Transcript Tobacco control policy – role of the CNCD Commission

The role of CNCD Commissions
in tackling chronic diseases –
The Barbados Experience
Dominica National Commission on CNCDs Capacity Building
Workshop, 19 January 2010
Professor Trevor A. Hassell,
Chairman Commission for CNCDs, Barbados
The burden of the CNCDs Barbados
 Quarter of men and more than a third of women
live with one or more CNCD
 Five leading causes of death are CNCDs
 Heart disease and stroke rank among leading causes of
death
 22% of Barbadian adults are hypertensive and 17.5% are
diabetic
 Diabetes and hypertension account for 20% of primary care
consultations
 Overweight/obesity: 60% of women and 1/3rd men
“ 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) all
resulting in some 50% of all deaths.”
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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Support for the CNCD Commission local
 The Barbados Strategic Plan for Health, 20022012
 Strategy for the prevention and control of CNCD
& Cabinet Note (2005) 26/MH.03, Ministry of
Health, Barbados (2004);
 International Consultation on a Strategy for the
Prevention and Control of CNCD for Barbados;
Ministry of Health, Barbados (2005)
 “Healthy Hearts for life”. Report of the Task Force
on the Development of Cardiovascular Services
(Jan. 2007); Ministry of Health, Barbados
Support for the CNCD Commission regional
 Heads of Government of CARICOM Summit
and Declaration against CNCDs, 2007
 Healthy Caribbean 2008 Chronic Disease
Conference: a wellness revolution event
CARICOM Heads of Government Summit on Chronic
Non-Communicable Diseases (CNCDs), 15
September 2007
adopted a fourteen-point declaration committing the
region to collective action to stop the epidemic of
CNCDs
 **Infrastructure: Secretariat / CCH3 / Regional
Plans, M & E;
 **National Commission, NCD Focal Point in MOH
 **Advocacy, Communications, Social marketing
 **Sustainable Financing
 **Surveillance, including Gender dimensions
Priorities of the Summit
 Tobacco (FCTC)
 Healthy Eating (DPAS):
– Trans Fat, Trade, Labeling
 Active Living (DPAS)
– Population-wide activities
– Schools/workplaces etc.
– 2nd Saturday in Sept: “Caribbean Wellness
Day”
 Screening and integrated management
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
Participants
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Agriculture
Business
Education
Faith Based
Finance
Food Industry
Gov./Policy
H C Providers
Health Finance
Labour
Legal
Media
NGO/CNCD
Pharma
Reg./Pol
Service Clubs
Sports/PA
Urban Dev.
Youth
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7
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5
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Anguilla
Antigua
Aruba
Bahamas
Barbados
Belize
BVI
Cayman islands
Dominica
Grenada
Guyana
Jamaica
Montserrat
St. Lucia
Trinidad and Tobago
St. Kitts
Outcomes
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Active Caribbean Workshop
Caribbean Civil Society Declaration on CNCDs
Caribbean Civil Society Action Plan for tackling CNCDs,
Conference Report produced as a Technical Report of the
Chronic Disease Research Centre, UWI
 Creation of a Caribbean civil society coalition for tackling
CNCDs - Healthy Caribbean Coalition
 Website: www.healthycaribbean.org.
 Co-sponsorship of upcoming University Diabetes Outreach
Conference, Jamaica, 2010
 CNCD media campaign for Barbados and the OECS
Summary of the Declaration
 10 point preamble and 12 point declaration
 Preamble recognizes the contribution of the CNCDs both to ill
health & disease and excessive financial burden, but
appreciates that much can be done
 Declares inter alia:
 Support for Heads of Government of CARICOM Declaration
on CNCDs
 Need to establish a Caribbean Civil society CNCD coalition
 Stresses the need for increased advocacy
 Promotion of healthy lifestyles
 Public education and media campaigns
 Seeks to hold Governments accountable
Summary of the Action Plan
 Action lines:
Establishment of Caribbean CNCD coalition
Advocacy
Support for Caribbean Wellness Day
Development of a communication strategy
Public education programme
Risk factor reduction
Support for country level activities
The National Commission for CNCDs,
Barbados
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Established January 2007
Inter-sectoral body
14 members and 4 ex-officio members
Volunteers paid small stipend
Meetings held monthly
Professional, administrative and secretarial support
provided by staff of the Health Promotion Unit
 No budget allocated to the Commission at start up
The Commission’s mandate
 Advise Minister of Health on CNCD policies and legislation
 Broker involvement of all sectors in program implementation
 Assist in mobilisation of resources to facilitate implementation
of programs
 Recommend relevant research
 Promote collaborations and partnerships
 Monitor regional and international trends
 Facilitate commissioning of audits /evaluation of CNCD
programs
 Recommend to Minister of Health framework that encourages
and promotes behaviour change to prevent CNCDs
Membership of NCCNCD, Barbados
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Professor Trevor Hassell MD., Chairman
Professor Henry Fraser MD., Dean Faculty of Medical Sciences
Mr. David Neiland , Businessman, the private sector
Mr Orlando Scott, trade union movement
Mr Wilfred Beckles, Barbados Association of Retired Persons
Mr. Michael Gaskin, teacher, physical education
Mr Adrian Randall , CEO, Heart & Stroke Foundation of Barbados
Dr Elliott Douglin MD., Representing Faith based organisations
Mrs. Sophia Cambridge, Advertising and media
Ms Candace Waldron, Youth Representative
Ms Zonia Phillips, Food and Nutrition advocate
Mr Barton Clarke Chief Agricultural Officer, Ministry of Agriculture
Mrs Wendy Griffith-Watson, Chief Education Officer
Mrs. Ena Harvey, IICA
Strategic Plan: Objectives
 Internal action:
Improved management of NCCNCD
Improved CNCD data management
 External action:
Health promotion
Reduction of CNCD risk factors
Quality CNCD treatment and care
Strategic Plan: Vision, mission and
values
 Vision: to be a leader in all major national
developments related to CNCDs in order to
achieve reduction in CNCDs
 Mission: Advises on, facilitates and promotes
evidence based best practices in Prevention
and Control of CNCDs
 Values: Transparency, inclusiveness, respect
for all views, adoption of evidence based
practices, accountability, and collaboration
Strategic plan: key strategies
 Strategic management issues
 Epidemiological data, Health Information
System and research
 Measures to support reduction of risk factors
 Health promotion
 Quality treatment and care
Strategic management issues
 Advisory body guiding and assisting a highly
motivated group of operational partners
 Driving CNCD interventions in collaboration
with:
Public and private sector
Government and NGOs
Professional and voluntary bodies
Community based organizations
Regional and international bodies
Epi- data, Health Information
Systems and Research
 Increasing access to data on CNCDs
 Strengthening functional links with CDRC/UWI
 Using the BNR as a priority data source to
inform actions of the CNCD Commission
 Increasing surveillance capacity of Ministry of
Health
 Using Health Information System
Measures to support reduction of
risk factors
 Declare CNCDs a national priority
 Enhance the role of the commission with the
public
 Giving the public access to CNCD data
 Inform the public of standards in treatment
and care
 Support on-going educational programmes
targeting health care professionals
Health promotion
 Integrate health promotion strategies in the
planning process
 Improve inter-sectoral collaboration
 Lobby where necessary for high impact
 Influence legislation and regulation
Quality treatment and care
 Establish standards for CNCD treatment and
care
Indicators of success
 Organizational and management structures
1. Budgetary funds allocated to CNCDs increased by 10%
2. Administrative staff added to MOH to support
Commission
3. Secretariat established
 Epi- data, HIS and research
1. Implementation of annual surveillance reporting system
for CNCDs
2. Regular outputs from BNR
3. Repeat BRFS survey in 2010
4. Establishment of a web portal for CNCDs
Indicators of success
 Risk factor reduction
1. Complete adoption of at least 3 articles of FCTC by end of
2009
2. National population salt reduction policy articulated and
programme implemented by 4th quarter of 2009
3. Support for CME of health professionals
4. Working relationship with National Nutrition Centre
 Health promotion
1. Representation of CNCDs at the level of the Social partnership
2. Sustained highly visible public education programme on CNCDs
 Quality treatment and care
1. Annual training given to health care professionals in CNCD
protocols
Tobacco exposure
 Significantly increase tax on tobacco products
 Remove duty free concessions on tobacco products at
the ports of entry
 Ban sale of tobacco products to minors
 Ensure that warning labels on tobacco products meet
international standards
 Ban smoking in public places
 Prohibit cigarette advertising at point of sale
Physical inactivity
 Make materials and aids used in exercise and physical
activity more affordable for personal use….VAT
exemption
 Enact policies to facilitate development of small
community gyms
 Create tax incentives for property developers to create
safe recreational spaces in communities
 Increase physical activity in schools
 Enact legislation and policies to make the city
and the country more conducive to walking and
riding
Hypertension and blood pressure
control
 Continue to make blood pressure lowering drugs
available at an affordable cost at point of
delivery….Drug formulary
 Produce a more cost effective and more rational
range of antihypertensive drugs
 Seek to provide delivery of care of hypertension
by primary care doctors using the chronic care
medical model
 Population salt reduction using a voluntary and
collaborative approach informed by national
policy
Diabetes and blood sugar control
Enhance the provision of drugs, syringes,
needles for diabetics…drug service
Provide blood glucose test strips
 Provide tax concessions or zero rate
glucometers
National Chronic Disease Registry
 An initiative of the Ministry of Health, executed on
contract by the Chronic Disease Research Centre
 Sub-registries of acute myocardial infarction,
stroke, and cancer, related risk factors and
outcomes
 Aims to inform and guide prevention and
intervention strategies, and optimal resource use
 Model for the region
 Complementary to PAHO/STEPS Risk Factor
surveillance program
The Commission and the Barbados
National Registry
 Chairman of the Commission has a “direct
interest” in the outputs of the Registry
 Commission facilitates and supports the work
of the Registry
 Commission monitors and evaluates the
operations of the Registry
 The Registry supports the information needs
of the Commission
The Commission and the Barbados
National Registry
 The Commission in conjunction with the CMO will :
Provide input to any public health, medical and
epidemiological issues arising from that work
Design and implement public awareness and
communication strategies about the contribution
of the Registry to population health status
improvement
Design and implement “professional awareness
strategies” to inform and engage the medical and
related professions in the activities of the Registry
Barbados Behavioural Risk Factor
Survey (STEPS): 25 years and older
 Tobacco exposure
8.4% current smokers
 Physical activity
51% low level of physical activity
 Eating habits/diet
95% ate less than 5 servings of fruit and
vegetables per day
Caribbean Wellness Day
 Introduced by Heads of Government of CARICOM
 Held on the 2nd Saturday in September
 Focus attention throughout the region on the
chronic diseases
 Coordinated by the CNCD Commission
 All sectors of the community invited to participate,
private sector, government, trade unions, civil
society, the academic and educational institutions,
faith based organisations
National Nutrition Improvement
and Salt Reduction Program
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Survey of population salt intake: initial and follow up
Healthy nutrition policies and actions in schools
Taxation policy around healthy food and beverages
Public education campaign on radio, TV, and print
media
Reformulation of food and drinks
“Salt choice the difficult choice”
Workshops and seminars for health care providers
Barber shop screening project
The National Chronic Non-Communicable
Disease Commission Logo
Nutrition guidelines for schools
 Produced 2009
 A tool for use in schools to assist teachers and
students in best practice nutrition
 Distribution of guidelines and implementation,
2010
Activities of the Commission
 Healthy Caribbean 2008 civil society conference
 Initiated service contracts with health NGOs
 Contributed to the Heads of Government of CARICOM
Summit, 2007
 Contributor and lead role in development of Cabinet
paper on CNCDs
 Consultation on trans fats / Faith based workshop
 Several lectures and presentations - CMOs and Ministers
of Health, OECS; New Delhi, India; Washington, USA
 Publication of brochure “Battling the hidden enemy”
 CNCD media campaign for Barbados and the OECS