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CARICOM Heads of Government Summit on Chronic Diseases. Presentation of Prime Minister Denzil Douglas. Overview of Presentation. Global situation with Chronic NCDs Caribbean situation and costs Caribbean Response Exploding common myths Review of effective interventions The Way Forward

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Caricom heads of government summit on chronic diseases

CARICOM Heads of Government Summit on Chronic Diseases

Presentation of Prime Minister Denzil Douglas


Overview of presentation
Overview of Presentation

  • Global situation with Chronic NCDs

  • Caribbean situation and costs

  • Caribbean Response

  • Exploding common myths

  • Review of effective interventions

  • The Way Forward

    • Addressing the risk factors

  • Globalisation and health


Globalisation and health the maladies of affluence
Globalisation and HealthTHE MALADIES OF AFFLUENCE

The Economist, August 11th 2007


The poor world is getting the rich world’s diseases

“Europeans have been exporting their maladies throughout history. They seem to be doing it again, but in a new way. In the past the problem was infection. Now illnesses associated with Western living standards are the fastest growing killers in poor and middle-income countries. Chronic disease has become the poor world’s greatest health problem”.

The Economist, August 11, 2007


Chronic diseases and their causes
Chronic Diseases and their Causes

Chronic Diseases

Heart Disease, Stroke, Cancer, Diabetes, Chronic Respiratory Disease

Biological Risk Factors

Modifiable: overweight, high cholesterol, high blood sugar, high blood pressure

Non-modifiable: Age, Sex, and Genetics

Behavioral Risk Factors

Tobacco use, physical inactivity, unhealthy diet, alcohol abuse

Social and Environmental Determinants

Social, economic and political conditions such as income, living and working conditions, physical infrastructure, environment, education, agriculture, and access to health services

Global Influences

Globalization of food supply, urbanization, technology, migration





Leading causes of death in caricom countries by sex 2004 minus jamaica

Heart Disease by Income Category, 2005

Cancers

Injuries and violence

Stroke

Diabetes

HIV/AIDS

Hypertension

Influenza/pneumonia

Heart Disease

Cancers

Diabetes

Stroke

Hypertension

HIV/AIDS

Influenza/pneumonia

Injuries and violence

Leading Causes of Death in CARICOM Countries by Sex, 2004 (MINUS Jamaica)

FEMALES

MALES

Source: CAREC, based on country mortality reports



Prevalence of diabetes among adults in the americas
Prevalence (%) of diabetes among adults in the Americas by Income Category, 2005

Source: Pan Am J Public Health 10(5), 2001; unpublished (CAMDI), Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care)


Caribbean trends in diabetes mortality
Caribbean trends in Diabetes mortality by Income Category, 2005


A consequence of diabetes
A consequence of Diabetes by Income Category, 2005


Amputations at the qeh 2002 2006
Amputations at the QEH 2002-2006 by Income Category, 2005

Source A. Hennis, 2007



From community surveys, the prevalence of hypertension in adults 25-64 years of age was:

Barbados 27.2 %

Jamaica 24.0 %

St. Lucia 25.9 %

The Bahamas 37.5%

Belize 37.3%

Trinidad TBD

Control of blood pressure would reduce the death rates from Cardiovascular Disease by about 15-20%.



Projected national income lost from ncds 2005 2015
Projected national income lost from NCDs ( 2005-2015) Hypertension (2000)

Projected

National

Income

Lost

from

NCDs

2005

-2015,

$USBN

600

500

400

300

200

100

0

Bra

Can

Chi

Ind

Nig

Pak

Rus

UK

Tan


Possible economic burden us million 2001
Possible economic burden Hypertension (2000)($US Million, 2001)



Exploding the myths
Exploding the Myths Hypertension (2000)

  • Myth:Chronic diseases are a problem of the rich countries

    Fact:Non-communicable disease account for more than half the burden of disease and 80% of the deaths in the poorer countries which carry a double burden of disease.


Developing countries carry a double disease burden
Developing countries carry a Hypertension (2000)double disease burden

Percentage of deaths by cause

Low- and Middle-income countries

High-income countries


Exploding the myths1
Exploding the Myths Hypertension (2000)

Myth:NCDs are a problem only of the elderly

Fact:Half of these diseases occur in adults less than 70 years of age and the problems often begin in the young e.g., obesity

Myth:NCDs affect men more than women

Fact:NCDs affect women and men almost equally and globally, heart disease is the largest cause of death in women.


Exploding the myths2
Exploding the Myths Hypertension (2000)

Myth:NCDs cannot be prevented

Fact:If the known risk factors are controlled, at least 80% of heart disease, stroke and diabetes and 40 % of cancers are preventable, and in addition there are cost-effective interventions available for control.


Exploding the myths3
Exploding the Myths Hypertension (2000)

  • Myth: people with NCDs are at fault and to be blamed because of their unhealthy lifestyles

  • Fact: individual responsibility, while important, only has full effect where people have equal access to healthy choices. Governments have a crucial role to play by altering the social environment to help make the healthy choice the easy choice.


Exploding the myths4
Exploding the myths Hypertension (2000)

  • Myth: “my grandfather smoked and lived to 90 years”, and “everyone has to die of something”

  • Fact: While some people who smoke will live a normal lifespan, the majority will have shorter, poorer quality lives. And yes, everyone has to die, but death does not need to be slow, painful or premature, as is so often the case with NCDs


What works
What works? Hypertension (2000)

  • A small shift in average population levels of several risk factors can lead to a large reduction in chronic diseases

  • Population wide approaches form the central strategy for preventing and controlling chronic disease epidemics, but should be combined with interventions for individuals

  • Many interventions are not only effective, but suitable for resource constrained settings



Relation of fitness to mortality t t st james cardiovascular study
Relation of fitness to mortality Hypertension (2000)T&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


Caribbean responses
Caribbean Responses Hypertension (2000)

  • Since the 1960s, history of collective action in health, formalized in 1986 as the Caribbean Cooperation in Health (CCH) initiative.

  • Countries, CAREC, CFNI and CHRC, CARICOM secretariat, PAHO/WHO and partners have had successes e.g.,, malnutrition and gastroenteritis, vaccine preventable diseases, HIV/AIDS (p (PANCAP).

  • CCH now entering 3rd phase: major thesis that Caribbean health can be improved through actions taken universally and collectively.

  • Current priorities for action under CCH include chronic diseases where the cited goals are to reduce deaths by 2% per year and to reduce serious, costly complications such as amputations or renal failure.


Caribbean responses summarised
Caribbean Responses Summarised Hypertension (2000)

Source: PAHO Survey of NCD National Response Capacity, 2005


Addressing the risk factors
Addressing the risk factors Hypertension (2000)

Tobacco and alcohol

  • Increase taxes with proceeds to prevention and treatment

  • Ban smoking in public places

  • Ban smoking in all schools

  • Ban cigarette and tobacco advertising near to schools

  • Curtail promotion of alcohol products targeted to women and children

  • Establish target dates for passage of the legal provisions in the FCTC already ratified.


Addressing the risk factors1
Addressing the risk factors Hypertension (2000)

Physical activity

  • Have physical education compulsory in schools and provide the facilities

  • Provide healthy, secure exercise spaces

  • Provide wellness centers

  • Give tax relief for worksite exercise facilities


Addressing the risk factors2
Addressing the risk factors Hypertension (2000)

Improve dietary practices

  • Promote a standard of meals in public eating places eg. eliminating trans fats

  • Provide healthy school meals

  • Establish community based networks for training in preparation of health foods

  • Mandate RNM to investigate the trade issues which impact negatively on healthy food imports

  • Promote elimination of trans fats from Caribbean diets


Addressing the risk factors3
Addressing the risk factors Hypertension (2000)

In the case of cancer

  • Primary prevention

    Eg screening and vaccination to prevent

    cervical cancer

    Promote screening for breast cancer


Secondary prevention
Secondary prevention Hypertension (2000)

  • Screening programs for NCDs

  • Provide health services with resources to apply the established cost-effective interventions

  • Establish mechanisms to ensure availability of the medications necessary for the long term treatment of NCDs when they occur


Critical other recommendations
Critical other recommendations Hypertension (2000)

  • Establish national level Commissions on NCDs

  • Mandate CAREC to establish a system of behavior and risk factor surveillance

  • Insist on the updating of the Caribbean Regional Plan of Action for NCDs

  • The Caribbean should name a “CARIBBEAN WELLNESS DAY”


Involve Partners Hypertension (2000)

  • PAHO/WHO

  • Financial institutions

  • Caribbean social partners – private sector and civil society

    Monitoring and evaluation

  • Designate CARICOM/PAHO as the joint Secretariat with responsibility for monitoring and reporting progress in the control of the NCDs.


The way forward
The way forward Hypertension (2000)

First: We can utilize the policy instruments at our disposal

legislation

taxation

regulation

Second: We should establish partnerships

Third: We must take personal responsibility and lead by example


Conclusions
CONCLUSIONS Hypertension (2000)

  • 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


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