Title: CARICOM Heads of Government Summit on Chronic Diseases
1CARICOM Heads of Government Summit on Chronic
Diseases
- Presentation of Prime Minister Denzil Douglas
2Overview of Presentation
- Global situation with Chronic NCDs
- Caribbean situation and costs
- Caribbean Response
- Exploding common myths
- Review of effective interventions
- The Way Forward
- Addressing the risk factors
- Globalisation and health
3Globalisation and HealthTHE MALADIES OF
AFFLUENCE
The Economist, August 11th 2007
4- The poor world is getting the rich worlds
diseases - Europeans have been exporting their maladies
throughout history. They seem to be doing it
again, but in a new way. In the past the problem
was infection. Now illnesses associated with
Western living standards are the fastest growing
killers in poor and middle-income countries.
Chronic disease has become the poor worlds
greatest health problem. - The Economist, August 11, 2007
5Chronic Diseases and their Causes
- Chronic Diseases
- Heart Disease, Stroke, Cancer, Diabetes, Chronic
Respiratory Disease - ?
- Biological Risk Factors
- Modifiable overweight, high cholesterol, high
blood sugar, high blood pressure - Non-modifiable Age, Sex, and Genetics
- ?
- Behavioral Risk Factors
- Tobacco use, physical inactivity, unhealthy diet,
alcohol abuse - ?
- Social and Environmental Determinants
- Social, economic and political conditions such as
income, living and working conditions, physical
infrastructure, environment, education,
agriculture, and access to health services - ?
- Global Influences
- Globalization of food supply, urbanization,
technology, migration
6Distribution of Deaths by Major Cause in the World
7Distribution of Deaths from Infectious and
Chronic Disease by Income Category, 2005
8Source CAREC, based on mortality reports from
countries
9Leading Causes of Death in CARICOM Countries by
Sex, 2004 (MINUS Jamaica)
MALES
FEMALES
- Heart Disease
- Cancers
- Diabetes
- Stroke
- Hypertension
- HIV/AIDS
- Influenza/pneumonia
- Injuries and violence
- Heart Disease
- Cancers
- Injuries and violence
- Stroke
- Diabetes
- HIV/AIDS
- Hypertension
- Influenza/pneumonia
Source CAREC, based on country mortality reports
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11Disability Adjusted Life Years (000) 2002
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14Prevalence () 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unpublished (CAMDI), Haiti (Diabetic Medicine)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)
15Caribbean trends in Diabetes mortality
16A consequence of Diabetes
17Amputations at the QEH 2002-2006
Diabetic Non diabetic
Male 308 116
Female 379 120
Total 995 236
Source A. Hennis, 2007
18Age adjusted death rates/100,000 population from
Diabetes (2000)
19- 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
- Trinidad TBD
- Control of blood pressure would reduce the death
rates from Cardiovascular Disease by about
15-20.
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21 Age adjusted death rates/100,000 population from
Hypertension (2000)
22Projected national income lost from NCDs (
2005-2015)
Projected
National
Income
Lost
from
NCDs
2005
-2015,
USBN
600
500
400
300
200
100
0
Bra
Can
Chi
Ind
Nig
Pak
Rus
UK
Tan
23Possible economic burden(US Million, 2001)
BAH BAR JAM TRT
Diabetes 27.3 37.8 208.8 494.4
Hypertension 46.4 72.7 251.6 259.5
Total 76.7 110.5 460.4 753.9
24Total cost of DM and H/T as percent of GDP
25Exploding the Myths
- Myth Chronic diseases are a problem of the rich
countries - Fact Non-communicable disease account for more
than half the burden of disease and 80 of the
deaths in the poorer countries which carry a
double burden of disease. -
26Developing countries carry a double disease
burden
Percentage of deaths by cause
Low- and Middle-income countries
High-income countries
27Exploding the Myths
- Myth NCDs are a problem only of the elderly
- Fact Half of these diseases occur in adults less
than 70 years of age and the problems often
begin in the young e.g., obesity - Myth NCDs affect men more than women
- Fact NCDs affect women and men almost equally
and globally, heart disease is the largest cause
of death in women.
28Exploding the Myths
- Myth NCDs cannot be prevented
- Fact If the known risk factors are controlled,
at least 80 of heart disease, stroke and
diabetes and 40 of cancers are preventable, and
in addition there are cost-effective
interventions available for control.
29Exploding the Myths
- Myth people with NCDs are at fault and to be
blamed because of their unhealthy lifestyles - Fact individual responsibility, while important,
only has full effect where people have equal
access to healthy choices. Governments have a
crucial role to play by altering the social
environment to help make the healthy choice the
easy choice.
30Exploding the myths
- Myth my grandfather smoked and lived to 90
years, and everyone has to die of something - Fact While some people who smoke will live a
normal lifespan, the majority will have shorter,
poorer quality lives. And yes, everyone has to
die, but death does not need to be slow, painful
or premature, as is so often the case with NCDs
31What works?
- A small shift in average population levels of
several risk factors can lead to a large
reduction in chronic diseases - Population wide approaches form the central
strategy for preventing and controlling chronic
disease epidemics, but should be combined with
interventions for individuals - Many interventions are not only effective, but
suitable for resource constrained settings
32Finland Dramatic Declines in NCD Mortality
33Relation of fitness to mortalityTT, St. James
Cardiovascular Study
- 1309 men had blood sugar, cholesterol, fitness
measured at baseline and then followed up
carefully for 7 years. - Unfit men compared with fit men were
- - 3.6 times more likely to die
- - 2.5 times more likely to have a heart
- attack
34Caribbean Responses
- Since the 1960s, history of collective action in
health, formalized in 1986 as the Caribbean
Cooperation in Health (CCH) initiative. - Countries, CAREC, CFNI and CHRC, CARICOM
secretariat, PAHO/WHO and partners have had
successes e.g.,, malnutrition and
gastroenteritis, vaccine preventable diseases,
HIV/AIDS (p (PANCAP). - CCH now entering 3rd phase major thesis that
Caribbean health can be improved through actions
taken universally and collectively. - Current priorities for action under CCH include
chronic diseases where the cited goals are to
reduce deaths by 2 per year and to reduce
serious, costly complications such as amputations
or renal failure.
35Caribbean Responses Summarised
Source PAHO Survey of NCD National Response
Capacity, 2005
36Addressing the risk factors
- Tobacco and alcohol
- Increase taxes with proceeds to prevention and
treatment - Ban smoking in public places
- Ban smoking in all schools
- Ban cigarette and tobacco advertising near to
schools - Curtail promotion of alcohol products targeted to
women and children - Establish target dates for passage of the legal
provisions in the FCTC already ratified.
37Addressing the risk factors
- Physical activity
- Have physical education compulsory in schools and
provide the facilities - Provide healthy, secure exercise spaces
- Provide wellness centers
- Give tax relief for worksite exercise facilities
38Addressing the risk factors
- Improve dietary practices
- Promote a standard of meals in public eating
places eg. eliminating trans fats - Provide healthy school meals
- Establish community based networks for training
in preparation of health foods - Mandate RNM to investigate the trade issues which
impact negatively on healthy food imports - Promote elimination of trans fats from Caribbean
diets
39Addressing the risk factors
- In the case of cancer
- Primary prevention
- Eg screening and vaccination to prevent
- cervical cancer
- Promote screening for breast cancer
40Secondary prevention
- Screening programs for NCDs
- Provide health services with resources to apply
the established cost-effective interventions - Establish mechanisms to ensure availability of
the medications necessary for the long term
treatment of NCDs when they occur
41Critical other recommendations
- Establish national level Commissions on NCDs
- Mandate CAREC to establish a system of behavior
and risk factor surveillance - Insist on the updating of the Caribbean Regional
Plan of Action for NCDs - The Caribbean should name a CARIBBEAN WELLNESS
DAY
42- Involve Partners
- PAHO/WHO
- Financial institutions
- Caribbean social partners private sector and
civil society - Monitoring and evaluation
- Designate CARICOM/PAHO as the joint Secretariat
with responsibility for monitoring and reporting
progress in the control of the NCDs.
43The way forward
- First We can utilize the policy instruments at
our disposal - legislation
- taxation
- regulation
- Second We should establish partnerships
- Third We must take personal responsibility and
lead by example
44CONCLUSIONS
- The Caribbean has a very serious problem -
getting worse - Economically and socially, it is not sustainable
- There are cost-effective interventions that work
why not utilise them? - We must put into effect National and
Caribbean-wide (CCH) plans - It is CRITICAL to strengthen health services to
for management and control of chronic diseases - Deepened partnership with public and private
sector, and civil society absolutely needed