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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

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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

Caricom heads of government summit on chronic diseases

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

Distribution of deaths by major cause in the world

Distribution of Deaths by Major Cause in the World

Distribution of deaths from infectious and chronic disease by income category 2005

Distribution of Deaths from Infectious and Chronic Disease by Income Category, 2005

Caricom heads of government summit on chronic diseases

Source: CAREC, based on mortality reports from countries

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

Heart Disease


Injuries and violence






Heart Disease







Injuries and violence

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



Source: CAREC, based on country mortality reports

Caricom heads of government summit on chronic diseases

Disability Adjusted Life Years (000) 2002

Prevalence of diabetes among adults in the americas

Prevalence (%) of diabetes among adults in the Americas

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

A consequence of diabetes

A consequence of Diabetes

Amputations at the qeh 2002 2006

Amputations at the QEH 2002-2006

Source A. Hennis, 2007

Age adjusted death rates 100 000 population from diabetes 2000

Age adjusted death rates/100,000 population from Diabetes (2000)

Caricom heads of government summit on chronic diseases

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%


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

Age adjusted death rates 100 000 population from hypertension 2000

Age adjusted death rates/100,000 population from Hypertension (2000)

Projected national income lost from ncds 2005 2015

Projected national income lost from NCDs ( 2005-2015)


























Possible economic burden us million 2001

Possible economic burden($US Million, 2001)

Total cost of dm and h t as percent of gdp

Total cost of DM and H/T as percent of GDP

Exploding the myths

Exploding the Myths

  • 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 double disease burden

Percentage of deaths by cause

Low- and Middle-income countries

High-income countries

Exploding the myths1

Exploding the Myths

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

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

  • 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

  • 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?

  • 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

Finland dramatic declines in ncd mortality

Finland: Dramatic Declines in NCD Mortality

Relation of fitness to mortality t t st james cardiovascular study

Relation of fitness to mortalityT&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


Caribbean responses

Caribbean Responses

  • 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

Source: PAHO Survey of NCD National Response Capacity, 2005

Addressing the risk factors

Addressing the risk factors

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

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

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

In the case of cancer

  • Primary prevention

    Eg screening and vaccination to prevent

    cervical cancer

    Promote screening for breast cancer

Secondary prevention

Secondary prevention

  • 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

  • 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”

Caricom heads of government summit on chronic diseases

Involve Partners


  • 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

First: We can utilize the policy instruments at our disposal




Second: We should establish partnerships

Third: We must take personal responsibility and lead by example



  • 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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