Rudolph Cummings MD, MPH; Program Manager, Health Sector Development, CARICOM 17 th February, 2013,...
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Transcript of Rudolph Cummings MD, MPH; Program Manager, Health Sector Development, CARICOM 17 th February, 2013,...
Rudolph Cummings MD, MPH; Program Manager, Health Sector Development, CARICOM
17th February, 2013, Guyana
CARICOM Addressing Addressing NCDsNCDs in the Region: in the Region:The Role of CARICOM The Role of CARICOM
CARICOM Leading Causes of Death in CARICOM Leading Causes of Death in CARICOM Countries by Sex, 2004 (- Jamaica)Countries by Sex, 2004 (- Jamaica)
1. Heart Disease2. Cancers3. Injuries and violence4. Stroke5. Diabetes6. HIV/AIDS7. Hypertension8. Influenza/pneumonia
1. Heart Disease2. Cancers3. Diabetes4. Stroke5. Hypertension6. HIV/AIDS7. Influenza/pneumonia8. Injuries and violence
MALES FEMALES
CARICOM
Crude Mortality Rates (per 100,000 population ) for Select Diseases: (2000-2004)CARICOM Member States
0
20
40
60
80
100
120
140
2000 2001 2002 2003 2004Year
Rat
es p
er 1
00,0
00 p
opul
atio
n
Heart Disease
Stroke
Diabetes
Injuries
Hypertensive Diseases
Cancers
HIV/AIDS
CARICOM
Adjusted Mortality Rates /100,000, Selected CARICOM countries vs. Canada 2003 - 2005
0
20
40
60
80
100
120
140
160
Trinidad & Tobago Guyana Suriname Bahamas Canada
DM IHD CVA
CARICOM
% Deaths Due to Selected Risk Factors
0
5
10
15
20
25
Hig
h B
P
Hig
h B
MI
(Obe
sity
)
Toba
cco
Alc
ohol
Hig
hC
hole
ster
ol
Phy
sica
lin
activ
ity
Low
frui
tan
d ve
g.in
take
Uns
afe
sex
Barbados Guyana Jamaica T&T
CARICOM
0
10
20
30
40
50
60
70 P
reva
len
ce (
%)
1970s 1980s 1990s 2000s
YEARS
Trends in Adult Overweight/Obesityin the Caribbean
Male
Female
CARICOM Potential Years of Life Lost <65years by main causes, 2000
& 2004, CARICOM countries (minus Jamaica)
0 10000 20000 30000 40000 50000 60000 70000
Chronic Disease
HIV/AIDS
Injuries
Y2004
Y2000
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
CARICOM
Economic Burden of Diabetes and Hypertension in Selected Caribbean Countries
(2001)
0
2
4
6
8
10
The Bahamas Barbados Jamaica TRT
Per
cen
tag
e o
f G
DP
(%
)
DIABETES HYPERTENSION BOTH
CARICOM Chronic Diseases and their CausesChronic Diseases and their Causes
CARICOM
NCD
4X4
Modifiable causative risk factors for NCDs
Tobacco use
Unhealthy diets
Physical inactivity
Harmful use of alcohol
Noncom
municable diseases
Heart disease and stroke Diabetes Cancer Chronic lung disease
CARICOM Caribbean’s leadership on NCDCaribbean’s leadership on NCD
• NCDs emerged as a priority– CCH ICCH I Nassau DeclarationNassau Declaration CCHD CCHD 1986 2001 2005 1986 2001 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 MandatesMandates• Global Strategy on
Diet Physical Activity and Health
• FCTC• WHA Res 58.22:
Cancer prevention and Control
• Port of Spain Port of Spain DeclarationDeclaration
• Strategic Plan of Strategic Plan of Action for the Action for the Prevention and Prevention and Control of NCDSControl of NCDS
• NCD Progress Indicator Matrix
CARICOM
POS NCD Summit Declaration (2007)POS NCD Summit Declaration (2007)
WHATWHAT TO DOTO 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 PrinciplesStrategic 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
Modifiable causative risk factors for NCDs
Tobacco use
Unhealthy diets
Physical inactivity
Harmful use of alcohol
Noncom
municable diseases
Heart disease and stroke Diabetes Cancer Chronic lung disease
CARICOM The Health Promotion LensThe Health Promotion LensHealthy Public Policy
Supportive Environments
Reorient Health Services
Empower Communities
Increase Personal Health Skills
Build alliances
CARICOM Diet and NutritionDiet 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 ActivityPhysical 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 mortalityRelation of fitness to mortalityT&T, St. James Cardiovascular StudyT&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 ControlTobacco 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)
Real price of cigarettes and consumption in South Africa, 1960-2003
Source: Van Welbeck 2003
0
200
400
600
800
100019
60
1964
1968
1972
1976
1980
1984
1988
1992
1996
2000
Rea
l p
rice
per
pac
k o
f 20
(
in c
on
stan
t 20
00 c
ents
)
0
500
1000
1500
2000
2500
Cig
aret
te c
on
sum
pti
on
(m
illi
on
s o
f p
acks
)
Real price of cigarettes Consumption of cigarettes
CARICOM Alcohol ControlAlcohol 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 InterventionsProposed CVD InterventionsSalt, tobacco, treatment =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 CommitmentCommitment
Establish national level Multi- Sectoral Bodies on NCDs
Develop, implement and monitor multi-sectoral NCD national Plans
Allocate resources for national NCD programmes
CARICOM Multi-sectoral InterventionsMulti-sectoral Interventions• 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 ResearchSurveillance 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 & PromotionEducation & 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 ManagementDisease 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 CONCLUSIONSCONCLUSIONS
• 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 StepsNext 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 Make the healthy choice the easy ChoiceChoice
CARICOM The Key to GUYANA’s Success . . .The Key to GUYANA’s Success . . .
CARICOM CARICOM: CARICOM: Health Sector Development, Human and Health Sector Development, Human and
Social Development DirectorateSocial Development Directorate
Dr. Rudolph CummingsProgramme [email protected]: 2220001-75 ext 2720 Ms. Renee Franklin Peroune
Senior [email protected]: 2220001-75 ext 2232
www.caricom.orghttps://www.facebook.com/cc.secretariat
CARICOM