Page 42 - GHES-2-3

Global Health Economics and
Sustainability
Jamaican specialized health-care history

must continually balance delivering effective health-care This increase in lifespan has resulted in a change in the
services with limited financial resources. The sustainability disease profile to those more associated with aging and
of healthcare in LMICs demands innovative approaches lifestyle choices, representing the “price” of progress (Wilks
that create equitable access to quality medical services et al., 1998). Predictably, these disorders have increasingly
with minimal financial investment (Zimlichman et al., contributed to health-care costs and now account for most
2021). Addressing the immense complexities of health- deaths in Jamaica, where the leading causes of death are
care sustainability in LMICs will illuminate the persistent, stroke, diabetes, and ischemic heart disease (Figure 2).
pervasive, and pernicious challenges these countries face
and the innovative strategies required to address them 2. History of healthcare in Jamaica
(Broomberg, 1994). The discussion on the optimal provision of healthcare in
The world remains, in many ways, unequal, most often Jamaica began almost 200 years ago. During the time of
spoken of in terms of inequality in access to financial capital slavery, enslaved people received varying degrees of care
and opportunity (Dzau et al., 2022). This inequality extends at the discretion of the planter. Typically, this provision
to health and healthcare, varying between countries and involved the contractual employment of a medical
even within countries, particularly in smaller developing practitioner who would visit the estate and provide care
countries with significant income disparities. Across the to the sick enslaved people. Estates often had “hot houses,”
spectrum of nations, and in the frequently mentioned which were small hospitals on the estate where patients
North-South divide, health-care issues differ (Abu-Zidan were looked after by black doctors who were not formally
& Rizk, 2005). In low-income countries, health problems licensed (Craton, 1974). With emancipation, many freed
often stem from trauma and infectious diseases related to slaves continued to work on the estate as “apprentices,”
inadequate public health infrastructure, leading to poor allowing them to avail themselves of the medical care
sanitation and limited access to clean water. Such conditions provided there. However, once they left the estate, or for
typically result in the proliferation of disease vectors, such those who left immediately after emancipation, they had
as rats or mosquitoes, causing infectious diseases such no access to this care and had to seek medical attention
as malaria and diarrheal syndromes that often claim the from private medical practitioners at significant personal
lives of young children or infants, significantly reducing cost (Kingston Public Hospital, 2022). The persisting lack
lifespans and quality of life (WHO, 2000a). of concern about health-care disparities in countries like
Jamaica, with a colonial past rooted in slavery, may be
As countries like Jamaica develop and improve partly attributed to the plantation owners being freed from
infrastructure, sanitation, and education, infectious diseases the responsibility for the health and welfare of their former
cease to be the primary causes of morbidity and mortality, slaves, and not being required to provide for this benefit
replaced by chronic noncommunicable diseases such as when re-engaging them as employees.
diabetes mellitus, hypertension, and obesity. These diseases
bring well-known, potentially economically devastating Certainly, the disparity as it exists now is not viewed
consequences, including stroke, heart attacks, and joint positively by anyone in Jamaican society, but its persistence
disorders (Boume & McGrowder, 2009). In addition, as is an issue of much discussion. It is quite evident that
employers in the retail and tourist industries care about
basic infrastructural and infectious issues are addressed, their employees’ health. However, the fact that this concern
population demographics shift, and older individuals suffer does not necessarily extend to the wider populace may
from diseases associated with aging, including Alzheimer’s indicate that the scale is too great for them to feel they
disease, Parkinson’s disease, epilepsy, and osteoarthritis. can usefully participate in addressing it. It remains the
Lifestyle-related health issues from inactivity, smoking, and perception that it is the government’s or the individual’s
alcohol consumption also become prevalent. This shift has responsibility. Two hundred years ago, the emancipation
been evident in Jamaica, a small island state in the English- of slaves also meant a significant loss of reliable income for
speaking Caribbean (Figueroa, 2001).
the approximately 200 medical practitioners in Jamaica at
In Jamaica, an upper-middle-income country, efforts that time, leading to great concern about their financial
since the 1950s to control infectious diseases by improving well-being, especially for rural doctors. This loss of income
infrastructure, water distribution, and immunization resulted in a marked reduction of medical practitioners on
against several childhood infectious diseases such as polio, the island by 1900 (Craton, 1974). Years of battle ensued
measles, and tetanus have been remarkably successful. as liberal Jamaicans, including some medical practitioners,
These efforts have contributed to a rapid increase in sought to establish a medical college in Jamaica that would
lifespan over the past 70 years (Moody, 1978; Riley, 2005) train and license physicians, including local black doctors.
(Figure 1). There was substantial pushback both locally and in the

Volume 2 Issue 3 (2024) 2 https://doi.org/10.36922/ghes.2709