Regional Workshop Economics of Prevention of Non-communicable Diseases (NCD) and Risk Factors (obesity, physical inactivity and poor diets) Mexico City, November 14-15, 2011 Rainford Wilks Tropical Medicine Research Institute, The UWI Jamaica

Objective To provide an insight into the burden of CNCD (mainly CVD) and risk factors in Jamaica (Data come primarily from National Health Survey of 2008) NB: Data on cancer and respiratory diseases are available and more is being collected but I do not have these today

Global Burden of CNCDs Globally CNCDs account for approximately 60% of all deaths and 43% of the burden of disease* Burden of non-communicable diseases in Caribbean has escalated - accounting for 60% of disease burden * Global Burden of Disease and Risk Factors (WHO)

Leading causes of death in Jamaica over the last 50 years Cause of Death Death Rate Per 100,000 Mean population   Total Male Female Cerebrovascular Diseases 77.9 69.4 86.3 Heart Diseases 76.5 70.9 62.1 Diabetes Mellitus 62.0 47.7 76.2 Hypertensive Diseases 32.1 27.6 36.6 Pneumonia 19.4 20.9 18.0 Cause of Death Death Rate Per 100,000 Mean population   Total Male Female Cerebrovascular Diseases 77.9 69.4 86.3 Heart Diseases 76.5 70.9 62.1 Diabetes Mellitus 62.0 47.7 76.2 Hypertensive Diseases 32.1 27.6 36.6 Pneumonia 19.4 20.9 18.0 Cause of Death Death Rate Per 100,000 Mean population   Total Male Female Cerebrovascular Diseases 77.9 69.4 86.3 Heart Diseases 76.5 70.9 62.1 Diabetes Mellitus 62.0 47.7 76.2 Hypertensive Diseases 32.1 27.6 36.6 Pneumonia 19.4 20.9 18.0  Leading causes of death in Jamaica over the last 50 years This slide shows the Jamaican disease transition so that in 1996, the leading causes of deaths were CNCDs Statistical Institute Of Jamaica

Leading Causes of Death (Jamaica) - 1 1998 1996 Disease # Rate # Rate Cerebrovasc dis. (1) 98.8 (1) 109.0 Diabetes mellitus (2) 56.2 (2) 53.3 Isch.Heart Dis. (3) 50.5 (3) 51.2 Hyperten. Dis. (4) 39.8 (4) 42.3 The next 2 slides, courtesy of Dr. McCaw-Binns and her colleagues, show the leading causes of death in 1998 in 1998, from data which multiple sources of detection rather than just relying on data from the Registrar General’s Report. This shows that CNCDs and CVDs in particular, are by far the leading causes of death in Jamaica. McCaw-Binns et al (under review)

Leading Causes of Death (Jamaica) - 2 1998 1996 Disease # Rate # Rate HIV disease (6) 23.9 (11) 15.8 Homicide/assault (5) 31.3 (5) 31.6 Heart failure (7) 20.9 (7) 21.0 Acute resp. infections (8) 19.0 (6) 21.6 Chronic lower resp (9) 8.8 (8) 18.0 Pulm.& other heart dis. (10) 18.4 (10) 16.8 McCaw-Binns et al (under review)

CVD Risk Factors in Jamaica Jamaican Healthy Lifestyle Survey 2007-2008 (15-74 yrs old)* showed prevalence estimate of Hypertension 25.5% Diabetes mellitus 7.9% Obesity 25.3% Salt added at table 6.1% These health conditions are associated with a high economic cost ** *Wilks et al 2009, **Ward E and Grant A, 2003 *http://www.mona.uwi.edu/reports/health/JHLSII_final_may09.pdf;

Sex Specific Prevalence (%) of CNCDs

Methods of Protein Preparation

Fruits and Vegetables Consumption among Jamaicans

Physical Activity Levels by Sex (%)

Prevalence of Nutritional status by Sex

Prevalence(%) of hypertension by BMI

Prevalence (%) of Diabetes by BMI

Prevalence(%) of High Cholesterol by BMI

Awareness, Treatment & Control Levels (%) Male Female Total Hypertension Aware Treatment Control 30.6 21.0 31.2 69.6 57.8 44.9 50.7 40.0 41.4 Diabetes 73.2 66.4 46.8 78.0 74.9 42.1 76.1 71.5 43.9 High Cholesterol 16.6 13.8 88.4 12.7 9.9 68.5 14.0 11.2 76.3

Alcohol and Substance Use Risk Behaviour Male Female Total Alcohol Use Current Past 80.1 4.0 49.2 3.9 64.3 3.0 Marijuana Use 22.9 22.3 4.4 10.0 13.5 16.0 Cigarette Smoking 22.1 23.0 7.2 10.8 14.5 16.8

Prevalence of Self-reported HA & Stroke in JHLS-II Overall Prevalence Heart Attack Stroke Percentage % 95% CI 0.65 [0.35 -1.21] 1.37 [1.00-1.88 Number of Persons 11839 [4575-19000] 25000 [17000-33000] Age categories 15-34 0.34 [0.08-1.45] 0.45 [0.17-1.21] 35-54 0.29 [0.06-1.28] 1.31 [0.68-2.52] 55-74 2.56 [1.20-5.38 4.50 [3.02-6.65] Ferguson et al. 2010

COST OF CHRONIC DISEASES Cost Item Diabetes (J$) Hypertension (J$) Direct Cost (2002) Hospitalization 135,464,269 (8%) 84,753,708 (7%) Clinic/Doctor’s Visits 332,500,000 (21%) 415,652,000 (33%) Drugs 113,800,284 (7%) 203,519,628 (16%) Laboratory/Diagnostic Tests 873,487,154 (54%) 357,847,984 (29%) Indirect Cost (2002) Productivity Loss 156,291,630 (10%) 186,339,706 (15%) Total Economic Burden 1,611,543,337 1,248,140,027 This was a study done by the Ministry of Health

Estimated 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 We have data for four of our countries on what it would cost to treat diabetes and hypertension adequately. The cost is staggering. In Jamaica it would be 460 million dollars-and that was in 2001. The cost would undoubtedly be much higher now. These data were provided by Dr.O Abdullahi Abdulkadri

Country: National level policies implemented Aimed to reduce the prevalence of chronic diseases (breast cancer, colo-rectal cancer, cardiovascular disease, diabetes, hypertension, other NCDs). Target population and year of implementation. Intended to modify behaviors: Alcoholism Tobacco Unhealthy diets Physical inactivity Salt National Strategic Plan for the Promotion of Healthy Lifestyles In Jamaica 2004-2008 - Addressed most issues listed - Current status uncertain

Summary Jamaica, like many middle income countries have a large burden of CNCD risk factors The response to this scenario is sub-optimal There are gaps in the situational analysis especially with respect to cancer and respiratory diseases but the former is being addressed There are gaps in capacity, in particular health economics There is a foundation on which to build and participate in initiatives such as this Workshop proposes

Country: JAMAICA Basic statistics about Noncommunicable Diseases (NCD) Burden of disease, available year and source. Mortality rate, available year and source. Prevalence of NCD, available year and source. Indirect and direct costs, available studies and source. Costs for medical attention. Taller Regional Economía de la prevención de ECNT y FR Ciudad de México, 14-15 de Noviembre del 2011 Regional workshop Economics of Prevention of NCD and RF Mexico City, 14-15 November 2011

Country: Health Systems topics Epidemiologic Surveillance. - National Surveys, 2001 & 2008. Next planned for 2015 Provider of health services. Medical units detection. Nutritional counseling units. Medical attention primary care. Medical attention specialized services. Financing resources for specific NCD programs available. Human resources specialized in NCDs prevention and treatment. Taller Regional Economía de la prevención de ECNT y FR Ciudad de México, 14-15 de Noviembre del 2011 Regional workshop Economics of Prevention of NCD and RF Mexico City, 14-15 November 2011

Country: Research in economic evaluation of NCDs Studies developed or commisioned by MoH, objectives, information used, year and main results. Basic economic information, including year and source of available information: Average wage Average monetary income (from household surveys) Availability of paid sick leave Level of sickness leave

Key questions for the future work What are the obstacles, in terms of methodology and availability of information, to estimate the net impact of NCDs on economic variables? What characteristics (variables, conditions) do data collection methods need to consider in order to capture these effects? What statistical methods are most appropriate for the purpose? What are the direct and indirect costs incurred by national health systems as a result of NCDs? Is there an association between the magnitude of the impact and the structure of the model of care? What are the implications of potential cost increases from the rising prevalence of NCDs in the Region for the financing and structure of health systems? What are the links between NCDs on the one hand, and development, economic growth rates and human capital accumulation (e.g., lost productivity due to disability, decline in labor supply, premature mortality, etc.) on the other? What are the long-term advantages of investing to expand prevention measures to achieve overall improvements in health? (See Technical Note as reference)