CARICOM

Regional Policy Dialogues in the Caribbean on Chronic Non-

Communicable Diseases

Dr. Rudolph O. Cummings MPH,

Program Manager,

Health Sector Development,

Caricom Secretariat

Montreal, May 2008

CARICOM

Regional SituationMortality and Morbidity

CARICOM

Mortality Attributable to Select Risk Factors (Latin America & Caribbean), from DCP2

0 100 200 300 400 500

Unsafe sex

Physical inactivity

Low fruits & veg

High cholesterol

Tobacco

Alcohol

Obesity

High BP

Attributable Deaths (thousands)

CARICOM

% Deaths Due to Selected Risk Factors in4 Caribbean Countries (PAHO)

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

Unsafe sex

Alcohol

Physical inactivity

Low fruit and veg

Tobacco

High Cholesterol

High BMI (Obesity)

High BP

Barbados Guyana Jamaica T&T

CARICOM

Major Causes of Death in the Caribbean, 1980 and 2000 (PAHO / Alleyne)

0% 5% 10% 15% 20% 25%

ARI

Hypertension

HIV/AIDS

Injuries

Stroke

Diabetes

Cancer

Heart Disease

1980 2000

CARICOM

Age adjusted death rates/100,000 population - 2000 (PAHO / Alleyne)

0

50

100

150

Death

Rate

/100,0

00

Hypertension Isch. Heart Disease Diabetes

CARICOM

Potential Impact for BP and Cholesterol Control

• Barbados: (Hennis et al, 2002)>40 yrs, HBP prevalence = 55%Awareness = 63%Treatment = 54%Control = 19%

treatment of those with chronic disease with aspirinand simple drugs to lower blood  pressure and cholesterol (18 million deaths averted  at a cost of $1.10per year)

CARICOM

POS NCD Declaration Update Report

CARICOM

Achievements – Infrastructure – Secretariat, Plans, M&E (POS #1, 14)

• Regional– Summit implementation grant from Public Health Agency

Canada: $507,000. (Spend by August 08) – PAHO/OCPC/CARICOM Secretariat

• Meets every 2 weeks, CMO’s chair, D/CFNI, D/CAREC

• Workplan drafted • Sharepoint site under construction

CARICOM

Monitoring and Evaluation (POS#13,11)

• Strengthen CAREC's Behavioural surveillance capacity– PAN AM STEPS NCD risk factor surveys, National

NCD Capacity Survey, Global School Health Survey

• Training and execution• Data analysis and use to monitor POS

Declaration– Decentralization of WHO InfoBase to CAREC– Collaboration with UWI/CAREC on IDB funded

surveillance project

CARICOM

Monitoring and Evaluation (POS#13,14) cont’d

• Strengthen OCPC coordination capacity – Alafia Samuels on staff from April 1st 2008

• Case study preparation – draft completed– Monitoring and Evaluation

• Summit Evaluation Framework used to report - v2 now circulated

• Accepted by Heads in March 08• Process, Output, Indicators, Sources of Data• Web-based reporting on sharepoint site (in

process)

CARICOM

Strengthening Country Capacity (POS#2)

• NCD Policy capacity building workshop for 10 ECC countries and Barbados, October 2007

• CARMEN meeting in Bahamas Nov 4 – 8, 2007

CARICOM

National NCD Summits (POS # 2)

• Dominica’s PM Skerritt convened National NCD Summit in Dominica 14 Dec 2007

• Barbados already has an NCD Commission since January 2007

• Trinidad formulating a “Healthy Lifestyles” initiative• At Heads Inter-sessional March 08, 5 committed to

convene NCD Summit– Guyana, Bahamas, Belize, St Vincent and Grenadines

and St Kitts/Nevis

CARICOM

Tobacco (POS #3,4)

• Countries who still need to ratify– Bahamas– Haiti– St Kitts and Nevis– St. Vincent & Grenadines– Suriname

• Letter of Intent to Gates for 5-yr, US$6 million to support Tobacco control in Caribbean, incl. legal support for drafting legislation (POS #3, #4)

CARICOM

Status of CARICOM COUNTRIES

PARTYPARTY SIGNEDSIGNED Ratified/Ratified/Acceded/ Acceded/ etcetc

Entry into Entry into forceforce

Deadline Deadline Article 11Article 11

Trinidad & Trinidad & TobagoTobago

27 Aug 0327 Aug 03 10 Aug 0410 Aug 04 27 Feb 0527 Feb 05 27 Feb 0827 Feb 08

JamaicaJamaica 24 Sept 0324 Sept 03 7 Jul 057 Jul 05 5 Oct 055 Oct 05 5 Oct 085 Oct 08

GuyanaGuyana 15 Sept 0515 Sept 05 14 Dec 0514 Dec 05 14 Dec 0814 Dec 08

BarbadosBarbados 28 Jun 0428 Jun 04 3 Nov 053 Nov 05 1 Feb 061 Feb 06 1 Feb 091 Feb 09

St. LuciaSt. Lucia 29 Jun 0429 Jun 04 7 Nov 057 Nov 05 5 Feb 065 Feb 06 5 Feb 095 Feb 09

Antigua & Antigua & BarbudaBarbuda

28 Jun 0428 Jun 04 5 Jun 065 Jun 06 3 Sept 063 Sept 06 3 Sept 093 Sept 09

DominicaDominica 29 Jun 0429 Jun 04 24 Jun 0624 Jun 06 22 Oct 0622 Oct 06 22 Oct 0922 Oct 09

CARICOM

PARTYPARTY Entry into Entry into forceforce

Deadline Deadline Article 11Article 11

Deadline Deadline Article 13Article 13

GrenadaGrenada 29 Jun 29 Jun 0404

14 Aug 0714 Aug 07 14 Nov 0714 Nov 07 14 Nov 10 14 Nov 10 14 Nov 1214 Nov 12

St Kits NevisSt Kits Nevis 29 Jun 29 Jun 0404

St. Vincent & St. Vincent & the the GrenadinesGrenadines

14 June 14 June 0404

Will ratifyWill ratify

BahamasBahamas 29 Jun 29 Jun 0404

SurinameSuriname

BelizeBelize

HaitiHaiti

MontserratMontserrat

Status of CARICOM COUNTRIESStatus of CARICOM COUNTRIES

CARICOM

SUPORTING THE CROSQ PROCESS

• Jamaica BoS designated to draft new regulations for packaging and labeling

• Draft standard circulated to member states for review and submission of comments

• Comments received from some member states

• Urgent need to strengthen the standard to meet the FCTC obligations

• CARICOM request to PAHO WDC and OCPC to support the process.

CARICOM

Healthy Eating (POS # 6,7,8 9) Ministers of Agriculture of CARICOM, St. Ann Declaration,

9 October 2007 • Implementing Agriculture and Food Policies to prevent

Obesity and NCDs in CARICOM• Use Regional and WTO agreements to ensure food security• Support the CRNM to pursue fair trade policies • Policies that explicitly incorporate nutritional goals• Elimination of trans-fats from our food supply using CFNI as a

focal point • Labeling of foods to indicate their nutritional content; • Public education for increased consumption of fruits and

vegetables • Food Security Plan for prevention and control of NCDs

CARICOM

Active Living, Caribbean Wellness Day 20th Sept 2008 (POS #6,10, 12,15)

Policy dialogue on scaling up physical activity, with CDC

6- 7 May 2008 in POS –

– To explore options for sustained physical activity– To present options to private sector meeting May

8 - 9– To plan for CWD 2008– Countries now have draft national plans

CARICOM

Advantages of Risk Charts

• Simplified, clear message and Cue for lay and PHC workers

• Reorient perception : practitioners identify total risk• Composite risk score : Process for fast-forwarding

those at highest risk• Risk approach/charts will guide intensification of

management, and not reduce treatment goals. • Practical for professionals and to patient• Empowering of individuals with the information about

their risk, how to reduce risk by moving from top right to bottom left in their age and sex category

CARICOM

Next Steps• CMOs approval in Surinam April 21 for MOH

introduction• Considered 4 instead of 5 levels ( green, yellow,

orange, red)• Availability of variables in PHC in the Caribbean?

Cholesterol testing should be encouraged • Pilot testing, perhaps through IDB Surveillance of DM

QOC projects• CHRC to produce “pocket guidelines” summaries of

its existing Clinical Guidelines, and review the proposal to integrate with the Risk Charts to produce “Caribbean Cardiovascular Disease Guidelines”

CARICOM

Media and Communications• Media group established and working virtually• Draft plan developed and under discussion• Need to document Health Promotion and

NCD Prevention and Control activities and initiatives in countries.

• Activities around World Health Day documented for the first time along sustainable transportation

• Public and private sharepoint site to share info e.g. TOR from Barbados NCD Commission, program from Dominica NCD Summit

CARICOM Involvement of Private Sector, Media

(POS #12)• CAIC engaged: Private Sector meeting 8-9 May

2008, POS– Hear the business case for Private Sector

involvement in NCD prevention and control– Discuss options for interventions (CFNI proposals)– Design a Plan of Action and implementation

mechanisms with partners• Workplace Wellness incentive-based awards• Healthy food policies (America’s / CARICOM

Pledge)• Media and communications• Support for Caribbean Wellness Day-promote a

park and biking and walking days

CARICOM

Next steps

• First Caribbean Wellness Day – Sept 13

• Caribbean 10k in July in Antigua

• Heads will demonstrate by example of walk to start point

• NGO forum in October to be coordinated in Barbados for Health NGOs –Prof. Hassel

CARICOM

THANK YOU