Transcript Addressing the NCD 4X4 in the Region: The Role of CARICOM

CARICOM
Addressing NCDs in the Region:
The Role of CARICOM
Rudolph Cummings MD, MPH; Program Manager,
Health Sector Development, CARICOM
17th February, 2013, Guyana
CARICOM
Leading Causes of Death in CARICOM
Countries by Sex, 2004 (- Jamaica)
FEMALES
MALES
1.
2.
3.
4.
5.
6.
7.
8.
Heart Disease
Cancers
Injuries and violence
Stroke
Diabetes
HIV/AIDS
Hypertension
Influenza/pneumonia
1.
2.
3.
4.
5.
6.
7.
8.
Heart Disease
Cancers
Diabetes
Stroke
Hypertension
HIV/AIDS
Influenza/pneumonia
Injuries and violence
Crude Mortality Rates (per 100,000 population ) for Select Diseases: (2000-2004)
CARICOM Member States
CARICOM
140
120
Heart
Disease
Rates per 100,000 population
100
Cancers
80
Diabetes
Stroke
60
Injuries
Hypertensive
Diseases
40
HIV/AIDS
20
0
2000
2001
2002
Year
2003
2004
CARICOM
Adjusted Mortality Rates /100,000, Selected CARICOM countries
vs. Canada 2003 - 2005
160
140
120
100
80
60
40
20
0
Trinidad & Tobago
Guyana
Suriname
DM
IHD
CVA
Bahamas
Canada
0
Barbados
Guyana
Jamaica
T&T
Unsafe sex
Low fruit
and veg.
intake
Physical
inactivity
High
Cholesterol
Alcohol
Tobacco
High BMI
(Obesity)
High BP
CARICOM
% Deaths Due to Selected Risk Factors
25
20
15
10
5
CARICOM
Trends in Adult Overweight/Obesity
in the Caribbean
70
60
Prevalence (%)
50
40
Male
30
Female
20
10
0
1970s
1980s
1990s
YEARS
2000s
Potential Years of Life Lost <65years by main causes, 2000
& 2004, CARICOM countries (minus Jamaica)
CARICOM
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
CARICOM
Percentage of GDP (%)
Economic Burden of Diabetes and
Hypertension in Selected Caribbean Countries
(2001)
10
8
6
4
2
0
The Bahamas
Barbados
DIABETES
Jamaica
HYPERTENSION
TRT
BOTH
CARICOM
Chronic Diseases and their Causes
CARICOM
NCD
4X4
Noncommunicable diseases
Heart disease
and stroke
Diabetes
Cancer
Chronic lung
disease
Modifiable causative risk factors for NCDs
Tobacco
use
Unhealthy
diets
Physical
inactivity
Harmful
use of
alcohol
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CARICOM
Caribbean’s leadership on NCD
• NCDs emerged as a priority
– CCH I Nassau Declaration
1986
2001
CCHD
2005
• Port of Spain Declaration 2007
• SUMMIT of the America and CHOGM –
2009
– Mandate to elevate issue to UN
• UNHLM - CARICOM lead UN Res.64/265
CARICOM
Mandates
• Port of Spain
Declaration
• Strategic Plan of
Action for the
Prevention and
Control of NCDS
• NCD Progress
Indicator Matrix
• Global Strategy on
Diet Physical
Activity and Health
• FCTC
• WHA Res 58.22:
Cancer prevention
and Control
CARICOM
POS NCD Summit Declaration (2007)
WHAT TO DO
• Tobacco control (#3,4)
• Healthy Eating (salt) (#6,7,8,9)
• Physical Activity (#10, 15)
• Treatment (#5)
WHERE TO DO IT
• Workplace (#10)
• Schools (#6)
• Faith based org.
• Communities
HOW TO DO IT
• NCD Secretariat, Plan, M&E
(#1, 14)
• NCD Commissions (#2)
• Surveillance, Gender (#11,
13)
• Partners – private sector,
civil society (P)
• Media & Communications
(#12)
• Sustainable financing (#4)
PAHO and CARICOM support
CARICOM
Strategic Plan - Guiding Principles
• The Caribbean Charter of Health Promotion
• Capacity building Member States through
the CARICOM/PAHO NCD Secretariat
• Focus on Gender dimensions of the
epidemic
• Multi-Sectoral/ Whole of Government
Approach
• Integrated Approach to prevention and
Control across the Life Course
CARICOM
NCD
4X4
Noncommunicable diseases
Heart disease
and stroke
Diabetes
Cancer
Chronic lung
disease
Modifiable causative risk factors for NCDs
Tobacco
use
Unhealthy
diets
Physical
inactivity
Harmful
use of
alcohol
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CARICOM
The Health Promotion Lens
Healthy Public Policy
Supportive Environments
Reorient Health Services
Empower Communities
Increase Personal Health Skills
Build alliances
CARICOM
Diet and Nutrition
• Multi-sector Nutrition and Food security Plans/
legislation
• Promote population and setting specific standards
for meals
– Reduce Salt, Fat/ Trans Fat, Sugar consumption
– Age appropriate FBDGs
– Provide healthy school meals
• Establish standards:
– Marketing of foods to children
– Packaging and Labelling of food products
• Scientific based Public Communication promoting
healthy eating
• Pricing tariffs – incentives for healthy foods (access,
affordability)
CARICOM
Physical Activity
• Mandate physical education in population
settings – legislation/ regulations/guidelines
• Increase safe public facilities that enable PA
• Scientific based public communication
promoting PA
• Develop, implement and or scale up
population setting based PA programmes
– Schools
– Workplaces
– Geriatric institutions etc
CARICOM
Relation of fitness to mortality
T&T, St. James Cardiovascular Study
• 1309 men had blood sugar, cholesterol, fitness
measured at baseline and then followed up
carefully for 7 years.
• Unfit men compared with fit men were:
- 3.6 times more likely to die
- 2.5 times more likely to have a heart
attack
CARICOM
Tobacco Control
• Monitor use of tobacco use and
prevention policies
• Protect people from tobacco smoke in
public places and workplaces
• Offer help to people who want to stop
using tobacco
• Enforce bans on tobacco advertising,
promotion and sponsorship
• Raise tobacco taxes and prices
Cigarette price and consumption show opposite trends
(2)
2500
800
2000
600
1500
400
1000
200
500
Real price of cigarettes
2000
1996
1992
1988
1984
1980
1976
1972
1968
0
1964
0
Cigarette consumption
(millions of packs)
1000
1960
Real price per pack of 20
( in constant 2000 cents)
Real price of cigarettes and consumption in South Africa, 19602003
Consumption of cigarettes
Source: Van Welbeck 2003
CARICOM
Alcohol Control
• Legislation, policies:
– underage drinking
– Use of alcohol by women of reproductive age
• Curtail advertising and promotion of
alcohol products targeted to women and
children
• Adopt measures in support of an
appropriate monitoring system for the
harmful use of alcohol
• Scientifically based population specific
public communication
CARICOM
Proposed CVD Interventions
Salt, tobacco, treatment =
• Globally,18 million deaths averted at a
cost of US$1.10 per year
• Estimated 38,000 lives saved in CARICOM
over 10 years
• Would add an average of 2 years of life
for every citizen
• Projected cost < 1% of existing health
budget.
CARICOM
Commitment
Establish national level Multi- Sectoral
Bodies on NCDs
Develop, implement and monitor multisectoral NCD national Plans
Allocate resources for national NCD
programmes
Multi-sectoral Interventions
CARICOM
• Healthy Eating
–
–
–
–
Trade policy, agri-food policies, fiscal policy,
Ministries of Trade, Finance, Agriculture
Private sector, Civil society, Consumer Affairs, Media
Food manufacturers, importers, providers
• Fast food sector, Restaurants
• Physical Activity
– Urban Planners, Ministries of Transportation, Local
Government, Education; Chambers of Commerce,
private sector
• Tobacco / Alcohol
– Attorney General, Ministries of Legal Affaires,
Finance, Trade
CARICOM
Surveillance and Research
• Establish Health information policy and
systems for NCDs
• Annual reports : Minimum Data Set
• Surveys: STEPS , GSHS, GYTS etc
• Evaluate interventions
• Collaborate with academic and research
institutions
Ability to disaggregate data – age and sex
CARICOM
Education & Promotion
• Caribbean Wellness Day
• National NCD Communication plans
• Scientific based population specific
communication
• Incorporate prevention and control
explicitly in poverty reduction and social
and economic policies
(www.healthycaribbean.org)
CARICOM
Disease Management
• Chronic Care Model
• NCD treatment protocols – age and
gender appropriate
• Screening programs for NCDs
• Provide health services PHC
• Establish mechanisms to ensure
availability of the medications necessary
for the long term treatment of NCDs
when they occur
CARICOM
CONCLUSIONS
• The Caribbean has a very serious problem - getting worse
• Economically and socially, it is not sustainable
• There are cost-effective interventions that work; why not
utilise them?
• We must put into effect National and Caribbean-wide
(CCH) plans
• It is CRITICAL to strengthen health services to for
management and control of chronic diseases
• Deepened partnership with public and private sector,
and civil society absolutely needed
CARICOM
Next Steps
• Evaluation of POS at 5
• Revise the NCD Progress Indicator Tool
• Establish a Regional Communications working
group and Regional NCD Communication
framework
• Revisiting Health School Initiative to address
NCDs
• Focus on Children 2013 – Regional Programmatic
Framework for addressing NCDs among Children
Make the healthy choice the easy Choice
CARICOM
The Key to GUYANA’s Success . . .
CARICOM
CARICOM:
Health Sector Development, Human and
Social Development Directorate
Dr. Rudolph Cummings
Programme Manager
[email protected]
Tel: 2220001-75 ext 2720
Ms. Renee Franklin Peroune
Senior ProjectOfficer
[email protected]
Tel: 2220001-75 ext 2232
https://www.facebook.com/cc.secretariat
www.caricom.org
CARICOM