healthy caribbean coalition global ncd epidemic and civil society responses

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Healthy Caribbean Coalition Global NCD epidemic and civil society responses

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Page 1: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Healthy Caribbean Coalition

Global NCD epidemic and civil society responses

Page 2: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 3: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Population 6,000,000,000

Total deaths per year 54,000,000 (0.9%)

Cardiovascular death 17,000,000 (31%)

44% coronary heart disease31% stroke78% in low income countries

AIDS 3,000,000Tuberculosis 1,000,000Malaria 1,000,000 (mostly in Africa)

Global causes of death

Page 4: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

from Murray & Lopez The Global Burden of Disease 1996

0 500 1000 1500

Established market economies

Former socialist economies

India

China

Other Asia

Sub-Saharan Africa

Middle Eastern Crescent

Latin America

Coronary heart disease

Cerebrovascular disease

Number x 103

Regional differences in cardiovascular disease in 1990

Page 5: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Global trends• Increasing and inexorable increase in the

global burden of the avoidable chronic diseases

• We are united by common challenges and solutions

• Collective solutions• International determinants of health and

disease• Previously unintended consequences of

development• No excuses now! Public health has grown

up – un-natural experiments.

Page 6: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Global developments and trends• WHO commission on the social

determinants of health (2009)

• The causes of the causes and inequalities

• Social determinants of health – economic, ,fiscal, market, commercial, environmental, social ,cultural and civic

• Lifestyles shaped by determinants

• Necessary but not sufficient conditions

Page 7: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Global developments and trends

• Unsustainable demands on health and social services

• Breakdown of the intergenerational contract

• Public health is about the influencing the control of the determinants

• HIE’s and the spread of chronic diseases to MLIE’s

• Absence from the MDG’s

Page 8: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Global developments and trends • Tobacco, food and alcohol culture and

economy

• Consumption industries

• Globalisation

• Power of the vested industries

• The games they play

• Health creating culture an economy

• Light touch self regulatory world

• Regulatory challenges

Page 9: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Global developments and trends • CNCD”S have been neglected especially

ion low and middle income economies and by development organisations and Governments

• Global economic and social polices are driving the chronic disease pandemic

• Political failure not a technical failure-low cost effective solutions available

• Political opportunities for progress are available

Page 10: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Global developments and trends

• Political opportunities for progress are available –ECOSOC, UN high level summit

• WHO NCD strategy• WHO recommendations on the marketing of

foods And non alcoholic beverages to children

• WHO salt• FCTC• WHO commission - social determinants

Page 11: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Summary:

The evidence matters•Importance of social justice.•Empowerment at the heart

•Material – income•Psychosocial – control•Political- having voice

•Evidence•Social determinants.•Social gradient.

•Action•Improve daily life•Tackle distribution power, money and resources.•Understand problem

Page 12: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Population level determinants of lifestyles• Social

• Environmental

• Economic

• Cultural

• Commercial and market

• Global/EU

• Civic

• POLITICAL

Page 13: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The Public Health Challenges

• Commercial determinants of health

• Changes in (over) consumption largely driven by unfettered marketing

• Dietary and market transitions – UK phenomena last 25 years. Changing faster elsewhere in the world - accelerated by globalisation and growth in neo liberal market economies

• Market and regulatory failures

• Public health failures

Page 14: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The Public Health Challenges

• Challenging the domination of self regulation – a mostly flawed concept

• Challenging the soft paternalistic responses which widen health inequalities

• Protecting children and young peoples health

• No longer unintended consequences – collateral damage

• Policy convergence – joining forces e.g. the Lisbon agenda - sustainable equitable economic development

Page 15: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Main prevention trends over 1980’s onwards

• Integration of chronic disease prevention policy and action –ACD’s

• Lifestyle - Primary risk factors

• New population level risk factors - obesity

• Changing intergenerational risks

• Ecological approach – tackling the social, economic and environmental determinants

• Inter-sectoral

Page 16: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What levers are available and who is the honest broker?

Page 17: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Get ahead of the curve and do not repeat mistakes made elsewhere and learn fast via a connected of global civil society community

Page 18: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The role of civil society in promoting the publics’ health• Sustainable social change

• Trusted

• Independent

• Non ideological

• Advocacy – voice amplified by powerful alliances

• Voice of the less well reached

• Keeping public health a public good

• Population health measures

Page 19: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The role of civil society in promoting the publics’ health

• Countervailing force for the excesses of industry and unhelpful and unproven ideologies

• Champion of the public interest

Page 20: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

TOBACCO CONTROL

Page 21: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The UK food culture and economy

Page 22: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

FOOD AND PHYSICAL ACTIVITY LINKS

Page 23: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

THE FUTURE

Page 24: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

After a two-year tour of the United States, Michelangelo's David is returning to Italy...

His tour sponsors were:

Page 25: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Why a project on obesity?1994-96 1997-99 2000-02

Source: IOTF

Male

Female

Data shown for England and Scotland

Page 26: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Foresight

Tackling Obesities: Future Choices

Page 27: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Project key messagesMost adults in the UK are already overweight.

Modern living insures every generation is heavier than the last – “Passive Obesity”.

By 2050 60% of men and 50% of women could be clinically obese. Without action, obesity related diseases will cost an extra £49.9 Billion per year

The obesity epidemic cannot be prevented by individual action alone and demands a societal approach.

Tackling obesity requires far greater change than anything tried so far, and at multiple levels; personal, family, community and population.

Preventing obesity is a societal challenge, similar to climate change. It requires partnership between government, science, business, and civil society.

Page 28: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Humans are

endowed with an

ANCIENT

PHYSIOLOGY

moulded by

famine ...

… especially when we do so little!

.... and ill equipped to

handle our modern food

environment ….

Page 29: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 30: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Parallel to Climate Change• Complex problem

• Challenge for whole of society

• There is a danger that the moment to act radically and coherently will be missed

• A market failure

Page 31: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Synergies with other policy areas

Page 32: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Healthy Weight, Healthy Lives

Page 33: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Architecture and characteristics

Cross government

Multi-sectoral

Environmental determinants

Population and individual

Whole systems impact

Multiple interventions

Natural experiments

Lifecourse

Page 34: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The big Five – the foods that most concern us

Snacks

Fast foods

Confectionery

Sweetened cereals

Soft drinks

Energy-dense and salt rich foods: contribute high proportion of calories to the dietencourage passive over-consumptionoften displace other healthier foods.

Page 35: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The recommended diet vs the advertised diet

Around three-quarters of food advertising to children is for sugary, fatty and salty foods. For every £1 spent by the WHO promoting healthy diets, £500 is spent by the food industry promoting unhealthy foods

Page 36: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 37: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 38: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The processed food culture and economy

Page 39: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 40: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Cadbury’s – chocolate for sport?

1 netball = 20,000 kcal

1 volleyball = 72,000 kcal

2 net posts = 1,200,000 kcal

Page 41: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

How popular Pepsi is!

Page 42: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Marketing to children

Page 43: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Give them your phone numberDownload their ring-tones

Page 44: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Marketing methods candy counting books

Page 45: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Equip the team...with McDonalds

Page 46: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Nutritional food labelling

Colour coded front-of-pack labelsQuick and easy for all social groupsEnables shoppers to accurately assess and compare products One universal scheme on all brands in all shopsPressure / praise for retailers and companiesFrame the arguments for EU regulation?

Page 47: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Outcomes• Product reformulation• Nutrient profiling established• Industry wide adoption of front of pack

nutrient signpost labelling• Industry behaviour publicly exposed• Opposition to industry’s flawed labelling

schemes to force a proper debate at EU level and set the scene for the review of the EU labelling directive

Page 48: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

GDA report – February 2007

Page 49: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 50: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 51: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Real change in behaviour

Sales of Sainsbury’s Ham and Pineapple thin and crispy pizza 335g down by 55% (One red, two amber and two green - WoH)

Sales of Sainsbury’s Ham and Pineapple Pizzeria 356g up 42% (All green - WoH)

Page 52: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NICE - IPTFA’s –policy goal

Ensure all groups in the population are protected from the harmful effects of IPTFA’s

Page 53: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

IPTFA’s - Natural experiments• Voluntary action

• Mandatory action – content and labelling

• Content – Denmark (at source) and New York

• Labelling – Canada, USA and PAHO (plus tax incentives)

• Labelling promotes product reformulation and substitution

• Marks and Spencer

Page 54: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Effect on bad LDL cholesterol

Effect on good HDL cholesterol

Saturated fat Raise ~

Trans fat Raise ~

Plant sterols and stanols

Lower Raise

Polyunsaturated fat Lower Raise

Oily fish and omega 3 oils

Lower Raise

Mono unsaturated fat Raise Raise

Effect of different fats on cholesterol

Bad

fa

t

Good

fat

Page 55: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Evidence summary:Country Time period Intervention Outcome

Finland 1972 – 1995 Mixed, incl.Low fat dairyAgriculture

Tot chol ↓ 17%

Norway 1975 - 1993 Mixed, incl.SubsidiesHealthy food

Tot chol ↓ 10%

Mauritius 1987 – 1992 Cooking oil switch

Tot. chol ↓ 0.82mmol/L

Poland 1990 - 1999 Veg. cooking oils & spreads

CHD ↓ 26%

Page 56: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Civil Society contributions• Advocacy - provide leadership where absent

from Government or accelerate the achievement of National goals

• Monitoring – self regulation codes

• Canvass public opinion

• Champion the public interest

• Counter industry distortions in partnership forum

• Essential democratic element –proxy citizen/ consumer group

• Policy research and development

Page 57: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Article in The Grocer – 17 March

Page 58: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The Healthy Food Code: what it brings

In home and

out of home

Addresses supply and

demand

All food – diet, meals,

snacks, caterers …

Healthier food

choices

The health and food

‘ask’ in one place

Action for all and

industry leaders

Page 59: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 60: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What is a health-creating economy?

• An economy that minimises the risks of avoidable chronic diseases that arise from the business practices of companies, and by government/EU policies that govern or influence their behaviours

• Focus on food, tobacco, alcohol & transport

Page 61: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Supply and demand policy levers

Page 62: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

SOME KEY UPSTREAM POLICY LEAVERS THAT SHAPE THE CULTURE AND MARKET

FOOD MARKETING

FOOD LABELLING

FOOD REFORMULATION

NUTRIENT PROFILING

SCHOOL FOOD

COMMON AGRICULTURAL POLICY

PUBLIC FOOD PROCUREMENT

SOCIAL MARKETING

Page 63: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What other policy leavers?Taxes and subsidies

Socially responsible investment

Independent monitoring particularly of industry based self regulation

HIA fully integrated in RIA’s and wider economic appraisal

Statutory regulation of marketing

Product standards

Page 64: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Agricultural policy

Page 65: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NICE - Common Agricultural Policy

• 2013 reforms

• Public health enshrined in EU law as a public good

• CAP spending – health comprehensively factored into impact assessments

• Shift from pillar one to pillar two mechanisms –nutritious foods such as fruit and vegetables whole grains and lean meats

Page 66: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

PUSH… and PULL…

Taxes and levies

Statutory regulation

Monitoring corporate practices

Engaging NGOs ↔

Incentives & subsidies

Voluntary controls

Socially Responsible Investment (SRI)

Engaging NGOs

Page 67: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Adam Smith The wealth of nations 1776

Sugar, rum and tobacco are commodities which are nowhere necessities of life, which are become objects of almost universal consumption and which are extremely proper subjects of taxation.

Page 68: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

2000s: solid evidence

“The scientific evidence is compelling. Physical activity not only contributes to well-being, but is also essential for good health.”

Professor Sir Liam DonaldsonChief Medical Officer,Department of Health

Page 69: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 70: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 71: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 72: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 73: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 74: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 75: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 76: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 77: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Transport and health

Page 78: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Take action on active travel asks

100 plus organisations

Ambitious targets for walking and cycling

10% transport budget – create safe attractive conditions

Make 20 mph or lower the norm for residential streets

Health check all transport an dland use decisions

Tackle bad driving

Page 79: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 80: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Reports

Page 81: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

A life-course approach eg. changing the nutritional balance of the diet

Rigorous food procurement/provision standards in public institutions

0-6 months 

Breast feeding

6-24 months

Improved weaning advice

0-4 years 4-16 years 16-65 years 60+   

Nutritional standards for pre-schools

Transformation of school food

Guidelines for workplace canteens

Nutritional standards for elderly care

Page 82: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The hazards associated with upstream measures

Page 83: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Dogma dilemma's• “What evidence and who care’s”

• Informing not lobbying –language political discourse

• David and Goliath

• Nanny state

• Children

• Public and professional support

• Precautionary principle

• Human rights

Page 84: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Dogma dilemma's

• Cost savings

• ST benefits

• Co-benefits

• Comprehensively understand markets and different forms of regulation-do not be out smarted

• Nuffield ladder of interventions

Page 85: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Covert consumption industry goals and behaviour

Grow the market, increase profits and shareholder value

Slow down regulatory reforms

Seek Government: Industry partnerships and seek to exclude civil society groups

Capture civil society organisations-set up BINGO’s

Sponsor government relations work

Page 86: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Industry strategy continued:

Maintain existing markets and grow new ones

Work in self regulatory cartelsObsfucation of issues - produce industry

bias researchDiscredit PINGO’sCreate counter marketing on nanny state

issuesCSR –commercial propaganda

Page 87: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Industry strategy continued:

Threaten to move industry base

EU and Global levels – protect unfettered commercial rights as absolutes and maximise the supremacy of these freedoms

Page 88: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Government and civil society responsesOnly establish tripartite partnerships

Combine HIA with RIA and wider economic appraisals

Adopt “polluter must pay” principle

Commission independent comprehensive monitoring

Secure independent industry technical expertise

Support international governance solutions

Page 89: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Continued

In short term - secure enabling international legislation

Utilise human and civil rights legislation

Establish highly responsive broadly based consumer and health advocacy alliances

Greater utilisation of civil society advocacy as part of the social marketing mix

Page 90: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Concluding remarks

• CNCD’S trends unsustainable

• We have the public health know how

• Industry and ideological interests

• Determinants of ACD’s and inequalities

• Transformational role of civil society

Page 91: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

The National Heart Forum

• Membership- 70 national organisations

• Chronic disease charities, professional, consumer and social policy organisations

• Policy development, advocacy and information

• Predominant focus on upstream national and international level policy and action

• Ecological, determinants based, social justice and health promoting approach

Page 92: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NHF functions

AnInternational/

National Centre of Excellence

Policy Research

Information Services

Consultation/Representation

Policy Development

Members Forum

Co-ordination/Collaboration

Diagram one

Page 93: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NHF scope of work

Primary prevention of

Avoidable Chronic Diseases

Cancer

Stroke

DiabetesObesity

CHD

Hypertensive diseases

Disease and Health Inequalities

Health andWellbeing

Diagram two

Page 94: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NHF strategic partnerships

NHF Members and

Partnerships

ConsumerOrganisations

Government

Chronic DiseaseCharities

Academia/Research

Social PolicyOrganisations

InternationalGovernmental Organisations

andNGOs

ProfessionalOrganisations

Diagram three

Page 95: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NHF Values and Principles

• Expert and evidence based

• All work underpinned by pursuit of equity and social justice

• Promoting early intervention and throughout the life course

• Tackling the root causes

• Maximizing social, economic, environmental co –benefits wherever possible

Page 96: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

NHF Values and Principles

• Remain independent of commercial and party political interests

• Act in the public interest and with the publics’ support

• Scale and seriousness of the epidemic means focus on high impact interventions

Page 97: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 98: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful ?• Integrity

• Independent of vested and ideological interests

• Dialogue not partnership that sells the soul

• Shared values and goals

• PINGO’s and BINGO’s

• Connected – nexus - real time information

• Become a player- “plugged in” where it maters- act on the inside and the outside

Page 99: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?• Movers and shakers-public health hero’s -

calculated risks

• Non compromised charities, professional, consumer, social policy and academic groups

• Powerful individual members and patrons

• Common issues

• A social movement

• Strategic –smart and tactical

• Focus and clarity about goals

Page 100: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?• Advocacy – clarity – always be the voice of

reason and reasonableness – acting in the public interest –advocacy bullets

• Public opinion• Play to strengths of different advocacy

styles across membership• Media links –salience• Ability to respond quickly• Handling controversy• Forum - hot topics – common positions

Page 101: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?• Respect differences and have caveats to

not necessarily represent everyone• Handling controversy –rapid responses• Human rights and freedoms• Policy acumen• Upstream high impact work downstream

support• Don’t delude your self – do things that

matter-do not get sucked downstream instead remove the sewage

Page 102: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?• Marshalling and promulgating evidence

and expertise

• Argue cost effectiveness and cost savings

• Rock solid ethics

• Leadership and co-ordination- clear priorities

• Cross sector and cross government

• Productive and respectful links to senior civil servants

Page 103: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?

• Mandates for change- social marketing mix - professional and political mandates

• Good governance: Wise governance –keep organisations and people linked

• Good organisation

• Work together- play each other in - trust-solidarity

• Legal protections- cover your back

• Quality

Page 104: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?• Representation

• Consultations- voice

• Transparency and openness

• Membership surveys - sensitive close working links

• Democratic working

• Collective bids

• Gossip, intelligence and ideas

Page 105: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

What probably makes a civil society network successful?• Power of a public interest alliance

• Energy, enthusiasm and passion

• Develop political acumen – nanny state arguments, children, ST benefits, cost savings, co-benefits

• Cross party political support for issues

• The hallmark/touchstone of an effective functioning democracy

Page 106: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 107: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Political literacy – new lexicons?

• Lifestyle necessary but not sufficient

• Behavioural determinants-population level interventions

• Nudge theory – supply and demand side incentives – default choices

• Choice architecture

• Nuffield ladder of interventions

• Upstream diversions

Page 108: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

“Walk before you can run but always stand up high”

Page 109: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

To subscribe e-mail Nicola Schmidt at [email protected]

Page 110: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 111: Healthy Caribbean Coalition Global NCD epidemic and civil society responses
Page 112: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

Beyond smoking kills

Page 113: Healthy Caribbean Coalition Global NCD epidemic and civil society responses

TobaccoNew strategy focus children and inequalities

– beyond Smoking Kills

Tobacco free society

Ban smoking in all public places -5 years

Total ban -10 years

Reintroduce above –inflation price escalator for tobacco products

Abolish prescription charges- NRT

Tough new targets for tobacco smuggling