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Executive Summary
Noncommunicable diseases (NCDs) represent the most significant and complex public-health challenge of the 21st century. This book argues that traditional approaches — focused on individual behavior, health services, and isolated risk factors — are fundamentally inadequate because they overlook the systemic roots of chronic disease. NCDs emerge from multi-layered, interacting drivers across biology, psychology, community dynamics, economic structures, governance arrangements, and planetary conditions.
The volume proposes a four-domain typology of NCD gaps:
- Burden–Response Alignment Gaps
– Policy and financing fail to match the scale and urgency of NCD burden. - Health-System Performance Gaps
– Primary care systems remain oriented toward acute illness, not chronic disease management.
– Medication access, clinical pathways, mental health, and continuity of care remain fragmented. - Structural & Developmental Determinant Gaps
– Children and adolescents face intensive exposure to ultra-processed foods, toxic stress, violence, climate hazards, and environmental instability.
– Early-life programming and intergenerational vulnerability accelerate early-onset NCD patterns. - Psychosocial & Temporal Coherence Gaps
– Misalignment of meaning, identity, community cohesion, political cycles, and long-term planning disrupts resilience and undermines sustainable progress.
Building on this typology, the book positions Caribbean Small Island Developing States (SIDS) as a global microcosm of the NCD crisis. The region’s small population size, climate exposure, food import dependency, and concentrated commercial environments create a unique but globally instructive setting where biological, social, and ecological pressures converge.
The proposed Port-of-Spain Declaration 2.0 (POS-2.0) offers a renewed regional compact integrating:
- fiscal policies (SSB taxes, FOPWL)
- food-system sovereignty
- school nutrition reform
- chronic-care modernization
- climate-resilient health systems
- mental-health and trauma-informed care
- community coherence-building
- regional governance harmonization and accountability
The book culminates in a unified systems model mapping NCD determinants across six nested layers: biological, behavioral, social/community, structural/commercial, governance, and planetary.
This integrated framework provides:
- a theoretical foundation for systems-level epidemiology
- a policy roadmap for Caribbean SIDS and other vulnerable regions
- a developmental and ecological analysis of NCD emergence
- a future-oriented vision for health systems grounded in coherence
The volume concludes by proposing new research priorities and outlining a pathway toward coherent health futures — societies whose political, economic, social, cultural, and ecological systems align with the biological conditions necessary for human flourishing.
