“It’s easier to ask for forgiveness than permission” - a colloquial mindset often used to justify impulsive decisions. In recent years, however, people seem to have adopted this reckless nature in the way they treat their health and bodies. Globally, the access to all sorts of harmful substances has become more abundant, and as a result, chronic diseases and deaths have seen a significant increase.

Although credited to one a many different reasons, the uproar of non-communicable diseases can often be traced back to lousy lifestyle choices, and three of the biggest are cardiovascular diseases, diabetes and obesity.

Cardiovascular diseases are more commonly known as CVD or heart disease and is the combination of the heart organ and its related blood vessels. Damage to this system can range anywhere from diseased blood vessels to structural problems or acute onset reactions due to blood clots. Known causes to date include hypertension, hyperlipidemia, genetics, or alcohol and tobacco use, and its symptoms are seen as the narrowing of the heart and blood vessels, irregular heart rhythms, malfunctioning heart valves, angina, dyspnea and fatigue. Repeated occurrences of such symptoms can either slowly lead to permanent complications or cause the individual to experience an acute event. Common long-term diseases can be coronary artery disease or high blood pressure, while common short-term harms could be cardiac arrest or arrhythmia, electrical malfunctions, loss of consciousness or breath control. All sorts of blockages and bleeds all exemplify the endless irregularities that come with CVDs.

Similar irregularities can also manifest in the pancreas, the evidence of diabetes. The disease occurs in two forms: type 1 and type 2. Both disrupt the correct maintenance of glucose and insulin in the body, but in different ways. T1D is known as an insulin deficiency. As a result of autoimmune defects, the body’s immune system attacks and kills its own pancreatic insulin producing beta cells. While it is still unclear what causes T1D, genetics, environmental and viral triggers are common threads across diagnoses. The chronic disease is typically detected at a young age and treated with lifelong insulin administration. T2D is known as an insulin resistance. As a result of obesity, genetics, age, poor diet and a lack of exercise, the body’s somatic cells develop an abnormal response to insulin. To combat the onset complications of type 2 diabetes, patients are treated with oral medication, insulin, and lifestyle improvement. The symptoms of both types of diabetes are unanimous: Increased urination and thirst, fatigue, blurred vision and unexplained weight loss all suggest that the body is exhibiting an abnormal relationship with glucose and insulin regulation.

The third and final NCD is obesity, a condition when the body holds extraneous amounts of fat. Generally, an individual with a body index of above 30 is classified as obese, and becomes significantly more at risk for CVDs, diabetes and cancer. The known risks to date include genetics that influence where one stores fat on the body, socioeconomic and lifestyle factors that impact one's access to healthy food, exercise and education, or metabolism that affect hunger and fullness hormones: gherkin and leptin. While many of these factors are inevitable, combatting the lifestyle influences has been at the forefront of obesity relief and minimizing its mortality.

These three non-communicable diseases are almost always grouped as one because of their undeniable exasperation of each other, increasing the complication, risk and severity.

Firstly, obesity and diabetes. A human body with glucose levels in-range have a pancreas producing proportional insulin to carbohydrates ingested, moving the glucose in the blood stream into the muscles, and storing the excess in the liver. Obese bodies, however, saturate the liver organ with fat. Glucose can no longer easily be stored nor used by cells and remain in the bloodstream, prompting the pancreas to produce more insulin that needed and weakening its function.

Secondly, diabetes and CVDs. The now glucose rich blood elevates its viscosity, demanding more pressure from the heart to pump it through the vessels of the body. Furthermore, glucose molecules have an affinity for lipoproteins, a molecule that allows cholesterol to transport through the blood. These sugar-coated LDLs stay in the blood stream longer, increasing plaque formation, and the chance that they stick to arterial walls.

Finally, cardiovascular disease and obesity. The same excess fat cells that saturate the liver do the same to the entire body, and alongside disrupting glucose levels they simultaneously increase production of estrogen. Insulin and estrogen hormones catalyze cell growth, and a surplus of both accelerates this division process: a dangerous threshold to cross as it may lead to cancer. The obvious overabundance of cells also requires more oxygen and faster delivery of hemoglobin throughout the body, but the fatty material buildup in the arteries coupled with hypertension both resulting from obesity severely increase the risk of acute cardiovascular events and diseases.

A big driving factor of non-communicable disease relief is its preventability. This is further evident as a surge of data depicts higher CVD, diabetes and obesity prominence in lower-income demographics, a blatant result of inequitable healthy lifestyle resource distribution. 

The Dominican Republic is one of many countries whose population suffers from a lack of disease prevention, showing “limited progress towards achieving the diet-related non-communicable disease (NCD) targets,” as stated by the Global Nutrition Report. Specific to the DR, individuals with obesity are six times more likely to develop type 2 diabetes, and those who have developed type 2 diabetes then become up to five times more at risk of cardiovascular disease. Almost 55% of premature adult male deaths are due to non-communicable diseases and female adults surpass this prevalence with 73%.

Of this mortality, an average of 35% are cardiovascular, with ischemic heart disease leading the cause. Diabetes is then also seen in 20% of adult male and 14% female, likely a result of the 25% and 38% of obese men and women respectively. This prevalence is failing to improve as obesity has almost tripled in Dominican children over the past two decades, and statistics of NCDs continue to grow.

While investigating the reason behind this surge, however, it is important to factor in cultural and community influences specific to the Dominican Republic. One of the biggest visible contributors is the cuisine. Typical meals combine rice, beans, and chicken or beef. Leafy greens are not common at meals, but cruciferous and root vegetables are often consumed. A general description of popular Dominican dishes would be hearty, greasy, and filling. To name a few: deep fried cheeses or plantains in vegetable oil, scrambled eggs with ham, pork rinds, and grilled meats.

The nation also has an affinity for strong flavors, the reason for the heavy use of salts, spices, oils and sugars. Nutritionally speaking, Dominicans predominantly turn to the carbohydrate, protein and lipid food groups. These are further prepared with a galore of salts and condiments, contributing to sodium and sugar consumption across the country.

Formally speaking, meals and food reflect greatly on their family-oriented culture, which in of itself is another contributing factors to lifestyle in the DR. large portions and a surplus of preparation are symbolic of the people’s hospitable and embracing attitudes. Buffet and family style eating is integral to the community and conversational nature of meals. These characteristics, however, are also consistent with a lack of portion control or intuitive consumption as nutrition and socializing become one of the same.

Communal interaction is also the reason for standardized religion, tradition and community in the country. Tradition and culture consistently dictate almost all of the lifestyle in the DR. The dominant religion is Christianity, observed by almost 70% of the population. In this belief, health and illness is perceived as God’s reward or punishment, and many families still turn to native healers, witch doctors, voodoo practitioners, herbalists and folk practitioners for solutions.

This approach to medicine is at times deemed as “old school”, and never truly evolves or transforms due to the low geographic mobility of small communities. Many of such communities also choose to avoid hospitals partly due part to the lack of transportation and convenience, but mainly due to a deep-rooted nature to obey the eldest man of the family. Listening to and standardizing beliefs of whole generations on one individual often deters the population from observing or trusting modern medicine.

The Dominican Republic also has epidemiological, political and socioeconomic evidence that explain the high prevalence of non-communicable diseases and their effects on the population. The challenging access to healthcare is visible starting from the medical personnel, with roughly only 1.45 doctors, nurses and midwives for every 1000 people.

The same lack of access applies to technology, as local insurance and distributors don’t cover or provide international technology or treatment, which becomes especially detrimental to those with chronic diseases. Long term treatment in the DR undoubtedly work, however opportunities and resources internationally, particularly in the United States, have produces results that significantly improve patients quality of life and overall health, often times to a reversible extent. Local insurance, however, doesn’t cover technology or treatment beyond national companies and clinics, hence limiting the options for many Dominicans to choose from. Furthermore, healthcare in the country pays much more focus on curative care in comparison to preventative care, therefore this limitation of extended support options further suffocates the chance of significant improvement of non-communicable disease diagnoses.

The limitations evident in local insurance is merely a subset of the much larger issue that is non-medical influences on medicine and its availability. Cardiovascular disease, diabetes and obesity rates result entirely from extended exposure to damaging substances that people inhale and ingest. This exposure only continues to increase as inequitable socioeconomic conditions prevent impoverished and discriminated communities from high quality education or lifestyle sources, but also healthcare and social services. This is further exasperated in the Dominican Republic as there exists still a fundamental stigma and negative prejudice towards lower income, disabled, female and LGBTQ+ individuals. With over 30% of the population still in poverty, the separation that occurs from this systematic disdain towards social different individuals causes many to remain making poor lifestyles choices that ultimately lead to the heightened NCD complications.

Majority of the most significant changes that can only be made politically, as regulation of how accessible any food in a country is mandated by governing parties. In the DR, the existing policies surrounding non communicable diseases include nationwide dietary guidelines, a mandate on salt iodization and an action plan related to NCD reduction in the population. There are, however, still policies absent that if implemented, can be pivotal to public health improvement in the country: taxation on sugar-sweetened beverages, reduction policy on sodium consumption and saturated fatty-acid intake, or some form of restriction on marketing of processed foods, especially of ones targeted towards children. Particularly in the Dominican Republic where sodium, sugars and fatty-acids are extremely common, adopting discussion and action to combat consumption of substances could be preventative towards non-communicable diseases.

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