Editorial | Errald Miller’s gift

If you don’t, or no longer, have an ethical obligation to allow public scrutiny of your private affairs, then being open about the state of your health is a sensitive, and likely difficult, decision. And especially so if the challenges faced are ones usually discussed in whispers, clouded in euphemisms and sometimes a source of stigma.

This newspaper therefore welcomes, and celebrates, last week’s decision by Errald Miller, to, for the first time, as her self-declared “chief protector”, talk publicly about his wife’s dementia. Mr Miller’s action will hopefully help to not only open, but deepen and widen a conversation on a condition that is discussed too little in Jamaica, yet will possibly increase as the island’s population grows greyer.

Errald Miller was a highly successful corporate leader in Jamaica and the wider Caribbean. He used to run, first, the Jamaica operations of what was then the British global telecommunications company, Cable and Wireless (Flow). He was later in charge of Cable and Wireless’ business throughout the Caribbean.

Then, but for very sporadic public forays, Mr Miller withdrew from the spotlight, preferring to provide quiet, behind-the-scenes, support to his wife, Portia Simpson Miller, the former leader of the People’s National Party (PNP) and Jamaica’s first female prime minister. They were married in 1998.

Mrs Simpson Miller, her party’s first, and still only, female leader, served as prime minister between 2006 and 2007, and then from 2012 to 2016. She is also the island’s only female head of government.

Mrs Simpson Miller retired from Parliament and as leader of the Opposition in 2017, after more than 40 years in politics.

Over the past eight years, her public appearances and statements have been few. It was known among her colleagues and in political circles that she faced the onset of dementia.

No formal announcement was made. Until last week, after her husband collected, on her behalf, Cuba’s Medal of Friendship.

“[It is] the first time I am going to say it to anybody (meaning as a public declaration), but she has been going through dementia,” Mr Miller said, of his wife, 79, who was among the Caribbean’s most charismatic politicians. She was well known for spontaneously hugging almost anyone she encountered, supporter or political adversary, and kissing them on both cheeks.

DEMOGRAPHIC SHIFTS

Dementia is the catch-all term for the symptoms of a range of conditions – of which the most commonly known is Alzheimer’s – that damage the brain, causing, among other things, cognitive decline, memory loss, confusion, and sometimes personality changes.

While dementia is not a natural part of ageing, age, experts say, is among the highest risk factors for the condition. The damage to the brain that manifests in dementia takes time to develop. So, the older people become, the greater their likelihood of having developed health conditions – such as hypertension and diabetes – that contribute to the onset of the disease.

Indeed, in most individuals, signs of dementia tend to manifest after age 65, with the risk factor for developing the condition doubling every five years after that age, experts say.

According to the World Health Organization (WHO), in 2021, an estimated 57 million people worldwide were living with dementia – 60 per cent of them in low- and middle-income countries. But. as populations age, that figure is expected to rise to 78 million by 2030, and nearly 140 million by 2050. Over 70 per cent of the dementia patients will be in low- and middle-income countries.

Jamaica – where one study found that just shy of six per cent of the elderly population suffers from dementia – seems a prime candidate to be part of this growth.

It is not only a middle-income country, but demographic shifts place it in the mix. Grey Jamaicans are the fastest-growing segment of the population, projected to reach around 20 per cent in 2050, from the current 9.7 per cent.

Errald Miller, who is fiercely protective of his wife, makes clear that caring for her is his sole focus.

“That’s my life,” he said. “I live for her. Only for her.”

SUPPORTIVE PUBLIC POLICY

Happily, Mrs Simpson Miller has a caring, supportive environment in her illness. It no doubt helps, too, that family can afford to provide the care she needs now, and will require as her condition progresses – as will probably be the case.

But there are, and will be, thousands of other Jamaicans with neither the understanding of the condition, nor the personal resources to provide the care needed by family and loved ones. Indeed, the WHO said that, in 2019, dementia cost global economies US$1.3 trillion, half of which was the value of the effort of informal carers, usually family members and friends. These carers, on average, provide five hours of supervision daily to people suffering from the condition. These costs will only rise.

The bottom line is that supportive public policy is necessary. And that policy must take into account that women, who outnumber men in Jamaica’s population, are disproportionately affected by dementia.

The health ministry’s plan to launch cognitive clinics to diagnose dementia and its precursor conditions is a good idea. However, this initiative must be underpinned by a national conversation geared at erasing stigma around the condition, and to make clear that it is a disease of the nervous system for which age is one of the risk factors. The conversation must also highlight the lifestyle choices that people can make to reduce the risk of developing dementia.

Additionally, public policy must include community support systems to help individuals and families who struggle, economically and otherwise, with the disease.

Further, although not directly related to dementia, given that age is a risk factor for the condition, Senator Floyd Morris proposed that legislation for the care and protection for the elderly must be given serious and urgent attention.

Jamaica should use the opportunity opened by Errald Miller’s candour to seriously address an issue that gets too little attention, or is fobbed off as an old people’s problem.