of the Bahamas healthcare system during the 20th century.
The Health Status (1900-1999)
During the pre-emancipation era, the health status of slaves in the Bahamas was characterized by favorable working conditions. Comparatively, the health conditions in the Bahamas were better than those of other plantation colonies since the region was not a sugar colony. The region's agriculture islands were primarily for planting cotton which was less labor intensive compared to the sugarcane which demanded intensive labor. Also, the area did not experience endemic diseases like malaria and yaws like the other Caribbean islands. However, as Nassau became a vital sea-port and a tourist hub, the state of health in the province began to deteriorate because of common disease epidemics such as yellow fever and typhoid. Tourists from foreign nations brought most of these illnesses and bred in crowded, unhygienic conditions.
Gray, Storr, Roberts, and Johnson (January 01, 2001) state that the reality concerning the occurrence of these diseases came to light through the famous Beveridge Report of 1926. The report stated that it was possible to eradicate some of the illnesses that were prevalent in most of the Bahamian islands. The report also gave an account of some preventable diseases which had been eliminated elsewhere. They include tuberculosis, pellagra, neonatal tetanus, worms, as well as typhoid.
Life Expectancy and Fertility Rates
However, since the Beveridge Report, life expectancy at birth has steadily improved from approximately 61 years in the period 1950 to 1955 to about 72 years in the years 1990 to 1995. In 1997, the average fertility rate of women in the Bahamas was 1.8 per 10,000 women of child-bearing age. Nevertheless, the trend began to change during the final years of the twentieth-century. Studies show that fertility rates among all age groups in the 1990s were lower those of the 1970s and 1980s. Conversely, the fertility rates among individuals of ages 35-39 increased considerably by 1991 (Table 1.1).
Table 1.1. Fertility Rate in Age Categories- The Bahamas, 1976, 1983 and 1991
Year Number of births per a thousand women of childbearing age
15-19 20-24 25-29 30-34 35-39 40-44 45-49
1976 125 214.1 165.9 123.9 70.6 24.8 3.3
1983 65.3 164.7 169.1 106.6 43.2 12 1.4
1991 65.7 129.6 129.5 94.5 52.8 11.8 1.5
The figures above are from a study conducted by the Vital Statistics Reports, Department of Statistics, Census of Events, Health Information and Research Unit. The report also shows that number of teenage pregnancies was increasing at a breakneck pace. Approximately 15% of the births in the Bahamas were by mothers aged 18 years and below. By the year 1990, foreigners accounted for 11.6% of the population though produced `17.1% of births that year. Consequently, there were 79 births per 1000 women of age 15-49 and 119 per 1000 non-nationals mothers of similar age.
Apart from that, reports by the Board of Health and their predecessor from the 1970s and 1980s pinpoint illnesses like influenza/pneumonia and tuberculosis as the leading causes of death. Recent studies show that, in the general population, heart-related diseases and cancer ranked as either the first or second most prevalent cause of mortality in the period of 1970-1980. Gray et al. (2001) state that beginning of the new millennium, records highlight long-lasting, non-communicable diseases predisposed by poor lifestyle habits such as lack of exercise, eating junk food and stress as the leading cause of death. They accounted for approximately 50% of all deaths in the nation. Also, a study conducted in 1999 identified that the prevalence of diabetes and hypertension in a population of 15 to 65-year-olds was about 10% and 13% respectively (Smith, 2015).
Besides, reports compiled by the Chief Medical Officer dating as early as the year 1929 indicate that sexually transmitted infections (STIs) were a nationwide endemic. Still, the problem of eradicating STIs remains a challenge in the Bahamas. The discovery of AIDS in the islands in 1985 escalated the issue further. By the year 1991, AIDS was already the second most common cause of mortality and morbidity in the Bahamas. The untreatable disease tops the list as the most frequent cause of death during the most productive stages of life among the youthful population. Death as a result of AIDS accounted for approximately 46% and 40% of the overall deaths among males and females respectively. Double the number of the men belonging to these age-groups die from AIDS compared to those of the women.
Additionally, the second most prevalent cause of death among males was trauma while for the women, malignant neoplasm came second. Consequently, illnesses and conditions arising from alcoholism and drug abuse have been a long-standing health concern in the islands since the 1950s. Mainly, addiction by 'crack cocaine' was identified as a national epidemic in 1985. The large-scale cocaine trafficking across the islands intensified the problem, with senior government officials being accused of taking part in the drug trade. That said, the infant mortality rate in the Bahamas has recorded high rates though the trend has been falling. Between 1974 and 1978, the infant mortality rate average 29.2 per 1000 live births yearly. Until 1990 the rates remained above 21. Nevertheless, the decline began in 1993 from 19.8 at that time to 14.1 in 1998 (Gray, Storr, Roberts, & London School of Hygiene and Tropical Medicine, 2001).
Finance and Expenditure Patterns
In the 1997 and 1998, the recurring government expenditure on health was $122, 151, 783. This value accounted for 14.5% of the overall government expenditure budget (Gray et al., 2001). This money was allocated to the Ministry of Health and the Department of Environmental Health Services. The analysis of patterns in the percentage of government spending on health shows that, before 1973, this proportion never exceeded 12%. However, in the 1973/1983, this rate varied between 13.9% and 14.9%. The government achieved the highest spending in 1986 at 15.6%. From 1986 to 1993, this amount stood at 15.16%. However, the government expenses regarding healthcare never exceeded 14.9% every year up to 1999.
Other Significant Developments in the Bahamas Health Sector during the 20th Century
In 1925, some tourists from America contracted typhoid fever in Nassau prompting the imperial government to dispatch a senior public health official to investigate the matter. The health expert reported the poor state of sewerage system in areas such as Nassau where projects were still underway. He attributed this to the occurrences of tuberculosis, tetanus, and venereal disease. He criticized the sanitary conditions of such areas and criticized the government's lopsided development projects, especially regarding the public health. Still, these conditions did not improve until 1936 when the British government decided to take responsibility for the Bahamas healthcare sector. Also, in 1950, a British official wrote about the dreadful sanitary and housing conditions in Nassau. Stating that, behind the city's magnificent mansions and beautiful streets are slums worse than those of the colonies in the West Indies. In 1953, approximately 65% of the households in Nassau lacked adequate running water.
Similarly, a memoir by Dr. Malcolm Hale published in 2003 provides a useful perspective to our discussion concerning the history of the Bahamas healthcare system. Dr. Hale came to Nassau in 1954 and was assigned the duty of a medical officer in the new Bahamas General Hospital. The hospital was renamed a year later to Princess Margaret Hospital after a visit by Princess Margaret. In retrospect, he asserts that the overall public health was below the required standards. Numerous cases of TB were reported daily. Most of the TB patients were from some of the islands such as the Rolleville and Moores Islands. These places had poor sanitation and also lacked a source of running water. Fortunately, his admission into the hospital concurred with the invention of a variety of effective medications. Thus, most patients were cured and lived. He recalls the dreadful status of the geriatric wards which he describes as pathological museums. There were numerous cases of elephantiasis as well as syphilis. The room designated for leprosy patients constituted small wooden cottages which were mostly overcrowded.
That said, other health experts who arrived in the Bahamas amidst that crisis include Dr. Arthur LB Plunkett and Sir Wilfred Beveridge. Both men came to the Bahamas in 1927 with Plunkett as the first to arrive. The latter was a public health specialist from the London School of Hygiene and Tropical medicine. He was assigned the task to investigate the sanitary conditions on New Providence. He was then to advise the state on the necessary changes that needed to be made to improve the health status of the majority of the population. He researched the hospital and conversed with the medical team Beveridge also visited the Athol Island and conducted a medical inspection on its quarantine station. He also inspected the island's public market and the abattoir. After doing a comprehensive study, he delivered a report that came to be known as the Beveridge Report. His report stated that the outbreak of diseases like typhoid fever, paratyphoid, dysentery, and gastroenteritis was because of poor sanitation in most households. He also attributed the prevalence of infant diarrhea to the lack of adequate care of infants and young children.
Furthermore, he also criticized the government's ignorance on matters regarding public health, regardless of the efforts by the Chief Medical Officer to bring the problem to their attention. Following the Beveridge Report, the government decided to implement the crucial changes. For example, it constructed the Nassau sewerage and drainage system, a project which engineer Plunkett was assigned to build. Apart from that, his recommendation that the Chief Medical Officer be given full executive control of the health department was implemented. Also, a range of unfamiliar diseases such as paratyphoid and dengue was brought to the attention of the Board of Health. Likewise, his report led to the adoption of public awareness campaigns to educate the masses on hygiene and communicable diseases.
In a nutshell, this essay discussed the history of the Bahamas healthcare system, highlighting some of the significant changes the sector underwent during the 20th century. Some of the developments mentioned include the construction of sewerage system as well the new...
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