While commenting on the state of health in Tobago, well-known and respected analyst Reggie Dumas openly wondered why life expectancy at birth was lower in Port of Spain and San Fernando, as opposed to Tobago (which had the highest life expectancy at birth).

This wonderment, also described as surprising by the commentator, caused me to hark back to some 30 years ago when I was in a different geographical space but in a not unfamiliar scenario.

As an associate professor in the Department of Community Medicine and International Health at Georgetown University in Washington, DC, my colleagues and I, isolated as we were from life in the inner city, were also at a loss to explain why life expectancy at birth in the nation's capital was so abysmally low. The answer we found was no further than a bus ride to the other side of town. It lay in the early demise of black youth—dominantly males, collateral damage in the drug trade and the HIV-AIDS scourge, which at the time festered in the inner city and the immediate environs.

Back to our situation in Trinidad and Tobago. When an 11-year-old loses his life in a hail of bullets, this one rash action means that 61 years of potentially useful and productive life is snatched from the society at large, given that life expectancy at birth in Trinidad and Tobago currently stands at 72 years. (It is lower for males and higher for females). Since the so-called "hot spots" in the country are primarily in the cities and larger towns, and that the persons lost in the mayhem are in the 16-to-30-year age group, one needs to look no further for answers than to Mr Dumas's why. The life expectancy at birth in this sub-group is depressing similar statistics for the larger group, ie, people living in Port of Spain and San Fernando.

The foregoing aside, finding solutions to the crime scourge will do little in terms of improving overall life expectancy at birth for our twin-island population. To his credit, Mr Dumas, in his article, touched on some of the issues that will keep us mired on the lower rungs of the healthy life expectancy ladder.

As long as the mindset on both sides of the political divide continues to see the solution to lie in building the hospital stock, in a situation that cries out for greater investments in primary health care, expectation of a long and healthy life will remain elusive for countless Trinbagonians. The situation calls for common sense trumping political expediency.

Happy 50th anniversary.

Kenwyn Nicholls, MD, MPH

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