Editorial | Recognising the importance of public health inspectors, community aides

The more dramatic stories coming from global north about COVID-19 are that of clogged hospital wards, overwhelmed doctors and nurses, shortages of ventilators and other respiratory equipment. The crisis, from this perspective, is high-tech.

Yet, in the absence of a vaccine against the coronavirus that causes the disease, the best antidote against its spread is decidedly and effectively low-tech. Avoid crowds, wash hands regularly, maintain good physical distance from other persons, and wear face masks in public. It is good, old-fashioned public-health advice, which, in Jamaica’s case, should expand the discussion on health policy in the post-COVID-19 environment.

Until the COVID-19 pandemic, two health issues commanded most of the attention of the policymakers in Jamaica. One is the need to combat the explosion of non-communicable diseases (NCDs), such as obesity, diabetes and hypertension. Health Minister Christopher Tufton’s faltered proposal for a tax on sugary drinks and his championing of a national fitness movement, Jamaica Moves, were part of this discourse. The other is the search for ways to deliver quality and affordable healthcare to Jamaicans, more than 17 per cent of whom live below the poverty line; only 3.7 per cent of the bottom quintile has any form of health insurance. The development of a national health insurance is on Dr Tufton’s agenda.

Renewed focus

This newspaper would now like the minister, in the same fashion he championed Jamaica Moves, to help make basic public-health issues, if not fashionable, be a subject of a renewed and aggressive national focus. This, to be clear, is not to suggest that public-health matters, including where hygiene standards impact the public, isn’t a matter of serious concern for Dr Tufton and the Government. Even before COVID-19, public-service announcements about the value of proper hygiene to good health and disease prevention were regularly aired in Jamaica. There are also ongoing community support services.

Our suggestion, however, is that these programmes be significantly increased, the status of public health inspectors enhanced, and that we revisit and, if required, reconfigure the old scheme of community health aides. In a sense, we propose a return to an approach to public-health management and education and information delivery that was in vogue more than 40 years ago, which helped to deliver first-world rates of longevity. Unfortunately, Jamaica has followed developed countries with regard to addressing NCDs.

COVID-19 reminds us of the relevance of the purposefulness of aggressive public-health engagement and, critically, messaging.

It’s neither surprising nor insignificant that in Parris Lyew-Ayee Jr’s analysis of areas at greatest risk for the spread of COVID-19, five of the top six are in decayed and poverty-stricken communities in downtown Kingston, where residents are likely to be at a low information threshold and lack facilities to maintain good hygiene. We expect there is a correlation between the circumstances of this group and those who lack health insurance. In all likelihood, they overlap.

Urban renewal

We have, of course, advocated for a massive programme of urban renewal in Jamaica, leveraging government resources, to encourage private capital and community equity to finance the transformation. But the current situation can’t await such project.

Indeed, implicit in Dr Lyew-Ayee’s analysis is, apart from access to healthcare if they are infected, the need for information, and reinforcing messages, about what at-risk people in vulnerable communities can do to lessen the possibility of becoming ill. These messages can’t be delivered from afar, or in a manner without relevance to people’s circumstances.

At another level, highly trained public health inspectors represent an early, and important, line of defence for the communities against zoonotic and other forms of infectious diseases, like COVID-19. We hardly think about it, but it is they who inspect communities, abattoirs, markets, restaurants, food-processing facilities and other establishments, whose maintenance of appropriate standards is important to the well-being of the nation’s health. Surprisingly, only around 500 public health inspectors work in Jamaica. And most people don’t have a sense that they are important.