| Summary: | This thesis consists of personal observations made during the two years, 1973 and 1974 when I was Chief Medical Officer on the Turks and Caicos Islands. These Islands are a British Colony of 6,000 people. They are located in the West Indies. Their History and Geography are briefly described. The problems of defining health are discussed in detail and there is a brief historical review of the methods of assessing Health. The different methods currently available for assessing Health are described in detail and the literature on this subject is reviewed. Mention is made of the difficulty of attempting to create a comprehensive Health Index. The Health of the people of the Turks and Caicos Islands was therefore assessed by looking at as many parameters of Health as possible. This includes an historical review of medicine on the islands; an evaluation of mortality statistics, hospital and out-patient consultations; several population surveys; assessment of the status of environmental health; and an analysis of the Islands medical resources and manpower. The entire population of 6,000 was included in the study. A single record folder was created for each person to include his total medical care - hospital and outpatient. The study is believed to be one of the most comprehensive studies of the total health of a complete community. Over 10,000 deaths on the Turks and Caicos Islands during the past 100 years were analysed by me. The results of cause of death and age at death are presented. Birth and death rates for the past 50 years have been calculated and the resultant graph analysed. All deaths during the years 1973 and 1974 have similarly been analysed. Over 25,000 out-patient consultations during 1973 and 1974 have boon classified by me, by diagnosis and age of patient. The results have been compared with the 1971 General Practice Survey in England. In addition, over 1,000 hospital discharges during 1973 and 1974 have been analysed, by diagnosis, age, sex, duration of stay and Island of origin of the patient. A wide range of population vital statistics has been presented. This includes population size and age distribution, movement between Islands and type of home. Birth, death and infant mortality rates have been calculated and discussed. Numerous population surveys have been carried out, and the results analysed. These include studies on chronic illness, visual problems, auditory problems, nutrition, infectious diseases and genetic abnormalities. The impact of a successful family planning programme is discussed. The Health of the Environment has been evaluated. A household survey was carried out to assess water, sewage and refuse status. Household pests were assessed. The Aedes aegypti was identified as a potentially harmful mosquito on the Islands. Water shortage was shown to be a major environmental health problem. The Islands social services and preventive medicine programmes are assessed and described. Throughout the study, comparison has been made with other regional West Indian Territories, with other small communities throughout the world, and with a developed nation represented by the United Kingdom. Differences between the Turks and Caicos Islands and other countries have been analysed and discussed. Finally the implications of being a small community are discussed as well as the impact of recent economic development on the Health of the Turks and Caicos Islanders.
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