Richard, you’re Minister of Public Health and Sport in Aruba. That’s a great combination, why did that arise and why was that important to combine?

Thanks. Well that was very important for me in demanding it because I needed to really. I had a plan before and the government also had a plan that they’ve been working on. My plan fit with the new political party that was going to take over and really I needed sports to implement some of the stuff that needed to happen in prevention.

And, of course, sports is positive because you actually do things, it’s exciting, it’s cool and it can go along with public health very well.

Yes, absolutely.

So what are you doing in Aruba? I know non-communicable diseases are a big curse in Aruba, as in many other countries.

Exactly. First we had to beef up our Public Health Department and create this health monitor. That took them two years but really this is the state of health of the island..

When you say beef up the Public Health Department, what did you do?

They were broken down, they didn’t have an epidemiology department that was worth anything. It was split up, the people that needed to be in there weren’t in there. It was really also by the cure and care sector it was seen as a sector that ran behind a couple of Dengue mosquitos and that’s about it, not really relevant to the care or relevant to what we did with vision or mission statements and governments.

So as far as you can tell, what are the data in Aruba concerning non-communicable diseases and childhood obesity, which is a big factor?

Exactly. We are higher than the US in obesity rates, grown-ups and children, so that’s alarming. NCD rates eats away most of our budget, our care budget, cure and care budget, with multiple comorbidities existing at the same time at older ages. So we’re really in a situation where it’s affecting our economic status, our economic growth, it’s affecting our finances, it’s affecting our development. And this is the translation that we were able to make to the government, to the other ministers and to the public and say, ‘Listen, if we don’t invest correctly with a vision, with a specific direction in care we are going to lose our developmental goals.’

Invest is one thing, you say in care, but also prevention and you’ve got to have codes of conduct with industry to prevent some of the factors that are causing these diseases, which include cancer of course, along with diabetes and cardiovascular disease. What are you doing exactly to make this happen?

On one side you need to go back to the basics and re-education your medical field. They have no understanding of prevention or how to begin to do it. They have no physiology training, or very little, nutrition training is at zero with them. And still your public looks at them as a figurehead; when they go for health advice they’ll go to the physician and go, ‘What do I need to do?’ So the physician needs to be better apt at answering these questions. So we’ve implemented exercises medicine into their electronic patient file dossiers. We put all our physicians on electronic patient files, no more discussion on privacy, we just did it. The healthcare system is monitored by a universal care system, the AZV which manages all physicians, all doctors’ contracts, everyone.

So you’re in a good position.

Yes, we have a good base to start with. Also our hospital is part of what we do. The first thing I did was write a plan, a document, we called it in Dutch, which is a document that specifically states where our emphasis is going to be – primary care, how much it’s going to grow a year in the next four years. So it’s really giving real specifics on we want to be at 9% GDP, we want to stay there, we want to have a 3-4% growth a year in care costs. And then start breaking it down which divisions, which specialities.

Yes, but you’re representing exercise but diet is important as well. You want to get rid of smoking but diet is very important. What can you do about this?

Absolutely, yes. Well with diet you can do a lot. One is the healthy school concepts, implementing making your schools healthy, so getting rid of all junk food, junk drinks out of your food systems.

Can you legislate or do you have to simply encourage?

You have to do both. It has to come from the parents, it has to come from the teachers and at the same time you have to have a stick with your legislation to punish.

And what do you do with the food industry? Are there any signs that you’re winning?

Yes, we’re starting with front of label food labelling because we import from all over the world, it’s an island. So no-one can read these labels that come so you have to do some front of food food labelling. We’re using our own system; we’ve created a new health guide which is a health guide that’s comprehendible, not a pyramid, not a scale but a sailboat. So all these tools that we’re implementing in schools, at the workplace, with people, also how we prepare foods, is moving that agenda.

Now, do you think, finally just very briefly, on your experience, that you can fight the growth of non-communicable diseases leading to cancer and everything else?

Absolutely and I think we have done that, one of the only countries in the world. We have shown that our population from 2006 has had a mass movement of 9%, which is just your regular people, kids, elderly, everyone, moving weekly minimum amounts, 150 minutes a week, to right now we’re looking at 39%, almost 40% of the population moving.