Child abuse rife on island, says health report
Adverse childhood experiences including sexual abuse are rife in the population, a review of Bermuda’s health needs has found, calling the island’s levels “shocking”.
The Government’s Bermuda Joint Strategic Needs Assessment of Health links “negative moral and health consequences” to a “failure to ensure that all children have the best start to life”.
The assessment, brought to the House of Assembly this summer by the health minister, Kim Wilson, also concludes that social factors wield “a greater overall influence on health than healthcare services”.
The sweeping review calls for better data collection ahead of delivering universal healthcare — stating that the island’s present employment-based health insurance arrangement “does not lend itself to providing comprehensive UHC [universal healthcare] and may exacerbate health inequalities”.
It finds that 90 per cent of residents “have experienced at least one type of adverse childhood experience”, with half of women in Bermuda reporting childhood sexual abuse defined as physical contact rather than offences such as exposure or grooming.
While child and maternal health are “in line, if not better, than peer countries”, the review sounds a warning over dropping immunisation rates, with measles coverage at 21 per cent for 2021, and polio coverage flagging.
It calls for a drive to boost vaccination back to “population herd immunity”.
However, the island is largely flying blind when it comes to “significant inequalities” in pay, employment, education and housing among its resident ethnic groups.
The report cites inconsistent data tracking on poverty as well as health outcomes by ethnicity, noting that Black and mixed-race people are “overrepresented” among the homeless or those in insecure housing.
On the population front, the assessment underscores the coming toll of an ageing population combined with Bermuda’s shrinking residential pool.
It notes that figures are based only on the 2016 census, with anecdotal evidence suggesting numbers of residents likely fell before 2021 because of emigration — but with no hard data backing it up.
The impact of Covid-19 on the island’s numbers is also left off, leaving “considerable uncertainty”.
Ms Wilson said the JSNA’s implications extended beyond health.
She added that the report showed the influence of “wider social and economic conditions, including our work, housing, education and local community networks”.
Ayo Oyinloye, the former chief medical officer, wrote that the review “unapologetically” zeroes in on the “strength and limitations” of data, adding there was still “much to do” to inform future decisions.
The review calls healthcare in Bermuda “a fragmented system of episodic single-condition management” and calls for an overhaul to prevent poor health from consuming a greater and “unsustainable” chunk of the gross domestic product.
It follows an announcement in the 2023 Throne Speech of the upcoming Steps 2024 population health survey, along with legislation pending to improve health data collection.
The most recent available accounting, from 2018, shows Bermuda spending $736.6 million on healthcare, with overseas treatment consuming 13 per cent — which the report calls comparatively high, and a likely driver of inequalities, given its link to supplementary health insurance benefits.
The review finds 11.5 to 12.5 per cent of FutureCare clients exhausting their annual prescription allowances early because of “multiple co-morbidities”.
It said the health system’s financing needed reform and that a treatment and financing package specific to the elderly was required.
It further calls for monitoring of essential medicine costs, with “mechanisms identified to ensure affordable access”.
Drivers of mortality in Bermuda, similar to other high-income jurisdictions, are smoking, alcohol, obesity, poor nutrition and lack of exercise.
Smoking appears lower than Britain and the US but the number of cigarettes individually consumed is higher.
Alcohol use, which is self-reported, stands at 54 per cent, but the island lacks guidance on consumption, along with data to “determine the percentage of the population whose drinking poses low, moderate, or high risks to health”.
Smoking is more prevalent in the unemployed and disabled out of work, while those of low socioeconomic status are “twice as likely to die” as a result of drinking than their high-end counterparts.
Just over a third of residents are obese, comparable to the US, and only 30 per cent of residents report meeting guidelines for daily fruit and vegetable consumption.
However, the island scores high on physical activity, with 79 per cent of residents saying they reach World Health Organisation recommendations — versus 24 per cent in the US.
Non-communicable diseases linked to the top-three lifestyle factors are said to be “the leading factors for insurance claims”, and the review calls for disease control plans backed by “high-quality data from disease registries” for common risk factors.
Dementia is given as the main mental health factor in claims totalling $1.26 million for 2020-21, while cancer-related claims add up to $12.13 million, followed by chronic kidney disease at $5.15 million.
Covid-19 insurance claims, in fourteenth place, account for just over $106,000.
Mortality overall rose in 2021, likely from Covid-19, but disease-specific data is available only up to 2019, preventing a “conclusive finding” from the coronavirus toll.
• To read the report in full, see Related Media
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