Transcript Slide 1

Mobilising and Empowering Health NGOs and
Civil Society in response to the NCDs
The Caribbean Health Summit.
East Caribbean Conference of Seventh-Day Adventists.
August 15, 2012. Hilton Hotel, Barbados.
Prof. Timothy Roach
Hon. Prof. Respiratory Disease, UWI Cave Hill.
President, Barbados Cancer Society.
The Chronic Non-Communicable
Diseases
“the lifestyle diseases”
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Cardiovascular Disease
Cancer
Chronic Respiratory Diseases
Diabetes
Leading Causes of Death in CARICOM Countries
by Sex, 2004 (excluding Jamaica)
MALES
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Heart Disease
Cancers
Injuries and violence
Stroke
Diabetes
HIV/AIDS
Hypertension
Influenza/pneumonia
FEMALES
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Heart Disease
Cancers
Diabetes
Stroke
Hypertension
HIV/AIDS
Influenza/pneumonia
Injuries and violence
Source: CAREC, based on country mortality reports
Crude Mortality Rates (per 100,000 population)
for Select Diseases: (2000-2004)
CARICOM Member States
140
Rates per 100,000 population
120
100
Heart
Disease
80
Cancers
Diabetes
Stroke
60
Injuries
40
Hypertensive
Diseases
HIV/AIDS
20
0
2000
2001
2002
2003
2004
Year
Source: CAREC, based on mortality reports from countries
Potential Years of Life Lost <65years by Main Causes, 2000
& 2004, CARICOM Countries (minus Jamaica)
Injuries
Y2004
HIV/AIDS
Y2000
Chronic Disease
0
10000 20000 30000 40000 50000 60000 70000
Source: CAREC, based on country mortality reports
Note: Chronic Disease includes heart disease, stroke, cancer, diabetes, hypertension,
chronic respiratory disease
‘Injuries’ includes traffic fatalities, homicide, suicide, drowning, falls, poisoning
Disability Adjusted Life Years (000) 2002
Mortality Attributable to Select Risk Factors (Latin America &
Caribbean)
High BP
Obesity
Alcohol
Tobacco
High cholesterol
Low fruits & veg
Physical inactivity
Unsafe sex
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100
200
300
Attributable Deaths (thousands)
400
500
The Problem
“Three primary risk factors (tobacco, poor
diet and physical inactivity) and three
intermediate risk factors (hypertension,
obesity and diabetes) lead to three diseases
(heart disease, lung disease and cancer)
resulting in 50% of all deaths”
Smoking Causes Death
Smoking causes approximately:
• 90% of all lung cancer deaths in men
• 80% of all lung cancer deaths in women
• 90% of deaths from chronic obstructive lung
disease
Smoking and Increased Health Risks
• Compared with nonsmokers smoking
increases the risk of—
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Coronary heart disease by 2 to 4 times
Stroke by 2 to 4 times
Men developing lung cancer by 23 times
Women developing lung cancer by 13 times
Dying from chronic obstructive lung diseases*
by 12 to 13 times
Smoking and Cancer
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Smoking causes the following cancers:
acute myeloid leukemia
kidney cancer
cancer of the pancreas
bladder cancer
cancer of the larynx
cancer of the pharynx
cancer of the cervix
lung cancer
stomach cancer
cancer of the esophagus
cancer of the oral cavity
Tobacco
• New strategy focus children and
inequalities .
• Tobacco free society
• Ban smoking in all public places -5 years
• Total ban -10 years
• Reintroduce above –inflation price
escalator for tobacco products
• Tough new targets for tobacco smuggling
Adam Smith The wealth of nations
1776
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Sugar, rum and tobacco are commodities
which are nowhere necessities of life,
which are become objects of almost
universal consumption and which are
extremely proper subjects of taxation.
OBESITY
obesity begins in childhood
After a two-year tour of the United States, Michelangelo's David is returning
to Italy...
His tour
sponsors were:
Humans are endowed with an
ANCIENT PHYSIOLOGY
moulded by famine ...
.... and ill equipped to handle our
modern food environment ….
… especially when we do so little!
The recommended diet vs
the advertised diet
• Around three-quarters of food advertising to children is for sugary, fatty and
salty foods. For every $1 spent by the WHO promoting healthy diets, $500 is
spent by the food industry promoting unhealthy foods
The big Five – the foods that most concern us
Snacks
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Fast
foods
Confectionery
Sweetened
cereals
Soft drinks
Energy-dense and salt
rich foods:
contribute high
proportion of calories to
the diet
encourage passive overconsumption
often displace other
healthier foods.
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Project key messages
Most adults in the Caribbean are already overweight.
Modern living insures every generation is heavier
than the last – “Passive Obesity”.
By 2030 60% of men and 50% of women could be
clinically obese. Without action, obesity related
diseases will cost an extra £49.9 Billion per year
The obesity epidemic cannot be prevented by
individual action alone and demands a societal
approach.
Tackling obesity requires far greater change than
anything tried so far, and at multiple levels; personal,
family, community and population.
Preventing obesity is a societal challenge, similar to
climate change. It requires partnership between
government, science, business, and civil society.
Hypertension
 Uncontrolled hypertension contributes to 45%
of all ill health from CVD
 Hypertension uncontrolled in 80% of
hypertensive Barbadians
 49 anti-hypertensive drugs available in
Barbados National Formulary
CARICOM
From community surveys, the prevalence
of hypertension in adults 25-64 years of age
was:
Barbados
27.2 %
Jamaica
24.0 %
St. Lucia
25.9 %
The Bahamas 37.5%
Belize
37.3%
Control of blood pressure would reduce the
death rates from Cardiovascular Disease by
about 15-20%.
Prevalence (%) of diabetes among adults in the Americas
Source: Pan Am J Public Health 10(5), 2001; unpublished (CAMDI),
Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care)
Caribbean Trends in Diabetes Mortality
80
Rate/100,000
70
60
Male
Female
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40
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20
1985
1990
1995
2000
Estimated Cost of Diabetes and Hypertension
as percent (%) of GDP
Estimated Economic Burden
($US Million, 2001)
BAH
BAR
JAM
TRT
27.3
37.8
208.8
494.4
Hypertension 46.4
72.7
251.6
259.5
Total
110.5
460.4
753.9
Diabetes
76.7
Purpose
 To bring together a wide spectrum of
partners from throughout the CARICOM
countries – civil society, the business
community, educators and researchers,
policy makers to plan civil society’s response
to the CNCD pandemic
Objectives
 Provide a forum for cross section of representatives
from various sectors of society to learn about CNCDs
and consider how best to tackle them
 Build capacity in important elements of civil society
 Identify and promote evidence based best practices
for addressing the CNCD epidemic in the Caribbean
 Strengthen capacity of civil society to monitor
implementation of the POS Summit Declaration
 Consider resource mobilization
Recent initiatives
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Ratification of the FCTC
Establishment of NCD Commissions
Recognition of Annual Caribbean Wellness Day
National Chronic Disease Registry, Barbados
Risk Factor Surveillance
Healthy Caribbean Coalition public education
campaign
 National Nutrition improvement and salt reduction
Recent initiatives
 CNCD National Summits held in Dominica and St. Lucia
 Blood Pressure Monitoring initiative in barber shops and
hairdressing salons developed in St. Kitts
 Completion of STEPS survey for CNCDs and risk factors in
Barbados, Dominica, BVI and St. Kitts and Nevis
 Grenada completed a Workplace Wellness Summit (Part 1)
 Expert consultations on Cancer Registries in Barbados,
Antigua and Barbuda and Grenada
Areas of support and
recommendations for further action
 Establishment of NCD Commissions in all OECS
countries
 Ratification and full implementation of FCTC
by all OECS countries
 Implementation of a population salt
reduction programmes in OECS countries
 Support by OECS Governments for HCC led
public education campaign on NCDs
Areas of support and
recommendations for further action
 Support for Annual Caribbean Wellness Day
 Acceptance of Caribbean Civil Society
Declaration and Action Plan for tackling NCDs
 Official recognition of the Healthy Caribbean
Coalition by OECS Ministers of Health
Healthy Weight, Healthy Lives
2000s: solid evidence
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“The scientific
evidence is compelling.
Physical activity not only
contributes to well-being,
but is also essential for good
health.”
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•Professor Sir Liam Donaldson
•Chief Medical Officer,
•Department of Health
What makes a civil society
network successful ?
• Integrity
• Independent of vested and ideological
interests
• Dialogue not partnership that sells the soul
• Shared values and goals
• Connected – nexus - real time information
• Become a player- “plugged in” where it
maters- act on the inside and the outside
What makes a civil society
network successful?
• Movers and shakers-public health hero’s calculated risks
• Non compromised charities, professional,
consumer, social policy and academic
groups
• Powerful individual members and patrons
• Common issues
• A social movement
• Strategic –smart and tactical
• Focus and clarity about goals
What makes a civil society
network successful?
• Advocacy – clarity – always be the voice of
reason and reasonableness – acting in the
public interest –advocacy bullets
• Public opinion
• Play to strengths of different advocacy
styles across membership
• Media links
• Ability to respond quickly
• Handling controversy
What probably makes a civil
society network successful?
• Respect differences and have caveats to not
necessarily represent everyone
• Handling controversy –rapid responses
• Human rights and freedoms
• Policy acumen
• Upstream - high impact : downstream support
• Don’t delude your self – do things that
matter.
What probably makes a civil
society network successful?
• Marshalling and promulgating evidence and
expertise
• Argue cost effectiveness and cost savings
• Rock solid ethics
• Leadership and co-ordination- clear
priorities
• Cross sector and cross government
• Productive and respectful links to senior
civil servants
What probably makes a civil
society network successful?
• Mandates for change- social marketing mix professional and political mandates
• Good governance: Wise governance –keep
organisations and people linked
• Good organisation
• Work together- trust-solidarity
• Legal protections- cover your back
• Quality
What probably makes a civil
society network successful?
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Representation
Consultations- voice
Transparency and openness
Membership surveys - sensitive close
working links
• Democratic working
• Collective bids
• Gossip, intelligence and ideas
What probably makes a civil
society network successful?
• Power of a public interest alliance
• Energy, enthusiasm and passion
• Develop political acumen – nanny state
arguments, children, ST benefits, cost
savings, co-benefits
• Cross party political support for issues
• The hallmark/touchstone of an effective
functioning democracy
The role of civil society in
promoting the publics’ health
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Sustainable social change
Trusted
Independent
Non ideological
Advocacy – voice amplified by powerful
alliances
• Voice of the less well reached
• Keeping public health a public good
• Population health measures
The role of civil society in
promoting the publics’ health
• Countervailing force for the excesses of
industry and unhelpful and unproven
ideologies
• Champion of the public interest
Architecture and characteristics
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Cross government
Multi-sectoral
Environmental determinants
Population and individual
Whole systems impact
Multiple interventions
Natural experiments
Lifecourse
Complementary
approaches to
chronic disease
prevention
Individual responsibility
Changes to the
"toxic" environment
HEALTH CARE
AND
DOCTOR
POLICY ENACTMENT
COMMUNITY AND CIVIL SOCIETY
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