The Department of Health and Social Security is publishing a study submitted during the public consultation period for the Regional Health Plan 2030 on the Azores Government platform, published yesterday in the Official Journal. The contribution makes a critical diagnosis of the state of health in the Azores.
According to the study for the Regional Health Plan 2030, the region “continues to maintain the worst national health indicators: we have a lower average life expectancy, more child and adult obesity, and more smoking. School dropout is the highest in the country, and the breastfeeding rate is the lowest. In addition, it is the region of the country with the highest prevalence of diabetes and iodine deficiency,” according to the National Diabetes Observatory, 2023.
A Regional Health Plan, according to the author of the contribution, “must respect the idiosyncrasies of a given region, but it must also be able to promote effective change in health planning at local level, making it an eminently practical and useful activity for both the community and the health services. It must point out regulatory, normative, administrative or other legislative measures aimed at creating environmental, socio-economic and social conditions that are favorable to individual and collective health,” he says.

The end of tobacco and sugar beet has not reduced tobacco and sugar consumption.

“We are undoubtedly the region in the country with the highest prevalence of diabetes and smoking. Until a few years ago, the region was the only one in the country that produced tobacco. With no support from the European Community and a lack of manpower, producers moved on to more profitable agricultural activities, so tobacco growing was completely abandoned. Even so, the activity of local tobacco companies is still significant in creating and maintaining jobs and in the tax revenue generated by tobacco consumption.”
“The same can be said for sugar,” states the study, “whose local production was ensured for many decades by the cultivation of sugar beet, now also non-existent.” However, “the end of the cycle of these agro-industrial activities has not led, as expected, to a reduction in tobacco and sugar consumption, which is still among the highest, if not the highest, in the country.”
The study says that “the persistence of these excesses, due to the inertia of habits established over decades, is one of the most important public health problems in the Azores.”
The statement adds that “changing this paradigm is not an easy task. But if, concerning tobacco consumption, we have seen the implementation of restrictive measures such as a ban on smoking in and around public places, an increase in the tax burden on tobacco sales, and heavy fines for offenders, the same cannot be said for fast food and soft drinks, which continue to be promoted everywhere.”

Increasing the tax burden on fast food

According to the author of this work, “The fight against obesity and diabetes will only succeed if there is a clear and determined indication that the persistent consumption of fast-absorbing carbohydrates and saturated fats puts consumers’ health at risk. This indication can be conveyed through increasing the tax burden on these products, restricting their advertising or making health labels mandatory, for example, indicating the sugar content of soft drink packaging.”
“What must not happen,” he adds, “is the pricing policy, particularly in large supermarkets, where bottled water is often more expensive than a soft drink pack of the same capacity. Cakes and desserts should also not be allowed to be sold in public institutions such as schools and health facilities.”
He adds that the general expression ‘chronic non-communicable diseases’ as a designation of the so-called civilizational diseases should specify that diabetes, hypertension, dyslipidemia, and cancer “are the real ‘predators’ in the Autonomous Region of the Azores.”

Type 2 diabetes mortality

He points out that by choosing tobacco, alcohol, and childhood obesity as priorities in the Regional Health Plan, “we run the risk of decontextualizing the need to reduce premature mortality in the coming years, making it a distant objective in the medium and long term and not in 2030, which is already here.”
He recommends that type 2 diabetes “cannot and should not be omitted from the Regional Health Plan. With an estimated prevalence of 16.3% in the Azorean adult population, it needs greater commitment and visibility, which can alert health authorities and the community in general to its risks, to its debilitating chronicity. It is in fact the leading cause of blindness, hemodialysis and kidney transplantation, non-traumatic amputations of the lower limbs, cardiovascular diseases, an impact that is too heavy to be minimized or ignored, if we take into account that diabetes screening is currently simple and effective when compared to other chronic conditions such as neoplasms.”
Screening for complications, particularly retinopathy,” has been perilous, with inexplicable interruptions to a simple and effective surveillance technique, he points out.
The goals proposed in the introduction to the Regional Health Plan are as follows: Reducing premature mortality (under 70) and improving healthy life expectancy (at 65).
Reducing risk factors related to non-communicable diseases: tobacco and alcohol consumption (and other drugs); changing lifestyles; childhood obesity; and Improving access to health care.
In the opinion of the author of the contribution, “the need to implement a single electronic register should be considered Ab Initio as a fundamental instrument in improving healthcare.” In this sense, “we believe that along with improved access to health care, its complementarity must be guaranteed at various levels, particularly between primary health care and differentiated health care, and this is only possible through the sharing of information between health care providers at the most diverse levels of referral.”

Encouraging iodine consumption

According to this document, preventing and controlling the most prevalent diseases (cardiovascular, oncological, diabetes, obesity) “involves promoting a healthy diet, reducing the consumption of saturated fat, salt, and sugar, as well as increasing the consumption of fruit and vegetables. Diet comes from the Greek díaita and means way of life. The philosopher Socrates’ phrase: “Eat to live, don’t live to eat,” embodies this ideal of food as a way of promoting well-being and not as an end in itself. This notion should be implemented in the community by encouraging an active life through the own or community production of vegetables.”
“Given the evidence of a deficient intake of iodine in children in the Autonomous Region of the Azores (Limbert et al., 2012), the guidelines on a balanced diet should reinforce the importance of appropriate iodine intake, through the consumption of foods that are usually sources of this element, namely: fish, legumes, vegetables and milk and other dairy products.”
“Replacing common salt with iodized salt can also contribute to an adequate intake of iodine,” he says.

An “efflorescence of concepts.”

The study concludes that the Regional Health Plan is presented as “an efflorescence of concepts and principles, and in this context, the quality of the fruit is always imprecise. But the concrete measures relegated to specific piecemeal programs are lacking.”
It adds that the governance model “doesn’t include the community, particularly local authorities and the social partners. It’s a model based on health services, which is unlikely to mobilize the community towards healthy lifestyle habits.”
He believes that local authorities “have a fundamental role to play in promoting health, for example by promoting pedestrianization, cycle paths and sports facilities. They are also at the forefront of licensing fast-food, drinks and similar establishments, as well as promoting physical activity and supporting sports clubs. They have the task and the capacity to implement healthy lifestyles and should therefore be preferred partners in health planning.”

in Correio dos Açores-Natalino Viveiros, director

Translated to English as a community outreach program from the Portuguese Beyond Borders Institute (PBBI) and the Modern and Classical Languages and Literatures Department (MCLL) as part of Bruma Publication and ADMA (Azores-Diaspora Media Alliance) at California State University, Fresno, PBBI thanks Luso Financial for sponsoring NOVIDADES.