Today’s Caribbean Current: Chronic Disease Risk Among Caribbean People – A Systems Perspective
Comparative population health data show a clear and consistent pattern. Caribbean People living outside the Caribbean experience significantly higher rates of chronic disease than those living in the region itself.
This difference is most pronounced for cardiovascular disease, but it extends across multiple chronic conditions and across multiple countries. Importantly, these patterns persist across very different healthcare systems, suggesting that access to care alone does not explain the gap.
What the Data Show
A five-country population-based study comparing Caribbean People living in Guyana and Jamaica with those living in North America and Europe found marked differences in cardiovascular disease prevalence.
Rates were approximately 12–14% within the Caribbean, compared with 25–41% outside the region, representing increases of up to 200% in some settings. Higher prevalence of hypertension and diabetes, alongside a greater overall chronic disease burden, was also observed.
Source: Lacey et al., Journal of Racial and Ethnic Health Disparities (2025).
Why Healthcare Access Alone Does Not Explain the Difference
Importantly, these differences are observed across universal healthcare systems, insurance-based systems, and mixed public–private models. This indicates that the observed disparities are not driven solely by healthcare availability or spending.
Instead, the evidence points to broader systemic and environmental influences that shape health long before individuals interact with health services.
The Role of Systems, Environments, and Daily Living Conditions
Regional evidence from the Pan American Health Organization (PAHO) consistently identifies cardiovascular disease, hypertension, and diabetes as leading causes of morbidity and mortality among Caribbean populations.
PAHO reports highlight prevention gaps, dietary transition, urbanisation, and psychosocial stress as key drivers of cardiometabolic risk, particularly where food environments and daily living conditions change.
What Global Evidence Tells Us
Global research reinforces this perspective. The World Health Organization’s (WHO) work on the social determinants of health demonstrates that outcomes are strongly shaped by where and how people live, not simply by healthcare services.
Similarly, Global Burden of Disease studies show that upstream risk factors—such as diet, physical inactivity, and chronic stress—often accumulate faster than healthcare systems can offset them.
The “Healthy Immigrant Effect” — and Why It Fades
Research on the so-called “healthy immigrant effect” helps explain these patterns. While people may initially arrive in new settings with relatively good health, this advantage erodes over time.
Multiple studies document rising cardiometabolic risk and declining self-rated health as individuals are exposed to high-stress, low-prevention environments, even where healthcare access is relatively strong.
A Systems Conclusion
Taken together, the evidence leads to a consistent conclusion:
The higher chronic disease burden observed among Caribbean People living outside the region reflects systems and environments, not individual failure or lack of resilience.
Implications for Caribbean Health Policy and Practice
For policymakers, clinicians, and communities—both within the region and across the diaspora—the implications are clear. Prevention must be central.
Chronic disease strategies must address stress, diet, food environments, and living conditions, and diaspora health outcomes should be recognised as part of the broader Caribbean health story. Healthy environments matter wherever Caribbean People live.
This article is part of a series entitled Today’s Caribbean Current, which explores emerging pressures shaping health systems across the region. Learn more about Caribbean Currents.
Selected Sources
- Lacey KK et al. (2025). The Health of First-Generation Caribbean People Across the Diaspora. Journal of Racial and Ethnic Health Disparities.
- Pagliai F & Dinu M et al. (2021). Consumption of ultra-processed foods and health status Systematic review and meta-analysis. British Journal of Nutrition.
- Kennedy S, Kidd MP, McDonald JT & Biddle N. (2015). The healthy immigrant effect Patterns and evidence from four countries. Journal of International Migration and Integration.
- Lu C & NG E. (2019). Health immigrant effect by immigrant category in Canada. Health Reports.
- Pan American Health Organization (PAHO). Regional noncommunicable disease burden and NCD country profiles. (PAHO official reports).
- World Health Organization (WHO). Social determinants of health and NCD frameworks.
- Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease 2019 – 2023 estimates.
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