The man who moves a mountain begins by carrying away small stones. – Confucius

While watching the excitement of the recently concluded Summer Olympics unfold, and cheering on Caribbean athletes, we recall three seemingly unrelated situations which have somehow proved to be more related than initially perceived.

On one hand, Portugal’s star football player Cristiano Ronaldo, recently made a bold but welcomed move and removed Coca-Cola bottles during a press conference and encouraged viewers to drink water instead. Next, there is a growing conversation/action across the Caribbean region around the need for front of package warning labels (FOPWL) as a key policy tool to help to reduce non-communicable diseases (NCDs). Thirdly, the head of the UK’s National Health Service (NHS) recently criticised the sponsorship alignment between the English cricket team and KP Snacks for its promotion of junk foods consumption among children.

Where the dissonance lies is that Ronaldo’s move as an athlete was mostly celebrated, and the NHS executive was bold to denounce the unhealthy alignment with sports and junk foods, while the Caribbean’s attempts at FOPWL have been met with backlash, counter-arguments, and in some instances staunch resistance.

What this brings to mind is the following questions:

* Why is Ronaldo’s move around a known unhealthy product celebrated?

* Why is the UK boldly speaking out against sports sponsorships that encourage an increase in childhood obesity, while the Caribbean region — which boasts athletic prowess — has met regional FOPWL efforts around a wide net of unhealthy products with resistance?

It is indeed no secret that unhealthy ultra-processed foods and drinks contribute to NCDs, which are major drivers of morbidity and mortality in the region. Though it is like a mountain that is hard to move, it is one which must be moved, if even bit by bit, beginning with carrying small stones.

For context, a study done by the Pan American Health Organisation (PAHO) in 2020, titled ‘Front-of-package labelling as a policy tool for the prevention of non-communicable disease in the Americas’ revealed that high blood pressure, high fasting blood sugar levels, and overweight/obesity are the top three risk factors for mortality in the Americas.

The study noted that, by 2017, NCDs were responsible for 44 per cent of all deaths in the region, or approximately 3.1 million deaths. These risk factors are also responsible for the greatest loss of years of healthy life in the Americas. Nations of the Americas lost 75.2 million years of healthy life in 2017 due to high blood pressure, high fasting blood sugar levels, and overweight/obesity.

This is startling data against the background of aging and contracting Caribbean populations with limited natural resources and increasing vulnerabilities. How does the region combat this problem which appears to be an unmovable mountain?

Regional health advocates, including the Healthy Caribbean Coalition (HCC), guided by global data, believe that we can dwindle those numbers through scientifically grounded recommended interventions such as octagonal front of package warning labels. This policy measure empowers consumers with the information needed to make healthier food decisions.

Though Ronaldo’s financial position as one of the most highly paid athletes could be seen as allowing him to oppose the tremendously powerful and influential global food and beverage industry, his actions are worth noting. The Caribbean, therefore, needs credible and legitimate goodwill ambassadors like Cristiano Ronaldo, who are fully aware of the negative effects of unhealthy, ultra-processed foods and drinks on our lives and those of our loved ones and practise what they preach in their own lives.

This begs the question, are there similar Caribbean athletes willing to make such audacious moves to promote health? Or, are athletes constrained or fearful of making such bold statements because it may reduce their earning capacity? Are there Caribbean companies willing to produce more healthy products with which athletes can be aligned?

When these questions are juxtaposed against each other it brings to stark reality the choice that is being made daily between health and profits. Why do bold statements in support of health often lead to “punishment” for those who dare oppose the profit-driven status quo? Is money more important than health?

Ronaldo is to be commended for sending such a powerful message of championing what we put in our bodies. His efforts should also be widely replicated if the Caribbean region is to showcase how serious it is about reducing preventable deaths linked to the foods we eat.

Here in the Caribbean region it would be interesting to hear the views of sporting associations, coaches, and athletes who emphasise healthy diets and exercise as a key part of their strategy to greatness, even while they promote unhealthy foods and beverages for huge sums of money.

Does the promotion of a healthy lifestyle only extend to the athletic side of life or does this also translate into their personal spaces and guide what they and their families consume? Isn’t there room for a shift where athletes can be aligned with healthy products that they can confidently say they consume as a part of their own training regime?

In summary, the Caribbean can be our own health and wellness ambassadors and address this regional problem of obesity and NCDs by carrying away small stones, or consistently chipping away at the mountain.

Our athletes and sporting associations who carry tremendous power and influence huge sections of the public — from children to adults — can be a huge part of this effort by raising their voices in support. FOPWL is one such unifying stance that the region can make. The other is for policymakers to ensure that profits do not get a more privileged position than the health of our people, especially in the face of overwhelming research and evidence which shows that, where citizens are educated about what is in their food, they are likely to make better consumption decisions.

Why, then, does there continue to be such pushback against major steps such as the utilisation of front of package nutrition warning labelling to safeguard the life of Caribbean citizens against the burden on health, human, and socio-economic development across the region?

Caribbean populations are aging and NCDs continue to negatively impact the quality and duration of life. Any effort to reduce their tragic toll requires an al- hands-on deck approach. Indeed, this requires not only policymakers developing and implementing policies to protect citizens, their own families, and themselves, but it also requires manufacturers, processors, and importers to play a role in reducing the morbidity and mortality associated with the foods we consume.

Our athletes, too, as mega influencers, and individuals who already embrace healthy diets and exercise in their own lives can rise to the challenge as healthy Caribbean champions. Caribbean athletes can be role models and dissuade their young and old followers from consuming products that are high in sugars, fats, and sodium.

Taking such a strong and principled stance will benefit everyone, our sporting industry included. Knowing this, will the Caribbean’s Cristiano Ronaldo please stand up?

The above piece is co-authored by Dr Jason Strachan, orthopaedic surgeon and senior medical research associate at Expert Institute; Taahir Bulbulia, Barbados’s ambassador to the International University Sports Federation; and Dr Offniel O Lamont, physiotherapist, sports medicine and neuro rehabilitation professional.