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

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Hig

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MI

(Obe

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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 Managerrcummings@caricom.orgTel: 2220001-75 ext 2720 Ms. Renee Franklin Peroune

Senior ProjectOfficerrfranklinperoune@caricom.orgTel: 2220001-75 ext 2232

www.caricom.orghttps://www.facebook.com/cc.secretariat

CARICOM