St Helena Online

Tag: diabetes

St Helena shows UK the way with fizzy drinks tax

St Helena appears to be showing Britain the way to tackle obesity, by introducing a sugar tax.

A levy on high-sugar drinks was announced in the island’s budget in the very month that England’s chief medical officer warned that the British government might have to consider such a measure.

But Dame Sally Davies said she hoped it would not be needed in the UK.

St Helena Government (SHG) is introducing the 75p-per-litre excise duty from May.

It is a move that some on the island have long campaigned for, including shop owner Nick Thorpe, who sees the vast scale of imports of sugary foods and drinks.

The island is reported to import nearly a million cans of fizzy drinks per year, for a population of just over 4,000 people.

The island’s incidence of type 2 diabetes, which is linked to obesity, is among the highest in the world. The government has warned that the cost of treating the condition has put a massive strain on the island’s health service, as well as damaging the lives of diabetics.

The new budget includes an additional £692,000 for the health service, and more than £1.5 million has been set aside to fund infrastructure improvements to the hospital, including the furnishing of a diagnostic suite.

Colin Owen, the island’s Financial Secretary, said: “The introduction of a new tax on high-sugar drinks and higher-than-inflation increases on tobacco form part of a raft of measures which demonstrate that SHG takes the health of St Helena seriously.”

He also announced the introduction of liquor duty at £3.50 per litre, and a new duty of £1 per litre for drinks with an alcoholic content of 3% or below.

Councillor Ian Rummery pointed out the timeliness of the move in an email to St Helena Online. He wrote:

“I see that a sugar/fat tax is being debated in the UK media with statements from Dame Sally Davies, the Medical Officer, and the BBC World Service Business Matters programme has a week-long special on obesity and discussions on a fat tax.

“While the world talks about it, here on St Helena we have just introduced a tax on sugary carbonated drinks.”

Dame Sally first raised the prospect of a sugar tax in comments to the UK Parliament’s Health Select Committee. She also suggested that sugar might be addictive – though some scientists disagreed.

In his budget speech, Mr Owen said: “On St Helena, over 300,000 litres of carbonated sugar sweetened beverages are imported per year.

“This equates to around 67 litres per year for each person currently on island, each of us drinking around 200 cans a year. Within this, some people will consume very little, while others may consume many more.

“Just to be clear on the figures, we import just under ONE MILLION cans of fizzy soft drinks each year. And each can on average contains over 35 grams of sugar.

“We currently have a very high rate of obesity, and type 2 diabetes. This has a very high cost to the St Helena health service and there is significant evidence to show direct links.

“Every additional regular can-sized, sugar-sweetened drink per day, increases the risk of developing type 2 diabetes by 18%.

“A number of studies document a link between fizzy soft drink consumption and higher blood pressure.

“And dental health is negatively influenced by consumption. Studies have shown that consumption nearly doubles the risk of dental cavities in children.”

He added that healthier diet drinks were currently more expensive than high-sugar drinks, especially those from South Africa.

“Research has shown that increasing the price of fizzy soft drinks will lead to a fall in consumption, as consumers switch to alternatives.”

The island budget also included a range of tax increases for alcohol, and a 5% increase in tax on all tobacco goods, taking the cost of a packet of 20 cigarettes to just under £5.

Mr Owen said: “The rate of throat cancer on island is one and half times more than the UK, the highest risk factors for throat cancer being smoking and drinking alcohol to excess. This above-inflation increase supports the health service.”

In his speech to Legislative Council on Friday, 21 March 2014, Mr Owen said:

“Madam Speaker this budget is different. It seeks to support not just economic development, but to support SHG’s top priority, health – and not just the health of individuals but that of the nation.

“I do not believe it’s right anymore to sit on the sidelines. We need to grab every opportunity available to support our health and green objectives, and that includes using the tax system to provide appropriate financial incentives. We need to change our tax policies to address the growing number of concerns around diabetes and cancers.”

He said the budget had been compiled by councillors, not just officials, which had brought fresh ideas.

Killer diabetes puts island under strain, says the Castle
Diabetes cases soar as island struggles with cost of healthcare
My sadness and anger at diabetes crisis, by writer Doreen

Plastic bag tax aims to cut landfill waste

The budget included new taxes of 5p on plastic bags and 1p on styrofoam containers for takeaway foods – both excise taxes, imposed within the island, as opposed to customs duties.

Mr Owen said: “Both products are made from petroleum and are not degradable. St Helena does not have the facilities to dispose of them and they end up in the landfill.

“Roughly 500,000 bags and containers are used per year and this is only likely to increase as tourism grows. Similar policies to reduce use of plastic bags have been very successful in places such as Wales.”

Budget facts

In his budget speech, Mr Owen said:

Prices in island shops rose by only 1.5%, against a forecast of just over 5%. But it was expected to rise during 2014.

The resident population averaged 4,297 people through 2013, and is forecast to reach to nearly 4,500 people in 2014.

More than 360 Saints were working on the airport project and unemployment was at an all-time low, with vacancies in government and the private sector. In total, 550 people were working on the project.

Income tax was set to have raised £3.4 million, some £325k ahead of targets.

Saints are letting out more properties than ever before.

Earnings from customs duties on alcohol and tobacco exceeded targets by £115,000 and £10,000.

The offshore fishing vessel MFV Extractor had been purchased, partly with funds from Enterprise St Helena (ESH) and would soon be leaving Cape Town to fish St Helena’s seamounts.

ESH had assisted in 30 youth training schemes and five public-private partnerships. More than 40 people enrolled as apprentices.

A 30-year planned maintenance programme for government housing began with the rewiring of flats in Jamestown.

Planning permission was granted for 65 homes in Half Tree Hollow, featuring wheelchair access and rainwater harvesting.

Two new “chuck and chew” waste lorries had been procured, along with 1,500 new wheelie bins.

Four conservation and environmental projects, due to start in April 2014, attracted grants worth more than £260,000.

Significant advances were made in standards of education. Almost half of the young people who took GCSEs in 2013 achieved a C grade or better in English and maths.

Mr Owen also said that December 2013 saw the introduction of a Minimum Income Standard. “St Helena should be proud that it is leading the world in ensuring that our benefits system properly reflects the actual costs of living here,” he said.

“This will be reviewed at least annually, with benefits adjusted accordingly – a tangible demonstration of our commitment to protect the most vulnerable from the rising cost of living. But this is only a starting point and we all know that there is much more to do.”

Other recommendations in the Sainsbury Report, commissioned from York University, would be considered over a five-year period – including a child benefit allowance, which the government planned to introduce from April 2015.

But he added: “Bringing benefits up to the level that we all see as desirable will be expensive, and to introduce every proposed reform now would simply be unaffordable.”

A settlement of £13.55 million in UK aid was confirmed on 13 March 2014 – an increase of £150,000 – with a further £4.5 million to cover the running costs refurbishment of the RMS St Helena.

The amount set aside for overseas medical referrals rose to £947,000, more than double the previous year’s figure.

Mr Owen said the budget also reconfirmed the government’s funding for the National Trust, New Horizons, Heritage Society and South Atlantic Media Services, and saw increased funding to SHAPE and the Public Solicitors Office, along with new funding for the Human Rights Office.

European funding of around 21.5 million Euros was likely to be made available for infrastructure development on St Helena, Tristan da Cunha and Ascension Island over the period 2016-20. Specific projects had yet to be formally agreed.

Children in danger from diet and poor exercise, warns medic

Young people on St Helena are being led into the grip of some of the medical world’s biggest killers, a departing doctor has warned.

Dr Ahmad Risk delivered his warning after two months as a temporary “locum” medic in Jamestown – watching parents ply their children with sugary drinks and salty food that could be cutting their lives short. 

And he said the whole community must play its part in fending off the disease – including families, teachers and the government.

The incidence of diabetes on St Helena is already five times as high as the global average. It has been blamed for more than six out of ten recent deaths on the island.

But poor diet and lack of exercise among modern-day children could make the scale of the problem even greater in the future.

Research shows obesity in childhood puts people at far greater risk of diabetes and other serious health problems in later life.

That means the sugary drinks and processed food the children consume today is greatly increasing the danger of dying prematurely, decades down the line.

Lack of fresh food makes the problem far more challenging, Dr Risk told Saint FM Community Radio, in an interview broadcast the day after his departure from the island.

He said: “We are bringing up a generation on processed food and canned food. These foods are notorious for their fat content, their sugar content, their salt content.

“And that’s dangerous.

“We are really leading a generation into one of the biggest killers in the medical world: diabetes, hypertension and heart disease.”

On 1 March 2013 there were 645 islanders being treated for the condition out of a population of just over 4,000 – nearly all with the avoidable type-2 strain, which doubles the risk of early death.

St Helena Government has warned that the high cost of treatment is crippling the island’s over-stretched health service, as well as causing a massive social cost – with too many people unable to work because of it.

Officials have taken serious steps to manage diabetes, appointing a specialist nurse running frequent clinics around the island.

But Dr Ahmed – who has 40 years’ medical experience around the world – said action needed to start with the very young.

He said: “I would like to put the responsibility on the family, on the parents and the schools.

“It has to start with the really young ones and it has to start within the home. We need to educate, raise awareness, and make the availability of good food a reality.

But he admitted: “You can’t tell people ‘You must eat fresh fruit and veg’, if they can’t find them or they are too expensive. Frozen veg are okay but not as good as fresh veg.

“So it’s a shared responsibility. The community as a whole – whether it’s government or the entrepreneurs or the industrialists on the island – need to do their share.

“This island used to supply a thousand ships a year. There’s plenty of land, plenty of talent, plenty of people who can can grow things. The island has very fertile soil – you can grow anything you want here.

“I don’t know why this is not happening.”

Lack of exercise among young people was leading to greater levels of obesity, he said.

“I find that the older people actually do more exercise than the younger people. They walk up the hill, and walk down the hill.”

Among adults, high consumption of alcohol is adding yet further to the rates of obesity, diabetes and heart disease, said Dr Risk.

He predicted that future tourists arriving by air would demand higher levels of health care.

But he said: “We need to think of the Saint population, particularly the young people of St Helena. If we do not look after their health and education now, then we are really being hostage to the future.” 

Food is the key to island life – and tackling its health crisis
Killer diabetes puts island under strain, says the Castle
Diabetes cases soar as island struggles with cost of healthcare

Health effects of childhood obesity – US health website

Food is the key to island life – and tackling its health crisis

A new body to promote food and healthy eating on St Helena is proposed in the island’s draft agriculture policy – even though it says food is already at the heart of island life.

And it says the new organisation could “make a significant contribution” to tackling hypertension by encouraging healthy eating. The island has one of the world’s highest rates for diabetes, which is strongly linked to poor diet.

The paper says agriculture is seen as having an increasing role in improving health, as well as being important to tourism.

The new body could provide recipes, encourage people to grow their own food, hold tasting sessions, monitor labelling and safety, and even set up an annual food fair, says the Growing Forward paper.

“The refurbishment of the market building will provide a focal point for the showcasing of local agricultural produce,” it says, “and bring growers and producers closer to each other and the community.”

The paper says new policy must take into account the island’s culture.

“Agriculture and food production, while very much viewed and managed as businesses, are also considered by those involved to be part of a way of life and a vocation,” it says.

“Change can be difficult in any case but can be especially challenging in a rural context where flexibility and mobility is constrained by low incomes, lack of other opportunities, lower educational attainment, a higher age profile and limited access to capital.

“The people of St Helena are highly skilled in the art of cooking and entertaining. Social unity and cohesion is food-centred on the island.

“Any agricultural policy that can assist in maintaining and developing this aspect of life is making a useful contribution to the social health and well-being of the islanders.”

Killer diabetes puts island under strain, says the Castle
Cut-price foods that left island with a bulging health problem

My sadness and anger at diabetes crisis, by writer Doreen

Doreen Gatien 100One in seven people on St Helena has diabetes – one of the highest rates for the disease on the planet. The scale of the crisis moved DOREEN GATIEN, a Saint writer now living in California, to make a cry from the heart.  

To say that I am really sorry to hear about the diabetes statistics at home is an understatement.

When I visited home, I would be both sad and angry at some of the reports from people about simple testing that is absolutely necessary, but not available. For example, mammograms.

Friends told me, “I guess they don’t have the money.” Oh, really?  I asked them, why wouldn’t the women in St Helena have access to this very important testing? Who was responsible?

We wondered why such an increase in St Helena in this disease, and that it was not caught until it reached an advanced stage! Are we still wondering?

Studies show that patients with diabetes have an increased risk of breast and uterine cancers. I am unsure if mammogram testing has since become available.

So, here I am again in 2013, with these same emotions: sadness and anger, as a nurse and as a Christian.

I am asking again, what or who is responsible for the outrageous number of diabetes patients? Is it diet alone?

Dealing with diabetes can be a strain: keeping up with daily care, and worrying about your future health. It takes strength, support and motivation to stay ahead.

I also grew up eating too many sugars. The island did not have access to as many different foods as it has now. So suckers, chocolates, sweets, iced cakes and many more of the like were our treats.

But now I am aware that complex carbohydrates are better choices than sugar. Now I always read labels.

Be aware there are “hidden” sugars in foods such as soft drinks (drink water instead), canned fruit, chocolate cake, chocolates, ice cream, jam and many more. 

And as you thank your merchants for what they are already doing to help with the diabetes crisis, I encourage you to request lots more healthy imported foods, and remember it is always better to pay a little more, because as the saying goes, “you get what you pay for.” 

So as I ponder the sad and deathly health situation at home, here is what I can share from afar. You might know all of this already, but I am sending it anyway with all of the love and deep concern in my heart, from a fellow Saint:

  • The first step to coping is acceptance
  • Each of the treatment tools for diabetes has a purpose, and each is important
  • Exercise: first element needed in a comprehensive diabetes lifestyle (we have such a beautiful island to walk over, easy access to the ocean and swimming pool, Jacobs Ladder – only 699 steps. Smile: you don’t have to do all)
  • Proper diet: using good sources of soluble and insoluble fibre

For diabetics, a high-carbohydrate, high-fibre diet:

  • Reduces levels of serum cholesterol and triglycerides
  • Reduces blood pressure in those with hypertension
  • Reduces risk of death from heart disease
  • Improves gastrointestinal function
  • Reduces body weight in the obese
  • Reduces risk of kidney damage
  • Reduces insulin requirements
  • Improves glycemic control.

Often our fear of change is driven by ignorance. Find a good cookbook, ask questions.

Remember, a healthy lifestyle is rewarding for diabetics and non-diabetics. And above all, fresh foods and wholefoods will always be the best choice in helping you to win the fight against the dreaded diabetes.

Killer diabetes puts island under strain, says the Castle
Diabetes cases soar as island struggles with cost of healthcare

Simplicity makes Ladder Hill life so beautiful

Killer diabetes puts island under strain, says the Castle

A rapid rise in diabetes cases is putting putting massive pressure on St Helena’s economy – as well as wrecking lives.

The island now has one of the worst rates of type 2 diabetes in the world, per head of population.

St Helena Government says the steep rise is partly down to increased testing, as part of a concerted fight against the disease.

On 1 March 2013 there were 645 islanders being treated for the condition, which doubles the risk of early death. That is roughly one in seven people on the island.

A statement from The Castle is blunt about the human costs of the disease – including as a cause of heart attacks.

“Of the 18 people who died from myocardial infarcts last year, 13 had diabetes.  More than half of other deaths had diabetes as a contributing factor.”

And it makes it clear the impact is felt far beyond the patients and their families.

“This high incidence places a tremendous burden on the health system in terms of man hours, the cost of medication, the cost of laboratory tests and the treatment of complications from diabetes,” says the statement.

“Absenteeism or early retirement and the cost of caring for people who are debilitated due to complications are a burden on the St Helena economy.”

It adds: “The prevalence of diabetes on St Helena is three times that of the UK and five times the global rate.

“Ten per cent of the current diabetics have been diagnosed in the last year.

“The high number of new cases is due to increased testing by the medical staff, increased awareness, and the ageing population.”

Although people of African and Asian descent are more prone to the disease, the government is clear about where the responsibility lies.

“Diabetes is preventable,” it says. “An active lifestyle and a healthy diet is all that is needed.”

SEE ALSO: Diabetes cases soar as island struggles with cost of healthcare

Diabetes cases soar as island struggles with cost of healthcare

One in seven people on St Helena has been diagnosed with diabetes – an increase of more than ten per cent in just two years.

On 1 March 2013 there were 645 islanders being treated for the disease, which doubles the risk of early death. 

In March 2011, the figure was “about 570”, according to a government report.

With a population of 4,247 people, the new figure gives the island one of the highest rates of diabetes in the world.

Treating the condition is putting massive pressure on St Helena’s health service, just as spending is being cut.

In the UK, the £9.8 billion annual cost of treating three million diabetics has prompted talk of a financial crisis for the National Health Service.  

And the incidence of diabetes on St Helena is five times as high as Britain’s.

A global increase in cases has been blamed on poor diet, increasing obesity and lack of exercise, along with smoking – all acknowledged problems on St Helena.

The World Health Organisation says that half of people with diabetes die of cardiovascular disease – mainly heart disease and strokes. Another 10-20 per cent die of kidney failure, it says.

The disease can damage the heart, blood vessels, eyes, kidneys and nerves. Two per cent of diabetics go blind after 15 years with the disease, and one in ten has severe loss of eyesight.

Other complications can lead to leg amputations.  

All but 16 patients on St Helena have type 2 diabetes, which usually appears well into adulthood. More than half are over 65.

Many Saints are genetically prone to fall victim to the disease, but onset of type 2 diabetes can be delayed or prevented by living a healthier lifestyle.

That includes avoiding tobacco and excess sugar, eating fresh fruit, and taking at least 30 minutes of moderate exercise each day.

But fresh food is expensive on St Helena, and many people consume fizzy drinks from South Africa that are very high in sugar.

The island’s most popular dishes also add to the risk of diabetes – including rice-based “plo”.

Concerns have also been raised about a lack of adequate sports facilities on the island.

Nick Thorpe, owner of various shops across the island, is candid about Saints’ appetite for unhealthy drinks.

“I reckon we import a container of fizzy drinks every six weeks,” he said. “Stocks are low at present. However, we have enough Coke to float a small cruiser.”

He has produced an inventory showing 73,740 packets of cigarettes – mostly State Express 555 – and 18,696 cans of Coca Cola, along with more than 35,000 cans of other brands.

High import duties on unhealthy food and drink was removed by the government to simplify that taxation system.

A specialist nurse runs diabetic clinics across the island, and many people have been given help with nutrition.

Hypertension is also a serious issue on the island, with a current caseload of 1,269 patients. Of those, 94 per cent have been evaluated by health staff in the past year, with 86 per cent of them reaching a target for managing blood pressure.

The figures for hypertension and diabetes were requested by St Helena Online after the February 2013 visit of UK aid advisers. Their report said health workers were successfully performing annual checks on diabetics, but a target for patients with blood glucose levels under control was unlikely to be met.

Diabetes target ‘unlikely to be met’
Cut-price foods that left island with a bulging health problem

Cut-price foods that left island with a bulging health problem

St Helena no longer has the highest incidence of type-2 diabetes in the world, but that’s only because it’s got even worse elsewhere. Cheap imports of sweet milk and rice may have kept Saints from starvation in harder times, but now the island’s health service is struggling with the consequences, says MIKE THORPE. A target for treating diabetics has been met, but another has not. 

The scale of diabetes on St Helena is hardly surprising when you look at the past in relation to this disease.

The government used to subsidise sugar, rice, flour, cheese, lard and evaporated milk, and control the price of bread. The staple diet some thirty years ago was curry and rice or fish and rice, maybe some cabbage. Tea was always served with lots of sugar and neat evaporated milk.

The wages were low and a treat was a tin of peaches – with more evaporated milk. For a drink, the children were given a syrup that was a mixture of sugar, water, citric acid and food colouring, which was diluted with more water.

Because these products were subsidised, that was all people could afford to live on.

The slaves that landed on the island and stayed were the ones that might not have survived the journey to the Americas, so not the healthiest stock to start with.

I have been asking for ages if someone will DNA-test the island before we get all mixed up with the influx from the airport: diabetes runs in families.

The government subsidies worked as a short-term fix, but I’m not sure it has helped in the long run.

Diabetes target ‘unlikely to be met’

Diabetes target ‘unlikely to be met’

Mixed results have been reported on efforts to tackle St Helena’s massive diabetes problem – one of the worst in the world.

Health workers have succeeded in performing annual checks on registered diabetics, according to the aide memoire issued at the end of the annual Development Assistance Planning Mission from the UK.

But it adds: “The 51% target for patients with blood glucose levels under control is unlikely to be achieved.”

The last figures published – in 2011 – showed there were 570 diagnosed diabetics on the island, most with the type 2 version of the condition.

Hypertension was also a serious issue.

Diabetic clinics had been set up on the island, led by a specialist nurse, though at one point the service came under strain because of staff shortages.

The condition is linked to obesity and poor diet, as well as genetic factors.

The health service had seen “generally good” performance in dealing with non-communicable diseases.

Some UK funding from the Health Link 3 project, which ended in March 2012, had still not been spent. Agreement was needed on how it should be used, said the aide memoire.



Campaign starts as smoking age rises to 18 (comment added)

Teenage smokers on St Helena will find their habit becomes illegal in public places from September 2012 – with the risk of a £500 fine if they break the new rules. At the moment, young people can legally smoke from their 16th birthday, but the minimum age will rise to 18.

The law does not put any lower age limit on smoking in private places.

A campaign has now started to help people on the island adjust to new legislation, which will also ban smoking in some buildings, and public transport. A competition to design “smoking kills” posters has been launched in schools.

The island has a significant problem with smoking, which is a cause of diabetes as well as numerous cancers.

The last government report on St Helena’s health service, issued early in 2011, said there were 570 diagnosed diabetics on the island out of a population of around 4,000 people – giving it one of the highest rates of diabetes in the world.

Two brands of cigarettes are among the five top-selling items at Thorpe’s stores, along with Coca Cola – fizzy drinks with high sugar content are also a factor in diabetes. Nick Thorpe says cigarettes are among the first goods to sell out on the island after new deliveries.

Retailers who sell cigarettes to under-18s will face a fine of up to £1,000 once the Tobacco Control Ordinance becomes law.

Anyone found smoking in a smoke-free place may be fined up to £300. Owners of premises or vehicles that are covered by the new law face the same fine for failing to display “no smoking” signs. Owners who fail to stop people from smoking in their smoke free premises may be fined up to £500.

Read more about the smoking campaign from St Helena Government here.


The UK should follow Saint Helena’s lead. Smoking is horrible! I refuse to date any guy who smokes – it makes you stink!

Amy Du Prez, London
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