Regional Summit on Chronic Non- Communicable …...Exploding the Myths often begin in the young...
Transcript of Regional Summit on Chronic Non- Communicable …...Exploding the Myths often begin in the young...
CARICOMCARICOM
Regional Summit on Chronic Non-Communicable DiseasesTrinidad and Tobago,g ,
15 September, 2007
Presentation byPrime Minister of St Kitts & Nevis
Hon Dr Denzil Douglas
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• Global situation with Chronic NCDs• Caribbean situation and costs• Caribbean Response
Overview ofPresentation
p• Exploding common myths• Review of effective interventions• The Way Forward
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THE MALADIES OF AFFLUENCE
Globalisation andHealth
The Economist, August 11th 2007
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The poor world is getting the rich world’s diseases
“Europeans have been exporting their maladiesthroughout history. They seem to be doing it again,but in a new way. In the past the problem wasy p pinfection. Now illnesses associated with Western livingstandards are the fastest growing killers in poor andmiddle-income countries. Chronic disease hasbecome the poor world’s greatest health problem”.
The Economist, August 11, 2007
CARICOMChronic Diseases
Heart Disease, Stroke, Cancer, Diabetes, Chronic RespiratoryDisease↑
Biological Risk FactorsModifiable: overweight, high cholesterol, high blood sugar, high
blood pressureNon-modifiable: Age, Sex, and Genetics
Chronic Diseasesand their Causes
Non modifiable: Age, Sex, and Genetics↑
Behavioral Risk FactorsTobacco use, physical inactivity, unhealthy diet, alcohol abuse
↑Social and Environmental Determinants
Social, economic and political conditions such as income, livingand working conditions, physical infrastructure, environment,
education, agriculture, and access to health services↑
Global InfluencesGlobalization of food supply, urbanization, technology, migration
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Distribution ofDeaths by Major
Cause in the World
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Distribution of Deathsfrom Infectious andChronic Disease byIncome Category, 2005
Crude Mortality Rates (per 100,000 population)for Select Diseases: (2000-2004)
CARICOM Member States
80
100
120
140
0,00
0 po
pula
tion
HeartDisease
Diabetes
Cancers
Source: CAREC, based on mortality reports from countries
2000 2001 2002 2003 2004Year
0
20
40
60
Rat
es p
er 1
00,0
00 p
opul
atio
n
StrokeDiabetes
Injuries
HypertensiveDiseases
HIV/AIDS
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Leading Causes of Death inCARICOM Countries bySex, 2004 (MINUS Jamaica)
1. Heart Disease2. Cancers3. Injuries and violence
1. Heart Disease2. Cancers3. Diabetes
MALES FEMALES
j4. Stroke5. Diabetes6. HIV/AIDS7. Hypertension8. Influenza/pneumonia
4. Stroke5. Hypertension6. HIV/AIDS7. Influenza/pneumonia8. Injuries and violence
Source: CAREC, based on country mortality reports
Potential Years of Life Lost <65years by Main Causes, 2000& 2004, CARICOM Countries (minus Jamaica)
HIV/AIDS
Injuries
Y2004Y2000
0 10000 20000 30000 40000 50000 60000 70000
Chronic Disease
Note: Chronic Disease includes heart disease, stroke, cancer, diabetes, hypertension,chronic respiratory disease
‘Injuries’ includes traffic fatalities, homicide, suicide, drowning, falls, poisoning
Source: CAREC, based on country mortality reports
200
250
300
Disability Adjusted Life Years (000) 2002
0
50
100
150
JAM TRT BAH BAR
Com DisNCDs
Mortality Attributable to Select Risk Factors (Latin America & Caribbean)from DCP2
Tobacco
Alcohol
Obesity
High BP
0 100 200 300 400 500
Unsafe sex
Physical inactivity
Low fruits & veg
High cholesterol
Attributable Deaths (thousands)
30
40
50
60ce
(%)
Trends in Adult Overweight/Obesityin the Caribbean
0
10
20
30
Prev
alen
ce (%
)
1970s 1980s 1990s
YEARS
MaleFemale
Prevalence (%) of diabetes among adults inthe Americas
8 68.799.3
10.711.812.412.612.7
16.4
Bolivia
Suriname
Nicaragua
USA
Mexico
Cuba
Belize
Jamaica
Trinidad/Tobago
Barbados
6.16.3
7.27.27.37.67.67.98.28.48.6
Honduras
Chile
Urban Peru
Paraguay
Haiti
Brazil
Argentina
Costa Rica
Colombia
Guatemala
Bolivia
Source: Pan Am J Public Health 10(5), 2001; unpublished(CAMDI), Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care)
Caribbean Trends in Diabetes Mortality
60
70
80
000
20
30
40
50
Rat
e/10
0,00
0
1985 1990 1995 2000
MaleFemale
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A Consequenceof Diabetes
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Amputations at theQEH 2002-2006
Diabetic Non diabetic
Male 308 116
Female 379 120
Total 995 236
Source A. Hennis, 2007
Age adjusted death rates/100,000population from Diabetes (2000)
80
100
120
0
20
40
60
BAH BAR GUY JAM SUR TRT CAN USA
From community surveys, theprevalence of hypertension in adults 25-64 years of age was:
Barbados 27.2 %Jamaica 24.0 %
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St. Lucia 25.9 %The Bahamas 37.5%Belize 37.3%
Control of blood pressure would reduce thedeath rates from Cardiovascular Disease byabout 15-20%.
Principal ClinicVisits,Saint Vincent &theGrenadines, 2000vs2003
15,000
20,000
2000
0
5,000
10,000
HTNor HTN/DM DMor DM/HTN Arthritis/Muscu
2003
Age adjusted death rates/100,000population from Hypertension (2000)
3035404550
05
1015202530
BAH BAR GUY JAM SUR TRT CAN USA
Projected national income lost from NCDs ( 2005-2015)Projected National Income Lost from NCDs
2005 -2015, $USBN
400
500
600
0
100
200
300
Bra Can Chi Ind Nig Pak Rus UK Tan
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EstimatedEconomic Burden($US Million, 2001)
BAH BAR JAM TRT
Diabetes 27.3 37.8 208.8 494.4
Hypertension 46.4 72.7 251.6 259.5
Total 76.7 110.5 460.4 753.9
Estimated Cost of Diabetes andHypertension as percent (%) of GDP
5
6
7
8
0
1
2
3
4
5
BAH BAR JAM TRT
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6%
Developing countriescarry a doubledisease burden
Percentage of deaths by cause
Low- and middle-income countries High-income countries
36%
10%
54%
non-communicable diseasescommunicable diseasesinjuries
87%
7%6%
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Exploding theMyths
Myth: Chronic diseases are a problemof the rich countries
Fact: Non-communicable diseaseaccount for more than half theburden of disease and 80% of thedeaths in the poorer countries whichcarry a double burden of disease.
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Myth: NCDs are a problem only of the elderly
Fact: Half of these diseases occur in adults lessthan 70 years of age and the problems
Exploding theMyths
y g poften begin in the young e.g., obesity
Myth: NCDs affect men more than women
Fact: NCDs affect women and men almostequally and globally, heart disease is thelargest cause of death in women.
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Exploding theMyths
Myth: NCDs cannot be prevented
Fact: If the known risk factors areFact: If the known risk factors arecontrolled, at least 80% of heartdisease, stroke and diabetes and40 % of cancers are preventable,and in addition there arecost effective interventions availablefor control.
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Exploding theMyths
Myth: people with NCDs are at fault andto be blamed because of theirunhealthy lifestyles
Fact: individual responsibility, while important,only has full effect where people haveequal access to healthy choices.Governments have a crucial role to playby altering the social environment to helpmake the healthy choice the easychoice.
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Exploding themyths
Myth: “my grandfather smoked and lived to90 years”, and “everyone has to die ofsomething”
Fact: While some people who smoke will livea normal lifespan, the majority will haveshorter, poorer quality lives. And yes,everyone has to die, but death does notneed to be slow, painful or premature,as is so often the case with NCDs
CARICOMWhat Works?
• A small shift in average population levels ofseveral risk factors can lead to a largereduction in chronic diseases
• Population wide approaches form the centralstrategy for preventing and controllingchronic disease epidemics, but should becombined with interventions for individuals
• Many interventions are not only effective, butsuitable for resource constrained settings
Finland: Dramatic Declines in NCD Mortality
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Relation of Fitness toRisk of Death, T&T,St. JamesCardiovascular Study
• 1309 men had blood sugar, cholesterol,fitness measured at baseline and thenfollowed up carefully for 7 yearsfollowed 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
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CaribbeanResponses
• Since the 1960s, history of collective action in health,formalized in 1986 as the Caribbean Cooperation in Health(CCH) initiative.
• Countries, CAREC, CFNI and CHRC, CARICOM Secretariat,PAHO/WHO and partners have had successes e.g.,,p g ,,malnutrition and gastroenteritis, vaccine preventablediseases, HIV/AIDS (p (PANCAP).
•• CCH now entering 3rd phase: major thesis that Caribbean
health can be improved through actions taken universallyand collectively.
• Current priorities for action under CCH include chronicdiseases where the cited goals are to reduce deaths by 2%per year and to reduce serious, costly complications such asamputations or renal failure.
Caribbean Responses Summarised
���Im p le m e n ta t io n o f F C T C
�N a t io n a l O b je c t iv e s
��N a t io n a l la w , le g is la t io n ,d e c r e e
�����N a t io n a l fo c a l p o in t ,D e p a r tm e n t o r U n it
TRT
SUR
JAM
HAI
GUY
BAR
BAH
ANT
ANG
���Im p le m e n ta t io n o f F C T C
�N a t io n a l O b je c t iv e s
��N a t io n a l la w , le g is la t io n ,d e c r e e
�����N a t io n a l fo c a l p o in t ,D e p a r tm e n t o r U n it
TRT
SUR
JAM
HAI
GUY
BAR
BAH
ANT
ANG
����F in a n c ia l r e s o u r c e s
�Q u a li t y a s s u r a n c e o fc a r e
�N a t io n a l s ta n d a rd s a n dp ro to c o ls fo r t re a tm e n t
�D e m o n s t r a t iv ec o m m u n it y -b a s e dp r o g r a m s
����N a t io n a l s y s te m o fH e a lth r e p o r ts , s u r v e ya n d s u r v e il la n c e
����Im p le m e n ta t io n o f D P A S
p
����F in a n c ia l r e s o u r c e s
�Q u a li t y a s s u r a n c e o fc a r e
�N a t io n a l s ta n d a rd s a n dp ro to c o ls fo r t re a tm e n t
�D e m o n s t r a t iv ec o m m u n it y -b a s e dp r o g r a m s
����N a t io n a l s y s te m o fH e a lth r e p o r ts , s u r v e ya n d s u r v e il la n c e
����Im p le m e n ta t io n o f D P A S
p
Source: PAHO Survey of NCD National Response Capacity, 2005
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Addressing therisk factors
Tobacco and alcohol• Increase taxes with proceeds to prevention
and treatment• Ban smoking in public places• Ban smoking in all schools• Ban cigarette and tobacco advertising near
to schools• Curtail promotion of alcohol products
targeted to women and children• Establish target dates for passage of the
legal provisions in the FCTC already ratified.
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Addressingthe risk factors
Physical activity
• Have physical education compulsory inh l d id th f ilitischools and provide the facilities
• Provide healthy, secure exercise spaces
• Provide wellness centers
• Give tax relief for worksite exercise facilities
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Addressing therisk factors
Improve dietary practices
• Promote a standard of meals in public eating placeseg. eliminating trans fats
• Provide healthy school meals
• Establish community based networks for training inpreparation of health foods
• Mandate RNM to investigate the trade issues whichimpact negatively on healthy food imports
• Promote elimination of trans fats from Caribbeandiets
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Addressing therisk factors
In the case of cancer
• Primary preventione.g. screening and vaccination to
prevent cervical cancer
Promote screening for breast cancer
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Secondaryprevention
• Screening programs for NCDs
• Provide health services with resourcesto apply the established cost effectiveto apply the established cost-effectiveinterventions
• Establish mechanisms to ensureavailability of the medicationsnecessary for the long term treatmentof NCDs when they occur
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Critical otherrecommendations
• Establish national level Commissions on NCDs
• Establish a system of behavior and risk factorsurveillance with support of CAREC and UWI
• Insist on the updating of the Caribbean RegionalPlan of Action for NCDs
• The Community should name a “CARICOMWELLNESS DAY”
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Involve Partners
• PAHO/WHO• Financial institutions• Caribbean social partners – private sector and civil
society
Monitoring and evaluation
• Designate CARICOM/PAHO as the joint Secretariatwith responsibility for monitoring and reportingprogress in the control of the NCDs.
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The WayForward
First: We can utilize the policy instrumentsat our disposal
legislationtaxationtaxationregulation
Second: We should establish partnerships
Third: We must take personal responsibilityand lead by example
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CONCLUSIONS
• The Caribbean has a very serious problem - gettingworse
• Economically and socially, it is not sustainable
• There are cost-effective interventions that work; why notutilise them?
• We must put into effect National and Caribbean-wide(CCH) plans
• It is CRITICAL to strengthen health services formanagement and control of chronic diseases
• Deepened partnership with public and private sector, andcivil society is absolutely needed
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Th k YThank You
Regional Summit on Chronic Non-Communicable Diseases, Trinidad and Tobago, 15 Sept, ‘07