The
Development Planning Unit
Government of the British Virgin Islands

NIDS FOOD AND NUTRITION

A NATIONAL FOOD AND
NUTRITION POLICY
AND PLAN OF ACTION FOR THE 
BRITISH VIRGIN ISLANDS (BVI)




Prepared by


The Intersectoral Nutrition Coordinating Committee
With Technical Support from
The Caribbean Food and Nutrition Institute (CFNI),
Pan American Health Organization/
World Health Organization (PAHO/WHO)

EXECUTIVE SUMMARY

The British Virgin Islands (BVI), an overseas dependent territory of the United Kingdom, with a population of 20,254 persons and an area of 59.3 square miles, is heavily dependent on tourism and banking as the agents of economic growth.

Over the last three decades the BVI, like the rest of the Caribbean, has been undergoing an epidemiological transition in nutritional health status and disease incidence. There has been an improvement in the nutritional health of children under five years of age. Up until the 1960s nutritional deficiencies and communicable diseases accounted for 20-50% of all deaths, particular in children. Today, between 7-21% of Caribbean men and 22-48% of Caribbean women are obese, and the main killers are chronic, non-communicable diseases. It is estimated that approximately 30% of adults 35 years and older have high blood pressure and about 10-15% have diabetes.

Obesity is the major risk factor for adult-onset diabetes. The same is true for high blood pressure (3-6 times higher rates in obese people); and heart disease (2 times higher deaths from heart attack of 5 –15% overweight, 5 times higher if >25% overweight). There is also evidence for higher rates of other diseases in both obese men and women: colo-rectal and prostate cancer; arthritis, and gall bladder disease. In the BVI levels of malnutrition are now negligible (less than 5%), however, in 1984, 21% of men and 48% of women found to be obese.

The limited contribution of the agriculture and fisheries sector to the gross domestic product suggests a low level of domestic production. The BVI is thus heavily dependent on food imports. Slaughtering of animals still occur under the trees. There is no legislation to ensure hat persons use an abattoir and Public Health has no authority to act. One main issue is that establishments are functioning using persons without food badges. In addition, there is an evolving phenomenon of Streets Foods without the adequate provisions for monitoring. The current legislation is ineffective.

Within the school system, Food and Nutrition is incorporated as part of the curriculum. There are also a few programmes geared towards improving healthy lifestyle behaviours of youths. Health Promotion is the key mechanism through which the programmes in the Health Education Unit are based.

It is against this background and the recognition of the close interrelationship between food, nutrition and health that the government is committed to formulating and implementing food and nutrition policies and programmes as apart of its national development thrust. This document brings together the deliberations of intersectoral workshops convened to address food and nutrition issues in a coordinated manner. The ultimate goal is improving the nutrition and health status of the population.

Subsidiary objectives include: 

1. Improving household food security
   
2. Ensuring the quality and safety of foods and minimize food borne illnesses.
   
3. Improving nutritional care for the socially vulnerable.
   
4. The reduction of morbidity and mortality due to the nutrition-related non-communicable chronic diseases.
   
5. The prevention and control of micronutrient deficiencies particularly iron deficiency anaemia among pregnant and lactating women and in children.
   
6. The reduction of protein energy malnutrition.
   
7. Strengthening the food and nutrition surveillance system.
   
8. Incorporating nutrition objectives into development plans

The following is a brief description of the programmes and projects in support of these objectives:

1. Household Food Security through promotion of domestic food production of a wide array of foods. Fisheries and Extension Officers will receive training in all areas to aid the process. Collaboration among Agriculture, Fisheries, Trade and Health Sectors will be promoted and weekly nutrient cost analysis reports will be published.
   
2. Food Quality and Safety by increasing the human resource capacity, developing a Public Health Unit and grading foods according to the USDA Standards.
   
3. Caring for the Socially Deprived and Nutritionally Vulnerable by training of care givers, supporting the non-governmental organizations that work with vulnerable groups, enacting legislation to protect social sector personnel and establishing standards for the registration and management of senior citizen homes.
   
4. Promotion of Healthy Lifestyles Habits through the implementation and evaluation of Project Lifestyles in schools and the Worksite Wellness Programme in the workplace. Early screening for diabetes and hypertension will be considered. Infectious diseases will be managed through the acquisition of vaccines and equipment training of staff and other appropriate interventions.
   
5. Promotion of Breastfeeding and Complementary Feeding through incorporation in the school curriculum and appropriate training for health professionals. The Young Child Feeding Guidelines for the Caribbean will be adopted and adapted together with the Baby Friendly Hospital Initiative.
   
6. Prevention and Control of Micronutrient Deficiencies through the strengthening of the surveillance to capture data on the Hb levels of infants, Children under 5 and pregnant women. The nutritional assessment of school children will also be strengthened to include Hb for 5 year olds.
   
7. Food and Nutrition Surveillance through identification of critical indictors, conducting training and preparing and distributing surveillance bulletins based on analyzed data.
   
8. Incorporating Nutritional Objectives into Development Policies and Programmes through holding quarterly intersectoral meetings, reviewing policies and plans annually, documentation of policies and plans of action and advocating incorporation into national development plans.

The multi – causal nature of food and nutrition problems point to the need for a multidisciplinary approach to their solution. The various activities proposed should be implemented in a co-ordinated manner to avoid duplication of efforts, minimize cost and maximize efficiency and effectiveness of the implementation process. The policies and plans will be co-ordinated with Sectoral policies and programmes to constitute a national development plan. Approved projects will be assigned to a lead agency and supporting agencies will be identified. The overall co-ordination of food and nutrition activities will be facilitated by the Intersectoral Food and Nutrition Committee.

1. INTRODUCTION

1.1 Physical Characteristics

The British Virgin Islands (BVI), an overseas territory of the United Kingdom, comprises approximately sixty islands, cays and rocks, located in the north eastern Caribbean archipelago, between 18° 20’ North latitude and 64° 30’ West longitude. The BVI has a total land area of 59.3 square miles; the four largest islands accounting for 48.4 square miles as follows: Tortola 21.5, Anegada 15.2, Virgin Gorda 8.5, and Jost Van Dyke 3.2.

The topography of the islands varies from being extremely flat in Anegada to mountainous and rugged in Tortola. Mount Sage is highest point at 1,780 feet above sea level.

The territory experiences a maritime sub-tropical climate with daytime temperatures ranging from 75° -85° and nighttime temperatures around 10° F lower. The territory which comes under the influence of the North East Trades, is within the hurricane belt and in the active earthquake zone.

BVI experiences a low annual average rainfall (approximately 40 inches) in coastal areas with a long dry period from January to August and a wet period from September to December. May/June are the driest months and October/November the wettest months. However, this has been changing over the past few years with a longer rainy season being observed. The water supply is from roof rainfall catchments, shallow wells and desalination plants.

The 2000 population was estimated at 20,254 with a male/female sex ratio of 1:064. Approximately 26.5% of the population is under 15 years and 4.8% above 65 years. The resident population is increased by the large number of tourists who remain for long periods.


1.2 Socioeconomic Profile

The BVI was traditionally an Agricultural/Fishing economy. This has changed over the past decades. Tourism related and the financial services sectors are the major contributors to the gross domestic product (GDP) which was estimated at US$682.8M. Visits by tourists numbered 392,290 in 1998 and 484,056 in 1999. Assuming an average stay of 9.4 days, the equivalent overall population increase is around 19%.

In 2000, Transport, Storage and Communications contributed 2.86% to GDP, Construction 2.78%, Wholesale and Retail 20.26%, Financial Intermediation 35.97% and Hotels and Restaurants 14.10%. Agriculture and Fishing accounted for only 1.67% of GDP.

The per capita GDP has increased steadily from US $18,875 in 1991 to US $33,713 in 2000. Inflation as measured by the Consumer Price Index (CPI) was 2.8% in 2000. The level of unemployment is low-estimated at 4% in 2000. Despite the high level of per capita gross domestic product and incomes, study in 1994 found that some 17.7% of households were relatively poor, that is, they had an ‘adult equivalent scale’ household per capita income below US$310.00per month.

The minimum wage in 1999 was US$4.00 per hour but this has been exceeded even as far back as the 1990s. The country boasts a per capita income that is well in excess of US$20,000.00


1.3 Food and Nutrition Policy Imperative

The Government of the BVI recognizes the pivotal role of health in the development process and the inseparable link between food, nutrition and health. Satisfactory nutrition and dietary well-being are desirable goals which could not be achieved without an adequate food supply; nor can good health be attained and maintained when satisfactory nutrition falters. Poor nutrition and health status, whether as a result of insufficient food intake, over consumption or nutritional imbalances, lowers productivity, threatens longevity and increases health care costs. A healthy population enhances productivity through physical and mental fitness and is more likely to exhibit socially acceptable behaviors.

Over the last three decades the BVI, like the rest of the Caribbean, has been undergoing an epidemiological transition in nutritional health status and disease incidence. Up until the 1960s nutritional deficiencies and communicable diseases accounted for 20-50% of all deaths, particularly in children. Today, between 7-21% of Caribbean men and 22-48% of Caribbean women are obese, and the main killers are chronic, non-communicable diseases. It is estimated that approximately 30% of adults 35 years and older have high blood pressure and about 10-15% have diabetes.

Obesity is the major risk factor for adult-onset diabetes (doubling of the risk of every 20% above normal weight for age). The same is true for high blood pressure (3-6 times higher rates in obese people); heart disease (2 times higher deaths from heart attack if 5-15% overweight, 5 times higher if >25% overweight). There is also evidence for higher rates of other diseases in both obese men and women: colo-rectal and prostate cancer; ovarian, uterine and breast cancer; arthritis, gall bladder disease. In the BVI levels of malnutrition are now negligible (less than 5%), however, in 1984 21% of men and 48% of women were found to be obese.


In order to address the emerging problems the Ministry of Health and Welfare in collaboration with the Caribbean Food and Nutrition Institute (CFNI) organized and conducted an intersectoral workshop on food and nutrition planning and coordination during December 8-10, 1999 with the following objectives:

• To increase the awareness of decision-makers, administrators, and the public of the inseparable linkages between food, nutrition and health, and the vital need for food and nutrition planning and coordination.
  
• To harmonize policies and programmes into an integrated National Plan of Action on Nutrition (NPAN).
  
• To intensify the collaboration among all sectors involved in food, nutrition and health activities through the development of a National Food and Nutrition Coordinating Mechanism.

This document brings together the deliberations of the workshop for consideration by the Government as an integral component of its development plan.

2. NUTRITION AND HEALTH STATUS

The BVI enjoys good immunization coverage when compared to ten years ago. This, together with a reasonably good public health system and initiative, has ensured the drastic reduction of many critical health problems once experienced. The prevailing social, demographic and economic conditions such as an aging population, and the influence of tourism, have had implications for the health status and practices of the population, as well as responses and expectations. Community health programmes continue to make progress in the promotion of health and longevity. Immunization for pre-school and school-leavers are actively pursued and much emphasis is placed on school and domiciliary services. Mental Health, Dental Health Care, Family Life Education and Health Education have become integral units of Community Health Services focusing mainly on preventive and promotive health.

Nutritional status of population is also considered good, in part due to the purchasing power of the population. Availability of specific food products may become a believed to contribute to the increasing problems of diabetes and hypertension, though no reliable data are available for confirmation.

Indicators for the assessment of nutrition and health status include birth weight, weight for age, haemoglobin (Hb) level, infant mortality rate, life expectancy at birth, prevalence of nutrition related chronic diseases and body mass index. These indicators are combined as applicable in describing the nutrition and health status of infants and children under five years, school children, pregnant and lactating women and adults and the elderly.


2.1 Mortality

Mortality data for 1991-1995 show that non-communicable chronic diseases have been the leading causes of death accounting for approximately 60% of all deaths. In particular, heart diseases, malignant neoplasm and cerebrovascular diseases have ranked in the top three positions. Accidents and injuries are also major causes of death. The main implications for this trend is that factors such as affluence, the aging process and lifestyles may be contributing factors.

The crude death rate fluctuated during the period 1991-1995, from a low of 4.61 per 1,000 in 1991 to 5.26 and 5.86 per 1,000 in 1992 and 1994 respectively. It showed a slight decline to 4.91 in 1995. It is likely that the next few years will see some increase in death rates as the proportion of the elderly population increases. A quarter of the number of deaths occurs in persons 80 years and over. Table 1 highlights the major causes of mortality during the period 1991 to 1995.

Table 1: Principal Causes of Mortality in 1991 to 1995

Source: Hospital Medical Records

2.2 Morbidity

More than 50% of the territory’s population is estimated to seek medical care from private physicians. Available data on morbidity are from public facilities, and do not show morbidity at private clinics. Morbidity data are routinely collected at Peebles Hospital and summarized according to ICD classifications. Health centre and hospital dada indicate that acute respiratory infections, dermatological problems and gastroenteritis are important causes of morbidity among children. Mental disorders and injuries stand out among adolescents and adults; and circulatory disorders (hypertension, ischaemic heart diseases, congestive heart failures), diabetes mellitus, and degenerative diseases are major causes of ill health among the elderly.
Table 2 shows the principal causes of Morbidity in 1996.

Table1: Principal Causes of Morbidity (hospitalization) in 1996

Source: Hospital Medical Records

2.3. Infants and Children Under Five Years 

Generally growth monitoring is not systematically done. There are no growth charts at the hospital but charts are plotted at the clinics where a system was set up to weigh, measure, and record. Parents are expected to return with the charts at every visit but they do not adhere for several reasons; one being lack of awareness of the importance.

    Low birth weight: The primary indicator of the nutritional status of infants is their birthweight at term. Birthweights 2,500 g or less is indicative of a low nutrition status of infants and a good predictor of ensuing nutrition status particularly in early life. The prevalence of low birthweight babies among teenagers was 8% in 1996, 7.6% in 1997 and 8.8% in 1998 which was not significantly different from the rest of mothers.

    Infant mortality: The infant mortality rate is subject to considerable variation due to the small denominator of live births. Since 1980 there has been a general downward trend in infant mortality rate from 44.1 per 1000 live births to 23.10 in 1991 and 13.94 in 1996. A low of 3.5 was recorded in 1995. The declining infant mortality rate is a good indicator of child survival and the improvement in overall effectiveness of the child health care system. Except for 1997 there has been a downward trend in total live births between 1993 when there were just over 300 and 1998 where there were 218. However, in 1999, live births increased to 315. During this same period, the trend in teenage births appeared U-shaped with 1993 accounting for 32 births, 1995 for 23 and 1998 for 29. Births to teenagers during the period fluctuated around 10%. Life expectancy at birth is 76.5 years for females and 72.5 for males.

    Weight for age: Data on weight for age are routinely collected at health clinics. These date serve to monitor progress in growth of the individual. However, there has not been a systematic analysis of the data to reveal prevalences of underweight, normalcy or obesity among the children. A 1984 survey revealed that the prevalence of undernutrition was less than 5% but that there were pockets of much higher levels that the average reflected. There was also a tendency to obesity in children under 5.

    Hb Levels: Information on Hb levels is not available for this group; nor for other micronutrients.
Breastfeeding: The initiation rate of breastfeeding is high but the percentage of mothers exclusively breastfeeding is very small. This could be due to the fact that there is not sufficient support both in the hospitals and in the community.

2.4 Children Five Years and Older

On entry at primary school, children undergo a medical examination to assess immunization status, nutritional development, vision and hearting status as well as Hb and sickle cell. Prior to secondary school entry, students undergo another complete physical examination. While the data are used for individual remedial action, they are not analyzed for overall surveillance purposes. Thus, no definitive statement can be made regarding the nutritional status of this age group. However, there has been an upsurge of cases of allergies in children being presented at the hospital.


2.5 Pregnant and Lactating Women

The relatively low prevalence of low birthweight babies suggests a good maternal nutrition status. Amaemia among antenatals is low – 10% in 1997. Haemoglobin levels of pregnant women are collected in the Ante-natal Clinics and submitted to the Health Information Unit. However, the data are not analyzed due to a shortage of appropriate staff.


2.6 Adults and the Elderly

The nutritional health status of this group is gleaned from data on morbidity. The major
causes of morbidity are hypertensive diseases, diabetes mellitus, malignant neoplasm (particularly breast, prostate, and cervical), bronchial asthma, arthritis and mental ill health, including substance abuse. These diseases account for over 70% of all deaths. Possible explanations for theses trends may include poor general dietary habits, poor diets before and during pregnancy and foetal development, early malnutrition, high levels of immunization coverage, as well as the presence of stress-inducing factors.

3. FOOD AVAILABILITY, HOUSEHOLD ACCESS AND SAFETY

3.1 Food Production

The BVI is heavily dependent on food imports. However, a small amount of local produce are exported as show in Table 3.

Table 3: Quantity and Value of Agricultural Exports

  
The limited contribution of the agriculture and fisheries sector to the gross domestic product suggests a low level of domestic production. The socio-economic and ecosystem dynamics of the various fisheries differ among the islands. The fisheries in Jost van Dyke services local demand. The fisheries is predominantly a trap fishery, lobsters being the key target species. Some of the main concerns here a pot theft; loss of pots due to boating activities; and illegal fishing by fishers from St. Thomas, USVI. In Anegada, there is artisanal fishery as well and Longlining. These fish are usually for hotels and restaurants. One of the major concerns here in addition to those stated for Jost van Dyke, is the management of the marine resources for both fishing and tourism.

3.2 Food Availability 

Assessments of food availability and household access are based on two relatively simple indicators. The first is a nutrients availability profile based on the compilation of a food balance sheet which shows the sources and disposition of the myriad of foods used by humans. Local food production plus food imports are adjusted for exports, stock changes, manufacture, animal feed, planting material and waste for the reference period (usually a year) to determine quantities available for human consumption. These are then converted to energy and nutrients on a per capital day basis and compared to average population requirements to determine levels of satisfaction.

The second is the cost of the basic ingredients for a 2004 kcal well –balanced daily diets for an average household. This estimated is then compared with the household earning potential at the minimum wage to determine what proportion of household earning would need to be devoted to food to ensure that energy and nutrients requirements are met. The cost of basic ingredients is computed on the most economical foods based on their energy and nutrients content per dollar expenditure. This information would then inform national food imports and minimum wage decisions.

Because of the general improvement in the economy, fueled by the tourism-related and financial services sectors, there is a wide array of foodstuffs and supermarkets, small shops and roadside markets.

3.3 Household Access 

The annual inflation rate in the BVI as measured by the CPI during the nineties has been relatively low. A Social Security Scheme is in effect which addresses the needs of vulnerable individuals.

3.4 Food and Water Quality and Safety

Assessment of food quality and safety starts at the farm and ends at consumers’ tables. Quality reflects the nutritive value and organoleptic properties of the various foods, while safety deals with whether or not the product preserves health and prolongs life. Therefore from the farm to the table, there are a number of factors that have to be considered to ensure the quality and safety of the food. If there are deficiencies in these factors, then the quality and safety of the foods could be compromised, which could pose and create serious health and health-related problems.

The Environmental Health Division ensures that all aspects of the environment with the potential to negatively impact human health are managed to ensure that all persons in the BVI can attain and maintain optimal health and social well-being.

There are a number of food establishments and street food vending emerging and an inadequate number of staff to monitor effectively all aspects of Food Safety. The present regulations do not allow for changes in science and technology. Trade licenses are granted without input from the Division of Environmental Health, whose staff only become involved after the business is in operation.

Many establishments function with persons who do not have food badges. One reason for this is that the legislation is ineffective. At present the BVI haws one functional abattoir located at Paraquita Bay operated by the Department of Agriculture. Staffing at the facility includes: one Abattoir Management; one Kill Floor Supervisor; one Abattoir Assistant; three Slaughtermen; one Labourer; one Veterinary Assistant/Meat Inspector; and one Veterinary Officer. Another slaughterhouse is under construction in Virgin Gorda, which when completed is expected to employ five persons.

To protect consumers the Health Department of the Ministry of Health and Welfare conducts food surveillance by inspecting all food establishments, condemning food as warranted, trains food handlers and conducts public education. All food handlers have a Food Handler’s Certificate. Some establishments are functioning using persons without food badges. In addition, there is an evolving phenomenon of Street Foods without the adequate provisions for monitoring.

Table 4: Food Condemnations 1994-1998

  During 1994-1998, 29,294.86 lbs of meat were condemned together with 6,029.7 lbs of fish and 3,134.30 lbs fruits and vegetables etc. (Table 4).

The food in the BVI is relatively safe. Ciquatera poisoning from fish occurs sporadically (CAREC Surveillance Report).

The water quality of the public supply is maintained at WHO’s Standards through bacteriological assessments every two months by the Public Health Department. Water in cisterns at homes is also examined and employees of water bottling companies are certified.

Maintaining the environment in a sanitary condition is fraught with difficulties. There is a recurring problem due to land and sea pollution involving indiscriminate disposal of used motor oil, old batteries, household and commercial chemicals, septic tank effluents as well as untreated sewage from yachts and marine businesses. Very few households (7%) are connected to the sewerage system and most rely on septic tanks. Poor soil permeability because of the heavy clays cause soakaways to malfunction frequently and pose a public health hazard. Some households (4%) have no approved toilet facilities.

Slaughtering of animals still occur under the trees. There is no legislation to ensure that persons use an abattoir and Public Health has not authority to act.

4. PHYSICAL ACTIVITY AND EXERCISE

Changing lifestyle in the Caribbean over the last thirty (30) years has had its influence on the health status of the people. Physical activity has been drastically reduced, predisposing the population to the lifestyle diseases – diabetes, hypertension, strokes, heart attack and cancers. This reduction in activity is associated with an increase in the affluence of the society and technological developments leading to automation. The BVI is no exception. More people now own cars, television sets and computers. There are more alternative modes of transportation that three decades ago, hence a natural activity such as “walking” is reduced to a minimum. Inactivity coupled with increasing energy intake leads to obesity and its associated diseases.

The human body was built for action and survival demands activity. A sedentary or inactive lifestyle increases the risk of diseases of the heart and blood vessels, intestines and other disorders. Any activity is better than no activity, but to be really fit, specific levels are needed to have a reasonable or healthy weight, flexibility of the joints, strength and endurance of the muscles, lungs, and blood vessels to meet everyday demands.

The general population and mostly those who need exercise either do not engage in exercise because they are too busy, have no time or do not think it is necessary. In addition, sporting activities which supply some form of exercise are scheduled weekly, but only 
on a small percentage of the population take part, mainly the youths. Some form of gardening is also done, thus providing some exercise, but only for a few people.

Different kinds of exercises produce different results. Some exercise programs are recommended for weight reductions, some for fitness and others for muscle building and sports. The health related exercises are those which promote normal weight and overall fitness. In general, the benefits of physical exercise include:

• Physical and mental energy and confidence
  

• Reduced body fat – weight control
  

• Improved skin and muscle tone
  

• Improved sleeping habits
  

• Reduced risk of cardiovascular (hart and blood vessels) diseases
  

• Reduced tension and increased ability to cope with stress
  

• Reduced fat and cholesterol in the blood
  

• Reduced blood pressure
  

• Strong bones in old age
  

• More enjoyable and perhaps longer life
  

• Improved appearance

The best activities are those that people feel are useful, enjoyable and which relieve tension or stress.

5. REVIEW OF FOOD AND NUTRITION-RELATED POLICIES AND PROGRAMMES

5.1 Trade Policies and Programmes


Despite the vast importation of food, the BVI does not have any stringent policies in place that serve to monitor and otherwise control the quality of imported food. Food policies are confined to local agricultural production and are generally aimed at increased output in an effort to diversify the economy while at the same time reducing the Food Import Bill.


5.2 Health Policies and Programmes

The Government of the BVI regards the health of the population as being crucial to the development process and as a good indicator of progress. The health policies and programmes ensure that health services are provided at an affordable cost to all segments of the population. The policies and programmes emphasize health promotion and prioritize strengthening of primary health care services, environmental health programmes including solid waste management, and improving hospital services. Government health services are given at a nominal fee in the main with full exception to certain groups. These groups include children, health workers, firefighters, the police, prisoners, prison officers, the elderly and the mentally ill.

The responsibility for providing public health and social services rests with the Ministry of Health and Welfare as is the task of regulating and monitoring health care provides in the private sector. The hospital services are presently under review and there is general recognition that the services need to be upgraded.


            Maternal and Child Health Services: Ante-natal care is provided to pregnant women at district clinics. All pregnant women are encouraged to access this service or make arrangements with private practitioners. By the 12th week of pregnancy, pregnant women are referred to the hospital clinic for comprehensive obstetric assessment to identify at-risk cases. In addition, Hb levels are determined and abnormal levels treated, tetanus toxoid is administered and VDRL tests conducted. Almost all local deliveries are hospital deliveries.

At the district clinics, a full range of child health services are provided. These include growth monitoring, breastfeeding and complementary feeding practices, immunization and parent counseling. On entering primary school children are screened for vision and hearing abnormalities and anaemia, including sickle cell anaemia. Another complete physical examination is conducted fro students prior to entering high school.


            Control of Nutrition-Related Chronic Diseases: The Ministry of Health and Welfare in collaboration with the Diabetic Association conducts programmes to prevent and control diabetes and hypertension, two diseases responsible for high morbidity and mortality in the BVI. These programmes include public education using the print and electronic media. And direct counselling services to patients. Based on protocols for the management of these conditions diabetes and hypertensive clinics are conducted in Road Town, East End, Capoons and Carrot Bay in Tortola and Northsound and The Valley in Virgin Gorda.


            Environmental Health: The Environmental Health Division undertakes activities relating to food and institutional hygiene, vector control water quality, the maintenance of public conveniences and the investigation of complaints of nuisance such as those problems including septic tanks and rodents. Measures to reduce the aedes aegypti mosquito population to minimize dengue fever transmission include fogging, oiling and predation by larvivourous fish.

Under the food hygiene programme, food service establishments are inspected regularly and training provided to food handlers. All food handlers are required to have physical examinations, laboratory tests (tuberculosis and VDRL included), and stool examinations for ova and parasites.

The Environmental Health Division monitors the quality of the water supplied by the Water and Sewerage Department as well s that at institutions such as schools, day care centers and clinics while ensuring a basic level of sanitation at these public institutions. In addition to monitoring, the Division conducts inspections, investigations and condemnations as well as educate the public, give advice and enforce the laws and regulations.

            Solid Waste: The Solid Waste Department is responsible for the collection and disposal of solid waste, road and gully cleaning and beautification. Open burning and landfill is practiced except on Tortola. Private contractors provide service to government and some businesses at a cost. The incinerator on Tortola handles hazardous and special waste.


5.3 Education Policies and Programmes

Presently at the British Virgin Islands school system, food and nutrition is incorporated as part of the curriculum of some subjects. In the primary school, health is taught from Stage One through Class V. The health curriculum includes food and nutrition. In three of the primary schools, Leonora Delville, Willard Wheatley, and Robinson O’Neal, the Healthy Lifestyle curriculum was piloted. The curriculum provided with that programme is still being used.

In addition to the health curriculum, the primary school students also learn about healthy lifestyle, which includes proper food and nutrition during their guidance session with the school counsellor. These lessons serve as a form of supplement to the regular lessons.

At the high school level, food and nutrition is incorporated as part of Integrated Science and Good and Nutrition, and Human Sociology Biology class. The Integrated Science class is a required course for students in Forms 1 to Forms 3. If that is the choice, those students will then continue through Form V.

The Human Sociology Biology class, which also covers some aspect of food and nutrition is available to the Form 4 students in the highest level of Home Economics. Students taking this course will also continue the course through Form V. 

A proposal for improving the health of youths through a comprehensive school health programme has been prepared by the Guidance Services, Ministry of Education and Culture and the Health Education Unit of the Ministry of Health. The programme will involve implementing procedures that contribute to the understanding, improvement and maintenance of the health of students and staff. Components of the school health programme include health services, health instruction, healthful school environment, physical education, food services, guidance and counselling and a school site health promotion programme for faculty and staff. Implementation by this programme should undoubtedly lay the foundation for a healthier population.

The British Virgin Islands has two Health Educators. The Health Education Unit provides technical guidance and support primarily to the other Units of the Health Department, Ministry of Health and Welfare on Information, Education and Communication (IEC). The Unit has worked closely with the Nutrition Unit to provide training for teachers and health professionals, prepare educational material and conduce research. The Unit’s present focus is on IEC, which is targeted at behaviour change of individuals. The Unit is in the process of shifting its focus to Health Promotion – a broad-based comprehensive approach, focused on the broader social, environmental and economic determinants of health.

In addition to health education, other components of health promotion include: intersectoral coordination, policy analysis and development, community developing advocacy, capacity building, research and evaluation. The work of the Unit is guided by the six strategies set out in the Caribbean Health Promotion Charter, which was updated from the Ottawa Charter: Formulating Healthy public policies; Reorienting health services; Building alliances with special emphasis on the media; Empowering communities to achieve well-being; Creating supportive environments; and Developing/Increasing personal health skills. The work of the unit is also guided by research which shows that:

• A comprehensive approach utilizing strategies is more effective and;
  

• Settings such as schools, workplaces and communities offer practical opportunities for the implementation of such comprehensive strategies.

Presently, the Unit is undertaking work to build capacity across the sectors in Health Promotion. It is developing the infrastructure needed to advance health promotion using the settings approach. Five key areas have been identified. These are: health promoting health services; healthy promoting schools; health promoting communities; health promoting tourism; and health promoting workplaces.

The Unit is also conducting the qualitative research for the Food Consumption Survey which will guide the quantitative component of the survey to be undertaken in 2003.


5.4 Agricultural Policies and Programmes

The policies in the area of agriculture include: encouragement of the younger generation to adopt farming as a profitable profession; bringing all cultiviable land into production of orchard crops, vegetables, livestock, poultry and ornamentals; encouraging increased production of fruits and vegetables in backyards; reducing the food import bill; assisting farmers in the marketing of their produce; and encouraging the construction of dams to help with irrigation and water for animals. Attainment of these rests on:

1. Minimizing the existing farming constraints such as water shortage, deforestation, soil erosion and inaccessible lands through infrastructure development.
   

2. Strengthening and improving the services offered by the Department of Agriculture.
   

3. Encouraging youths to adopt farming as a profitable profession and assisting farmers in the marketing of produce by providing contacts with hotels, restaurants and supermarkets. 

Infrastructure development focuses on water conservation through the construction of mini dams, ponds for the collection of run off as well as rehabilitation of existing wells and construction of new wells, construction of motorable feeder roads to lands with good agricultural potential; improving marketing infrastructure by establishing collection points, facilities for gardening, packaging and storage and improving public markets. The conservation of and enhancement of environmental integrity is being addressed by enforcing quarantine laws and forestry regulations, watershed protection to improve the quantity and quality of ground water through preservation of existing ground cover as well as reforestation and observance of general soil conservation measures of farm lands and other areas.

The service of the department of agriculture include continuous training of farmers in improved and appropriate production technology involving high-tech farming systems such as hydroponics, zero-grazing and so on; and the provision of support services such as land preparation, seeds and seedlings, crop spraying, stud service and slaughtering of animals. Orchard crops (fruits and nuts), vegetables, livestock, poultry and ornamentals on farms and backyard gardens are being emphasized in the programme.

The Veterinary Division ensures that animals are slaughtered under conditions that are hygienic and that the meat is wholesome and fit for human consumption. This includes ensuring that a rigorous programme of ante and post mortem inspection of all animals slaughtered at the facility is carried out. The Division also ensures that meat is properly stored and transported. The Department of Agriculture is working on the construction of a modern abattoir and hopes that the systems and procedures employed therein would enable the meat produced to meet standards comparable to the United States Department of Agriculture (USDA). Plans are also being put in place to build a poultry processing plant that will also result in the sanitary slaughtering of poultry.

The Department, in collaboration with the Ministry of Natural Resources and Labour, is working on a new Slaughter House Act that will seek to effectively control the slaughtering of livestock so that the meat produced will be wholesome and fit for human consumption. Through the Ministry of Natural Resources and Labour, the Department is supporting the Modernization of the Food, Animal and Plant Health Legislative Framework in CARICOM States. This process has as its primary aim the strengthening of the national food safety systems through a process of modernization of the food legislative framework.

To provide the services in a timely and efficient manner, the Department of Agriculture is developing and organizational structured that is effective and flexible to meet the needs of the farming community. Young BV Islands are being recruited to gradually replace expatriate staff and training conducted to improve the professional capability of staff. A participatory management system is in operation to allow for all levels of staff to be involved in the planning process while facilitating decentralization of decision-makers. This system promotes team spirit, dedication and accountability.

The choice of farming as a profession is being promoted by establishing school gardens, encouraging senior students to pursue agricultural sciences for higher learning and highlighting the achievements of successful and prosperous young farmers.

The fisheries management plan seeks to ensure that the fishery and resource base on which it depends are managed in a suitable manner for the greatest possible benefit of the people of the BVI. The goal is to ensure that stocks are maintained at, or are restored to, levels that can maximize sustainable yield given an appropriate environmentally sound and economically justified effort.

Effective management for sustainability of the resource base involves the rational exploitation of under-utilized resources while actively regulating unsustainable levels of use and the exploitation of threatened resources; protecting rare and fragile ecosystems, the use of selective gear, and practices to minimize changes to the marine environment and by catch of not-target species; and effective enforcement of fisheries legislation.

Contribution of the fisheries sector to the GDP and foreign exchange earnings is being enhanced through the establishment of the BVI Fishing Company and the development of aquaculture enterprises. Efficient marketing and distribution of fish and fish products including price monitoring will be promoted by the company.

Development of a consensus based framework for integration of marine and coastal resource use is being facilitated by intersectoral collaboration and coordination and participatory management.

A special Y2K Food Contingency Plan has been developed and is being implemented. The basic objectives of the plan are:

• To produce additional food consisting of about 100 tongs of assorted vegetables, ground provisions, meats and staples in the first quarter of the year 2000.
  

• To demonstrate the productive capability of the Agricultural Sector when an increased level of funding is provided.
  

• To demonstrate the importance of the Agricultural Sector and its linkage to the tourism sector through the increase use of local food.
  

• To utilize approximately one hundred and ten acres of land in the production of livestock, poultry and crops.
  

• To mobilize a group of farmers throughout the British Virgin Islands.

Vehicles for extension and spraying services, tractors and implements for land preparation, irrigation, veterinary supplies, planting materials and chemicals and water trucks have been purchased for use by farmers. An extension officer provides technical and logistical support to cooperating farmers. Labourers have been recruited to assist in the crop and livestock production effort on the Stock Farm and Anegada mini-agricultural station.

A marketing officer has the responsibility to develop a marketing system to deal with the increased high quality local production by facilitating the marketing of food and improving the relationship between producers and marketers.

Two green houses on the stock farm have been upgraded and a new one constructed at the Anegada substation to accommodate increased seedling production for farmers. Two 40 ft refrigerated containers have been acquired for the storage of agricultural produce.

Public awareness of the programme has been facilitated by a series of meetings: a) with farmers to encourage cooperation and commitment to the programme; b) with marketers, hoteliers and restaurateurs to obtain commitment to purchase produce from the plan; c) with the hoteliers and commerce association and farmers to enhance a cooperation among the stakeholder. Through the programme, farmers have been mobilized to undertake increased food production. Major constraints faced by farmers are being addressed and there is greater cooperation between farmers, food marketers and consumers.


5.5 Social Services Policies and Programmes

A social security scheme has been in effect since 2 July 1980 and was established by Act No. 17 of 1979 of the Legislative Council. It is a compulsory insurance scheme to which employees, employers and self-employed persons contribute. The scheme provides cash benefits in cases of sickness, pregnancy, old age, disability or death and pays medical expenses due to employment injury. The scheme is managed by the Social Security Board which comes under the portfolio of the Minister of Finance. The board consists of seven members – two representing employers, two representing employees, two representing government and a Director. The Act specifically charges the Director with the responsibility for the management of the funds, in particular the collection of contributions and the payment of benefits.

The Social Security Board covers all working persons who are 15 years of age and under 65 years. Insured persons are covered for up to a maximum of $348.00 weekly or $18,096 annually or proportionately fortnightly (696.00) semi-monthly (754.00) four weekly ($1,392.00) and monthly (1,508.00).

Qualification for full age pension is based on a minimum of 500 (or 10 years) contributions. A special pension could be paid to persons who fail to qualify for a full pension if at least 250 contributions were made to the scheme by such persons. The maximum pension payable is 60% of the average and annual insurable earnings. The pension is payable monthly and continues for life regardless of employment status.

6. PROPOSED POLICIES AND PROGRAMMES

The overview of the food, nutrition and health situation points to an increasing availability of food supplies, a reduction in macronutrient undernutrition and an increasing tendency towards obesity along with increased morbidity and mortality due to the non-communicable chronic diseases – heart disease, neoplasms, hypertension and diabetes. The database for this rigorous analysis of food availability, household access and nutritional status among various age groups and sexes is apparently available but the analysis has not yet been conducted. The analysis of such data would be given priority as an integral component of the strengthening of the food and nutrition surveillance system.

The review of the current policies and programmes reveals an impressive array of priorities, objectives and decisions which should impact favourably on the food, nutrition and health situation. The policies and programmes are in the main vertical in nature. That is to say, programmes in the Ministry of Agriculture have little horizontal connection with health programmes. In essence, there is lack of policies and programmes coordination among the food and nutrition related sectors. To maximize the effectiveness of the policies and programmes an intersectoral food and nutrition coordinating mechanism will be established. This body will ensure a coordinated approach to food and nutrition planning and implementation.

The ultimate goal of this food and nutrition thrust is to improve the nutritional health status of the population of the British Virgin Islands. More specifically, this policy seeks to:

• Improve household food security;
  

• Protect consumers through improved food quality and safety;
  

• care for the socially deprived and nutritionally vulnerable;
  

• reduce the prevalence of the nutrition-related non-communicable chronic diseases through the promotion of healthy diets and lifestyles;
  

• promote breastfeeding;
  

• reduce the prevalence of iron-deficiency anaemia in children under 5 and pregnant and lactating women;
  

• assess, analyze and monitor food and nutrition situations and maintain adequate food and nutrition surveillance;
  

• incorporate nutrition objectives in the overall development plans.

These objectives are in keeping with commitments made by the Governments at the International Conference of Nutrition (ICN) in December, 1992. The activities are detailed in the accompanying plan of action organized in a logical framework.


6.1 Improving Household Food Security

Through the health promotion activities, in particular the promotion of dietary guidelines, an increased desire for health promoting diets is anticipated. In order to enable low income earners to meet the cost of nutritious diets, the following measures will be adopted: a) an improved price information system to promote economical ingredients for well-balanced diets; b) a minimum wage and social security system will be indexed to the cost of basic ingredients; and c) greater domestic production of foods will be promoted. To achieve this, urgent attention will be paid to soil and water conservation such that strategies are developed and implemented to ensure that the dependency on rainfed agriculture is reduced and more water be made available through the construction of dams for use in crop irrigation and livestock production. The Ministry of Agriculture will provide extension, veterinary, fisheries and plant protection services, advice and infrastructure such as feeder roads at minimal costs.

Duty free concessions will continue to be provided on motor vehicles utilized in farming enterprises. Planting material for food crops, livestock for upgrading local herds, agricultural chemicals, animal feeds, fencing material, fishing boats and allied equipment and materials for making fish pots, will be made available at concessionary rates. Crown lands will continue to be made available for farming a low rental rates and long term leases be made available to qualifying farmers. Ice for the preservation of fish will be provided at minimal costs. The BVI Development Bank will continue to provide credit to farmers and fishermen at interest rates lower than which can be obtained at commercial banks.


6.2 Protecting Consumers through Food Quality and Safety

The risk of food borne illnesses will be reduced through public education and training in all aspects of the proper handling of foods from production or import to consumption. The control flies, rodents and other disease carrying vermin will be promoted. The frequency of inspections of food establishments will be increased and training of food handlers conducted. There needs to be a more structured approach to Port Health with increased food inspection at the port. Inspections at supermarkets should also be increased. The human resource capacity will be increased to ensure food safety at point of sale and restaurants. A Port Health Unit will be developed. Foods will also be graded according to USDA Standard. Public Health Regulations will be revised to give it more power to deal with consumer issues and legislation developed. Basic legislation and support mechanisms will be put in place and standards defined. A Solid Waste Management Programme will be developed.

6.3 Caring for the Socially Deprived and Nutritionally Vulnerable

A feature of the free enterprise system is that all segments of the population do not benefit equitably from the development process. Some persons or households could be socially deprived and nutritionally vulnerable. Every effort will be made to identify these persons and households and special provisions made for their care. Care-gives of this group will be trained and periodic support to non-governmental organizations. Work with these groups will be increased. Living quarters for the socially deprived and nutritionally vulnerable will be upgraded and their clinical needs addressed. Old age pensions and social security payments will reflect the cost of ingredients for well-balanced 2,400 kcal diets relative to other living expenses. Based on current estimates such payments should be in excess of US$ 400 per month.

6.4 Promoting Appropriate Diets and Healthy Lifestyles

Nutrition-related and lifestyle diseases are among the ten leading causes of mortality. These include cancers, heart disease, stroke, diabetes, hypertension and accidents and injuries. As life expectancy increases the prevalence of these conditions are likely to increase. However, their onset could be delayed through a modification of food consumption patterns, increasing physical activity levels, drinking alcohol in moderation, avoiding tobacco use and drugs, wearing seat belts and managing stress.

The combination of proper diet and exercise is crucial to preventing or delaying the onset of the nutrition-related not-communicable diseases. Through a healthy lifestyle promotion program utilizing the print and electronic media, the population would be more informed of the importance of diet and exercise. Project Lifestyle will be extended to more primary and secondary schools and Worksite Wellness Programmmes promoted at work places. Surveys will be conducted to determine the current allergies in children in the BVI. Educational materials will be developed and promoted. These will include dietary guidelines and other positive lifestyle promotion initiative. Legislation will be enacted to regulate the promotion of tobacco products and alcohol.

The introduction of Acquired Immune Deficiency Syndrome (AIDS) has put the population at greater risk of infectious diseases which adversely affects nutritional status. The high levels of protection against vaccine preventable diseases afforded by the expanded program of immunization will be maintained. Equipment and supplies of vaccines will be increased to meet future demands and training of staff will be intensified. Protocols for the managing of infectious diseases will be updated and promoted at the various clinic service areas.

The Health Department will collaborate with the Education Department to promote healthy lifestyles through the PTAs and vendors.


6.5 Promoting Breastfeeding

Breastfeeding and complementary feeding will be promoted in schools, hospitals and clinics, and in the media. Young child feeding will be incorporated into the food and nutrition curriculum and infused into the teaching of biology and family life. Appropriate steps will be taken to ensure that Peebles Hospital is certified ‘Baby Friendly.’ 


6.6 Preventing and Controlling Micronutrient Deficiencies

The anaemia surveillance system will be strengthened/developed so that information on Hb levels of Infants and Children under 5 could be obtained. The system will include assessment at 4 weeks, 18 months and 3 years. 

6.7 Assessing, Analyzing and Monitoring Food and Nutrition Situations

Surveillance is an important activity of the food and nutrition planning process. Changes in the food and nutrition situation are monitored and the information used in identifying target groups, planning programs, allocating budgets and evaluating the impact of programs. A system will be put in place to collect and analyze data. The food and nutrition surveillance system will be strengthened through the establishment and filling of a post of Nutrition Surveillance Officer, Ministry of Health. The incumbent will be responsible for collating, analyzing and disseminating information on food availability, household access and nutritional and health status of the population. Food and nutrition profiles will be updated annually and the impact of food and nutrition programs evaluated.

6.8 Incorporating Nutritional Objectives into Development Policies and Programmes

Through this policy document the foundation will be laid for incorporating nutritional objectives into development policies and programs by the Ministry of Planning and other food and nutrition-related Ministries. The Intersectoral Food and Nutrition Committee will be formalized and charged with the coordination of food and nutrition programs. Regular meetings will be held to monitor progress in the implementation of policies and programs. Annual workshops will be convened to review progress towards targets, evaluate impact and establish priorities for the coming years. 

6.9 Projects and Plan of Action

The following table highlights the programmes and projects suggested to form the action plan. Indicators of progress are specified as well as means of verification and underlying assumptions. This plan of action in the logical framework format, will serve as a basis for co-ordination and evaluation of progress and impact of programmes.

6.1 Improving Household Food Security