Jamaica’s growing crisis

Jamaica Cancer Society (JCS) radiographer Donnett Hyman (left) demonstrates the functions of the organisation's newly acquired mammography machine to JCS Executive Director Yulit Gordon (second left), Health Minister Dr Fenton Ferguson (second right) and JCS Chairman Earl Jarrett. Gordon estimates that being stricken by cancer can cost someone over $4.5 million

WHILE we debate the economic challenges facing Jamaica, there is an emerging crisis that many are not speaking of, but which we must address as a country. This is the health of our population, and as a result the cost it currently has and its continued impact as it worsens. If, of course, we do nothing about it.

Anyone who knows me understands how important health management is to me. In fact, my passion for lifestyle management led me to write a book (Achieving Life's Equilibrium) and one aspect of that is health management, which I also have done a few presentations on.

The data on Jamaica shows that non-communicable diseases (NCDs) account for 56 per cent of all deaths, 20 per cent of which are caused by cancer, and cost approximately US$170 million ($19.2 billion) annually. Much of this cost is avoidable just by changing some aspects of our lifestyle, such as healthier food choices and exercise. What this means is that our failure to make the right lifestyle choices is causing us to spend up to $19 billion per annum on health costs, much of which could be going towards welfare, education, or some other growth inducement spending.

The Lancet Medical Journal recently reported that high body-mass index increases the risk of developing the 10 most common cancers, according to a study conducted on over five million people. Researchers estimate that over 12,000 cases of these 10 cancers each year is attributable to being overweight, or obesity, and estimates that if average BMI continues to increase there could be an extra 3,500 cancer cases annually.

Yulit Gordon, the Executive Director of the Jamaica Cancer Society (JCS), estimates that being stricken by cancer can cost someone over $4.5 million (assuming four chemotherapy treatments) in addition to the costs to visit the doctor and hospital stay and tests. So an individual could easily spend over $6 million in the initial fight against cancer. And I say initial because many times it recurs. The JCS is doing a very good job in the fight against cancer but is in need of greater support to be able to be even more effective.

There are, of course, other significant costs for an individual to deal with NCDs, such as high blood pressure and diabetes. These NCDs are the main reasons for many of us starting to show our age, and all because we make incorrect lifestyle choices; if the proper decisions are made many of these NCDs and associated costs are totally avoidable.

In addition to the cost on the health care system, and ultimately the fiscal accounts and taxes, the fact is that many of the drugs and products used in the treatment of NCDs are imported. So if we assume that 70 per cent of the US$170 million annually is imported, then it means that NCDs are adding US$119 million ($13.4 billion) to our trade deficit annually, which is just under 10 per cent of the current account deficit.

This cost to our fiscal and balance of payments accounts does not include the cost to GDP from productive hours lost due to sick leave or death. If we assume that 40 per cent of our workforce takes their entitled seven days' sick leave per year, then on average this could negatively impact GDP by over $10 billion annually.

Even at the lower estimates, the computations show that the cost of NCDs to Jamaica is an ever growing threat, is totally avoidable, and is a cost that I don't think we emphasise enough. Certainly if you are trying to improve the cost structure (profitability) of a company, one of the first things that you do is to look at the "low-hanging fruit". In other words it is easiest to minimise avoidable costs as a means of improving the financial situation. So while we focus on new taxes, earnings, or wages and salaries, the fact is that if we look carefully at the fiscal accounts there are significant costs that can be avoided by just doing things differently. This is something I remember Ronnie Thwaites stressing when he was on Power 106 for a very long time.

But are we ready to take responsibility and make the necessary lifestyle changes? The truth is that even many of us who promote the idea of lifestyle changes are guilty of poor choices ourselves, and the most effective way to influence people is to ensure that you are a good example. I am always amazed at the way adults, for example, tell children about certain ways they should behave but at the same time do the same things they tell them not to do. So they tell them, "Do not drink and drive, do not text while driving, make sure you eat properly," etc. However, I see many adults setting a bad example for children to follow even in front of the same children that they instruct.

I also notice that many children today are living a lifestyle that will ensure they have health issues earlier, rather than later. Certainly in my teenage days when there was one television station that signed on at 5:00 pm, and there were no video games, we had no option but to go outside and engage in some physical activity like football, cricket, and so on. I also have noticed that when one speaks about the quality of a school we refer to academics and not emphasise the importance of physical education, the result being that many of the children leave school today academically brilliant but without the physical foundation that will ensure that they are healthy enough to enjoy the money they earn from the academic achievements. So many of our children are just ticking time bombs for NCDs.

There is no doubt that if we continue to ignore the necessary lifestyle choices that will improve our health, then we can safely say that Jamaica will face a health crisis in NCDs, similar to developed countries like the US, and this will impact even more on our fiscal accounts and balance of payments.

So while we try to solve our economic circumstances, we should recognise the role that behavioural choices play in our economic challenges, and the significant cost it has, both nationally and individually. In fact, I have heard many people say they cannot afford to eat properly, as proper nutrition costs more. While this may be true in relation to the direct cost of nutrition, they haven't considered the current and future medical expenses from poor nutrition choices, which ends up being significantly more and the negative impact on quality of life.

Apart from the cost, though, we should be encouraging our children to make healthier choices for their own benefit, and my own view is that this has more to do with lack of exercise and consumption of many of the imported processed foods, as our own local brands and produce are a lot healthier. Yet another reason to support Jamaican products.

Social justice and economic development

EVERYONE should know by now that I believe the economic programme is being managed properly, as the fiscal and legislative adjustments being made are definitely the right option for creating a positive environment for economic development. And certainly, more importantly, is that the leadership of the programme, headed by Peter Phillips, has shown the willingness to see it through to a successful end.

Even with this, though, the economy is still in a very fragile state, with unemployment still too high, and despite improvements in the fiscal and other macroeconomic indicators, we still have a very far way to go. Importantly, any letup on the implementation of the programme, or even a natural disaster, could cause us to be back in dire economic circumstances. So it is important for us to stick to it.

On the other hand, we also need to realise that sustainable economic and social development cannot be achieved merely by implementing this programme, or getting in significant foreign investments, as has happened in the past. The only way for us to truly see sustained development is for any such development to be inclusive of the masses of people. In other words, any path that we are on must of necessity provide opportunities for the ordinary Jamaican to excel, and very importantly Government's primary role must be to ensure that the vulnerable are not only protected, through social programmes, but also have equal access to the opportunities for elevation available.

So everyone should have access to the best education, justice, and social welfare protection where needed.

It is with this in mind that it really hurt me when I heard about the Mario Deane situation. Not because it hasn't happened before, and similarly I was outraged, but because he died on the day we were celebrating our 52nd anniversary of independence as a nation. And my perspective is that independence not only means the right to govern your own affairs, but of necessity independence comes with the responsibility to ensure that we treat others right, as well as manage our own affairs properly.

So a child who attains adulthood is not just independent because he/she earns money. Those allowed independence must practise good citizenship and must manage their affairs properly. Any mismanagement of that independence results in it being taken away. So if you are reckless with your finances and have to rely on others to support you, then you are once again dependent, and similarly, if you break the law your independence can be taken away from you.

Similarly, a country that cannot manage the responsibility of Independence will also become dependent. This is our case with the dependence on the international lending agencies, and other countries that we rely on for aid. Even though we attained Independence in 1962, the way we have managed our affairs has resulted in us losing much of that independence. So, to be independent implies being responsible.

One of the responsibilities of Independence is being fair to all; even those you think may offend you. Because it is when we can truly forgive the indiscretions of others that we have really matured as independent people, and a country. Remaining independent also means accepting responsibility.

The Mario Deane case showed both sides of this argument, as first it showed that the response from the police involved demonstrated that they never accepted responsibility of the power to detain persons against their will. I would have expected a statement to the effect: "We regret to inform the people of Jamaica that Mr. Mario Deane was severely beaten by other detained persons. We accept the responsibility for persons in our care, and will be vigorously investigating this matter to see who is directly responsible and will make our findings known in the shortest possible time." Instead the response was to first deny culpability and then charge two persons, with no apology. It took the ministers of Justice and National Security, the acting commissioner, some politicians, INDECOM, and civil society to express outrage and apologise. Still no one from Barnett Street, from what I know, has issued any statement of apology. If so then I stand corrected.

What as a country we have also failed to understand is that in order to have sustained economic development, it is necessary to also have social justice. Whenever there is no social justice, it results in lost opportunities and wasted talent. It also results in wasted productive hours, as instead of cleaning up the mess caused by some functionaries of the state, we could be planning how to increase agricultural and other production. If we were to do an analysis on the amount of time and resources wasted trying to correct social ills I am sure that it could significantly add to GDP.

This means of course ensuring that law and order exists in the country. And this does not only apply to the citizens who should be abiding by the laws of the land, but it also applies to those with the responsibility for creating and enforcing laws.

As Peter Tosh said, everyone is crying out for peace but there can be no peace without justice. I want to go a step further and say that there can be no sustained economic development without social justice and stability. Just look at the Middle East.

As a country we have made strides. I find that the policymakers are more willing today to engage stakeholders. We see that with the response to criticisms of the recent legislative changes, which has been to engage stakeholders. I personally also see improved customer service within the public sector, and improved service delivery. This even extends to the security forces, as the police are a lot more courteous than days gone by.

However, in order to make that next step to sustainable development, and achieving Vision 2030, social justice must be at the top of the agenda.

Role of values and attitudes in development

DAVIES… when he tries to introduce discipline to the transport system, the response is protest and demonstration

Earlier this week I ran into Bunny Goodison, and we got to talking about the demise of values and attitudes in Jamaica. We spoke about the fact that even though we may see growth in the economy, there is still a critical mass of the population that doesn't know what it means to be productive, and sadly, may not easily find a place in a more competitive economy.

So even as we see the employment numbers declining, and GDP growth chugging along, the fact is that there is still a great concern about many of the youths who grew up in a time when the values of working were never a priority. In fact, Bunny said we may have about two generations that fall into that category.

As I thought about this some more over the ensuing days, I reflected on the importance that was placed on this by former PM PJ Patterson, in his Values and Attitudes campaign. He realised how much of a problem the lack of proper attitudes and values was going to be for the proper development of Jamaica.

The reality is that no country can develop in any sustainable way without a foundation of proper values and attitudes. One may argue that this is the reason we have laws, that is, to bring people in line when they deviate. However, this is only effective when the general behaviour of society is aligned with ethical values and attitudes, and the unethical behaviour is in the minority.

Jamaica has, however, developed in such a way that it seems as if the unethical behaviour is challenging ethical behaviour as the acceptable way of life. When this happens, the laws are not as meaningful, because the people who have grown up accepting unethical behaviour are the ones who enforce the laws.

So many of us grew up accepting indiscipline on our roads -- drinking while driving, boorish behaviour by taxis and buses -- children in bars and at betting shops, underage drinking and smoking, evasion of taxes, domestic violence, and the list goes on.

The danger of constant exposure to that sort of behaviour is that we accept it as the norm, therefore when the child that grew up in this culture becomes a police officer, he/she turns a blind eye to indiscipline.

The reasons for this acceptable norm of behaviour are complex, and sociologists may need to explain it, but one reason for it is the attitude we had in the 1970s and 1980s, where even the slogan of our tourism campaign was 'Jamaica, no problem'. So Jamaica was a laid-back place for both locals and tourists. We could consume alcohol and drive, play music at anytime of the night, tourist harassment was seen as hustling, and if the authorities came down on someone for breaking the law, the attitude was "Bwoy, look how dem fighting down the poor man."

The result of all of this was that anyone who wanted to enforce the law was seen as unreasonable, and this was in no small way promoted by the attitude of politics and the politicians.

So when the political parties had rallies, it was okay for the supporters to hang outside of the buses and destroy property as they travelled to meetings. Some will remember when the supporters, under the influence of political fever, would smash the windows of stores and engage in violent confrontations. In fact, there was a time when political meetings were being held that the law-abiding citizen would stay off the road and allow the law breakers to gain acceptance.

Combine all of this breakdown in proper behaviour with the fact that around the end of the 1980s to today, the role model of many young people became the deejay and the area don. As Bunny said, when he was growing up everyone wanted to be a lawyer, doctor, accountant, nurse, teacher, or other professional.

Today, I see some change as people look to become sports personalities or entrepreneurs, but the values and attitudes have still not improved.

By the late 2000s, the politicians, many of whom helped to create the societal indiscipline, decided that out of necessity we needed to change it for the better. By that time there was a serious breakdown in values, and the two generations that Bunny referred to did not know how to be productive contributors, and this is reflected in the type of music we produce.

So the lyrics of music today tell the children -- who are encouraged by their parents to gyrate to it -- that they must take advantage of the other sex or glorify the gun culture. This, of course, didn't start today, as in the late 1960s to 1970s the "rude boy" culture started to find its way into songs, in response to the perceived social oppression of the time. But at that time there was still respect for authority.

So today, the Government is trying to change that lack of disrespect for authority and indiscipline. The problem is that after decades of acceptable social decay, any attempt to change it will meet resistance. So when Dr Omar Davies tries to introduce discipline to the transport system, the response is protest and demonstration.

When the police try to maintain road discipline or deal with night noise, the patrons come down on them as "fighting against" people who want to make a living. When the tax authorities try to deal with tax evasion they face an uphill battle.

If, however, we want to create a country that is the preferred place to live, raise families, work, and invest, then we must create a society where the rule of law and order is paramount. The only way for us to create this is to ensure that engrained in all of us, as law-abiding citizens, is the desire to always do the right thing. This is not something that can be enforced by application of the law only. It must be learned as a way of life.

As I said to Bunny, I grew up learning from my parents that I should always do the right thing, no matter what the immediate consequences, as this is the only way to hold your head high over time. But how many of us have been able to learn that, given that many of the parents -- themselves teenagers -- were not prepared with that knowledge, much more to teach it.

In fact, the school curriculum never taught you, and still doesn't teach you, to be a good parent or a good citizen. I would go as far as to say that some teachers themselves are not good role models for the children they lead, as they themselves lacked the grounding in proper values and attitudes.

So thanks for the conversation, Bunny. Indeed, if we are to develop a society aligned with Vision 2030, then I don't think it is possible without us changing our values and attitudes, as we could end up with a lot of money but an undisciplined society.

Why private sector-led growth is good for earnings

THE recent Observer report that 7,000 professionals have left Jamaica over the past few years has received much attention. We all know that teachers, nurses, engineers, accountants, and other professionals have been making the trek up north in the hope of either finding employment or seeking better salaries.

This "brain migration" is definitely the best way to exploit the value of these trained minds, primarily through remittances. The greater value is to have them stay in Jamaica and contribute their minds, through ideas and innovation in services and products. You only have to think about the impact of someone like Steve Jobs on the American economy versus any remittances that might have been sent back to another country.

In other words, the value of one idea can be worth much more than the remittances from one million or more people on the economy where the idea is developed.

The question we should ask ourselves is, how can

Canada, or the US, compensate Jamaican-trained professionals more than we can afford to do? Why can't we pay our own professionals more than they can demand in another country? For example, why are Jamaican-trained teachers and nurses able to command higher salaries in North America, and other countries, than they do here? After all, the act of a plane trip doesn't automatically transform them into higher-earning individuals.

It is important to understand this if we are to seriously attack the problem of relatively low wages in Jamaica, and my view is that the reason for this imbalance has to do with the size of the private sector in the economy in relation to the size of government.

In other words, private sector-led economies are always, on the whole, more productive and innovative, and it is productivity and innovation that drive value, which in turn drive financial reward, whether at the organisational or personal level.

This drive for productivity and innovation is, of course, driven by the profit motive, as economics teaches us. In other words, people will always find ways to be more productive and innovate in circumstances where they are rewarded with something they desire. So the motivation doesn't necessarily have to be money.

However, our motivations are driven by

what Organisational Behaviour studies refer to as Maslow's Hierarchy of Needs. In other words, at the basic level man is motivated by food and shelter, but after he acquires enough food and shelter his motivation is more influenced by other things such as clothing style, car, house, education, etc.

At the highest level the motivation is self-actualisation, which is why many billionaires become philanthropists. That is because they are more motivated by being recognised for doing good than for making much more money.

It is this same reasoning that drives the profit motive for companies, that causes economies to grow, value to be added, and similar employees in prosperous countries to be rewarded more than poorer countries.

And it is the absence of this structure that has caused relatively lower wages in Jamaica. In other words, the declining levels of productivity in Jamaica have been the primary problem, which simply means that if your output per hour is declining, then obviously your income per hour must also be declining.

So the key to greater wages, and ultimately sustainable economic growth, is to improve productivity. It is therefore important to understand what causes our declining productivity and the consequence of relatively lower GDP per capita and lower wages.

Arguments are made that the high level of public sector employment is a major problem. However, when you compare Jamaica's percentage of workers in the public sector to other countries like the US and UK, the rates are pretty similar. In fact, some countries that have had significant economic challenges have had a lower rate employed in the public sector.

This is because it is not how many people are employed in the public sector but rather what are the productivity levels in the public sector, in terms of delivering public services and goods. In other words, the efficiency of the bureaucracy is key to determining productivity and explain why bureaucracy is such a big inhibitor to Jamaica's growth.

What is also important for the private sector is that greater facilitation is made for the more innovative ideas to succeed and for workers to be rewarded based on their productivity. And this is the reason that the minimum wage by itself cannot improve living standards, even though a minimum level is important to prevent exploitation. Moving wages by legislation does not guarantee improved living standards; instead, it has the opposite effect of increasing inflation.

So in both the public and private sectors the only real living standard improvements must come from greater productivity and innovation through delivering goods and services that consumers want. Simply increasing productivity and being innovative do not, by themselves, guarantee greater financial returns, but must be coupled with a consumer demand for what is being produced.

How does the private sector address this? If a company produces goods and services which are not in demand, that company will go out of business. On the public sector side, however, this must be carefully looked at by the policy makers to ensure that whatever services are being provided are in demand.

So duplication of effort by public sector bodies or legislating that the public pay for unnecessary services is merely increasing costs and reducing productivity. Also, providing much-needed services inefficiently has the same effect.

This is why the legislative and competitive environment changes being undertaken under the current economic and monetary programme are so important, and welcome. However, it must go further to ensure that the delivery of services by the bureaucracy is as efficient as it can be.

If we can achieve this, and ensure that we facilitate the profit motive of the private sector (ensuring, of course, it is legal, fair, and accessible to all), then we will eventually start seeing greater productivity and wages moving to the levels of other countries.