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Regional Policy Dialogues in the Caribbean on Chronic Non-Communicable Diseases Dr. Rudolph O. Cummings MPH, Program Manager, Health Sector Development, Caricom Secretariat Montreal, May 2008. Regional Situation Mortality and Morbidity. Potential Impact for BP and Cholesterol Control.
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Regional Policy Dialogues in the Caribbean on Chronic Non-Communicable Diseases Dr. Rudolph O. Cummings MPH, Program Manager, Health Sector Development, Caricom Secretariat Montreal, May 2008
Potential Impact for BP and Cholesterol Control • Barbados: (Hennis et al, 2002) >40 yrs, HBP prevalence = 55% Awareness = 63% Treatment = 54% Control = 19% treatment of those with chronic disease with aspirin and simple drugs to lower blood pressure and cholesterol (18 million deaths averted at a cost of $1.10 per year)
Achievements – Infrastructure – Secretariat, Plans, M&E (POS #1, 14) • Regional • Summit implementation grant from Public Health Agency Canada: $507,000. (Spend by August 08) • PAHO/OCPC/CARICOM Secretariat • Meets every 2 weeks, CMO’s chair, D/CFNI, D/CAREC • Workplan drafted • Sharepoint site under construction
Monitoring and Evaluation (POS#13,11) • StrengthenCAREC's Behavioural surveillance capacity • PAN AM STEPS NCD risk factor surveys, National NCD Capacity Survey, Global School Health Survey • Training and execution • Data analysis and use to monitor POS Declaration • Decentralization of WHO InfoBase to CAREC • Collaboration with UWI/CAREC on IDB funded surveillance project
Monitoring and Evaluation (POS#13,14) cont’d • Strengthen OCPC coordination capacity – Alafia Samuels on staff from April 1st 2008 • Case study preparation – draft completed • Monitoring and Evaluation • Summit Evaluation Framework used to report - v2 now circulated • Accepted by Heads in March 08 • Process, Output, Indicators, Sources of Data • Web-based reporting on sharepoint site (in process)
Strengthening Country Capacity (POS#2) • NCD Policy capacity building workshop for 10 ECC countries and Barbados, October 2007 • CARMEN meeting in Bahamas Nov 4 – 8, 2007
National NCD Summits (POS # 2) • Dominica’s PM Skerritt convened National NCD Summit in Dominica 14 Dec 2007 • Barbados already has an NCD Commission since January 2007 • Trinidad formulating a “Healthy Lifestyles” initiative • At Heads Inter-sessional March 08, 5 committed to convene NCD Summit • Guyana, Bahamas, Belize, St Vincent and Grenadines and St Kitts/Nevis
Tobacco (POS #3,4) • Countries who still need to ratify • Bahamas • Haiti • St Kitts and Nevis • St. Vincent & Grenadines • Suriname • Letter of Intent to Gates for 5-yr, US$6 million to support Tobacco control in Caribbean, incl. legal support for drafting legislation (POS #3, #4)
SUPORTING THE CROSQ PROCESS • Jamaica BoS designated to draft new regulations for packaging and labeling • Draft standard circulated to member states for review and submission of comments • Comments received from some member states • Urgent need to strengthen the standard to meet the FCTC obligations • CARICOM request to PAHO WDC and OCPC to support the process.
Healthy Eating (POS # 6,7,8 9) Ministers of Agriculture of CARICOM, St. Ann Declaration, 9 October 2007 • Implementing Agriculture and Food Policies to prevent Obesity and NCDs in CARICOM • Use Regional and WTO agreements to ensure food security • Support the CRNM to pursue fair trade policies • Policies that explicitly incorporate nutritional goals • Elimination of trans-fats from our food supply using CFNI as a focal point • Labeling of foods to indicate their nutritional content; • Public education for increased consumption of fruits and vegetables • Food Security Plan for prevention and control of NCDs
Active Living, Caribbean Wellness Day 20th Sept 2008 (POS #6,10, 12,15) Policy dialogue on scaling up physical activity, with CDC 6- 7 May 2008 in POS – • To explore options for sustained physical activity • To present options to private sector meeting May 8 - 9 • To plan for CWD 2008 • Countries now have draft national plans
Advantages of Risk Charts • Simplified, clear message and Cue for lay and PHC workers • Reorient perception : practitioners identify total risk • Composite risk score : Process for fast-forwarding those at highest risk • Risk approach/charts will guide intensification of management, and not reduce treatment goals. • Practical for professionals and to patient • Empowering of individuals with the information about their risk, how to reduce risk by moving from top right to bottom left in their age and sex category
Next Steps • CMOs approval in Surinam April 21 for MOH introduction • Considered 4 instead of 5 levels ( green, yellow, orange, red) • Availability of variables in PHC in the Caribbean? Cholesterol testing should be encouraged • Pilot testing, perhaps through IDB Surveillance of DM QOC projects • CHRC to produce “pocket guidelines” summaries of its existing Clinical Guidelines, and review the proposal to integrate with the Risk Charts to produce “Caribbean Cardiovascular Disease Guidelines”
Media and Communications • Media group established and working virtually • Draft plan developed and under discussion • Need to document Health Promotion and NCD Prevention and Control activities and initiatives in countries. • Activities around World Health Day documented for the first time along sustainable transportation • Public and private sharepoint site to share info e.g. TOR from Barbados NCD Commission, program from Dominica NCD Summit
Involvement of Private Sector, Media (POS #12) • CAIC engaged: Private Sector meeting 8-9 May 2008, POS • Hear the business case for Private Sector involvement in NCD prevention and control • Discuss options for interventions (CFNI proposals) • Design a Plan of Action and implementation mechanisms with partners • Workplace Wellness incentive-based awards • Healthy food policies (America’s / CARICOM Pledge) • Media and communications • Support for Caribbean Wellness Day-promote a park and biking and walking days
Next steps • First Caribbean Wellness Day – Sept 13 • Caribbean 10k in July in Antigua • Heads will demonstrate by example of walk to start point • NGO forum in October to be coordinated in Barbados for Health NGOs –Prof. Hassel