Food and climate are our medicine. Health is not only about sickness
but primarily about well-being.
In 2020, the severe secondary effects of the coronavirus pandemic have put the health and well-being of our community high on the national policy agenda. A return to normal pre-corona conditions is not an option, as they were far from optimal. A large proportion of the Curaçaoan community then suffered from avoidable health problems, experience inequitable access to health services, had to navigate their way in the fragmented organization of healthcare delivery, and were rarely considered in national policy initiatives. Instead, it was understood that the coronavirus crisis offered a unique and valuable opportunity to improve on the status quo, thereby advancing the long-term health, resilience, and productivity of our community – in the meanwhile preparing them for future challenges that will, undoubtedly, come.
In 2030, after years of increasing health deprivation of the Curaçaoan population relative to the Netherlands and other politically affiliated Caribbean states, Curaçao is back on track to reach one of the highest life expectancies in the Caribbean again. The paradigm shift from curative healthcare to a broader understanding of health is well underway. We try not only to make sick people better but also to keep healthy people healthy. It is now widely understood that the unequal distribution of social and economic factors as education, housing, income, and employment produces significant inequities in health, and therefore requires appropriate policy responses. People from all backgrounds now have the opportunity to live and work in healthy environments, to eat healthy nutrition, to fall back on a social safety net, to attend quality educational facilities, and to access healthcare services equally. Moreover, substantial efforts have been made on collective health protection measures such as road safety, improving water and air quality, waste disposal, and sewage systems, and translated intangible results.
In 2030, there is a strong and continuous political commitment to improve and protect the health of our small island community, thereby acknowledging the World Health Organization’s vision that the highest achievable level of mental and physical health is a fundamental human right. Politicians, policymakers, and public servants, through a coherent network of government, community, private, and nonprofit organizations, strive for the provision of high-quality health and social services. Guided by sound research, relevant and timely information is available for decision-makers to prioritize policy areas of suboptimal performance. As these areas are likely to produce the most significant benefits for the community, the scarce resources are deployed with emphasis on optimizing existing services and introducing effective interventions. In these endeavors, strong collaborations between local and Dutch health organizations provide the required level of scale, adequate tools and knowledge, and sufficient financial and human resources to tackle the complex challenges our community faces.
The Covid-19 crisis will bring many opportunities and new challenges as well.
We see (2020) centralized government interventions globally. Depending on the political situation, these interventions vary from very harsh (total lockdowns) to more modest interventions.
What we also see is that there are numerous initiatives that would not have evolved otherwise. All of sudden it is possible to have meetings and conversations online—work from home. Consulting doctors through an e-consult seems possible. One of the young entrepreneurs here at Curaçao started a 3-D printing company to manufacture face masks for healthcare workers. His issue: upscaling. Who will help him to create a sustainable business out of this? The question for him will be to find scale amidst a global eruption of similar initiatives. Curaçao is small and needs to open up to the world.
When it comes to health and well-being, Curaçao will need a sustainable approach to prevent people from becoming one of the many with a chronic disease. There have been many plans and initiatives to focus on this topic. Curaçao has too many cases of obesity, diabetes, etcetera that eventually result in multiple organ failure. Implementation obviously has failed. What I ask people to focus on, while discussing Curaçao 2030 is “how do we make sure that implementation will not be a failure again”.
Curaçao, according to government documents, has five major problems in healthcare:
Medication is too expensive (generic drugs are much cheaper, but the procurement monopolies need to transform)
The income of independent consultants are on the higher side (the CMC has since its opening a proper and regulated income structure for its consultants which includes appropriate incentives for quantity and quality of care provided)
Too many patients are sent abroad for treatment (this may decrease since the new CMC has more facilities and fresh consultants available)
Hospital care is expensive (due to the disastrous history of the construction of the CMC) and
Prevention and lifestyle management are lacking.
Looking forward to 2030 and beyond, the most significant challenge will be number 5 on the list. Numbers 1,2, and 3 might be brought under control somehow if the government is able and willing to intervene with focus on sustainable healthcare for all.
Now the discussion is on the table on how to intervene massively in the field of lifestyle and prevention of chronic diseases. This relates to access to primary care (including the growing number of refugees), changing food and drinking habits, proper housing, and sanitation, etcetera. The population needs to be massively educated, and there are many case studies available globally to learn from on how to do this. Besides the family doctor (whose reimbursement system needs a critical review as well), we need family health workers in the communities, barbers that help educate people on healthy habits, proper income for the lowest strata of the community. Technology might help since the whole world seems to be supported by smartphone apps, but I suspect that this is a much more deeply rooted problem that needs explicit attention in the 2030 debate.
There should be an independent partnership where organizations and formal networks, active in care and welfare, unite to contribute to the continuous improvement of cohesion, quality, and efficiency of the health care and welfare of the people on the island.
We need a partnership where the network within which joint agreements are made; the meeting place and ‘development place’ with room for debate and vision development; the center for result and future-oriented cooperation; the connecting link and point of contact for stakeholders in care and welfare; the center of bundled knowledge and expertise. Many fields of activity are included in the areas of healthcare, cure, and well-being (prevention, social domain).
Fields of activity:
Nursing and caring
Care for the disabled
Well-being, including the social domain, such as youth care, guidance, and daytime activities and the social participation of people with a distance to the labor market
General practitioner care
Specific care provisions, such as ambulance care, signaling and alerting.
The client/patient is able to obtain and maintain control over his well-being, care, and treatment, with or without the support of informal care, professional care providers and well-being professionals and technological aids;
Through continuous attention to prevention, the improvement of health care, the connection between care and welfare, the welfare and health of citizens in Curaçao;
Healthcare is of a good and affordable level; accessible, available and affordable; basic care close to home and specialized care-centered;
The quality and safety of care provision, support and information transfer is anchored in all care processes and care chains and networks in the field of care and welfare;
The connection and cooperation between care and welfare are optimal and anchored. By joining forces, integrated and coordinated services in the field of care and welfare are possible.
There is optimal and proactive cooperation at all levels of sub-sectors, institutions, and organizations, with as few barriers as possible in the transfer of clients and patients and taking into account a constantly changing context;
Sufficient care and welfare professionals are available.
Integrated Care and Welfare: whereby all organizations work together optimally in care chains and networks so that the patient or client receives the best possible care and support. Transparent and optimal cooperation with GMN, interest organizations, and funders of care and welfare. Quality and safety of care provision, employees, and information transfer are paramount.
Prevention: Prevention has a central place in health care. Eating healthier, not smoking, drinking less, and exercising more promotes health and reduces the demand for care. Professional care providers also have a task in this, as well as welfare professionals. They identify, take the lead, and set a good example of a healthy lifestyle.
Participation- participation makes you healthy: Many health problems are not isolated but are related to behavior and the social environment (family, relationships, work, income, education level, and housing). Participation - in society, work, and training - promotes well-being and health.
Curaçao has a low unemployment rate. Everybody will have a job, and the government will subsidize some jobs. On the job training is the way of the future. There is a form of Universal Basic Income (UBI) replacing the so-called “onderstand”. Poverty will be reduced by offering excellent education and creating meaningful jobs.