When budget time comes around, most Bahamians focus on taxes, incentives, expenditure, the deficit and the national debt.
What is almost never discussed is the impact budgetary support for youth development, maternal and child health, and healthy lifestyles initiatives can have on the country’s ability to make inroads into crime, poverty, incidence of chronic noncommunicable diseases, unemployment and lack of productivity.
Our society is keen on compartmentalization.
We recognize deficiencies in individual social categories, but we do not often take the time to recognize how weaknesses in one area affect the viability and success of another area.
This narrow quality of thinking often manifests itself in a lack of synergy when it comes to policymaking.
In short, maternal and child health, parenting dynamics, youth opportunities, as well as nutrition and lifestyle choices, all ultimately correlate with scholastic performance, productivity in the workplace, economic output, public expenditure for health care, and levels of crime and social stability.
National budgets are about choices, and they tell us not only where a government’s priorities lie, but can also provide hints at what a society values most.
It is true that the higher the country’s debt burden as expressed through its ratio of debt to gross domestic product, the more difficult it is to allocate increased funding to diverse programs.
What is also true is that traditionally, key social and wellness programs and initiatives have not been given the budgetary priority commensurate with their far-reaching importance.
When serious crime is on an uptick in the country, lawmakers predictably offer commentary on the need to find ways to address causes of criminality, particularly when young people are the perpetrators or victims.
Those who study the budget each fiscal year would know that allocations for many of the country’s youth development programs have not received increases in many years, and in some notable cases have decreased.
Overall, the allocations seem but a drop in the bucket investment into the lives of youngsters nationwide.
Youth development programs are important for children and teens because they address their social and physical needs, and well-structured programs nurture talents and equip youngsters with positive life skills for adulthood.
Regarding positive youth programs, research indicates that young people who are surrounded by a variety of opportunities for positive encounters engage in less risky behavior and ultimately show evidence of higher rates of successful transitions into adulthood according to youth.gov, a United States government website that supports the creation, maintenance and strengthening of effective youth programs.
The site adds, “A comprehensive study that looked at more than 200 school-based social-emotional learning programs, found that program participants showed significant improvement in social and emotional skills, attitudes, and academic performance and reductions in internalizing symptoms and risky behaviors.”
Youth development programs in The Bahamas span areas including sports, the arts, entrepreneurial development, character building and leadership.
Perspective compared allocations for youth programs and subventions in the fiscal budget prior to Hurricane Dorian (FY2019/2020), with yearly allocations leading back to the oldest available budget on the Bahamas government’s website (FY2011/2012), with the following findings:
Allocations for the after-school program decreased over the period from $636,000 to $400,000; aid to student athletes decreased from $180,000 to $142,500; contributions to sports, civics and youth organizations decreased from $360,000 to $300,000; Junior Achievement decreased from $200,000 to $190,000; and the allocation to National Youth Ambassadors decreased from $10,000 to $5,000.
Allocations to the Bahamas National Youth Choir, National Youth Orchestra and National Children’s Choir were unchanged at $51,000; $25,000 and $25,000 respectively.
Allocations of $25,000 each to the Boy’s Brigade, Boys Scouts and Girl Guides Association were unchanged, as was the $39,000 allocation to the National Dance Company.
Increases over the period have occurred in the Self-Starter program from $500,000 to $840,000, and a new allocation in 2019 of $170,000 for the National Dance School was included under the Ministry of Youth, Sports and Culture.
At the last census report in 2010, children and adolescents made up over one third (36 percent) of the population, with 125,301 youngsters ages 19 and under, counted in the population of 351,461.
But though the nation’s youth make up over 35 percent of the population, the recurrent budget for the Ministry of Youth, Sports and Culture is less than one percent of the total estimated recurrent expenditure for the 2021/2022 fiscal year.
MATERNAL, CHILD AND FAMILY HEALTH
Hundreds of millions are spent each year in The Bahamas due to chronic noncommunicable diseases (CNCDs), and the viability, health and scholastic potential of thousands of the country’s children are threatened by inadequate nutrition.
The path to chronic noncommunicable diseases brought about by lifestyle choices actually begins at the earliest stages of life, where nutritional choices and eating patterns establish attitudes toward food and diet that can persist into adulthood.
A look at total health sector spending in 2017 reveals that approximately $800 million was spent – 46 percent by the public sector, 25 percent to private insurance, and 29 percent in out of pocket expenses.
The cost of chronic noncommunicable diseases has been estimated at anywhere between $400 million and $500 million annually.
Meanwhile, the country’s infant mortality rate, which is a global indicator of a country’s health and its standard of medical care, education and sanitation, rose from a low of 12.7 infant deaths per 1,000 live births in 2001, to a high of 21.1 in 2009, coming in at 16 in 2016, according to Ministry of Health statistics.
The country’s infant mortality rate in 2016 was well above that of comparable countries in the region.
An enhanced, well-funded and well-resourced focus on child and maternal health is a foundational investment in reversing the trajectory of chronic illness that is limiting the country’s economic potential, assuming a sizable share of public finances, and reducing overall quality of life.
In the upcoming fiscal year, a paltry $10,000 is allocated for the maternal and child health program in the Ministry of Health.
A critical facet of maternal and child health is the role of breastfeeding.
The Bahamas regrettably has one of the lowest breastfeeding rates in the world.
According to the World Health Organization (WHO), “Breastmilk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses. Breastmilk provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one third during the second year of life.
“Breastfed children perform better on intelligence tests, are less likely to be overweight or obese and less prone to diabetes later in life. Women who breastfeed also have a reduced risk of breast and ovarian cancers.”
Moreover, breastfeeding reduces the cost of nutrition for babies because breastmilk is free, which is a significant benefit given the high cost of formula that prompts some mothers to ration serving sizes to their children, thereby leading to newborn and infant malnutrition.
Without adequate intervention, malnourished babies could go on to become malnourished children who struggle in school, and are plagued by health challenges.
The Lactation Unit of the Ministry of Health is woefully underfunded and understaffed, leaving it challenged to make significant inroads into nationwide breastfeeding rates.
Meantime, evidence shows that midwifery is vital to save the lives of mothers and newborns.
The WHO indicates that midwifery encompasses care of women during pregnancy, labor, and the postpartum period, as well as care of the newborn.
It includes measures aimed at preventing health problems in pregnancy, the detection of abnormal conditions, the procurement of medical assistance when necessary, and the execution of emergency measures in the absence of medical help.
For the public healthcare system nationwide, just $70,000 is allocated for midwifery.
Just $15,000 is allocated for the chronic noncommunicable diseases program within the Ministry of Health, and $10,000 is allocated for the national breast cancer initiative.
Impacting lifestyle trends that contribute to a declining level of health in The Bahamas not only takes financial and human resources, but political will.
During his tenure, former Health Minister Dr. Duane Sands announced a removal of sugary drinks from all Ministry of Health facilities, as part of an initiative geared toward healthier lifestyle choices.
It is observed that following his resignation, the sugary drinks were returned – an example of the kind of transient political focus that remains a stumbling block to national progress.
Studies point to a diet of added sugars leading to a higher risk of CNCDs, including diabetes, obesity, non-alcoholic fatty liver disease, cardiovascular disease, cognitive decline and some forms of cancer.
According to Komen Bahamas, health officials estimate that between 300 and 500 new cases of breast cancer are diagnosed in The Bahamas each year, with almost 48 percent of women diagnosed being under the age of 50.
And the WHO’s Global Cancer Observatory estimates that 876 new cases of cancer were diagnosed in The Bahamas last year with 467 deaths.
It puts the number of prevalent cases cancer over a five-year period at 2,555.
Regarding family health, $30,000 is allocated for the national parenting program, and $105,000 is allocated for family planning.
There is little argument that parenting deficiencies are at the heart of social ills plaguing this country.
An expanded national parenting program working with both the public and private sectors, could assist in equipping more parents with skills necessary to better perform their essential role in the society.
Broadening access to family planning services could allow women and men to make better lifestyle decisions, so as to lessen pressures placed on the state by parents who are unable to adequately provide for their children.
Everyone will not become a commercial farmer, but many people can take steps toward feeding themselves by initiating backyard farming.
The allocation for backyard farming in the upcoming fiscal year was slashed by 50 percent over the current period, from $80,000 to $40,000.
This is a shortsighted budgetary choice, considering that backyard farming can be a core initiative that is directly tied to fostering a healthy lifestyle and cutting risks of CNCDs.
According to Harvard Health, backyard farming helps individuals to eat more fresh fruits and vegetables, noting, “You decide what kinds of fertilizers and pesticides come in contact with your food. It lets you control when to harvest your food. Vegetables that ripen in the garden have more nutrients than some store-bought vegetables that must be picked early.”
Since many fruits, vegetables and herbs can be grown in pots, backyard farming can be carried out even if one lives in an apartment, or does not have a personal backyard space.
With the cost of produce and groceries steadily increasing, backyard farming can save families money, and can evolve to become a community effort that provides healthy food to those in need.
Any initiative that empowers Bahamians to provide for their own well-being, lessens reliance on the state, which in turn relieves pressure on public finances that can be used to spur development in other areas.
Sound national budgeting is not carried out in a vacuum, but is typically in line with a defined national development plan.
Future budgets must demonstrate a deeper appreciation of the interconnected social dynamics that contribute to larger problems that big-ticket budgetary initiatives seek to address.
The quality of investment we make in these dynamics, and the quality of leadership that guides such investments, greatly impact prospects for the country’s future growth and development.