The Experience of Building Momentum in GHD on Chronic Disease Prevention and Control:

1. The Experience of Building Momentum in GHD on Chronic Disease Prevention and Control: From the Caribbean toward the UN Summit 2011 C. James Hospedales, Senior Advisor & Coordinator, NCD Prevention & Control PAHO/WHO

2. Overview • Background • CARICOM Summit on Chronic Disease • Lessons learned in GHD • Next Steps towards the UN Summit

3. CARMEN Network MembersArgent, Anguilla, Ant&Barb, Aruba, Barbados , Bahamas, Brazil, Can, Colombia, Costa Rica, Cuba, Curacao, Chile, Dominica, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Jamaica Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, St Kitts & Nevis, St Lucia, Trin. & Tobago, Uruguay 32 Prospective Members Honduras, Venezuela, Bolivia CARMEN SCHOOL Collaborating membersSLU,USF,NHLBI,CDC, PHAC AMNET, RAFA,ILSI,F&V • Special • USA-Mexico (border) • Caribbean CARMEN

4. English-Speaking Caribbean; 14 countries, 7.5million people

5. All is not well in Paradise

6. UN High Level Meeting /Summit on Chronic Diseases, September 2011 • Many things have contributed: What was the role of the Caribbean in leading to this major opportunity for health?

7. What has led the UN General Assembly to convene the UN Summit in 2011? May 2000 World Health Assembly endorses the 'Global strategy on the prevention and control of NCDs September 2002 World Summit on Sustainable Development (Jo’burg) adopts 'Plan for Implementation‘ on NCDs May 2003 World Health Assembly endorses the 'WHO Framework Convention on Tobacco Control'. May 2004 World Health Assembly endorses the 'Global strategy on diet, physical activity and health'. December2006 UN General Assembly adopts resolution A/RES/61/225 (develop national policies for diabetes) September2007 Caribbean Community (CARICOM) Heads of Government adopt declaration on NCDs May 2008 WHA endorses WHO 'Action Plan for the Global Strategy for the Prevention and Control of NCDs'. April 2009 Summit of the Americas Conclusion includes Articles 28 and 29 on NCDs November 2009 Commonwealth Heads Government issued a statement to combat NCDs. January 2010 Drafting group led by the Caribbean Community convenes to develop a resolution on NCDs. May 2010 A/RES/64/265 adopted unanimously by the UN GA; co-sponsored by 78 countries, including Canada and USA

8. The CARICOM Heads Summit on NCDs, Sept 15, 2007, Trinidad & Tobago • “We, the Heads of State of the Caribbean Community….” • 15-point “Port of Spain Declaration”; multi-sectoral • Tobacco – Ratify and implement the WHO Framework Convention on Tobacco Control: taxation, packaging, earmark some revenue for health promotion & disease prevention, ban smoking in public places • Healthy Diet - Trade policies on food imports, agriculture policies, Healthy school meals, Food labeling, reduce or eliminate trans fats • Physical activity-physical education in schools; physical activity in work places; improve public facilities for physical activity • Health services - screening and management of NCDs to achieve 80% coverage by 2012; primary and secondary prevention, comprehensive health education • Monitoring - Surveillance of risk factors; monitoring of the actions agreed upon in Declaration (CARICOM Secretariat, CAREC, UWI & PAHO/WHO) • Mobilizing Society - National Commissions on NCDs; including public, private sector and civil society, media and communications industry • Caribbean Wellness Day – Second Saturdays in September WWW.CARICOM.ORG

9. What are the lessons learned in Global Health Diplomacy from the CARICOM?

10. Lessons Learned – from case study and from reflection • Progression and confluence of factors; not one single effort • Absolute need for evidence / data • Making the case: Speaking to head, heart and pocket • Political structure, and history of Caribbean cooperation in health • Importance of Champions: Political, technical, public health • “Pre-selling” by visiting countries/ Cabinets • PAHO-CARICOM collaboration • Country involvement in planning and preparation • Media and NGO involvement • International partners; especially Canada

11. 1. Progression and confluence of factors; not one single effort • Nassau Declaration of 2001: “The Health of the Region is the Wealth of the Region”, CARICOM Heads Conference • Caribbean Commission on Health and Development, 2003-05: identified Chronic Diseases, HIV/AIDS, and injuries and violence as “super priorities” for health • National level events, T&T, Barbados, Jamaica • Global /hemispheric awareness emerging

12. 2. Absolute need for evidence / data • Caribbean Epidemiology Centre (CAREC) – mortality and risk factor trends • Caribbean Food and Nutrition Institute – dietary trends, obesity trends • University West Indies – economic impact data • U of Toronto, W Bank, CARICOM Trade desk – tobacco, financing issues, trade policy options, respectively

13. 2. Absolute need for evidence / data • Caribbean Epidemiology Centre (CAREC) – mortality and risk factor trends • Caribbean Food and Nutrition Institute – dietary trends, obesity trends • University West Indies – economic impact data • U of Toronto, W Bank, CARICOM Trade desk – tobacco, financing issues, trade policy options, respectively Data are necessary but not sufficient!

14. 3. Speaking to Head, Heart and Pocket NCDs: Biggest cause premature death in the Caribbean

15. Speaking to Head, Heart and Pocket NCDs: Biggest cause premature death 45-yr old man with diabetes and amputation

16. Speaking to Head, Heart and Pocket NCDs: Biggest cause premature death 45-yr old man with diabetes and amputation 3-5% GDP loss due to diabetes, hypertension in T&T, Jamaica, Barbados

17. Speaking to Head, Heart and Pocket NCDs: Biggest cause premature death 45-yr old man with diabetes and amputation 3-5% GDP loss due to diabetes, hypertension in T&T, Jamaica, Barbados Tobacco control could save lives and raise $150M revenue in CARICOM

18. 4. Political Structure, and History of Caribbean Cooperation in Health • A political structure that facilitated regional appreciation of the problem and could mandate regional action, complementary to national action. • The Caribbean Community (CARICOM) is a formal political structure supported by the Treaty of Chaguaramas and a Secretariat • Council of Human & Social Development; Ministers of Health & others • Conference of Heads of Government – twice yearly • Caribbean Cooperation in Health – since 1986; polio, measles, rubella elimination; regional health institutions

19. 5. Importance of Champions: Political, Technical, Public Health Dr Eddie Greene, Asst Sec General Human & Social Development CARICOM Sir George Alleyne Chancellor UWI Former D/PAHO Dr Mirta Roses D/PAHO

21. 6. Pre-selling by visiting countries/ Cabinets • Chairman or members of Commission on Health and Development visited all CARICOM Countries and spoke to Cabinet, PM, Parliament between 2004-2007 • Allowed individual persuasion and consideration of situation of country

22. 7. PAHO/WHO-CARICOM Collaboration – critical for success

23. 8. Country involvement in planning and preparation • Planning team included 4 CARICOM Chief Medical Officers • Survey of national NCD capacity and policies • Standard template for posters of national situation to be presented at the Summit • Progress reported regularly to Health Ministers

24. 9. Media and NGO Involvement • Not as intensive as planned • “One Caribbean Media” conglomerate printed free Summit supplements and distributed in Sunday newspapers in most territories prior to the Summit • Media articles, interviews • Healthy Caribbean Coalition born; a civil society alliance to combat chronic disease and risk factors

25. 10. Importance of International Partners: Special Role of Canada • Public Health Agency of Canada provided a grant to PAHO support the Summit implementation and preliminary steps after • WHO Collaborating Centre on NCD Policy in PHAC provided technical assistance with case study of 26 key informants on perceptions of the Summit • CIDA provided a grant to the CARICOM Secretariat to support conduct of the Summit

26. Lessons Learned – from case study and from reflection • Progression and confluence of factors; not one single effort • Absolute need for evidence / data • Making the case: Speaking to head, heart and pocket • Political structure, and history of Caribbean cooperation in health • Importance of Champions: Political, technical, public health • “Pre-selling” by visiting countries/ Cabinets • PAHO-CARICOM collaboration • Country involvement in planning and preparation • Media and NGO involvement • International partners; especially Canada

27. Next Steps • So you had the Summit; so what? • Implementation is key and in countries lags behind political statements • Twice-yearly monitoring mechanism helps greatly • Caribbean Wellness Day – amazing mobilization • Application of lessons learned to South and Central America • Healthy Caribbean Coalition – civil society alliance to combat NCDs and risk factors – beginning a texting campaign to create the “global demonstration” • UN Summit

28. NCD Progress Indicator Status / Capacity by Country in Implementing NCD Summit Declaration - September 2010

29. UN Summit on NCDs 2011 • Unique policy window opening; think big • Need to Unite forces in NCDs, Risk Factors, H. Prom • Need roadmap/battle plan: before, during, after • Country by country advocacy campaign • Evidence - packaged to speak to head, heart & pocket • How do we create a “Global Demonstration”? • Champions, going viral, media advocacy • Be clear on “the ask”

30. SICA Presidential summit LAC Civil Soc G-8 France Obesity Forum

31. “Running through the tape”… of the UN Summit

32. THANK YOU OBRIGADA MUCHAS GRACIAS