FOLLOW UP REPORT OF THE CARIBBEAN COMMISSION ON HEALTH AND DEVELOPMENT

Presentation Transcript

Presented to the 27th Meeting of the Caribbean Heads of Government

St.Kitts and Nevis

July ,2006

George Alleyne

In the presentation of the CCHD one year ago, I emphasized that the major health /disease problems that the Caribbean would have to face in the immediate future were;

Non Communicable Diseases

HIV/AIDS

Injuries and violence

With respect to HIV/AIDS

“ Several recent developments in the Caribbean region ( in Bahamas, Barbados, Bermuda, Dominican Republic and Haiti ) give cause for guarded optimism-with some HIV prevalence declines evident among pregnant women, signs of increased condom use among sex workers and expansion of voluntary testing and counseling”.

(UNAIDS, 2005)

Estimated deaths from AIDS during 2004

Eastern Europe

& Central Asia

60 000

[39 000 – 87 000]

Western & Central Europe

6 500

[<8 500]

North America

16 000

[8 400 – 25 000]

East Asia

51 000

[25 000 – 86 000]

North Africa & Middle East

28 000

[12 000 – 72 000]

Caribbean

36 000

[24 000 – 61 000]

South

& South-East Asia

490 000

[300 000 – 750 000]

Sub-Saharan Africa

2.3 million

[2.1 – 2.6 million]

Latin America

95 000

[73 000 – 120 000]

Oceania

700

[<1 700]

Total: 3.1 (2.8 – 3.5) million

UNAIDS

3.1 million deaths from AIDS in the world in 2004

(30,000 in the wider Caribbean)

(1137 in CMC’s in 2003)

35 million deaths from NCDs projected in the world in 2005

(30,785 in JA, TRT,GUY, BAR in 2001)

The reason for showing these data on AIDS and NCDs is not to seek any diminution of effort over HIV/AIDS. The Caribbean should be proud of what it has done and should continue.

The reason is to stimulate similar concern and ACTION with regard to NCDs at the level of the Heads of Government

Non communicable diseases

1-The evidence

The relative and absolute magnitude of the problem

The economics of the problem

2-The possible solutions

At the population level

At the individual level

1980 (%)

Heart Disease - 20

Cancer - 12

Stroke - 11

Injuries - 8

Hypertension - 6

ARI - 5

Diabetes - 4

2000 (%)

Heart Disease - 16

Cancer - 15

Stroke - 10

Diabetes - 10

Injuries - 7

HIV/AIDS - 6

Hypertension - 6

Major causes of death in the Caribbean

Age Adjusted Death Rates For Selected Cardiovascular Conditions, late 1990’s, Per 100,000

CauseBar TrTCub ArgCan USA

Stroke 81.0 94.9 48.1 48.4 24.2 26.9

CHD 55.8 151.2 104.9 44.3 77.6 86.2

HHD 12.1 31.5 7.5 9.0 2.2 8.2

DM2 66.8 108.2 14.5 15.5 10.4 13.7

PAHO 2004, Page 87

Disability Adjusted Life Years (DALYs) 2001

Costs (US $ Million)for treatment of all diabetes and hypertension

% deaths due to selected risk factors

Population based policy interventions for control of NCD’s especially CVD.

Fiscal policies
Regulations and standards
Education and health promotion
Policies to workers and communities
Tobacco control

Reduce death from Cardiovascular Disease

Combat tobacco use
--tax tobacco products
--restrict smoking in public places-
--provide replacement therapy and cessation tools
Policies to promote exercise and healthy weights-NB physical ed. in schools
Policies to reduce in the population intake of salt, unhealthy fats, and excess calories

Price of cigarettes and consumption in S.Africa

Source: Saloojee 1995

Source: Jha and Chaloupka, 1999, 2000

Specific policy recommendations to the Heads of Government

1-Combat tobacco use

tax tobacco products

ban smoking in public places

2-Target children

make physical education compulsory

ensure healthy school meals

restrict advertising that promotes unhealthy diets

3-Make regulations and standards

ensure marketed foods show calorie & fat content

regulate importation of fats (consult RNM)

.

Long term treatment after a non-fatal stroke or heart attack (secondary prevention)

And finally

The Ministers of Health in COHSOD have developed a Regional Strategic Plan which deals not only with the policy issues highlighted here, but with all aspects related to the control of NCDs. This plan is yet to be funded and made operational.

The Plan should be supported.