It has been said that Bermuda’s health problems are entirely due to Bermudians’ personal lifestyle choices when it comes to factors such as diet and activity. Specifically, overweight people not controlling what they eat and doing too little exercise are blamed for Bermuda’s health outcomes failing to match its high expenditure on medical care.

There is no doubt that Bermuda has a very unhealthy population, which is very expensive for the country due to increased morbidity and utilisation of health care resources: three out of four adults are either overweight or obese; one in two adults has a chronic health condition such as hypertension or diabetes. The leading causes of illness and death in Bermuda are related to such chronic diseases.

Bermuda spends more than $770 million a year on health costs and the overall lack of affordability and sustainability of the health system is, indeed, alarming. But is this excessive health expenditure and high prevalence of chronic diseases simply because Bermudians are slothful gluttons?

We would do well to remember the axiom that for every complex human problem there is a simple answer - which is wrong. Chronic diseases are, in fact, complex entities caused by multiple factors including, among other things, childhood adversity, genetics, environment and culture.

It’s not surprising that there is a powerful relationship between our emotional experiences as children and our future adult mental health, physical health, and mortality. Over the past 20 years a large body of scientific evidence robustly confirms that exposure to adverse childhood experiences increases the risk for future chronic diseases in children and adults in a dose-dependent manner. Such childhood traumas are, unfortunately, common. For example, according to a survey by the Bermuda Health Council and Scars, one in three Bermudians have been the victim of sexual abuse before the age of 18.

Physiological and bio-molecular studies are increasingly establishing the mechanisms, or vectors, for how childhood trauma leads to changes in the development of nervous, endocrine, and immune systems. These impacts can cause impaired cognitive, social, and emotional functioning and can eventually lead to mental disorders such as post traumatic stress disorder (PTSD), depression and ADHD.

The adoption and persistence of health-damaging behaviours such as binge eating and addiction are associated with these mental health conditions and, in turn, increase the risk of chronic disease. These mental disorders are treatable but often unrecognised and therefore untreated. This is especially true for Binge Eating Disorder (BED). BED is the most common eating disorder with a prevalence of 50 per cent in those with a body mass index of 40 or greater.

Another significant factor is inherited intergenerational trauma, which is highly relevant to Bermuda. The science of epigenetic inheritance of trauma is young but suggests that the effects of historical trauma can be passed down the generations in humans.

Cultural factors include structural racism and racial disparities in healthcare - the racial difference in take up of the Covid vaccine is a good example of this. Environmental issues range from factors such as the fact that our diet - the Western diet - is the unhealthiest in the world and the lack of sidewalks in Bermuda encourages us to use the car, even for short distances.

So there is more to our pandemic of chronic diseases than the deadly sins of sloth and gluttony. Tackling this problem requires more than simply blaming the victim for a lack of moral fibre and willpower. Our hope is that there will be increased awareness of the complex range of issues that need to be addressed to tackle this problem.

Potential political and cultural changes include ongoing efforts to address structural racism, improved access to healthy foods and road safety initiatives to promote walking and cycling over the use of cars.

Solutions will require a range of interventions in multiple areas. The proposed universal access to the healthcare system to ensure treatment for physical and mental disorders will be welcome. Collaborative and integrated treatment for physical and mental disorders will help to address the underlying causes of chronic diseases, especially with respect to trauma, so that these can also be treated in tandem with effectively managing the resulting diseases.

Dr Annabel Fountain is an endocrinologist, diabetes and obesity specialist and Dr Grant Farquhar is a psychiatrist. Both can be contacted at Kindred Ltd