Chronic diseases, including the quartet of silent killers, obesity, hypertension heart disease and diabetes, now represent the most significant health care problem and the most important cause of mortality confronting the English-speaking Caribbean. Significantly all of these conditions have the same strong lifestyle components as risk factors and demand a common approach to prevention and management. In Barbados it is estimated that 25,000 people have diabetes and if the present trend continues this figure may double by 2020. Recent figures suggest that diabetes and its related complications account for a huge burden of disease and debt much of which may be preventable.

The need for more appropriate management of the chronic diseases and particularly diabetes has been acknowledged for some time and papers recommending a proactive preventive approach to effective management through education have been presented to Government on several occasions. However evidence for the benefit of such measures has been lacking until recently. In 1994 the DCCT, a multi-centre study presented evidence that the control of plasma glucose levels in Type 1 diabetes could reduce complications of nephropathy, neuropathy and renal disease. Shortly thereafter, the UKPDS suggested that reduction of plasma glucose levels, especially if combined with good control of blood pressure and plasma lipids could reduce some of the macro-vascular complications including IHD. However the North Karelia study in Finland is the first major population-based study demonstrating that public education resulting in life style modification of the population at large could benefit the health of the entire population reducing the incidence of chronic disease including heart disease.

In 1989 the Council of Health Ministers Conference pledged to give greater consideration to the improvement of diabetes management, and in 1998 the Ministry of Health in Barbados, recognizing the need to improve diabetes care at a national level, requested technical assistance from PAHO in this respect. As a result of that initiative a document, protocols for the management and surveillance of diabetes on the island, was produced outlining the burden of diabetes and establishing an approach for management. Seminal to the document was the concept of a diabetes center where initiatives could be taken to create a database, improve public awareness and education in the chronic diseases, enhance training and diabetes education of health professionals, and conduct appropriate research including screening, in conjunction with established research facilities both locally and internationally. In the belief that the introduction of these measures could have a significant impact on diabetes preventive care in Barbados, the Government accepted the proposals and agreed to introduce them into the polyclinic system.

At this time a private Foundation out of London offered to fund a diabetes center in Barbados and the Barbados Diabetes Foundation was formed in order to conduct the affairs of the Center. It was a requirement that the Foundation, in addition to carrying out its stated goals, should be sustainable. Having secured the support of Government in terms of a subvention for the first 5 years and a lease of a parcel of government land at the Enmore complex, Dr Jordan and his colleagues established a plan which would govern the activities of the  Foundation for foreseeable the future.

The plan included the following elements: