Health, lifestyle and health care utilization among health professionals

doi:10.4236/health.2010.26083

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Vol.2, No.6, 557-565 (2010) Hea lth

doi:10.4236/health.2010.26083

Health, lifestyle and health care utilization among health

professionals

Paul A. Bourne1*, Lilleth V. Glen1, Hazel Laws1, Maureen D. Kerr-Campbell2

1Department of Community Health and Psychiatry, University of the West Indies, Kingston, Jamaica; *Corresponding Author: paul-

bourne1@yahoo.com

2Systems Development Unit, Main Library, University of the West Indies, Kingston, Jamaica

Received 2 February 2010; revised 22 February 2010; accepted 26 February 2010.

ABSTRACT

Health care workers are responsible for the ex-

ecution of the health policy of a nation, yet little

if any empirical evidence is there on health,

lifestyle, health choices, and health conditions

of health care workers in the rural parish of

Hanover, Jamaica. The current study examines

health, lifestyle and health behaviour among

health professional in Hanover. The current

study has a sample of 212 respondents. A 26-

item questionnaire was used to collect the data.

Data from the questionnaires were coded and

entered into a micro-computer and analysis

done using SPSS for Widows Version 15.0 soft-

ware. The Chi-square test was used to test as-

sociation between non-metric variables. A p-

value < 0.05 (two-tailed) was selected to indicate

statistical significance. It was found that 16.0%

of respondents had diabetes mellitus (2.8% of

males compared to 19.8% females); 22.6% had

hypertension (25.5% of female and 12.8% of

males); 0.5% breast cancer; 0.5% stomach

cancer; 1.9% enlarged heart; and 0.5% ischemic

heart disease. Forty-three percentage points of

the sample was overweight, 33.5% obese and

24.1% had a normal weight. Over 15% of nurses

and doctors were obese compared to 38% of

ancillary staffers. Twenty percentage points of

respondents consume alcohol on a regular ba-

sis; 15.6% do no regular physical exercise,

42.4% add sweetening to their hot beverages,

and 4.7% were smokers. There is a need for

public health practitioners to formulate a health

intervention programme that will target people

in Hanover, but also specific groups such as

doctors, nurses, administrative, ancillary sta-

ffers and technical staffers.

Keywords: Health Care Workers; Health; Lifestyle;

Health Choices; Health Behaviour; Hanover;

Jamaica

1. INTRODUCT ION

Empirically, it is well established that poverty and illness

are positive associated with each other and that 80% of

all chronic illnesses were in low-to-middle income

countries [1-3]. Sen [1] encapsulated this well when he

stated that low levels of unemployment in the economy

is associated with higher levels of capabilities, suggest-

ing that poverty predisposed people to illnesses. The

World health organization (WHO) [2] reported that 60%

of global mortality is caused by chronic illness and

four-fifths of chronic dysfunctions are in low-to-middle

income countries. This concurs with Sen’s finding that

poverty does not only predisposed people to illnesses but

that it accounts for premature mortality.

In many developing countries, the living standards of

low income households could be improved by improving

health services [4]. The lack of resources available for

use by the government of Jamaica to address poverty in

a significant way negatively impacts health care. There

is a significant statistical correlation between poverty

and illnesses in Jamaica [5,6]. A study by Bourne [5]

found: 1) a positive correlation between not seeking

medical care and poverty (r2 = 0.58), 2) a positive corre-

lation between poverty and unemployment (r2 = 0.48),

and 3) an inverse correlation between mortality and po-

verty (r2 = 0.51). These findings do not substantiate the

findings in the literature of the correlation between pre-

mature mortality and poverty. Despite Bourne’s findings,

the level of poverty in Jamaica was 9.9% in 2007. This

was 15.3% in rural areas compared to 6.2% in urban and

4.0% in peri-urban area [7]. Another important finding is

that rural residents indicated the highest percentage

points of illness (17.3%) compared to urban (14.1%) and

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

558

peri-urban residents (13.9%).

Although premature mortality was empirically not

found using the data for Jamaica, the positive correlation

between poverty and illness is present and cannot be

ove rlooked as there are public health challenges owing

to this reality. Jamaica an English-speaking Caribbean

nation is a developing country. In 2007, it had a popula-

tion of 2,682,120 people (49.3% males); 75% black and

13% mixed; a growth rate of 0.47; 10.9% elderly popu-

lation (i.e., 60+ year old); a crude death rate of 6.4 per

1,000; crude birth rate of 17.0 per 1,000 [8]; income

inequality of 0.4 (Gini coefficient); and 71.3% of the

poor lived in rural areas [7]. The country is geographical

divided into 14 parishes and three counties (Cornwall,

Middlesex and Surrey). Cornwall covers the Western

belt which includes parishes such as Westmoreland, Ha-

nover, St. James and St. Elizabeth. Middlesex constitutes

the middle proportions of the island with parishes such

as Clarendon and St. Catherine. Surrey comprises the

Eastern region with parishes such as Kingston, St. Tho-

mas and Portland. Cities accounts for 27.3% of the pop-

ulation, peri-urban 30.2% and rural areas, 42.5% in

2007.

With 43 out of every 100 Jamaicans resided in rural

areas and those areas have 15.3% of the poverty, public

health policy makers are concerned about health care

and behaviour among rural residents. Hanover has the

smallest percent of the nation’s population (2.6%—

69,660, in 2007), with one urban centre (i .e., Lucea) [9].

Lucea, the capital of Hanover is home to about 5,951

people. The parish of Hanover therefore is substantially

rural, and the people rely on tourism, agriculture and

seasonal employment for their economic livelihood. Al-

though Hanover is rural and shares many of the eco-

nomic challenges of rural zones, little if no information

is available about health, lifestyle practices and health

care seeking behaviour of the residents. Since public

health agencies relies on research information to make

inform decision that can effectively aid in improving the

health of a population, then it follows that pertinent in-

formation is needed on residents of Hanover in order to

enhance public health capability on the parish. Most if

not all the health information on Hanover is from the

Ministry of Health (MOH) which only produce standard

curative statistics (i.e., health service utilization; mortal-

ity; health care expenditure; health care resources; mor-

bidity) [10-12]. The findings from this study will add

value to the existing literature by examining health in-

formation on persons in the parish. This was done by

examining health, lifestyle and health behaviour among

health professional in Hanover in order to understanding

choices, decision and health among its residents, with

the purpose of aiding policy formulation and health in-

tervention programmes for the parish.

2. MATERIALS AND METHODS

2.1. Sample, Sampling Methods and Setting

We selected a representative sample of people from Ha-

nover’s health institutions, which had sufficient num-

bers to represent the people of the parish. The MOH in

Jamaica sub-divided the country into 4 regional adminis-

trative authorities (RHAs): the South-East (SERHA);

South (SRHA); North-East (NERHA), and Western

(WRHA). The NERHA covers four parishes—Hanover,

Westmoreland, St. James and Trelawny. Another classi-

fication of the island is statistical one based on Enume-

ration Districts (EDs). The Planning Institute of Jamaica

(PIOJ) and Statistical Institute of Jamaica (STATIN)

used Primary Sampling Units (PSUs) as its sampling

frame from which it design surveys of the national pop-

ulation [7]. A PSU is an ED or a composition of EDs,

usually consisting of 100 dwellings in a rural area and

150 dwellings in urban areas [7]. STATIN further refined

required dwellings by stating that up to 400 households

constituted a PSU [9]. The EDs are independent geo-

graphical units which share common boun- daries with

contiguous EDs. In keeping with a sampling error of ±

3% and a confidence interval of 95%, the calculated

population for selection was 280 respondents. In another

survey, the researchers used 36 persons per ED to calcu-

late a representative sample of the nation [13,14]. Ha-

nover has 4 PSUs, which means that using 36 persons

per ED the sample should be 144. Hence, based on pre-

vious surveys, the current study is sufficient to general-

ize on the parish because it is has representative sample

size [13,14]. The current sample of 212 respondents

represents 0.3% of the population of the parish of Ha-

nover (in 2007; n = 69,660). For this study, the sample

was stratified by area of work, area of residence, and a

Kish Random Selection Method of sub-sampling was

used to select the actual respondents thereby facilitating

independence of response [15]. On occasions when an

individual was selected and could not participate, no

other person was used to replace the individual. In cases

where the selected person was not available a minimum

of three call-back visits would be made to that person’s

place of work. The response rate was 75.7%, of which

1.3% of the data were lost during data cleaning. This is

in keeping with surveys conducted by PIOJ and STATIN

[7], and Wilks et al. [14]. For the survey study 77.8% of

the sample was female, which is similar to that reported

by Wilks et al. [14] in which the female sample was

75.9%.

2.2. Questionnaire Reliability

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

559

Test-retest reliability of the questionnaire was conducted

for a month (i.e., February 2008) prior to the main study.

The instrument was vetted by academics from the Uni-

versity of the West Indies, Mona, Jamaica. Then 20 res-

pondents who were non-participants (i.e., health profes-

sional in Westmoreland Health Services) in the main

study were interviewed on two separate occasions ap-

proximately 7 days apart. The reliabilities were deter-

mined by the percentage of agreement. Modifications

were made to the final instrument based on the recom-

mendations, queries and issues raised by the participants

in order to attain clarity and conciseness of questions.

A 26-item questionnaire was used to collect the data.

The instrument was sub-divided into general demo-

graphic profile of the sample; family history; health

seeking behaviour; chronic illnesses, perception on

prostate examination and choice of method in prostate

examination.

2.3. Measure

Regional Health Authorities: Decentralization of public

health care the shifted the central government (i.e., MOH)

into four semi-autonomous regional bodies: South-East,

North -East, Western, and Southern.

Standardized instruments were used to record partici-

pant’s weight (in kilograms) and height (in squared me-

tres). The body mass index (BMI) is the weight in kg

divided by height in m2. The classification of the World

Health Organization was used in this study. The BMI

was classified as normal, overweight and obese.

Normal BMI is defined as 18.5 kg/m2 to 24.99 kg/m2.

Overweight BMI is defined as 25.00 kg/m2 to 29.00

kg/m2 and obese BMI is defined as ≥ 30.00 kg/m2. Risky

behaviour denotes unhealthy health choices such as

smoking, alcohol consumption, infrequent exercise, poor

dietary habit and food choices. The participants’ health

status was measured using BMI categorization.

Technical staffers include trained personnel such as

dental nurses, health educators, nutritionists and public

health inspectors, contact investigators, pharmacists, and

lab technicians.

The technical support staff comprises community

health-aides, psychiatric aides, ward assistants, porters,

mosquito spray men and community peer educators.

Administrative staffers constitute administrator, parish

manager, personnel officer, and matron. The administra-

tive support staff comprises accountants, security per-

sonnel, medical records officers, secretaries, drivers,

telephone operators; cashiers and clerks. The ancillary

staffers are cleaners, cooks and gardeners.

2.4. Data Analysi s

The data were double entered using SPSS, verified and

cleaned. Data was stored, retrieved and analyzed, using

SPSS for Windows (16.0). Percentages were used to

provide background information on demographic cha-

racteristics on sample, knowledge of prostate and self-

reported information on prostate. Chi-square tests were

utilized to examine whether statistical associations ex-

isted between non-metric dependent and independent

variables. A p-value of 5% (i.e., 95% confidence interval)

will be used to determine statistical associations between

variables.

2.5. Ethics

This study sought and was granted ethical approval by

the University of the West Indies, Mona, Ethics Com-

mittee. All participants gave written consent, and they

were informed of procedures and the choice of with-

drawal at any time convenient to them if they so desire.

The data received from the participants is reported below.

3. RESULTS

A sample of 212 respondents was interviewed for this

study: females, 77.8%; blacks, 90%; single, 46.7%; ter-

tiary level education, 39.8%; full-time employed, 86.8%;

religious, 97.6%; nurses and doctors comprised of 22.3%

of the sample (Table 1). Forty-seven percentage points

of the sample were Seventh Day Adventist and Pente-

costal members; 42.5% were overweight, 33.5% obese

and 24.1% had a normal weight.

In Table 2 which reports information on particular

self-reported diagnosed health conditions, 16.0% of res-

pondents had diabetes mellitus; 22.6% had hypertension;

0.5% breast cancer; 0.5% stomach cancer; 1.9% en-

larged heart and 0.5% ischemic heart disease.

In Table 3 which reports information on the lifestyle

behaviour of respondents, 20.3% of respondents con-

sumed alcohol on a regular basis; 15.6% do no regular

physical exercise, 42.4% add sweetening to their hot

beverages, and 4.7% were smokers.

A significant statistical relationship exists between

BMI categorisation and occupation of the persons in the

study (P < 0.01). Just over 15% of nurses and medical

doctors were obese compared to 38.2% of ancillary staf-

fers (Table 4). In Table 5, of the 178 respondents who

indicated that they do some form of physical activity per

week over the survey period, 52.3% spent at least one

hour on the activity. Of the different typology of occupa-

tion, technical support staff had the lowest percentage

points of engagement for at least one hour (20.0%); with

administrative support staff recorded the greatest en-

gagement of 1 hour or more in physical activity (63.5%).

On disaggregating the aforementioned demographic,

Table 1. Demographic characteristics of sample.

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

560

Characteristics n %

Gender

Male 47 22.2

Female 165 77.8

Ethnicity

Black 191 90.0

Burmese 1 0.5

Indian 5 2.4

Mixe d 15 7.1

Marital status

Single 99 46.7

Married 80 37.7

Common-law 14 6.6

Widowed 4 1.9

Divorced or separated 5 7.1

Education

Primary or below 11 5.2

Secondary 116 55.0

Tertiary 84 39.8

Employment status

Employed 184 86.8

Unem ployed 25 11.8

Not stated 3 1.4

Religious

Yes 207 97.6

No 5 2.4

BMI categorization

Normal 71 33.5

Overweight 90 42.5

Obese 51 24.0

Occupation

Nurses and doctors 45 22.3

Other technical staffers 28 13.9

Technical support staff 56 27.7

Administrative staffers 10 5.0

Administrative support staff 29 14.4

Ancillary 34 16.8

Age Mean (SD) 41.0 years (11.8)

Table 2. Self-reported diagnosed chronic health conditions.

Characteristics n %

Diabetes mellitus

Yes 34 16.0

No 178 84.0

Hypertension

Yes 48 22.6

No 164 77.4

Cancer

Breast

Yes 1 0.5

No 211 99.5

Stomach

Yes 1 0.5

No 211 99.5

Enlarged heart

Yes 4 1.9

No 208 98.1

Ischemic heart disease

Yes 1 0.5

No 211 99.5

health and lifestyle characteristic of the sample, 2.8% of

those with diabetes mellitus were males compared to

19.8% females. Of the diagnosed diabetics, the majority

were ancillary staffers (36.4%); 45.5% were 40 to 49

years old; and 36.4% were 31 to 45 years old (χ2 =

10.577, P < 0.005).

Of the 22.6% of the sample who had hypertension,

25.5% were female and 12.8% were males. The highest

percentage points of the sample that had hypertension

were 31 to 45 years old (47.9%), 27.1% were at least 45

years old, and 6.3% were unable to recall the age when

they were first diagnosed with hypertension. When oc-

cupation of respondents was disaggregated by diagnosed

hypertensive cases, technical staffers recorded the high

percentage points of cases (33.9%) followed by ancillary

staffers (32.4%); nurses and medical doctors (22.2%);

administrative staffers (20.0%) and administrative sup-

port staff (13.8%) (χ2 = 15.375, P < 0.0001). Concur-

rently, a statistical relationship existed between over-

weight respondents and hypertensive respondents (P <

0.0001).

No significant statistical association was found be-

tween BMI categorisation and gender of respondents (χ2

= 3.793, P = 0.150). However, a significant relationship

Table 3. Lifestyle behaviour.

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

561

Characteristics n %

Smoking behaviour

Smoke 10 4.7

Do not smoke 202 95.3

Regular alcohol consumption

Yes 43 20.3

No 169 79.7

Physical activity (i.e. , exercise)

None 33 15.6

1 – 2 times a week 100 46.7

4 – 6 time a week 61 29.0

7 times a week 18 8.7

Dietary habits

Special dieting 49 23.0

Eat anything 163 77.0

Adding sweetening to hot beverage

Yes 90 42.4

No 122 57.6

Breast examination

Mo nthly 69 42.0

Rarely 31 18.4

Never 65 39.6

Leisure time activity

Sitting watching TV/reading 73 34.2

Cycling 30 14.2

Gardening or farming 56 26.4

Playing indoor games (chess, scrabble,

domino, etc) 35 16.5

Regular physical activity (i.e., exercise) 18 8.7

Rectal examination

Yes 10 4.7

No 30 14.2

Did not answer 172 81.1

How do you prepare or eat meat

Eat no meat 29 13.7

Fried 71 33.3

Stewed 55 26.0

Baked 12 5.9

Jerked 45 21.1

Table 4. BMI categorisation by occupation.

Occupation

BMI categorisation

Normal Overweight Obe se

% % %

Nurses/doctors 33.3 57.1 15.6

Other technical staff 46.4 42.9 10.7

Technical support staff 28.6 37.5 33.9

Administrative staff 50.0 40.0 10.0

Administrative support staff

41.4 44.8 13.8

Ancillary staff 20.6 41.2 38.2

P < 0.01

existed between BMI categorisation and self-reported

diagnosed health condition (P < 0.0001). Disaggregated

the smoker cohort revealed that 57.1% consumed be-

tween 1 to 9 cigarettes per day, and that males were

more likely to be smokers (57.1%) than females

(42.9%).

Significant more males regularly consume alcohol

(12.6%) than females (9.1%) (P < 0.0001). However,

more females (47.9%) than males (13.3%) indicated that

they were regularly engaged in physical activities (or

exercise). The age cohort that indicated the most en-

gagement in physical activity was 60+ year olds (67.1%).

Of the 60+ year olds who are engaged in regular physi-

cal activities, 13.7% indicated that they do so every day

over the survey period. The percentage of other age co-

horts and their engagement in physical activities were 50

to 59 years (59.1%); 30 to 39 years (56.5%) and 40 to 49

years (54.5%).

Of the 34.2% who indicated sitting watching televi-

sion or reading as their leisure activities, 65% did this on

a daily basis and 18% between 4 to 6 times per week.

Furthermore, 43% of overweight respondents were en-

gaged in sitting and watching television or reading as

their leisure activities compared to 32% of those who

were obese. Concurrently, 17% of females were engaged

in sitting and watching television or reading as their lei-

sure activities compared to 8.3% of males. Forty-three

percent of overweight respondents were 40- 49 years old

and 24.1% of the obese were in this age cohort.

Of the respondents who indicated being on a special

dietary programme (23%), 35.4% were on low salt;

25.2% vegetarians; 16.8% weight loss; 12.4% low fat;

4.0% weight gain and 6.2% were on low cholesterol

programme. Health care workers in Hanover prefer to

consume fried meats, and this was mostly higher among

those younger than 20 years (50.0%) followed by those

50-59 years (49.0%) and those 40-49 years (31.3%) as

Vol.2, No.6, 557-565 (2010) Hea lth

doi:10.4236/health.2010.26083

Table 5. Physical activity (in duration of time per day) by occupation.

Characteristic

Physical activity (in duration of time per day)

Tot al

< 15 minutes

15 – 29 mi-

nutes

30 – 44 minutes 45– 59 minutes > 1 hr

n (%) n (%) n (%) n (%) n (%) n (%)

Occupation

Nurses/doctors 6 (16.2) 7 (18.9) 3 (8.1) 1 (2.7) 20 (54.1) 37 (20.8)

Other technical staff 3 (13.0) 6 (26.1) 3 (13.0) 1 (4.3) 6 (43.5) 19 (10.7)

Technical support staff 4 (40.0) 3 (30.0) 1 (10.0) 0 (0.0) 2 (20.0) 10 (5.6)

Administrative staff 5 (18.5) 6 (22.2) 2 (7.4) 0 (0.0) 14 (51.9) 27 (15.2)

Administrative support staff 5 (9.6) 7 (13.5) 2 (3.8) 5 (9.6) 33 (63.5) 52 (29.2)

Ancillary staff 2 (6.1) 2 (6.1) 9 (27.3) 2 (6.1) 18 (54.5) 33 (18.5)

Total, n 25 31 20 9 93 178

well as the those 20-29 years (31.3%). Ancillary workers

were most likely to consume fried meats (68%) com-

pared to any other occupational group. Twenty five per-

cent of the same had fruit juice (17.5% had it 2-3 times

daily; 11.3% had it occasionally), and 49.5% had soda

(57.1% had it occasionally; 14.3% daily and 1.9% 6 days

per week). Twenty nine percent had vegetables daily,

23% 2-3 times per week and 0.5% never had vegetables.

On general health care-seeking behaviour, 28% of

female respondents indicated having visited a health care

provider in the last 6 months for breast examination.

There was no significant statistical association between

breast examination and occupation (P > 0.05); BMI (P >

0.05) and health conditions (P > 0.05). The majority of

the females had done a pap smear (75%). Of those who

indicated that they had not done a pap smear, the highest

were among administrative staff (42.9%) followed by

other technical staff (35.7%); administrative support

staff (31.2%) and the least by technical support staff

(12.2%). Forty percent of female have not done a breast

examination compared to 62.9% of males who had never

had a rectal examination. A significant relationship ex-

isted between rectal examination and occupational type

(P < 0.0001). The percentage points of males who had

never done a rectal examination by occupational type

can be disaggregated as technical support staff, 87.5%;

administrative support staff, 60.1%; other technical staff,

55.6%. Furthermore, the highest number of males who

had not done a rectal examination was among those 50

to 59 years old (69.2%).

4. DISCUSS IONS

This study examined the lifestyle, health and the use of

health care services of some health care workers in the

parish of Hanover, Jamaica. Generally, the health status

of people who are employed to health institutions in

Hanover is good, but when this was disaggregated into

occupational types more information was revealed that

indicated worrying signs for health care in the future.

Using BMI categorisation to measure health status, the

findings revealed that 34% of employees were classified

as having normal weight, 43% overweight and 24% ob-

ese. Apart from the afore-mentioned findings, 16.0% had

diabetes mellitus, 22.6% hypertension, 0.5% breast can-

cer, 0.5% stomach cancer, 1.9% enlarged heart and 0.5%

ischemic heart disease. Concurrently, 22% of men had

done a rectal examination for prostate cancer, 60% of

women had done a breast examination, 77% indicated

that they eat every and/or anything, 42% added swee-

tening to their hot beverage, 5% were smokers and 16%

do no physical activities and 34% indicated that their

leisure time was spent sitting watching television and/or

reading. The disaggregation of BMI by occupation re-

vealed that most doctors and nurses were at least over-

weight (73%); other technical staff (54%); technical

support staff (71%) and those in the ancillary categoriza-

tion were most likely to be in the overweight category

(79%).

In 2007, statistics from the PIOJ and STATIN [7] re-

vealed that 12% of Jamaicans had diabetes mellitus and

22% had hypertension. On disaggregating the figures,

8% of males had diabetes mellitus compared to 14% of

fem ales, and 16% of males had hypertension compared

to 27% of females. Although 1.3 times more people in

the current study had diabetes mellitus compared to the

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

563

population, disaggregating the figures by sexes revealed

a remarkable difference. In the current study diabetes

mellitus disparity between the sexes was 7.1 times

(males, 2.8%; females, 19.8%) compared to 1.8 times in

the national survey. With respect to hypertension, there

was no difference between the percentage of those with

diabetes in the country and health workers in Hanover.

There are no available statistics on diabetes mellitus and

hypertension by occupational type in the literature, and

therefore the findings from this study provides this val-

uable information. The findings showed that hyperten-

sion was not greater among females than males; but it

was also highest among those 31-45 years and among

technical support as well as ancillary staffers. Both tech-

nical support and ancillary staffers are among the poor,

which concurs with the literature that poverty is asso-

ciated with more illness as concur by the findings of this

study [2,15-17].

This study highlighted that there was no statistical as-

sociation between gender and BMI categorization, how-

ever one existed for BMI and self-reported diagnosed

health condition. Low socioeconomic status is empiri-

cally established as having more people with illness, but

the current study further shows that they were more

likely to be obese than those who are more likely to be in

the middle-to-upper class. The study also revealed that

34% of those in the technical support staff and 38% of

those in ancillary staff category were obese and these

persons are in the low socioeconomic status compared to

16% of medical doctors and nurse who are mid-

dle-to-upper class individuals. Despite this finding, it

can be inferred that the schedules of medical doctors and

nurses in addition to their and lifestyle may account for a

significant percent of them being at least overweight.

This has implications for the future of the health sectors

as overweight and obesity are associated with increased

risk of morbidities and mortalities.

The sedentary lifestyle of health care professionals in

Hanover may lead to a public health problem which may

become worse in the future if not addressed. The health

behaviour of the persons in the study is also a cause for

concern and although their lifestyle is a sedentary one,

they make more unhealthy lifestyle choices than healthy

ones. It is clear from the findings that education,

knowledge of health and health care are not influencing

the decision of health care providers in Hanover. The

fi ndings concur with a study which showed that

non-comm unica ble diseases are largely apart of the life-

style of Jamaicans, and that 50% of deaths were owing

to non-communicable diseases such as heart, stroke,

diabetes mellitus, cancers and obesity [18]. A study in by

O’Connell and Gray [19] found that four-fifths of those

with stroke had high blood pressure when they were

taken to hospital for treatment post-stroke, and that

two-thirds of them had a history of hypertension. A later

study by Woo et al. [8] found that untreated hyperten-

sion was a significant risk of hemorrhagic stroke (i.e.,

OR = 3.5, 95% CI = 2.3, 5.2; P < 0.0001), and that

treated hypertension was significantly lower in causing

hemorrhagic (OR = 1.4, 95% CI = 1.0 to 1.9; P = 0.03).

The WHO revealed that obesity was associated with

health problems such as respiratory difficulties, chronic

musculoskeletal problems, skin problems and infertility

[20], indicating the pending public health challenge in

the health sectors in Hanover.

In 2000, the Jamaica Lifestyle Survey revealed that

8% of Jamaican had diabetes mellitus (96.1% of males

and 9.1% of females) and that the most cases were

among the elderly (i.e., 60 + years) [21], which reiterate

the health problem challenge that Hanover faces and

speaks to the role of culture and low socioeconomic sta-

tus influencing the healthy lifestyle choices of residents

in Hanover. Morrison [22] in an article entitled ‘Diabetes

and hypertension: Twin Trouble’ showed that diabetes

mellitus and hypertension have now become the two

major chronic non-communicable diseases thus health

problems for Jamaicans and in the wider Caribbean. This

finding was also corroborated by Callender [23] who

found that there is a positive association between di-

abetic and hypertensive patients (i.e., 50% of individuals

with diabetes had a history of hypertension), which em-

phasizes the public health problem of unhealthy health

workers in Hanover.

When the sedentary lifestyle, unhealthy lifestyle

choices, and low socioeconomic status are coupled with

the fact that the sample is relatively middle-aged to old

(i.e., mean age was 41.0 years), it was observed that with

the increased risk of morbidities and disabilities asso-

ciated with ageing, the health of individuals in this study

becomes exacerbated by the unhealthy diet, alcohol

consumption, lack of exercise and sedentary lifestyle.

While the prevalence of smokers among residents and

health workers in Hanover (4.7%) are lower than the

national figures (17.7%), the percentage points of male

smokers in this was 2.3 times more than the prevalence

in the national (24.8%) and this was 5.9 times more fe-

males in this sample compared to the national figures

(7.1%).

The fact that the majority in each category of health

care workers are obese is a worrying finding. Instructing

patients to take care of their health in an environment

where healthcare workers are overweight including

nurses and medical doctors may cause patients to ignore

the information they receive from health care staff.

There is an area for future research. Another area for

future research should be an examination of the reasons

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

564

why some health care workers particularly the profes-

sionals who have years of education, knowledge, expe-

rience and training become engaged in unhealthy life-

style practices. Once the reasons for the poor lifestyle

choices of health care workers that affect their health are

understood, further research is necessary on the content

and procedures that are required for a strategic and ef-

fective national health literacy communication pro-

gramme. This programme should be cognizant of the

fact that education and knowledge about health does not

automatically influence the educated knowledge holders’

behavior in a positive way. There is also need for re-

search on how training and wellness programme for

health care workers on the job including medical doctors

and nurses would influence the choices they make about

their health.

5. CONCLUSIONS

The current study has revealed pertinent information on

the perception of health care workers about healthy life-

style, health choices and general perception of residents

in Hanover on their health. Smoking, obesity, over-

weight, high cholesterol, sedentary lifestyle, unhealthy

lifestyle practices and low socioeconomic status in-

creased the risk of cardiovascular diseases in health

workers in Hanover and this is further complicated by

hypertension, diabetes mellitus and unhealthy choices.

The level of health education is greater among health

workers than non-health care workers which indicate

that the pending health problems in Hanover would have

been understated by the current study. There is a need for

public health practitioners to formulate a health inter-

vention programme that will target people in Hanover

including specific groups such as medical doctors,

nurses, administrative, ancillary staffers and technical

staffers in health care institution in the parish of Hanover.

Clearly education and knowledge of health do not lead

to better and healthier choices by health care workers in

Hanover, and this could be a general social dilemma as

the general populace may be left to use home remedy if

premature mortality were to befall those high risk health

workers in Hanover. Then, there is reality of an increase

burden of health care workers in Hanover on the health

care services in the future, which would increase health

care expenditure for the country.

REFERENCES

[1] Sen, A. (1979) Poverty: An ordinal approach to mea-

sure ment. Econometricia, 44(2), 219-231.

[2] World Health Organization (2005) Preventing chronic

diseases a vital investment. Geneva.

[3] Emerson, E. (2009) Relative child po verty, income in-

equality, wealth, and healt h . Journal of the American

Medical Association, 30 1(4), 425-426.

[4] Mitra, A. and Tsujita, Y. (2009) Hea l th-P overty nexus: A

study of low income households in India. International

Journal of Child and Adolescent Health, 2(1), 99-107.

[5] Bourne, P.A. (2009) Impact of poverty, not seeking

medical care, unemployment, inflation, self-reported ill-

ness, health insurance on mortality in Jamaica. North

American Journal of Medical Sciences, 1(3), 99-109.

[6] Levy, H. (1996) They cry ‘Respect’: Urban violence and

poverty in Jamaica. The Centre for Population, Commu-

nity and Social Change, University of the West Indies,

Kingston.

[7] Planning Institute of Jamaica and Statistical Institute of

Jamaica (2007) Jamaica survey of living conditions.

Kingston.

[8] Woo, D., Haverbusch, M., Sekar, P., Kissela, B., Khoury,

J., Schneider, A., Kleindorfer, D., Szaflarski, J., Pancioli,

A., Jauch, E., Moomaw, C., Sauerbeck, L., Gebel, J. and

Broderick J. (2004) Effect of untreated hypertension on

hemorrhagic stroke. Stroke, 35(7), 1703-1708.

[9] Statistical Institute of Jamaica (2008) Demographic sta-

tistics, 2001, 2007. Kingston.

[10] Ministry of Health (2005-2008) Annual report, 2004-

2007. Policy, Planning and Development Division, King-

s ton.

[11] Ward, E. and Grant, A. (2005) Epidemiological prolife of

selected health conditions and services in Jamaica, 1990-

2002. Health Promotion and Protection Division, Minis-

try of Health, K ingst on.

[12] Pan American Health Organization (2007) Health in the

Americas. Countries, 2, Washington DC.

[13] Ataman, S.L., Cooper, R., Rotimi, C., McGee, D., Oso-

timehin, B., Kadiri, S., Kingue, S., Muna, W., Fraser, H.,

Forrester, T. and Wilks, R. (1996) Standardization of

blood pressure measurement in a international compara-

tive study. Journal of Clinical Epidemiology, 49(8), 869-

877.

[14] Wilks, R., Younger, N., Mullings, J., Zohoori, N., Figue-

roa, P., Tulloch-Reid, M., Ferguson, T., Walters, C., Be n-

nett, F., Forrester, T., Ward, E. and Ashley, D. (2007)

Factors affecting study efficiency and item non-response

in health surveys in developing countries: The Jamaica

national healthy lifestyle survey. BMC Med Research

Methodology, 7(13), 1-14.

[15] List, J. (2006) Illness, poverty and the invisible patient.

American Medical Association Journal of Ethics, Virtual

M entor , 8(11), 705-708.

[16] Link, B.G. and Phelan, J.C. (1995) Social conditions as

fundamental cause of disease. Journal of Health and So-

cial Behavior, 36(Special Iss ue), 80-94.

[17] Foster, A. (1994) Poverty and illness in low-income rural

areas. American Economic Review, 84(2), 216-220.

[18] Ministry of Health (2004) National policy for the promo-

tion of healthy lifestyle in Jamaica. Health Promotion

and Protection Division, Kingston.

[19] O’Connell, J.E. and Gray, C.S. (1994) Treating hyperten-

sion after stroke. British Medical Journal, 308(6943),

1523-1524.

P. A. Bourne et al. / HEALTH 2 (2010 ) 557-565

565

[20] World Health Organization (2003) Obesity and overweight.

Geneva. http://www.who.int/dietphysicalactivity/publica

tions/facts/obesity/en/.

[21] Ministry of Health (2004) National policy for the promo-

tion of healthy lifestyle in Jamaica. Health Promotion

and Protection Division, Kingston.

[22] Morrison, E. (2000) Diabetes and hypertension: Twin

trouble. Cajanus, 33(2), 61-63.

[23] Callender, J. (2000) Lifestyle management in the hyper-

tensive diabetic. Cajanus, 33(2), 67-70.