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St. Kitts and Nevis, a small, two-island federation in the Caribbean, experienced a shift in its epidemiologic profile starting in the late twentieth century. During the colonial era, diseases related to overcrowding, poor environmental sanitation, poor personal hygiene, and nutritional deficiency, due to the poor social and economic conditions in which the majority of people in St. Kitts and Nevis lived and worked, dominated the public health profile. This picture has changed dramatically since the 1980s to a health situation in which lifestyle-related, noncommunicable conditions predominate. This article provides a summary of and historical context for the current health profile of the population, as well as outlines the challenges faced by healthcare administrators today in a nation in which the provision of health care is centered on universal coverage and access.
INTRODUCTION
Prior to the arrival of Europeans in the fifteenth century, the Kalinago people, who called the islands Liamuiga ("fertile island") and Oualie ("land of beautiful water"), inhabited the islands of St. Kitts and Nevis. Christopher Columbus sailed past St. Kitts and Nevis in 1493 and is credited with discovering the islands for Europe. Though Columbus named the islands San Jorge and San Martín, the names were later changed to San Cristobal and Nuestra Señora de las Nieves by Spanish sailors and later shortened to their current forms (Hubbard, 2002, 13). In 1623, Sir Thomas Warner established the first successful English Colony in the West Indies on St. Kitts, soon to be followed by the establishment of a French colony in 1625.
The era between 1620 and 1830 was characterized by violence and the colonial exploitation of enslaved labor to produce commodities such as tobacco, cotton, and sugar. Europeans seized the land from the islands' original inhabitants, and eventually massacred many of them, driving out those who remained (Dyde, 1999, 21). The inhabitants of St. Kitts and Nevis continued to suffer from a number of man-made and natural calamities during this period of colonial exploitation by the English, French and Dutch (Ibid.), a period during which the slave and sugar trades were prominent activities. Clearly, colonialism had a profound impact on the history of the islands. Though they achieved autonomy in 1967, it was not until 1983 that they were granted full...