FOLLOW UP REPORT OF THE CARIBBEAN COMMISSION ON HEALTH AND DEVELOPMENT

1. FOLLOW UP REPORT OF THE CARIBBEAN COMMISSION ON HEALTH AND DEVELOPMENT Presented to the 27th Meeting of the Caribbean Heads of Government St.Kitts and Nevis July ,2006 George Alleyne

2. 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

3. 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)

4. 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

5. 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)

6. 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

8. 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

9. 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

10. 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

11. Disability Adjusted Life Years (DALYs) 2001

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

13. % deaths due to selected risk factors

14. % deaths due to selected risk factors

15. 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

16. 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

17. Price of cigarettes and consumption in S.Africa Source: Saloojee 1995

18. Source: Jha and Chaloupka, 1999, 2000

19. 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)

20. . © Gaziano 2001

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

22. 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.

23. 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)