Rudolph Cummings MD, MPH; Program Manager, Health Sector Development, CARICOM 17 th February, 2013, Guyana CARICOM Addressing NCDs in the Region: The Role of CARICOM

CARICOM Leading Causes of Death in CARICOM Countries by Sex, 2004 (- Jamaica) 1.Heart Disease 2.Cancers 3.Injuries and violence 4.Stroke 5.Diabetes 6.HIV/AIDS 7.Hypertension 8.Influenza/pneumonia 1.Heart Disease 2.Cancers 3.Diabetes 4.Stroke 5.Hypertension 6.HIV/AIDS 7.Influenza/pneumonia 8.Injuries and violence MALES FEMALES

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Potential Years of Life Lost <65years by main causes, 2000 & 2004, CARICOM countries (minus Jamaica) Chronic Disease HIV/AIDS Injuries Y2004 Y2000 Note: Chronic Disease includes heart disease, stroke, cancer, diabetes, hypertension, chronic respiratory disease ‘Injuries’ includes traffic fatalities, homicide, suicide, drowning, falls, poisoning Source: CAREC, based on country mortality reports

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Chronic Diseases and their Causes

CARICOM NCD 4X4 Modifiable causative risk factors for NCDs Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicable diseas es Heart disease and stroke Diabetes Cancer Chronic lung disease

CARICOM Caribbean’s leadership on NCD NCDs emerged as a priority – CCH INassau DeclarationCCHD – CCH I Nassau Declaration CCHD Port of Spain Declaration 2007 SUMMIT of the America and CHOGM – 2009 – Mandate to elevate issue to UN UNHLM - CARICOM lead UN Res.64/265

CARICOM Mandates Global Strategy on Diet Physical Activity and Health FCTC WHA Res 58.22: Cancer prevention and Control Port of Spain Declaration Port of Spain Declaration Strategic Plan of Action for the Prevention and Control of NCDS Strategic Plan of Action for the Prevention and Control of NCDS NCD Progress Indicator Matrix

CARICOM POS NCD Summit Declaration (2007) WHAT TO DO Tobacco control (#3,4) Healthy Eating (salt) (#6,7,8,9) Physical Activity (#10, 15) Treatment (#5) WHERE TO DO IT Workplace (#10) Schools (#6) Faith based org. Communities HOW TO DO IT NCD Secretariat, Plan, M&E (#1, 14) NCD Commissions (#2) Surveillance, Gender (#11, 13) Partners – private sector, civil society (P) Media & Communications (#12) Sustainable financing (#4) PAHO and CARICOM support

CARICOM Strategic Plan - Guiding Principles The Caribbean Charter of Health Promotion Capacity building Member States through the CARICOM/PAHO NCD Secretariat Focus on Gender dimensions of the epidemic Multi-Sectoral/ Whole of Government Approach Integrated Approach to prevention and Control across the Life Course

CARICOM NCD 4X4 Modifiable causative risk factors for NCDs Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Noncommunicable diseas es Heart disease and stroke Diabetes Cancer Chronic lung disease

CARICOM The Health Promotion Lens Healthy Public Policy Supportive Environments Reorient Health Services Empower Communities Increase Personal Health Skills Build alliances

CARICOM Diet and Nutrition Multi-sector Nutrition and Food security Plans/ legislation Promote population and setting specific standards for meals – Reduce Salt, Fat/ Trans Fat, Sugar consumption – Age appropriate FBDGs – Provide healthy school meals Establish standards: – Marketing of foods to children – Packaging and Labelling of food products Scientific based Public Communication promoting healthy eating Pricing tariffs – incentives for healthy foods (access, affordability)

CARICOM Physical Activity Mandate physical education in population settings – legislation/ regulations/guidelines Increase safe public facilities that enable PA Scientific based public communication promoting PA Develop, implement and or scale up population setting based PA programmes – Schools – Workplaces – Geriatric institutions etc

CARICOM Relation of fitness to mortality T&T, 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: times more likely to die times more likely to have a heart attack

CARICOM Tobacco Control Monitor use of tobacco use and prevention policies Protect people from tobacco smoke in public places and workplaces Offer help to people who want to stop using tobacco Enforce bans on tobacco advertising, promotion and sponsorship Raise tobacco taxes and prices

Cigarette price and consumption show opposite trends (2) Real price of cigarettes and consumption in South Africa, Source: Van Welbeck 2003

CARICOM Alcohol Control Legislation, policies: – underage drinking – Use of alcohol by women of reproductive age Curtail advertising and promotion of alcohol products targeted to women and children Adopt measures in support of an appropriate monitoring system for the harmful use of alcohol Scientifically based population specific public communication

CARICOM Proposed CVD Interventions Salt, tobacco, treatment = Globally,18 million deaths averted at a cost of US$1.10 per year Estimated 38,000 lives saved in CARICOM over 10 years Would add an average of 2 years of life for every citizen Projected cost < 1% of existing health budget.

CARICOM Commitment Establish national level Multi- Sectoral Bodies on NCDs Develop, implement and monitor multi- sectoral NCD national Plans Allocate resources for national NCD programmes

CARICOM Multi-sectoral Interventions Healthy Eating – Trade policy, agri-food policies, fiscal policy, – Ministries of Trade, Finance, Agriculture – Private sector, Civil society, Consumer Affairs, Media – Food manufacturers, importers, providers Fast food sector, Restaurants Physical Activity – Urban Planners, Ministries of Transportation, Local Government, Education; Chambers of Commerce, private sector Tobacco / Alcohol – Attorney General, Ministries of Legal Affaires, Finance, Trade

CARICOM Surveillance and Research Establish Health information policy and systems for NCDs Annual reports : Minimum Data Set Surveys: STEPS, GSHS, GYTS etc Evaluate interventions Collaborate with academic and research institutions Ability to disaggregate data – age and sex

CARICOM Education & Promotion Caribbean Wellness Day National NCD Communication plans Scientific based population specific communication Incorporate prevention and control explicitly in poverty reduction and social and economic policies (

CARICOM Disease Management Chronic Care Model NCD treatment protocols – age and gender appropriate Screening programs for NCDs Provide health services PHC Establish mechanisms to ensure availability of the medications necessary for the long term treatment of NCDs when they occur

CARICOM CONCLUSIONS 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

CARICOM Next Steps Evaluation of POS at 5 Revise the NCD Progress Indicator Tool Establish a Regional Communications working group and Regional NCD Communication framework Revisiting Health School Initiative to address NCDs Focus on Children 2013 – Regional Programmatic Framework for addressing NCDs among Children Make the healthy choice the easy Choice

CARICOM The Key to GUYANA’s Success...

CARICOM CARICOM: Health Sector Development, Human and Social Development Directorate Dr. Rudolph Cummings Programme Manager Tel: ext 2720 Ms. Renee Franklin Peroune Senior ProjectOfficer Tel: ext

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