Continuing its efforts to advocate for tobacco cessation and reduction of sugar consumption, FDI conducted its Two Risk Factors Too Many Diseases capacity building workshop in collaboration with the Bahamas Dental Association in the Bahamas. The workshop took place over two days and featured leading figures and dental associations from the Caribbean Community (CARICOM), including the Jamaica Dental Association, Barbados Dental Association, Bermuda Dental Association, Colegio de Cirujanos Dentistas de Costa Rica, Federación Odontológica Colombiana, and Alliance for a Cavity Free Future.

To understand the importance of this event and the subsequent development of the CARICOM Declaration on Sugar Sweetened Beverages (SSBs), FDI led an interview with workshop participant and the President of the Barbados Dental Association, Dr Vidya Armogan. Read further to learn why such advocacy initiatives are important and what more can be achieved to improve oral health in the region.

Access the CARICOM Declaration on sugar sweetened beverages

The CARICOM event is the first FDI event to be held in the Caribbean region for many years. What was the impact of bringing together the regional dental associations at such an occasion?

Phenomenal. The concept of “Think Globally, Act Locally” comes to mind and there are two distinct benefits in bringing together people from a region. Firstly, countries in the region sharing common issues from governmental to cultural issues to infrastructure constraints, which hinder the delivery of care, can benefit from formulating a policy that addresses common regional challenges.  Someone formulating that policy who sits extra-regionally may devise a plan that is not going to be successful in reality. While we could bring those people together anywhere in the world, there is a significant benefit to hosting the meeting in the region, allowing people in the host country to interact with the delegates from both the region and extra-regionally. The second major benefit is exposing the extra-regional participants to the local regional challenges and experiences.  A participant commented that “he hadn’t seen so many SSBs in one place for a long time.”  Such a simple observation underscores the ‘local knowledge and challenges’ that extra-regional delegates are then educated about.  They also get to understand the cost-of-living issues and challenges that the society faces in the host country – which are similar in all of the countries regionally.

What are the main challenges to improving oral health and integrating it into universal healthcare in Barbados and the CARICOM region?

While there are many challenges to improving oral health and integrating it into universal healthcare, the single biggest issue is likely education of the public. Considering that the burden of educational load falls on the Government whose policies, inertia and priority towards oral health has always been, and continues to be, lacking, it is unsurprising that the concept of universal healthcare would not be a priority. The Barbados Government Dental Services continues to face staff shortages; infrastructure failure; equipment failure, and technology gripes, among other things. Education, however, is not solely the responsibility of the Government.  The Barbados Dental Association (and member organizations in each country) should now take the lead and spearhead the education of the public.  Non-Governmental Organizations (NGOs) and private entities should now co-ordinate efforts through the Barbados Dental Association to create an effective campaign to raise awareness of oral health.

Two other critical factors affecting the improvement of oral health are access and cost. While the population has availability to provision of care, much of that is centered around the major cities and hubs, as expected.  Being a small island that is quite well developed, the ability of the population to reach healthcare facilities is not unreasonable.  Government polyclinics were supposed to provide care in more rural settings, but the dental arm of those facilities is currently non-functional. Cost also remains another barrier to entry for oral healthcare.  Certainly, in a post-pandemic environment with supply chain disruptions and shipping/logistic complications, the cost of everything has increased significantly.  Coupled with in-country post-pandemic expenditures which have seen a dramatic rise in the cost-of-living and additional taxation, the access to disposable income thus available to ‘optional’ services is far reduced. The BDA has been lobbying for eliminating all duties and taxes on dental/medical equipment and supplies.  This will reduce/stabilize costs and allow our citizens faster access to new equipment/technologies.  Ironically, spending money on prevention at this juncture, for both citizens and the government, is what will future-protect long term unnecessary spending.

What will be the impact of the CARICOM Declaration on sugar sweetened beverages and how do you plan to implement the changes?

I’d anticipate that the FDI CARICOM Declaration on SSBs will have a positive impact on the development of policy and in the fight to improve the health of our citizens. In a culture that craves sugar – we consume 54.3kg/person vs a global average of 20.1kg/person – any attempt to restrict access to things perceived as a ‘treat’ would be met with resistance.  However, armed with the information from FDI and other NGOs, it becomes far easier to educate government and policy holders to do the right thing. Implementation is key, and education is the cornerstone.  The CARICOM Declaration will greatly assist in getting the necessary parties to the table to begin consultations on the way forward. We have thus far formed a special committee to implement the changes stated within the CARICOM Declaration as deemed fit, including the creation of presentation for stakeholders and launch of Public Service announcements for educational purposes.

It is my belief that if we engage with Government and the Public in this manner, we will be able to create the momentum necessary to dramatically improve the oral (and general) healthcare of all of our citizens and create a model for development for other nations.

Are you excited for the first No Sugar Day in 2023, and do you have activities in mind?

The implementation of a No Sugar Day is fantastic as it focuses the public on a significant event. The Barbados Dental Association will likely engage the public through a media blitz – informing on the importance of sugar reduction in our society. This action, while important, will be more successful if there are alternatives presented, and as such, we hope to be hosting a Sugar Free cooking/baking competition nationally.  We would also like to have each restaurant create a ‘Sugar Free Dessert” to place on their menu – impacting not only our local population but also our international guests. Involving the Minister of Health and the Prime Minister of Barbados are also critical elements as they are well respected and can provide the necessary momentum to highlight the issues we face in our society. Other NGOs, such as the Barbados Diabetes Society, will be contacted to host a joint Health Fair for free screenings in select areas.

Editor’s note: this interview has been edited for length and clarity.