Tackling non-communicable disease risk in young adults across the Caribbean: a call to action

Non-communicable diseases (NCDs) pose a significant and growing threat to public health worldwide. Nowhere is this challenge more pronounced than in the Caribbean,1 where the burden of NCDs is extremely high, accounting for 76.8% of total deaths in 2016.2 The prevalence of NCDs is expected to rise, with young adults increasingly affected by their burdensome consequences.3 This makes it unlikely that the region will meet the target of reducing NCDs by one-third by 2030, as set by the UN Sustainable Development Goals. Despite young adults (18–25 years old) comprising a quarter of the general population in the region, specific data on NCDs in this demographic is lacking. However, modifiable factors such as health-related behaviours are receiving much-needed attention. Data indicate that the prevalence of young adults with one component of metabolic syndrome (eg, overweight/obesity or elevated blood pressure) is over 50%, excessive alcohol use is at least 40%, physical inactivity is over 60% and tobacco smoking is at least 16%.4 5 Improving these lifestyle habits requires effective, tailored intervention strategies, which are challenging to implement in the geologically complex and culturally diverse Caribbean.

Urbanisation in the Caribbean is highly prevalent, with several nations declared as Small Island Developing States.6 These territories are characterised by small size, limited resources and vulnerability to external economic and environmental shocks. Many Caribbean nations face decreased land availability, leading to informal settlements or inner-city communities with higher unemployment and poverty rates.6 These informal communities often have substandard housing and lack infrastructure to support health and well-being. Climate change further exacerbates public health issues by impacting food and water safety, access to natural resources and economic stability. Young adults in these inner-city areas are less likely to access resources that promote healthful behaviours and are at greater risk of developing NCDs.7

Young adults are a neglected sociodemographic group in health initiatives and research, as they are no longer targeted by school-based efforts and are often excluded from active population health screening initiatives due to their age. This neglect is more pronounced in the Caribbean, where underfunded health surveillance systems can not accurately detect the health status of young adults. Despite regional initiatives like Caribbean Moves and the CARPHA Childhood Obesity Project (CARPHA), the efficacy of these interventions in reducing NCD risk among young adults remains unclear.

Given that young adulthood is a crucial life stage for determining future health outcomes,8 9 investing in improving health markers and behaviours in this demographic may be the best opportunity to halt the rise of NCDs. This commentary explores key environmental, social, cultural and environmental factors influencing NCD prevalence, highlights challenges in developing and implementing initiatives to reduce NCD risk factors, and examines the potential of implementation science to enhance health provisions aimed at reducing NCD risk in Caribbean young adults.