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392 The major expectations of this chapter are that you will recognise that the study of social issues such as poverty, health and the environment is based on a development perspective that puts the well-being of people first; comes out of recent thinking about s...

392 The major expectations of this chapter are that you will recognise that the study of social issues such as poverty, health and the environment is based on a development perspective that puts the well-being of people first; comes out of recent thinking about sustainability; is influenced by the Human Development Paradigm; can be more meaningfully studied as an integrated study of all three ; shows crucial links to our history as a colonized region; can be approached through the various sociological perspectives; depends on mastering the key terms and concepts associated with each; depends on you bringing together knowledge you have already acquired about social stratification, social organisation, socialisation, social structure, social change and culture; is rooted in the interplay of aspects of social life – historical, economic, social, cultural, political and environmental; demonstrates both positive and negative effects on Caribbean society; shows regional trends that can be uncovered by statistical and non-statistical means; can only be of value to the region if the measures devised to address each social issue are precise, appropriate and relevant.  393 12 Caribbean Social Issues: Poverty, Health and Environment We tend to be more aware of immediate social problems such as crime and unemployment rather than the underlying social issues that give rise to such problems. In this chapter we will explore specific social issues related to poverty, health and the environment to raise awareness of how these issues impact social life. One of the important points to note in such a study is that while an issue may be labelled as having to do with ‘poverty’ or ‘health’, it may really be the outcome of inter-relationships between poverty, health and the environment. To a large extent, the environment tends to be a forgotten or is an underplayed factor in social issues. For example, a number of diseases that affect the poor result from environmental risk factors. Living in sub-standard dwellings which are overcrowded, and where there are minimal levels of sanitation, constitutes environmental risk for a range of diseases such as respiratory infections, diarrhoea, cholera, intestinal parasites, gastro-enteritis, and tuberculosis. Moreover, as the chapter will show, climate change is expected to worsen the health impacts on the poor. 12.1 Terms and Concepts These were concentrated mostly in Sub-Saharan Africa and South Asia. In the Caribbean, poverty levels vary Related to Poverty, widely, even within countries, as the following examples show. Generally speaking rural poverty is greater than Health and urban poverty. Environment The Human Poverty Index (HPI-1) value for Barbados (3%) for 2008 ranked the country 1st out of This section describes the key indicators, concepts the 108 developing countries for which the index was and terms associated with each of the social issues - calculated. However, in 2012 19.3% of Barbadians, in poverty, health and environment. Whilst each social 15% of national households, had an income below the issue interacts with the other, you will note that poverty line, while 9.1%, just under 7% of households, only a few measures take account of this multidimensional were living below the indigence line, which marks food nature of social problems. poverty (see Box 12.1 on page 394). A study on living conditions in St Lucia revealed that 12.1.1 Poverty poverty increased from 25.1% in 1995 to 28.8% in One of the difficulties of comparing poverty levels in 2005, but indigence fell from 7.1% to 1.6% over the different countries is that poverty is conceptualised same period (CDB, 2007). differently by different data-gathering organisations In 2005 Haiti (65%) and Suriname (63%) had the so that the measures obtained vary significantly. In highest levels of poverty in the region (Bourne, 2005). addition, data is more readily available in some countries so that statistics for comparison purposes may be up to Measuring Poverty date for some but lagging behind for others. Poverty is defined and measured in various ways and In 2013 the World Bank reported that 1.2 billion these definitions will influence the measures devised to people worldwide had an income of US$1.25 a day or less. calculate poverty levels in a country (Box 12.1). 394 PART III: INTRODUCTION TO DEVELOPMENT ISSUES average for a specific country. To determine who may be poor in relation to others, all the people in a country are BOX 12.1 ranked in terms of income. Then the lowest 10% or 15% are considered poor in relation to the others. This statistic Establishing Poverty Lines in cannot be used for global comparisons because those Barbados and Guyana with the lowest income in a developed country are much The indigence line or the food poverty line in better off in monetary terms than their counterparts in Barbados is the annual minimum cost of the a developing country. Relative poverty, however, is a food basket (MCFB) while the poverty line is good indicator of the extent of inequality in a society. It the MCFB + non food items. The average per sees poverty as deprivation of economic resources which capita indigence line for Barbados has been are necessary for full participation in social life. established at Bds$3,970 while the overall poverty line stands at Bds$7,861 per annum The reality for much of the world’s poor though is (Caribbean Trakker, 2012). that their consumption of goods and services may not In Guyana moderate poverty is defined depend too much on income or purchasing power but on as not having sufficient income to afford a home, family and community-made goods or exchanges specified bundle of basic food and non-food in kind. items. This consumption bundle, expressed as the national average household per Social definition of poverty capita expenditure per month on food and This idea of poverty goes beyond measuring level of non-food items, was quantified at G$11,840 in 2006. Extreme poverty is defined as income and physical livelihood as the basis for identifying having insufficient income to afford even the poor. It targets the idea that if one cannot go to the food items in the bundle. This food- school, or access reliable health care, clean water, proper consumption bundle was quantified at sanitation, and adequate housing, then one is living in G$8,400 in 2006 (UNDP, 2012, p.2). a state of deprivation, or poverty, regardless of income. This definition focuses on social exclusion or marginalisation which identifies persons or areas (for example, inner- city areas and some rural communities) which tend to be marked by interlinked conditions such as under- or Absolute poverty unemployment, few reliable social services, overcrowded This is otherwise known as subsistence poverty and is a housing and high-crime environments. measure that uses a yardstick against which a person’s income is compared to find out what level of resources Subjective poverty a person has at her/his disposal to meet basic needs. This idea of poverty involves the poor in assessing their According to UNICEF (2008), this depends not only on own status. Critics of the absolute and relative approaches income but on access to services. Through these estimates to defining poverty argue that various agencies assign an absolute poverty measure was established at US$2 a poverty status based on objective monetary criteria day (with $1 a day or less signifying extreme poverty and do not take into account whether the persons so including severe deprivation or indigence – where food assigned actually do indeed feel poor. In the Caribbean a consumption is too low to guarantee adequate nutrition generation ago our parents spoke about growing up poor to maintain good bodily health). These statistics apply but they didn’t feel poor because there was plenty to eat only to developing countries. For developed countries, and much to do in the ‘great outdoors’. The subjective the poverty line is set as high as US$25 a day (because approach starts by asking households how they evaluate the cost of living in these countries can be very high). In their own situation – how satisfied they are with their the Caribbean, there are slight variations from country lives and the state of their well-being. This brings to the to country in defining the poverty line because the exact fore the multidimensional nature of poverty (outlined later in income or calories needed to survive will differ from this section) because persons could be feeling dissatisfied one region to the next. However, absolute poverty is in all or only some of the domains that pertain to a feeling used widely as a means of comparing different countries of being poor – e.g. income, health, job or leisure. because it is an easy to apply numerical value. The capabilities approach Relative poverty This originated in the work of Amartya Sen (§10.1.2). This measures income or resources in relation to the He extended the concept of poverty beyond income  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 395 and consumption levels, even beyond income-related Table 12.1 Selected countries showing estimation of indicators such as access to health care, to a consideration population below the poverty line of what people can be and do. The different approaches to defining poverty described Country Population below Year of above reflect different ideas of development taken by the poverty line (%) estimate the different sociological perspectives. For example Chad 80 2001 absolute poverty is linked to an emphasis on income and economic progress and has a Functionalist perspective; Haiti 80 2001 relative poverty is linked to Marxist and Critical theories Zimbabwe 68 2004 of underdevelopment; social definitions to Critical theory; subjective poverty to Interpretive theories about Honduras 60 2010 the meanings people have for the conditions under which Mexico 51 2012 they live; and Sen’s capabilities approach is a postmodern concept. What these conflicting views on defining Belize 43 2010 poverty show us is that it is multidimensional in nature, Grenada 38 2008 and one perspective or approach may capture only one or some aspects of it. Furthermore, poverty is experienced Guyana 35 2006 differently by the elderly, the marginalised, women, Dominican Rep. 34 2010 children and so on, so there is a need to deconstruct poverty to understand its impact on the lives of different Bangladesh 32 2010 social groups. India 30 2010 ACTIVITY 12.1 Dominica 29 2009 Venezuela 27 2011 Applying Social Theory Outline the problems/issues involved in defining Trinidad & Tobago 17 2007 poverty at the level of the family. Jamaica 17 2009 United States 15 2010 Poverty Lines and Maps Source: CIA World Factbook (2012). Population Below Poverty Line. The poverty line divides those in poverty from those At http://www.indexmundi.com/map/?v=69, accessed 16 December 2103. who have enough. In the Caribbean the numbers of people living below the poverty line varies across the poor and they remain the poorest group of citizens in region (Table 12.1). Guyana. Region 1 (Barima-Waini), Region 9 (Upper Poverty maps give a spatial representation of how the Takatu/Upper Essequibo) and Region 8 (Potaro/ indicators of human wellbeing and poverty vary within Siparuni) are the most marginalised regions and are also a country, using census information. They are useful inhabited by a higher concentration of Amerindians. because they show: the variations in poverty by region in a country Household Expenditure Per Capita (HEPC) (important to know in addressing inequality); This is a headcount approach used by the World Bank pockets of poverty (can help governments to understand where standards of living are measured by household the determinants of poverty, especially in urban areas); expenditure per capita. This indicator was devised in the distribution of social services such as schools, response to the criticism that absolute poverty measures health centres, and police stations in relation to such as the poverty line were incapable of distinguishing poor households (helps in determining the level of between the wealth/lack of wealth of different groups in deprivation). society and particularly between households. As a result, Figure 12.1 (page 396) is a poverty map for Guyana. It macro-level indicators, such as the poverty line, are indicates that most of Guyana’s poor live in rural districts supplemented by data collected at the level of households and extreme poverty is more likely to be found in the and individuals, such as survey data of individual interior. As many as 77% of Amerindians are classed as households based on consumption expenditure per capita. 396 PART III: INTRODUCTION TO DEVELOPMENT ISSUES nature of ‘development’. The HDI measures three aspects Pomeroon- Atlantic of human development: Supenaam Ocean life expectancy at birth measures the expectation V ENEZUELA Essequibo Islands- of having a long and healthy life West Demerara Barima-Waini educational attainment measures the level of skills Demerara- and knowledge in the society through indicators such Mahaica as adult literacy and gross enrolment ratio in schools; Mahaica- Berbice income/wealth measures the chances of having Cuyuni-Mazaruni an acceptable standard of living – based on Gross National Income per capita. However, countries Upper Demerara have different levels of prices so to be able to compare Berbice Potaro- them meaningfully the data from all countries are Siparuni converted to a common currency which allows for GUYANA PPP (Purchasing Power Parity). In this way GNI SURINAME per capita, based on PPP in US dollars, better reflects Marginality index comparability in living standards across the globe. 2.12 to 2.13 1.98 to 2.05 Upper Takutu- Gross National Income (GNI) is a measurement of 1.02 to 1.98 Upper Essequibo wealth that includes the GDP (Gross Development East Berbice- Product: the total value of goods and services 0.58 to 1.02 Corentyne 0.30 to 0.58 produced within a country) and the GNP (Gross National Product: the net income from abroad. 0.23 to 0.30 -0.14 to 0.19 -0.3 to -0.14 BRAZIL The importance of the HDI is that it created a single statistic for each country arising out of the above three indicators to summarise the level of both social and Figure 12.1 Poverty map for Guyana economic development. The HDI is expressed as a value between 0 and 1. (Refer to §10.3.5 and Table 10.7 for a list The World Bank calculates the HEPC using the consumer of countries and their HDI rankings.) prices for one specific year which is kept constant. Private household consumption expenditure is the market value Multidimensional Poverty Index (MPI) of all goods and services, including durable products (such as cars, washing machines, and home computers), The MPI measures deprivations across the same three purchased by households. Usually a Household and dimensions as the HDI. UNDP published the MPI for Income and Expenditure Survey will collect data on the first time in 2010. Like development, poverty is housing, electricity, fuel and similar costs, as well as daily multidimensional but this has been largely overlooked food purchases. A Living Standards Measurement Survey in previous attempts to measure poverty. The MPI collects data on other non-food expenditures. All this complements money-based measures by considering data assists in ranking households in the country into multiple deprivations and their overlap. consumption quintiles, with quintile 1 being the poorest The Caribbean Human Development Report 2012 used and quintile 5 the wealthiest. It sometimes takes years for the following indicators for the MPI: one of these surveys to be completed (like a census) and nutrition; so the findings have to be backdated to one specific year child mortality; held as a constant (conditions may have changed by the years of schooling; time this data is published). school enrolment; living standards such as access to toilets, clean water, Human Development Index (HDI) electricity, cooking fuel and others. This indicator (see §10.1.2) was devised by the UNDP Not only is it not restricted to income poverty, but it in the 1990s, a decade when the human development identifies overlapping areas of deprivation. A household paradigm became more accepted by international bodies is multidimensionally poor if it is deprived in at least and governments. Traditional economistic emphases two to six indicators. Further, it can show how poverty in measuring poverty were criticised and replaced by changes in incidence and intensity for different regions composite measurements representing the multidimensional and ethnic groups.  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 397 For developing countries, the MPI has revealed a Women trend that the lower the national HDI, the more likely Women make up the majority of the poor in many it is that that multidimensional poverty exceeds income countries. The feminisation of poverty thesis describes poverty (UNDP, 2012). South Asia and Sub-Saharan the growing numbers of women who live in poverty. Africa suffer the most deprivations. In Mexico, higher One of the main predictors of female poverty is single multidimensional poverty was found amongst indigenous motherhood. While the feminisation of poverty is felt peoples and in India amongst those considered to be of worldwide, Brown (2001) states that in the Caribbean the lower castes. In the Caribbean the situation differs the gender disparity in poverty varies – in Jamaica there from country to country as you can see in Table 12.2. are higher rates of poverty among women whereas the Very low levels of poverty are indicated by an MPI close opposite is the case in Grenada. to 0.000. It is important to understand women as more than a homogeneous group, even poor women. Women who live ACTIVITY 12.2 in rural areas are among the poorest in the Caribbean. In addition to being poor they are inadequately served with Social Theory Concepts basic healthcare, training and education, and economic Revise §9.1 and distinguish between the following opportunities. Their poverty is likely to be chronic as concepts: underclass, proletariat, subaltern class, the they suffer marginalisation at different levels – gender working class. inequities and material deprivation. Children Categories of the Poor The poverty of women impacts directly on the poverty of children. Wherever women live in poverty, so too will Income-based definitions of poverty tend to treat the their children, whether in rural or urban environments. poor as a large uniform body. With the micro-data that The prevalence of households headed by single women, household surveys yield, we can now recognise that in particular, in the Caribbean means that a significant the poor are differentiated into sub-groups. These sub- number of children are affected by the same factors groups span many social groups with differing income that keep women in subservient jobs and vulnerable to and other characteristics and their recognition leads chronic and extreme poverty. (The poorer the household to an understanding of poverty as a result of multiple the less capacity is there for members to withstand interacting factors at the global and household level. external shocks such as natural disasters, loss of a job, and In addition, these sub-groups may overlap, e.g. poor declining production.) unemployed, rural women. The sub-groups or categories of the poor are detailed below. Table 12.2 Multidimensional poverty rankings for selected Caribbean and South American countries Country HDI rank in 2012 MPI1 (% of people in multidimensional Intensity of deprivation (%) poverty) Barbados 38 not calculated2 n/a Belize 96 5.6 42.6 Jamaica 85 not calculated2 n/a Trinidad & Tobago 67 5.6 35.1 Peru 77 15.7 42.2 Guyana 118 7.7 39.2 Haiti 161 56.4 53 Notes: 1 Multidimensional Poverty Indicator 2 MPI has not been calculated owing to a lack of data. Sources: http://hdr.undp.org/en/data; http://hdr.undp.org/sites/default/files/Country-Profiles/JAM.pdf; http://hdr.undp.org/sites/default/files/Country-Profiles/BRB.pdf. 398 PART III: INTRODUCTION TO DEVELOPMENT ISSUES Youth Brown (2001) regards poverty in the Caribbean as something of a youthful phenomenon. In the study he conducted of selected countries, the highest proportion of the poor was found to be below 25 years of age. If we regard ‘young adults’ as those between secondary school leaving age (16–19 years) and the age of 25 years, we can identify factors that could lead to an intensification of poverty for this sub-group, from different perspectives. An inter-generational perspective would see poor young adults as inheriting certain conditions from their parents. As children grow into youths, the cumulative effects of parental and childhood poverty would influence their life chances. needs are different. In the last group, services such as A life course perspective looks at the important terminal care represent an important need. Gender events and rites of passage that individuals in society also plays a part, for women more than men make up must negotiate from birth to childhood, adulthood, the elderly poor and natural and gender imbalances are maturity and old age. Where young adults are exacerbated by the practice of migrants leaving their concerned, leaving school, dating, getting a job, getting offspring in the care of their grandparents. Geographical married, becoming a parent, looking for adequate locations vary, but in Jamaica, for example, census data housing, are significant lifecourse events. A poor youth indicate that the elderly tend to live in their homes with who has experienced childhood poverty can hardly their families and the majority live in rural areas, which achieve these challenges effectively. Experiences of record the highest levels of poverty. early childhood deprivation, such as poor nutrition, abandonment, living in unhealthy environments and The unemployed and underemployed being subject to a range of childhood afflictions and These two categories of population are likely to become diseases, could take a heavy toll on an individual’s poor if they have insufficient resources from welfare cognitive and healthy functioning. In such a case payments or family support networks. Even with support intergenerational poverty becomes chronic – the child their poverty can intensify over time if their employment of poor parents becomes in turn a poor adult/parent. status does not improve. We saw above that throughout the Caribbean youth The elderly had the highest levels of poverty. It is not surprising According to the Demographic Transition Model then to note that youth also record the highest rates (§10.4.4), the elderly are increasing in number in of unemployment. In Trinidad & Tobago while the Caribbean society. The transition to modern, urban national average for unemployment stands at 7%, for lifestyles, where more women are educated and are the sub-group 15–25 years it is 18–20%. Young school holding down careers and stable jobs, together with leavers find it extremely difficult to secure employment family planning campaigns, are possible reasons for the nowadays because the formal, wage-sector labour decline in birth rates. Longevity is therefore increasing. markets cannot absorb the thousands who leave school Unfortunately, the aged are vulnerable to poverty, every year. In the not-too-distant past, Caribbean especially those who have low incomes or pensions economies were expanding and so new recruits could which are fixed and cannot keep pace with inflation be offered employment in the public service, the police and the rising costs of medical care and senior citizens’ service, nursing, teaching, and in the private sector. homes and facilities. It is poor adults who transition into Migration was an easier option then and that helped the bulk of the elderly poor and older persons may rely lessen the population pressure on scarce resources. heavily on their children and other relatives to afford Today, the downturn in the world economy has been them a better quality of existence. followed by shrinking in certain sectors of Caribbean Like other categories of the poor among the aged economies and so the labour market is contracting and there are sub-groups. We can identify age groups (e.g. unpredictable. In addition, it is very difficult for youth the younger elderly (60–74 years) and the older elderly (over (without professional development skills and expertise) 75 years), or even the oldest old (85+ years), each of whose to gain visas to migrate legally.  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 399 While all the countries of the Caribbean exhibit these employed persons in Guyana and 12% for St Kitts trends, unemployment is more entrenched in some. In and Nevis. In both Barbados and The Bahamas, the Grenada national average unemployment stands at 37%, working poor represent only about 4% of all those according to government sources in 2013. In the rural employed. areas unemployment is high particularly among youth, The typical ages of working poor are between 25 fishermen and women who are heads of households. and 44 years. This is also the age group of the highest Young people tend to drift away to the towns or to look numbers of employed persons in these countries. towards the tourism sector or migrate if they can. They The working poor have low levels of education; do not see agriculture as a viable option. The agricultural usually primary education is the highest level of workers left are elderly and to a large extent cannot education attained (for example 83% in Jamaica), and overcome the constraints of small landholdings, lack of only 2%–8% had achieved tertiary education. technical skills, and lack of access to credit facilities. This The majority are employed in agriculture, social deepens poverty in the rural areas. Rural youth who go services, construction and sales. In Jamaica 34% of to urban areas also find difficulty in securing a job there. the working poor are in agriculture. In The Bahamas Where gender is concerned, women in the Caribbean 57% of them are in elementary occupations such as are almost twice as likely as men to be unemployed. In unskilled or manual jobs (domestic helpers, street Trinidad & Tobago it should be noted that women with vendors, garbage collectors and labourers). a secondary education have a higher unemployment rate More males are found in agricultural occupations and than men with any level of education, including those females dominate in sales and clerical positions. with no education! This gender gap in unemployment People with special needs may stem partly from the types of jobs normally accessed by each gender. Women tend to be concentrated in fewer This is an omnibus term in that it includes all persons who occupations such as clerks and service workers, while are in some way disadvantaged, especially those who men are more widely distributed through professional, experience disability. The World Bank (2011) describes managerial, manufacturing, agriculture and construction disability as a condition experienced by some persons occupations. In addition women are more likely to be in their interaction with others where they are denied unemployed than men whatever their industry sector. This rights and opportunities largely because they differ in points to women and men being treated differently in the capabilities and levels of functioning relative to others. labour market and it would seem that there is a preference Box 12.2 on page 402 describes some characteristics of for male workers by employers. Higher unemployment this group in the Caribbean. This World Bank description among women is a serious Caribbean-wide problem may be surprising as a definition of disability because it because of the prevalence of female-headed households. stresses the social milieu. It says that even if people have a physical, sensory or mental limitation, that in itself does The working poor not make them ‘disabled’. It is confrontation with social The working poor as a group is often studied alongside exclusion, stigma and neglect that exacerbates their those who are underemployed or self-employed. Working condition because to a large extent they are denied what poor are defined by the International Labour Organisation a functioning member of society has access to – schools, (ILO) as jobs, and public services. The facilities and amenities that ought to be put in place for people with special needs individuals engaged in either paid or self employment to enable them to function more effectively in society who belong to households with an adult equivalent are largely missing, especially in developing countries. per capita household expenditure (or income) that Hence, the definition does not emphasise the impairment falls below a specified poverty line. (ILO, 2006, p.1) a person suffers but the limitations imposed on the person by how society is organised – the social, cultural, Based on Labour Force Surveys and Surveys of Living economic and environmental barriers that prevent them Conditions for eight Caribbean countries – The Bahamas, from participating fully in social life. (There is more on Barbados, Dominica, Grenada, Guyana, Jamaica, Saint disablement later in this chapter; see §12.1.2.) Kitts and Nevis, and Trinidad and Tobago – the ILO About 82% of disabled people in Latin America (2006) conducted a study to identify the characteristics of and the Caribbean live in poverty. Disability is thus the working poor. Their findings are summarised below. an important cause and consequence of poverty. For The numbers of the working poor are high in example, disability causes poverty when certain ailments some countries; for example, they constitute 29% of 400 PART III: INTRODUCTION TO DEVELOPMENT ISSUES BOX 12.2 A Study of Disability in the Caribbean For four Caribbean countries, Schmid et al. (2008) working conditions, alcoholism, obesity, lack of made the following findings. exercise and smoking). Disability prevalence rates ranged from 2.2% to School-age boys and male youth were generally 8.4% of the total population. found with higher rates of learning, speech and Those who suffer most from disabilities were behavioural disabilities than girls of the same over the age of 60 years. age-groups. Of those over 60 years with disabilities, women It is important to note that the majority of were in the majority, and suffered mainly from disabled persons in this study reported that lifestyle-related chronic diseases. they did not have access to devices that could assist them to be more functional. Such devices In the younger age-groups men were found can include hearing aids, walkers, wheelchairs, to be more prone to disabilities than young prostheses, and braille as well as, software that women, mainly as a consequence of lifestyle- allows voice recognition or modified keyboards related behaviour (vehicular accidents, unsafe that could enable use of computers. and impairments prevent persons from getting a job Single-parent families and staying employed. This can be addressed through The proportion of this group in the population is adequate health care for those in need and continuing increasing, not only in the Caribbean, but the world support via home care. Disability allowances can also over. In the Caribbean, the majority of these families assist in this regard. live in mother- or grandmother-headed households, also In all Caribbean countries, there is limited data known as matrifocal households. As we have seen, to a on persons with special needs. More thorough data- large extent women experience more poverty than men. gathering is necessary where these groups are concerned, In Jamaica, for example, male-headed households are so that government planners can be aware of their needs. smaller and have a per capita expenditure 10 times higher However, the fact that information is scant largely stems than female-headed households (Smith & Ashiabi, 2007). from the social location of these groups – to a large extent Other Caribbean research reveals a varied picture across they are ‘hidden’, they are not vocal and only in rare the Caribbean (Figure 12.2). cases do they agitate for more recognition, and they are While single-mothered households of higher stigmatised. In society, they lack power because they are achieving women are not at risk for falling into poverty, not seen as ‘normal’ people (the more politically correct the majority of single-parent families are vulnerable, term is the ‘non-disabled’). low-income families in particular. If the mother in a Often the dialogue on eradication of poverty does not single-parent family falls ill, the slim safety net of the include disability. This is because people with disabilities family disappears. In the Caribbean where there tends to are traditionally seen through one of two perspectives be an extensive network of kin, support may be available – the medical model which defines a person by their – but this may not be enough to keep the family intact disability, e.g. as an autistic or dyslexic child; or the charity and out of poverty. The father of the family too may be model, which sees them as ‘sufferers’ and seeks to alleviate a contributor but the unemployment rate among adult their pain. By contrast, the social model recognises that men of a lower socio-economic class is high, so that men this is a group of widely diverse persons with different may also be not in a position to help. levels of capabilities and functionings who become Indigenous peoples ‘disabled’ through being excluded and marginalised in social life. Poverty eradication cannot be successful if the There are relatively large groups of First Peoples in three linkages between poverty and disability continue to go English-speaking Caribbean territories, Dominica, Belize unrecognised. and Guyana. Throughout the Caribbean, the indigenous peoples record the highest levels of poverty in the region.  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 401 Dominica has some 3,300 Kalinago (Carib) the most poorly equipped schools and the least- descendants living mostly in the north of the island. qualified teachers in the nation are found here. In Over half of these households have no one working many of the communities there is a high incidence of in the formal wage economy – they are mainly intestinal diseases and in 2008 there was only one subsistence farmers. Further, their housing conditions hospital for an estimated 30,000 inhabitants are substantially worse than the other poor households: (CACHR, 2008). Employment opportunities are 39% do not have access to safe water and there are scarce in Toledo and Mayan groups are calling for the very few with flush toilets. However, most of them preservation of their lands so that they can continue own their land which helps them to survive at a their traditional milpa farming system. subsistence level (IMF, 2006). It is estimated that 28.8% Milpa cultivation is carried out by a family, who of Dominican people live in poverty but where the clears part of the forest and cultivates the land and Kalinago population is concerned, the figure is 49.8%. then allows it to lie in fallow for a number of years This is startling especially when they make up only 5% while they cultivate other sections. of the national population (CDB, 2013). Clearly, this over-representation among the poor shows a deeply It is a centuries-old system that allows for high yields, entrenched tradition of marginalisation. but also the ‘resting’ of the land in the fallow period so In Belize, the indigenous include descendants of the that the soil recovers its nutrients, and the minimum Mayan Indians who make up about 10% of the need for artificial pesticides and fertilisers. It fits in population, and the Garifuna, a mixed group of today with the thinking of the ‘green movement’, Africans and Amerindians, comprising 6% of the soil conservationists and sustainable development. population; 77% of Mayans are counted among the However, the issue is tied up in the unwillingness of poor and they survive mainly by subsistence farming the government to lose lucrative alliances with foreign and hunting. Toledo in the south of Belize is an area developers and forestry companies. They now infringe which experiences the highest poverty levels in Belize on Mayan historic homelands and are not as careful of and is home to 65% of the Mayan people. Some of the environment as the milpa system was. A t l a 96% of poor households USA n t i c are female-headed 60% of households below The O c the poverty line are Gulf of Ba e a ha n headed by women ma Mexico s 30% of female-headed households live below Cuba Puerto the poverty line Dominican Rico Haiti Republic Barbados Mexico Men in rural areas control St. Vincent & 30.5% of households are Jamaica larger and more potentially The Grenadines C headed by single women a productive pieces of land Grenada defined as poor r i b b a Trinidad Belize e a n S e & Tobago Poverty is higher among Guatemala Honduras female-headed households Venezuela Figure 12.2 Map showing female-headed Caribbean households in poverty (Source: UN Women, at http://www.unifemcar.org/ge_iss.cfm?SubID=168&link_=1, accessed 18 December 2013.) 402 PART III: INTRODUCTION TO DEVELOPMENT ISSUES In Guyana there are approximately 55,000 on health. Collaboration is necessary between different Amerindians dispersed throughout the country government ministries working together with NGOs in nine tribal groupings –the Wai Wai, Patamona, and CBOs (community-based organisations) to provide Arecuna, Macusi, Wapisiana, Carib, Warrau, Arawak development opportunities that decrease the levels of and Akawaio, making up approximately 9% of the material and social deprivation in a country. Guyanese population, and the majority of their communities are located in rural and isolated parts Defining Concepts Related to Health of the country (Figure 12.1). They suffer from a long Positive and negative health history of neglect and marginalisation. In particular, A positive way of defining health is to look at it in a holistic there seem to have been many attempts in the past by way – that is, to take into account someone’s general state the authorities to wrest some of their more valuable of well-being, mental and emotional as well as physical. lands from them – lands rich in timber and mineral (The spiritual dimension is also included.) This, however, resources, and to repay them through a fund which is not a dominant way of describing health and is more would focus on improving the standard of living in likely to be held by naturopathic healers, yoga devotees, Amerindian villages. Contributions to this fund have herbalists and all those who subscribe to alternative/ been minimal. Amerindians are not in a position of complementary wellness philosophies. However, the power to monitor government business and to date positive concept of health has been receiving attention they continue to receive inadequate social services, internationally because it is important in health promotion education and job opportunities. They are minimally – educating members of the public to take an active represented in the government and popular perception stance towards safeguarding their own health. tends to portray them as backward and dependent. The phrase primary health care is linked to ideas of Extreme poverty in the hinterlands has forced them to positive health in that it invites a collaboration between seek work in mining and urban centres where they eke community health personnel and individuals to engage out a precarious living. Women too have been forced in healthy practices in order to prevent the onset of disease to leave their families in the care of older relatives as and disability and to increase one’s level of wellness. they seek menial jobs in the urban, coastal region. For example, by incorporating an exercise programme Caribbean countries seem to have continued the into one’s daily routines, understanding nutrition marginalisation and exploitation of the indigenous and making informed choices about what one eats, peoples that began with Columbus, and was refraining from smoking, drinking too much alcohol, perpetuated by the other European colonisers. After and/or the recreational use of drugs, and avoiding other Independence, the urban Afro- and Indo-elites began a risky behaviours. Primary health care involves local policy of decolonisation and opened up education and clinics, general practitioners and those who practise employment opportunities for previously obstructed complementary medicine. Hospitals represent secondary groups. However, the image of progress and development heath care and tertiary health care refers to institutions which remained exclusively Eurocentric, and the Amerindians take care of the terminally ill. (There is an assessment of were largely forgotten. primary health strategies later in the chapter in §12.4.2). To efficiently address the Amerindians’ poverty, Caribbean nations have to reverse historical trends that have marginalised this group. However, a one-size notion of development may not work for ethnic minorities. More dialogue with Amerindian leaders, more consultation and more collaboration could be a major strategy directed at reducing poverty among this group and enhancing sustainable development in the nation. 12.1.2 Health The interrelationships between the three social issues of health, poverty and the environment make it clear that policy-makers in heath alone cannot adequately address the problems created by the effects of poverty  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 403 A negative definition of health emphasises the ‘absence to a large extent determines how that person assesses of disease’. This is the biomedical view and is the dominant their wellness and health. Someone may have a condition perspective in the social institution of health (Box 12.3). such as diabetes and feel healthy and well; a person may One of the outcomes of this negative view of health is be confined to a wheelchair because of a disability but that ordinary individuals (who do not have biomedical report that they are healthy and well; and someone may knowledge) are not encouraged to take responsibility for feel ill but have no disease. Illness, then, is a subjective their own health and well-being. This promotes a passive state whilst having a disease requires independent attitude to one’s health and a belief that only doctors have corroboration. The situation is further complicated the knowledge, power and authority to pronounce on by social factors, for example, level of education. matters of health. Historically, hospitals became a place The more education one has the more likely one where one was ‘fixed’ and made healthy again. Those is to visit the doctor for illness. This does not mean that who advocate health promotion and primary health care the more educated are prone to illness but rather that oppose this view and claim that people have become too they have knowledge which encourages them to be dependent on doctors and hospitals for their health care. proactive in health seeking. Illness and disease Disability Distinguishing between terms such as ‘illness’ and The main influences which construct our ideas about ‘disease’ introduces social attitudes to health. While disability stem from the biomedical model. This the medical world looks at disease and illness as being encourages us to ‘see’ a disability as something peculiar related concepts, many ordinary persons see different to a person who has come to this condition as a result of connections. For example, how someone looks and feels having a disease or impairment that affected him/her in BOX 12.3 The Biomedical Model From the 18th century to the present, medicine children, differentiated according to ethnicity has been deeply influenced by the scientific and socio-economic status, yield certain high-risk method and today the focus is on the pathology populations. These should be identified by public of disease – the specific anatomic or functional health officials. Understanding the lifestyles of manifestations of disease. When confronted by these groups enables public health policies to be illness or disease, doctors attempt to find out more put in place to address their health needs. about the underlying pathological processes that may be causing the condition. For that they rely on medical technicians and laboratories to test blood, to carry out X-rays and scans, to apply certain drugs and assess their effects on the symptoms. The emphasis is narrow – on the pathology of the disease and its effects on the human body – not necessarily on the patient and his/her life as a person. Medical knowledge, such as the specific aetiology of disease (the paths the disease took, the organs it affected and related symptoms) is the province of certified specialists. Whilst the bio-medical model is dominant in the individual interactions between doctor and patient, in hospitals and among the medical fraternity, where public health indicators are concerned there is need to think about human populations as a collective and therefore sociological thinking becomes important. Social groups such as the elderly, women, and 404 PART III: INTRODUCTION TO DEVELOPMENT ISSUES this way. Earlier in the chapter we talked about the way of the ways institutional care is provided. Usually, such in which society (influenced by the biomedical model) residential facilities cater to the needs of the chronically defines persons with disabilities, in terms of their disability ill or disabled and those suffering from mental illness. (‘the autistic child’ instead of ‘a child with autism’). In the case of the latter, institutional care may also be Some disabled people, however (e.g. those with hearing custodial, seeking to protect society from those who may problems) see themselves as healthy and well-adjusted to be mentally ‘unbalanced’. Box 12.4 examines the stigma their condition rather than disabled. attached to mental illness. Opposition to the dominance of the biomedical There is a large body of literature which speaks to the model in defining who is a disabled person has led to the dehumanising experience of being a patient or inmate of relational or social view that disability is a consequence a medical or other type of institution. This may include of social oppression and discrimination. Health sexual and physical abuse, especially of children and the professionals are more likely to hold the biomedical view elderly. Goffman (1968) describes the experience of life and the disabled and their various groups and movements in institutions as batch living. He underscores the reality tend to hold the social view which is more radical. that to live successfully in an institution one has to obey rules and regulations. Obedience and conformity are Institutionalisation prized over individuality or personal choice. This is This refers to the practice of placing patients in a health or demeaning because all inmates are treated as a uniform other facility for a period of care. Figure 12.3 shows some group and given very few periods of freedom. orphanages, halfway homes for houses and foster homes senior citizens hospices, which offer care and comfort to terminally Institutional hospitals and nursing homes ill patients Care for the chronically disabled hospitals and nursing homes and schools homes for the for the handicapped mentally ill Figure 12.3 Institutional care BOX 12.4 Stigma and Mental Illness The history of naming mental institutions shows imply that the inmates in these institutions are attempts to reduce the stigma attached to mental quite different from the rest of the population illness. In Trinidad & Tobago the Belmont Lunatic and prone to such disorders. It also attempts to Asylum was established in 1858 and later grew into confront a prominent perception (and a reality the larger St Ann’s Asylum which became popularly in some cases) that mental institutions serve known as ‘The Madhouse’. In 1935 the name was the function of protecting the people outside changed to the St Ann’s Mental Hospital and still from those inside. By choosing to label a mental later, in 1961, to the St Ann’s Hospital. These name condition as an ‘illness’ which can be treated in a changes are sensitive to how medical terms can ‘hospital’, health authorities are trying to reinforce stigmatise persons and they raise awareness that the idea that mental health is applicable to the words ‘lunatic’, ‘asylum’ and ‘mental hospital’ everyone.  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 405 Morbidity and the close relationship between the environment, This refers to numbers of people experiencing ill health health and poverty is masked. In this section we will during a specific time period. Public health research explore the links between environmental health and in Caribbean countries reveals the fact that the major poverty. Environmental health refers to the public health causes of morbidity are diabetes and cardio-vascular issue of protecting citizens from harmful environments diseases, which stem largely from unhealthy lifestyles. that threaten their health. Threats come from pollution, Arthritis and hypertension are chronic complaints of the disease vectors such as mosquitoes, levels of toxicity, elderly. Overweight and obesity are growing problems natural and man-made hazards and habitat changes that among youth and other groups whilst malnutrition and affect society. undernutrition are experienced by certain groups – those who are extremely poor and the elderly who live alone. Climate Change Mortality There is an on-going debate about climate change but to a large extent major world bodies have accepted statistical Mortality statistics give the number of deaths in a data showing long-term changes in the distribution of country over a specified time such as a year (§10.3.2). weather patterns and weather events. They emphasise These statistics – the death rate, infant mortality rate that the accelerated changes they see are unlikely to be a (IMR), and morbidity rate – give important information natural occurrence and are more likely to be due to regarding public health. For example, Trinidad & Tobago anthropogenic global warming. Burning of fossil has indicated a slight increase in maternal mortality and the IMR from the 1990s to the present. This has Anthropogenic global warming refers to the rise been linked by various organisations to the difficulties in temperatures of the earth’s atmosphere and oceans of poorer groups and those in rural areas in accessing induced by human activities. adequate prenatal and post-natal care. fuels leads to increasing levels of greenhouse gases (e.g. carbon dioxide) in the atmosphere. These trap heat in Health Problems in the Caribbean – Prevention and the lower atmosphere and do not allow it to flow freely Control into space. Air pollution caused by human activities is one of the primary ways in which greenhouse gases are added A study of the social institution of health in the Caribbean to the atmosphere. The warming up of the planet is an reveals the decline in some illnesses and diseases, for environmental health issue because it poses a number of example, communicable diseases such as tuberculosis, risks to human populations. small pox, cholera, leprosy, polio and others. Success in Climate experts predict not only heavier rainfall and these areas have been largely due to advances in public more powerful hurricanes but rainier wet seasons and health – vaccines, spraying, public awareness campaigns, drier dry seasons affecting crop production and resulting cleaning up the drinking water supplies, modernising in food scarcity. Periods of drought will become more the sewage system and monitoring food establishments. common and last longer. Today the causes of morbidity and mortality stem largely Constant high temperatures are driving the melting from lifestyle diseases, such as HIV/AIDS (which is a of the ice caps and so sea levels are rising. An increase communicable disease), and type II diabetes, substance in the number of intense hurricanes likely to affect the abuse, obesity, and hypertension (which are non- region is also predicted, because hurricanes form partly communicable). There are also rising levels of mental as a response to high sea-surface temperatures. The illness, the causes of which are more complex. These destructive potential of a Category 4 or 5 hurricane issues are described in Box 12.5 (page 406), a case study can produce large-scale devastation. More powerful of lifestyle diseases in Trinidad & Tobago. storms also bring much more rainfall leading to massive flooding, destruction of property and livelihoods and 12.1.3 The Environment increased coastal erosion. Warmer temperatures also While poverty and health are widely recognised as cause sea levels to rise, as the ice sheets at the North and social issues and as immensely important to the stability South Poles melt into the oceans. (See http://geology. and well-being of society, the environment tends to be com/sea-level-rise/ for a useful interactive map showing regarded as the neutral ‘backdrop’ to our activities, one the effects of sea level rises worldwide.) These changes that belongs to all of us. It is seldom seen as a ‘social’ issue represent a direct threat to life and livelihood in all low- 406 PART III: INTRODUCTION TO DEVELOPMENT ISSUES BOX 12.5 Case Study: Lifestyle Diseases in Trinidad & Tobago HIV/AIDS alcohol) is closely associated with drink-driving, The Ministry of Health offers free antiretroviral child and spousal abuse, and homicides. Alcohol drugs that suppress the HIV virus in infected use among the young is increasing, particularly the persons. (In pregnant women the drugs prevent school-aged population. the virus from passing to the foetus.) HIV/AIDS Among adults, the main drugs used, apart from services provide youth with information to enable alcohol, are marijuana and cocaine. In addition to them to make informed choices, increase their the harmful effects of these drugs on individuals awareness of sexual risk-reduction behaviour and their families, the use of crack cocaine is also and increase knowledge of safer sex practices. associated with unsafe sexual practices and the Antiretroviral therapy has reduced the morbidity spread of HIV/AIDS. and mortality due to HIV infection. However, new Diabetes and Obesity cases of HIV among the 15–24 age group are a cause for worry. They now account for 4.3% of all Obesity is directly related to most cases of type II new infections and females have a higher incidence diabetes, high blood pressure and cardiovascular of infection than males. In fact, the number of diseases. It is therefore the single most important new HIV-positive cases reported for young women condition that can be targeted to reduce the between the ages of 15 to 19 years is nearly three incidence of these diseases. Obesity is on the times that reported for males in the same age increase, with over 55% of the whole population group (Ministry of Health, 2012, p. 9). Another classified as obese. Children are becoming concern is that reliance on drug therapy is not overweight because of their lifestyles – particularly sustainable given the fact that we do not yet know unhealthy eating patterns and lack of physical the long-term side effects, and increasing numbers activity linked with the popularity of television, of HIV-infected persons have developed high computer use and video games among this age resistance to the drugs. There is also a shortage of group. This trend is associated with the sharp rise doctors trained in this specialised field. in diabetes among the school-age population. Substance Abuse There has been a 300% increase in children that are overweight and obese over the past ten (10) years, from The average age of first time use of alcoholic just over 8% in 2001 to 24% in 2010 beverages was 10.9 years with seventy five percent (75%) (Ministry of Health, 2012). of all students having initiated alcohol use by age 13 (Ministry of Health, 2012, p.6). In 2012 there were 175,000 diabetics in the Trinidad & Tobago population as a whole. Diabetes This is a major public health issue, because not only is ranked second among causes of death in this is it detrimental to the individual, but it impacts country in spite of many government initiatives. negatively on others – abuse of drugs (including lying coastal communities in the Caribbean, such as leads to increasing poverty and health risks in rural areas. Dominica (Box 12.6). As indicated above climate change is likely to While these are general concerns for everyone, the threaten health and well-being among the population impact on the poor is severe. Their health suffers – as the production of food decreases. This is a matter of especially the elderly and the very young – from excessive food security – ensuring that adequate supplies of food are heat, and they will tend to develop respiratory, bronchial available on a consistent basis. As food supplies dwindle and asthmatic complaints. Given that they are likely to the poorer sectors of the population would not have the be malnourished in the first instance, levels of morbidity ability to access resources to obtain nutritious foods. are projected to increase. In the case of the rural poor, in some areas continued drought may lead to desertification as Pollution the lands the people once cultivated become increasingly Pollution of the environment is another major factor dessicated. Such lands have to be abandoned to that threatens the lives and livelihoods of citizens, but food and cash crop production. Climate change therefore particularly that of the poor. They are more likely to  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 407 BOX 12.6 Case Study: Climate Change and Dominica One of the effects of global warming is a projected major dislocation and over $EC 162 million worth rise in sea level by about 1 metre over the next of damage, amounting to 58% of the country’s hundred years. Dominica is a mountainous island GDP. Longer-term adverse effects include the and so most of the settlement is on the coast. loss of income and employment and the need to However, significantly large coastal plains occur deploy scarce resources for the rebuilding effort, in the south-west, where the capital, Roseau, is instead of funding disease prevention initiatives, located and where most of the people live. Rising for example. Like many Caribbean countries, sea levels thus pose a major hazard to Dominica certain events (a hurricane, an earthquake or because all the lands under an altitude of 100 a slump in world commodity prices) pose a metres in the south-west is either built up for shock to the economy and poverty immediately human settlement or cultivated for food and cash increases. Creating sustainable livelihoods is a crop production. Not only could valuable lowlands major objective of development plans and seeks be submerged but coral reefs may be destroyed to ensure that a people can cope and recover (the coral polyps can survive only in waters where quickly from shocks and strains in the economy by sunlight can penetrate) and once the reefs are using environmental assets wisely, which includes removed, coastal erosion would increase. the notion that resource use must also provide A small, vulnerable island-state like Dominica for future generations. Countries as vulnerable cannot withstand the constant impacts of as Dominica need to move swiftly to organise a hurricanes or the longer term phenomenon of response to these threats by preparing informed rising sea levels. Hurricane Dean in 2007 caused and detailed disaster preparedness plans. live and work in areas with high levels of air, land, water interception by the leaves, branches and trunks of the and noise pollution. Since especially in the rural areas tree and then further infiltration of the rain water into they rely so closely on the resource base for a livelihood, the soil, depending on the size of the drainage basin, it increasing pollution and environmental degradation will may be days before such water reaches a watercourse. directly affect their sources of income and their health. Forests therefore play a vital role in regulating river flow In Box 12.7 (pages 408–409), pollution is discussed in – there is no spike in river levels following a rainfall relation to poverty and health in Jamaica. event and similarly, it would take a long time without rain for the river level to drop. If the forests are removed, Deforestation and Forest Degradation rivers can disappear. Forests are also important to protect In the larger Caribbean territories much of the forest cover biodiversity and small ethnic communities, as well as for has been cleared for agriculture and urban development. recreation and tourism, especially scenic spaces. Only in the relatively mountainous settlements, has the land remained in forest. This forest cover is important in How the Environment Impacts on Poverty and Health preventing soil erosion by protecting the soil from strong Poor families are extremely vulnerable to environmental winds and heavy rainfall and floods. Soil degradation hazards, and lack access to good health facilities. In rural actually encourages flooding because when rain falls areas they may have to travel long distances to a clinic, the hard compacted earth does not allow infiltration and their very poverty prevents them from accessing and all water runs swiftly downhill. Soil then collects health care which may be closer: daily paid workers on river beds and raises the level so that it takes less cannot afford the hours away from their job and the water for the river to reach bankfull stage and flooding opening and closing hours of the clinic often makes it inevitably results. A Caribbean example of large-scale inaccessible. Service in the public hospitals and clinics land degradation is Haiti, one of the poorest nations on on which they rely may be irregular, prescription drugs earth (Box 12.8, page 410). are unavailable and there may be a long waiting list for Maintaining an extensive forest cover is an important use of dialysis machines, hospital beds and operations. environmental goal because forests help to delay the Poor people suffer and mask pain and discomfort much impact of rainfall events in the drainage basin. Through longer than they should, often going to the doctor only 408 PART III: INTRODUCTION TO DEVELOPMENT ISSUES BOX 12.7 Case Study: Pollution, Poverty and Health in Jamaica Air Pollution those taking tourists out on the waters, as well as This is mainly an urban phenomenon in Jamaica poor fisher folk, have experienced a drastic decline but it is also found in mining districts scattered in earnings. throughout the countryside. The production of Land Pollution bauxite and alumina, the burning of fossil fuels This is otherwise known as land degradation and to produce electricity, and the manufacture refers to the decline in land quality caused mostly of cement, chemicals and petroleum all emit by human activities. Land degradation may result pollutants into the atmosphere. In addition, the in ugly landscapes characterised by indiscriminate increase in the number of motor vehicles in the dumping, or by deeply scarred areas where almost Kingston Metropolitan Area (KMA), adds to the all of the top soil has been removed and the land pollution, particularly carbon monoxide. is criss-crossed by ravines and gullies. Soil erosion A higher incidence of persons suffering from leads to a decline in productivity of the land. In respiratory diseases have been found in areas Jamaica, the big sugar estates have grown cane close to bauxite and alumina plants, factories under a system of monoculture for long periods making sulphuric acid, and parts of urban areas without ‘resting’ the land (i.e. leaving it fallow). greatly affected by smoke. Those who live near In such circumstances the soil becomes depleted dump sites, for example, have to breathe air with in certain nutrients which make it less fertile. a high content of particulate matter and these Commercial agriculture also entails the use of contaminants restrict the ability of the lungs to mechanisation, fertilisers and pesticides which use oxygen. Hence, there is an increased risk of results in further degradation: morbidity and mortality among those groups living near to such sites, but particularly among infants, Mechanisation causes soil compaction – those suffering from chronic heart and lung tamping down the soil so that infiltration is disease, and the elderly. reduced and roots disturbed. The soil becomes more acidic when fertilisers Water Pollution are used improperly. Jamaica receives its water supply directly from Pesticides reduce the levels of useful insects rainfall, from surface water (rivers, ponds, and such as bees. streams) and from underground systems (springs and wells). Groundwater supplies are threatened, especially near bauxite mines, by deposits of Production trends show a general decline and caustic soda (lakes of red mud waste) and seepages this is unfortunate because many labourers are from unlined solid waste dump sites. Also, poorly employed in the sugar industry on the estates constructed sewerage systems, particularly in addition to the small sugar-cane farmers. The soakaway pits, drain waste directly into the fortunes of much of the agricultural poor are underground water supply. Near the sources of closely tied to the buoyancy of the sugar industry. rivers and springs, pit latrines pose a particular The majority of small cultivators who contribute danger especially if communities further downriver to the food economy also engage in practices that use river water for domestic purposes. are ill-suited to the land. For example, soil erosion Coastal waters have been polluted by dense is encouraged when steep slopes are cultivated, settlements which put pressure on fragile coastal similarly when slash and burn exposes the soil resources. For example, effluents such as sewage, to the elements. However, local knowledge and oil spills, industrial wastes and agricultural traditional farming practices have helped to chemicals drain heavy metals into wetlands and keep small farmers in business and continuing to coastal waters. These are toxic to marine life and produce food for domestic markets. In parts of St can intervene and destroy parts of the food chain. Elizabeth where vegetables are grown, farmers Fishing in offshore areas in and around Kingston struggle with moisture deficiency and low rainfall has almost come to a halt because of the high and have relied on traditional knowledge to levels of toxicity in the harbour waters. Biodiversity keep a certain proportion of their plots under a also has declined because of pollutants. Persons permanent cover of dried grass mulch. The grass who depend directly on coastal resources such as cover reduces soil moisture loss, erosion and weeds.  CHAPTER 12: CARIBBEAN SOCIAL ISSUES: POVERTY, HEALTH AND ENVIRONMENT 409 BOX 12.7 Case Study: Pollution, Poverty and Health in Jamaica (continued) In urban environments land degradation to garages, schools, restaurants, playing fields, occurs where there is inadequate solid–waste laundries, and all types of businesses. Wealthy management and unplanned housing persons tend to live in residential areas that are development. Population growth, rural–urban zoned for housing and usually there is no variation drift, and the expansion of industrial activities in land use. have resulted in intense competition for land. The varieties of urban land use, for example, in Table 12.3 Decibel levels of some common noises Kingston, create the conditions for degradation – crowded housing, indiscriminate dumping, and Noise Decibel level polluted watercourses. The ‘modern’ economy, then, poses more of a threat to the environment jet airplane during takeoff 150 than poor farmers. (25 metres) Noise Pollution Fireworks 140 This is usually defined as any noise or sound that is annoying or physically harmful to persons. In Thunderclaps (close) 120 Jamaica there are frequent newspaper reports Chainsaw 120 about very loud music played in residential areas at all hours of the day and night with little loud rock/steelpan music 110 intervention form the authorities. at a concert The impact of exposure to sound pressure levels above Walkman on 5/10 setting 94 85 decibels (dB) for more than eight hours, or 100 dB for electric drill 90 just 15 minutes, damages the hearing. A car horn at 120 dB causes noise-induced hearing loss after just seven lawnmower 90 minutes. At 160 dB, the eardrum can break instantly, and 180 dB can permanently kill inner-ear tissue city traffic noise (inside car) 70 (Harris, 2012). normal conversation 60 Table 12.3 gives the decibel levels of some other whisper