The quiet crisis of non-communicable disease in the Caribbean

While the world’s attention is often captured by infectious disease outbreaks, a quieter, more insidious crisis is tightening its grip on the Caribbean: an epidemic of non-communicable diseases (NCDs). These chronic conditions, including: heart disease, diabetes, cancer, and dementia, are now the leading cause of death and disability in the region, accounting for 39% to 67% of all deaths across 22 Caribbean territories.

However, to attribute this epidemic solely to individual lifestyle choices would be to ignore the deeper, more complex narrative of socioeconomic inequality that is the true driver of this public health emergency.

The data paints a stark picture of the NCD burden. Heart disease remains the leading cause of death, responsible for 13% to 25% of all mortality, followed closely by cancer (8%-25%). Diabetes prevalence has reached 12.14% in the Caribbean, significantly higher than the 10.70% in the United States, with mortality rates nearly double (6.41% vs. 3.50%). Perhaps most alarming is the dementia crisis: Latin America and the Caribbean have among the highest prevalence rates globally, reaching 11.7% in the Dominican Republic, 11.6% in Puerto Rico, and 10.8% in Cuba, placing immense strain on health systems that lack adequate knowledge, awareness, and services.

Diabetes and obesity in the Caribbean emerge from a complex interplay of economic instability, food insecurity, and constrained access to healthcare. A 2025 cross sectional study demonstrates that these structural conditions exert far greater influence on disease prevalence than individual behaviours. Food insecurity affects 29.8% of the Caribbean population compared to just 9.1% in the US, while unemployment stands at 14.8% versus 3.7%. Physical inactivity, poor diet, and sedentary lifestyles arise from structural inequalities that limit access to safe environments, nutritious food, and preventive health resources, contributing directly to non-communicable disease burden.

The socioeconomic drivers of NCDs are further illuminated by significant disparities across the Caribbean populations and conditions. Caribbean women are 60% more likely to have diabetes and twice as likely to be obese as men. Cataract disease falls most heavily on lower income populations, as limited access to timely diagnosis and treatment shapes vision loss outcomes.

Even skin diseases (e.g. atopic dermatitis, psoriasis, eczema, skin cancers, melanoma) follow this pattern: lower GDP countries experience higher disability-adjusted life years (DALYs) for infectious skin conditions, while higher GDP nations bear greater burdens from non-infectious dermatological diseases. Several Caribbean countries ranked among the top worldwide for annual increases in DALYs for melanoma, nonmelanoma skin cancers, bacterial skin disease, and total skin and subcutaneous diseases between 1990 and 2017. In the Bahamas, relatively high national income coexists with some of the Caribbean region’s highest diabetes related mortality, a pattern shaped by extreme wealth inequality measured by a GINI coefficient of 57.18 compared with 39.8 in the United States, along with high out of pocket healthcare costs, and underdiagnosis that leave many residents without timely care.

The economic consequences are devastating, creating a vicious cycle of poverty and disease. Economic losses linked to non-communicable diseases and mental health conditions are projected to be substantial across the region between 2015 and 2030. Estimates place total losses at nearly US$82 billion in Costa Rica, US$18.45 billion in Jamaica, and more than US$477 billion in Peru. While the scale of impact differs across countries, the patterns reveal important distinctions. In Costa Rica and Peru, respiratory disease and mental health conditions account for much of the lost economic output, while in Jamaica cardiovascular disease stands out as the dominant driver, responsible for 20.8 percent of total projected losses, followed by cancer. Climate vulnerability compounds these challenges: chronic NCDs are responsible for at least 30% of deaths following recent hurricanes in the Caribbean, as access to medication and services collapses during disasters.

Addressing this crisis requires a fundamental shift in approach. We should move beyond individual-focused health education and tackle the social determinants of health head-on. This means implementing comprehensive public policies that: improve food security, create economic opportunities, and ensure equitable access to quality healthcare. Prevention, diagnosis, and management of conditions like Type 2 diabetes remain insufficient throughout the region and throughout the diaspora. Investing in our health now a moral imperative and an economic necessity.

As Caribbean wisdom has long reminded us, health is wealth, and the region’s future prosperity depends on treating it as such.