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THE POS DECLARATION
HEALTHY CARIBBEAN 2012
Dr. Fitzroy J. HenryCARIBBEAN FOOD AND NUTRITION INSTITUTE
(PAHO/WHO)
RALLYING FOR ACTION ON NCD
Kingston, JamaicaMay 28-29, 2012
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OUTLINE OF PRESENTATION
• POS - PROGRESS
• POS - CHALLENGES
• POS - ROLE OF CIVIL SOCIETY
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POS Progress Indicator Status by theme
1. Commitment2. Tobacco3. Nutrition4. Physical Activity5. Education/Promotion6. Surveillance7. Treatment
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NCD Plan NCD Summit National NCD Commissions
NCD Commuica-tions Plan
NCD Budget0
10
20
30
40
50
60
70
80
90NCD Status -Commitment
In process/partial
In place
NCD Progress Indicator
Perc
enta
ge (%
)
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FCTC ratified Smoke free public places
Bans on advert-ising & promo-
tion
Tobacco taxes0
10
20
30
40
50
60
70
80
90
100
NCD Status - Tobacco
In process/partialIn place
NCD Progress Indicator
Perc
enta
ge (%
)
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Food & Nutrition
Plan
Policy & standards
Labeling Trade agreements
Trans fat free food
supply
0
10
20
30
40
50
60
70
80NCD Status - Nutrition
In process/partial
In place
NCD Progress Indicator
Perc
enta
ge (%
)
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Mass PA in public spaces
Mandatory PA in schools
Mandatory PA in housing
0
10
20
30
40
50
60
70
80
90
NCD Status - Physical Activity (PA)
In process/partialIn place
NCD Progress Indicator
Perc
enta
ge (%
)
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CWD celebrations ≥ 30 days media broadcast
≥ 50% public and private institutions
with PA and healthy eating programmes
0
10
20
30
40
50
60
70
80
90
100NCD Status - Education/Promotion
In process/partialIn place
NCD Progress Indicator
Perc
enta
ge (%
)
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Global School Health Survey
Global Youth Tobacco Survey
Surveillance: STEPS
Minimum Data Set reporting
0
10
20
30
40
50
60
70
80
90
100NCD Status - Surveillance
In process/partialIn place
NCD Progress Indicator
Perc
enta
ge (%
)
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QOC CVD/ Diab
etics demonstr
ation pro
ject
Chronic
Care M
odel/NCD tr
eatment p
roto
cols
0
20
40
60
80
NCD Status - Treatment
In progress/partialIn place
NCD Progress Indicator
Perc
enta
ge (%
)
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GUYBAR
TRTJAM BER
GRECAY
DOM STLSUR BEL
BVISKN
BAHANT
MONSVG
ANG TCIHAI
0
10
20
30
40
50
60
70
80
90
100
NCD Progress Indicator Status by country
In process/partial
In place
Country
Perc
enta
ge (%
)
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SUMMARY OF PROGRESS • Barbados, number one country to fully
implement many of the plans (76%)• Other countries with high
implementation include Jamaica, Guyana and Trinidad and Tobago
• The least complying countries to the recommendations are Haiti, Anguilla and Turks & Caicos
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POS Declaration:
essential
but
not sufficient
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POS – NCD CHALLENGES
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Highest Female (15yr+) Overwt/Obesity in the world (WHO 2011)
Rank Country %
1 Nauru 82
2 Tonga 81
3 Micronesia
79
4 Cook Is. 73
5 Samoa 72
6 Niue 70
7 Kuwait 67
Rank Country %
8 Barbados 63
9 Palau 62
10 Trinidad 61
11 Dominica 60
12 Egypt 59
13 USA 55
14 Jamaica 53
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Main Causes of Death in the Caribbean
1980 (%)1. Heart Disease - 202. Cancer - 123. Stroke - 114. Injuries - 85. Hypertension - 66. ARI - 57. Diabetes - 4
Obesity Related = 53%
2000 (%)1. Heart Disease - 162. Cancer - 153. Stroke - 104. Diabetes - 105. Injuries - 76. HIV/AIDS- 67. Hypertension - 6
Obesity Related = 57%
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0
20
40
60
80
(%
)
1970s 1980s 1990s 2000s
Male
Female
ADULT OVERWEIGHT/OBESITY TRENDS IN THE CARIBBEAN
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Mortality from Coronary Heart Disease in Norway
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POLICY GOALS - Norway
• Decrease fat from 40% to 35% through gradual alteration
• Decrease supply of fats replaced by foods containing starch, cereals and potatoes
• Limit the proportion of sugar in the energy supply
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POLICY MEASURES TO ACHIEVE GOALS
(Norwegian Ministry of Agriculture, 1975)• Setting consumer and producer
price and income subsidies jointly in nutritionally justifiable ways
• Ensuring low prices for food grain, skimmed and low-fat milk, vegetables and potatoes
• Avoidance of low prices for sugar, butter & margarine
• Regulating food processing, labelling and marketing to promote provision and sale of healthy foods
• Public and professional education and information
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Nutrients at Dietary Wholesale Level (Per Person Per Day)
1970 1975 1980 1985 1990 1993
Energy (kcal) Protein (g) Fat (g) Carbohydrate (total)
2860 85 126 352
2900 86 129 345
3170 94 135 390
3020 94 122 378
2910 94 111 377
2980 96 112 392
Starch (g) Sugar (g) Dietary fiber (g)
185 115 -
174 91 21
185 120 23
174 118 24
177 118 22
185 122 23
Percentage Distribution of Energy: Protein Fat Carbohydrate
12 39 49
12 40 48
12 38 50
13 35 51
13 35 52
13 34 53
Source: Norwegian Nutrition Council (1995)
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Food Consumption at Wholesale Level (Kg Per Person Per year)
1970 1975 1980 1985 1990 1995 Cereals Potatoes, unrefined Potatoes, refined Vegetables
71 79 7 40
75 71 8 37
80 60 12 51
75 63 17 47
79 51 19 55
81 48 23 58
Fruits Meat Eggs Fish, approximate
67 43 10 30
74 52 10 35
75 55 11
-
85 54 13 -
72 54 11 40
81 59 11 40
Whole Milk (3.8%) Low Fat Milk (1.5%) Skimmed Milk (1.5%) Cheese
172 - 14 9
169 - 28 12
164 - 28 12
124 28 30 13
56 84 31 13
50 85 29 14
Butter Margarine, total Low Fat Margarine Oil & Other Fats
5.4 19 - 4.4
4.7 18 - 4.2
5.6 16 - 4.7
4.8 14 0.2 4.1
3.3 13 2.4 4.0
3.1 14 2.7 3.9
Source: Norwegian Nutrition Council (1995)
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Mortality from Coronary Heart Disease in Norway
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Energy Consumption/Person - Jamaica
1600
1800
2000
2200
2400
2600
2800
3000
1961-63 1971-73 1981-83 1991-93 2001-03 2005-07
Ca
lori
es
/ca
pu
t/d
ay
Goal
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Sugar Consumption/Person - Jamaica
0
100
200
300
400
500
600
1961-63 1971-73 1981-83 1991-93 2001-2003 2005-2007
Cal
ori
es/c
apu
t/d
ay
Imported
Local
Goal
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Consumption of Fats & Oils/Person - Jamaica
0
50
100
150
200
250
300
350
400
450
500
1961-63 1971-73 1981-83 1991-93 2001-2003 2005-2007
Cal
ori
es/c
apu
t/d
ay
Imported
Local
Goal
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POS – NCD CHALLENGES
1. REFINED STRATEGY
2.COST OF INTERVENTION
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Direct Cost of Diabetes & HypertensionCaribbean Countries Total Cost (DM & HTA) (US$ M) Total Cost (DM & HTA) (% PHEx)
Guyana 74.5 211.3
Jamaica 289.0 175.3
Suriname 42.3 122.2
St Vincent & Grenadines 12.2 83.0
Dominica 8.0 69.3
St Lucia 17.0 66.1
St Kitts & Nevis 4.9 47.9
Belize 19.6 47.8
Trinidad & Tobago 131.6 41.0
Barbados 38.1 31.6
Anguilla 1.6 30.5
Montserrat 1.1 27.2
Antigua/Barbuda 7.7 25.7
Grenada 6.0 25.5
BVI 2.6 18.4
Bahamas 34.8 17.6
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GIVEN THE CHALLENGES
PRIORITIZE THE APPROACH:-
1. MORE EMPHASIS - To target Obesity/NCDs thru strategies on Food Availability, Accessibility & Consumption
2. Focus on Public Policies – Regulation, Standards and (dis) incentives
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POS – NCD CONTROL
ROLE OF KEY ACTORS
1. INTERNATIONAL
2. NATIONAL
3. PRIVATE SECTOR
4. CIVIL SOCIETY
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Who would make it?
TRANS FATS – CIVIL SOCIETY ACTION USA TODAY
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INT’L NAT’L PRIVSEC
CIVIL SOC
Review taxation to enable access to healthier foods & recreation
XXX X
Importation restrictions, subsidies and taxes
X XXX
Regulate the amount of trans fat, sat fat salt and sugar content of foods
XXX XX X
Nutrient content disclosure; misleading ADs; restrictions on marketing practices in schools; promote marketing health foods.
X XXX XX
Density of fast food outlets; labeling and claims
XX XX XX
KEY ACTIONS TO COMBAT NCDsOBESITY PREVENTION - WHO SHOULD DO WHAT?
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INT’L NAT’L PRIVSEC
CIVIL SOC
Provide subsidies for rural and remote area transport of fresh foods.
XX X
Curb inappropriate advertising and promoting of nutrient poor foods
XX XX XXX
Reshape urban environment towards healthy options
XXX XX
Physical Education in schools XX XX XIncentives for using public transport; urban bicycle loan schemes
XXX X
Expand supply of relevant work force (nutritionists, etc.)
XXX
Develop effective media advertising and public education campaigns
XXX XXX
Enhance food labeling to healthier choices
X XX XX XXX
Embed PA and healthy eating in school, workplace and community
XX XXX
KEY ACTIONS TO COMBAT NCDsOBESITY PREVENTION - WHO SHOULD DO WHAT?
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INT’L NAT’L PRIVSEC
CIVIL SOC
Reshape consumer demand to low risk drinking – marketing etc
XX XXX x
Reshape supply to low-risk products - Taxation
X XXX x
Legislation on responsible serving of alcohol
XXX
KEY ACTIONS TO COMBAT NCDsALCOHOL - WHO SHOULD DO WHAT?
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INT’L NAT’L PRIVSEC
CIVIL SOC
Classify films RE: Smoking X XX XX XConsumer info - Larger and more warnings labeling etc.
X XXX XX
Increase frequency, reach and intensity of campaigns
X X XXX
Promote smoke-free policies in public places
X XXX XX
Ensure cigarettes become significantly more expensive
XX XX X
Regulate the supply of tobacco products and exposure to tobacco smoke
XXX
Ensure smokers are encouraged to quit when contacting health services.
XXX XX
KEY ACTIONS TO COMBAT NCDsTOBACCO - WHO SHOULD DO WHAT?
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SUMMARY• POS: PROGRESS - ACHIEVEMENTS
• POS: CHALLENGES - COST & APPROACH
• POS: KEY ROLE OF CIVIL SOCIETY
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THANK YOU