Addressing NCDs in the Region: The Role of CARICOM

1. CARICOM Addressing NCDs in the Region:The Role of CARICOM Rudolph Cummings MD, MPH; Program Manager, Health Sector Development, CARICOM 17th February, 2013, Guyana

2. Leading Causes of Death in CARICOM Countries by Sex, 2004 (- Jamaica) FEMALES MALES • Heart Disease • Cancers • Diabetes • Stroke • Hypertension • HIV/AIDS • Influenza/pneumonia • Injuries and violence • Heart Disease • Cancers • Injuries and violence • Stroke • Diabetes • HIV/AIDS • Hypertension • Influenza/pneumonia

7. Injuries Y2004 HIV/AIDS Y2000 Chronic Disease 0 10000 20000 30000 40000 50000 60000 70000 Potential Years of Life Lost <65years by main causes, 2000 & 2004, CARICOM countries (minus Jamaica) Source: CAREC, based on country mortality reports Note: Chronic Disease includes heart disease, stroke, cancer, diabetes, hypertension, chronic respiratory disease ‘Injuries’ includes traffic fatalities, homicide, suicide, drowning, falls, poisoning

9. Chronic Diseases and their Causes

11. Caribbean’s leadership on NCD • NCDs emerged as a priority • CCH INassau DeclarationCCHD 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

12. Mandates • Port of Spain Declaration • Strategic Plan of Action for the Prevention and Control of NCDS • NCD Progress Indicator Matrix • Global Strategy on Diet Physical Activity and Health • FCTC • WHA Res 58.22: Cancer prevention and Control

13. POS NCD Summit Declaration (2007) WHATTO DO • Tobacco control (#3,4) • Healthy Eating (salt) (#6,7,8,9) • Physical Activity (#10, 15) • Treatment (#5) WHERETO 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

14. Strategic 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

16. The Health Promotion Lens Healthy Public Policy Supportive Environments Reorient Health Services Empower Communities Increase Personal Health Skills Build alliances

17. Diet 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)

18. Physical 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

19. 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 attack

20. Tobacco 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

21. Cigarette price and consumption show opposite trends (2)Real price of cigarettes and consumption in South Africa, 1960-2003 Source: Van Welbeck 2003

22. Alcohol 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

25. Proposed CVD InterventionsSalt, 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.

26. Commitment • Establish national level Multi- Sectoral Bodies on NCDs • Develop, implement and monitor multi-sectoral NCD national Plans • Allocate resources for national NCD programmes

27. Multi-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

28. Surveillance 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

29. Education & 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)

30. Disease 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

31. CONCLUSIONS • 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

32. Next 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 Choice

33. The Key to GUYANA’s Success . . .

34. CARICOM: Health Sector Development, Human and Social Development Directorate Dr. Rudolph Cummings Programme Manager rcummings@caricom.org Tel: 2220001-75 ext 2720 Ms. Renee Franklin Peroune Senior ProjectOfficer rfranklinperoune@caricom.org Tel: 2220001-75 ext 2232 https://www.facebook.com/cc.secretariat www.caricom.org