The Caribbean

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The Caribbean metabolic-health transition

The Caribbean is not one food culture or one health profile. Large islands, small states and continental Caribbean territories differ in language, history, income, agriculture, migration and access to care. Across the region, however, many communities face the same structural transition: locally produced staples, legumes, fruit, vegetables and fish coexist with increasing dependence on imported refined foods, sugary drinks and heavily marketed ultra-processed products.

Key regional pattern

Caribbean countries face a triple burden of malnutrition: undernutrition, micronutrient deficiency, and overweight or obesity can occur in the same country, community or household. PAHO identifies noncommunicable diseases—including cardiovascular disease, diabetes and cancer—as dominant causes of illness and premature death across much of the region. Small-island food systems also face high shipping costs, limited land and water, climate hazards and exposure to global price shocks.

Sugar history and the modern food environment

Sugar shaped Caribbean economies through plantation systems, colonial extraction and forced labour. That history matters, but today’s metabolic burden cannot be attributed to history alone. Modern sweetened beverages, energy drinks, packaged snacks, refined baked goods and convenience foods are inexpensive, widely distributed and intensively marketed. They compete with local foods whose production, storage and preparation may require more time or investment.

Frequent high intake of added sugar—particularly in beverages—can contribute to excess energy intake, higher triglycerides, insulin resistance and fatty-liver risk. Fructose is substantially metabolized in the liver, but no single nutrient explains diabetes or obesity. Total diet, alcohol, sleep, activity, medicines, stress, income and health-care access all influence outcomes.

Caribbean foods are part of the solution

Ground provisions such as yam, cassava, dasheen and sweet potato; breadfruit and plantain; peas, beans and pigeon peas; callaloo and other leafy vegetables; fruit; and fish remain important regional assets. These foods are not automatically protective or harmful. Preparation, portion, affordability and the food served alongside them matter.

A practical approach can preserve familiar meals while increasing legumes and vegetables, moderating refined-starch portions, reducing routine frying, and making water the everyday drink. Cultural identity and metabolic health are not opposing goals.

Genes, ancestry and clinical care

Caribbean populations include diverse African, Indigenous, European, South Asian, East Asian, Middle Eastern and mixed ancestries. Genetic variants may modify susceptibility to diabetes, uric-acid disorders or other metabolic conditions, but ancestry is not destiny and cannot replace clinical assessment. Variation within communities is substantial.

Screening should be based on family history, blood pressure, waist and weight trends, glucose or HbA1c, lipids, kidney and liver indicators, medicines and individual circumstances. Health communication should never portray a culture, body type or ethnic identity as the disease.

Climate resilience is metabolic-health policy

Hurricanes, drought, flooding, heat and saltwater intrusion can damage crops, fisheries, roads, electricity and cold storage. After a severe storm, shelf-stable imported foods may be the only immediately available option. Resilience therefore requires more than advising people to “eat local.” It requires protected water supplies, diverse crops, storm-ready storage, local seed and planting material, reliable ports and roads, and emergency food stocks designed for nutrition as well as calories.

Agriculture, tourism and public purchasing

Schools, hospitals, government agencies and hotels can create dependable markets for farmers and fishers when purchasing standards include local producers. Investments in irrigation, protected agriculture, cold chains, small-scale processing and farm-to-market transport can reduce loss and make fresh food more competitive.

Regional priorities

• Reduce children’s routine exposure to sugary drinks and unhealthy food marketing.
• Make safe water widely available in schools and public places.
• Strengthen detection and long-term care for diabetes, hypertension, kidney disease and fatty liver.
• Publish comparable national surveillance with dates, methods and uncertainty.
• Build climate-resilient local food systems rather than relying on individual behaviour alone.
• Design programmes with communities and avoid stigma, blame and cultural stereotyping.

Explore Caribbean country pages

• Jamaica — food heritage, agriculture, imports and climate resilience.
• Trinidad and Tobago — a diverse food culture and two-island context.
• Dominican Republic — urban development, tourism and agriculture.
• Haiti — food insecurity, undernutrition and chronic disease.
• Cuba — primary care, food supply and population ageing.
• Barbados — sugar policy, water constraints and Blackbelly sheep.

Selected authoritative sources

• PAHO: Noncommunicable diseases
• PAHO: Caribbean climate and health country profiles
• FAO: Resilient Caribbean Initiative

Subsection navigation: Latin America and Caribbean • Mexico • Central America • Caribbean • Andes • Brazil • Urban Latin America

A Region Defined by Sugar

The Caribbean has a unique historical relationship with sugar—both production and consumption. Today, that legacy intersects with modern processed food systems.

What Changed

Traditional:

• root crops
• fish
• local produce

Modern:

• sugary beverages
• processed foods
• refined starches

Mechanism

• Fructose via GLUT5
• Liver metabolism via Ketohexokinase

Disease Expression

• High Type 2 diabetes prevalence
• Obesity
• Metabolic dysfunction–associated steatotic liver disease

Why the Caribbean Matters

The Caribbean reflects both:

• historical sugar exposure,
• and modern processed food dominance.

It is a powerful case study in long-term metabolic risk.

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Latin America & Caribbean • Mexico • Central America • Caribbean • Andes • Brazil • Urban Latin

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