The Chronic Disease problem in the Caribbean – civil society perspective

1. The Chronic Disease problem in the Caribbean – civil society perspective Twelfth OECS Health Ministers Meeting, 11th September 2009 Prof. Trevor A. Hassell Chairman of the Healthy Caribbean Coalition, Chairman of the National Commission for Chronic Non Communicable disease, Barbados

2. “Three primary risk factors (tobacco, poor diet and physical inactivity) and three intermediate risk factors (hypertension, obesity and diabetes) lead to three diseases (heart disease, lung disease and cancer) resulting in 50% of all deaths”

3. Crude Mortality Rates (per 100,000 population) for Select Diseases: (2000-2004) 140 120 Heart 100 Disease Cancers 80 Rates per 100,000 population Diabetes Stroke 60 Injuries 40 Hypertensive Diseases HIV/AIDS 20 0 2000 2001 2002 2003 2004 CARICOM MemberStates Year Source: CAREC, based on mortality reports from countries

4. Heart Disease 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 (excluding Jamaica) MALES FEMALES Source: CAREC, based on country mortality reports

5. 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

6. Disability Adjusted Life Years (000) 2002

7. High BP Obesity Alcohol Tobacco High cholesterol Low fruits & veg Physical inactivity Unsafe sex Mortality Attributable to Select Risk Factors (Latin America & Caribbean) from DCP2 0 100 200 300 400 500 Attributable Deaths (thousands)

9. Prevalence (%) of diabetes among adults in the Americas Source: Pan Am J Public Health 10(5), 2001; unpublished (CAMDI), Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care)

10. 80 70 60 Male 50 Rate/100,000 Female 40 30 20 1985 1990 1995 2000 Caribbean Trends in Diabetes Mortality

11. CARICOM 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%.

12. Hypertension • Uncontrolled hypertension contributes to 45% of all ill health from CVD • Hypertension uncontrolled in 80% of hypertensive Barbadians • 49 anti-hypertensive drugs available in Barbados National Formulary

13. Estimated Economic Burden($US Million, 2001)

14. Estimated Cost of Diabetes and Hypertension as percent (%) of GDP

15. Caribbean Initiatives and Reports • Caribbean Commission on Health and Development Report • Nassau Declaration, CARICOM Heads of Government, 2001 • Caribbean Charter for Health Promotion • Caribbean Cooperation in Health initiative 1,11, 111 • Caribbean Regional Plan for Prevention and Control of NCDs and Injuries, 2008-2012, PAHO • Heads of Government of CARICOM Summit and Declaration against CNCDs, 2007

17. Purpose • To bring together a wide spectrum of partners from throughout the CARICOM countries – civil society, the business community, educators and researchers, policy makers to plan civil society’s response to the CNCD pandemic

18. Objectives • Provide a forum for cross section of representatives from various sectors of society to learn about CNCDs and consider how best to tackle them • Build capacity in important elements of civil society • Identify and promote evidence based best practices for addressing the CNCD epidemic in the Caribbean • Strengthen capacity of civil society to monitorimplementation of the POS Summit Declaration • Consider resource mobilization

19. Recent initiatives • Ratification of the FCTC • Establishment of NCD Commissions • Recognition of Annual Caribbean Wellness Day • National Chronic Disease Registry, Barbados • Risk Factor Surveillance • Healthy Caribbean Coalition public education campaign • National Nutrition improvement and salt reduction

20. Recent initiatives • CNCD National Summits held in Dominica and St. Lucia • Blood Pressure Monitoring initiative in barber shops and hairdressing salons developed in St. Kitts • Completion of STEPS survey for CNCDs and risk factors in Barbados, Dominica, BVI and St. Kitts and Nevis • Grenada completed a Workplace Wellness Summit (Part 1) • Expert consultations on Cancer Registries in Barbados, Antigua and Barbuda and Grenada

21. Complementary approaches to chronic disease prevention Individual responsibility Changes to the "toxic" environment HEALTH CARE AND DOCTOR POLICY ENACTMENT COMMUNITY AND CIVIL SOCIETY

22. Areas of support and recommendations for further action • Establishment of NCD Commissions in all OECS countries • Ratification and full implementation of FCTC by all OECS countries • Implementation of a population salt reduction programmes in OECS countries • Support by OECS Governments for HCC led public education campaign on NCDs

23. Areas of support and recommendations for further action • Support for Annual Caribbean Wellness Day • Acceptance of Caribbean Civil Society Declaration and Action Plan for tackling NCDs • Official recognition of the Healthy Caribbean Coalition by OECS Ministers of Health

24. www.healthycaribbean.org Thank You