1. 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

2. 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

3. 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)

4. 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

5. Leading Causes of Death (Jamaica) - 1
Disease # Rate # Rate
Cerebrovasc dis (1) (1) 109.0
Diabetes mellitus (2) (2)
Isch.Heart Dis (3) (3)
Hyperten. Dis (4) (4)
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)

6. Leading Causes of Death (Jamaica) - 2
Disease # Rate # Rate
HIV disease (6) (11) 15.8
Homicide/assault (5) (5)
Heart failure (7) (7)
Acute resp. infections (8) (6)
Chronic lower resp (9) (8)
Pulm.& other heart dis (10) (10)
McCaw-Binns et al (under review)

7. CVD Risk Factors in Jamaica
Jamaican Healthy Lifestyle Survey (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 *

8. Sex Specific Prevalence (%) of CNCDs

9. Methods of Protein Preparation

10. Fruits and Vegetables Consumption among Jamaicans

11. Physical Activity Levels by Sex (%)

12. Prevalence of Nutritional status by Sex

13. Prevalence(%) of hypertension by BMI

14. Prevalence (%) of Diabetes by BMI

15. Prevalence(%) of High Cholesterol by BMI

16. 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

17. 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

18. Prevalence of Self-reported HA & Stroke in JHLS-II
Overall Prevalence
Heart Attack
Stroke
Percentage %
95% CI
0.65
[ ]
1.37 [
Number of Persons
11839
[ ]
25000
[ ]
Age categories
15-34
0.34
[ ]
0.45
[ ]
35-54
0.29
[ ]
1.31
[ ]
55-74
2.56 [
4.50
[ ]
Ferguson et al. 2010

19. 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

20. 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 The cost would undoubtedly be much higher now. These data were provided by Dr.O Abdullahi Abdulkadri

21. 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
- Addressed most issues listed
- Current status uncertain

22. 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

23. 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, de Noviembre del 2011
Regional workshop Economics of Prevention of NCD and RF Mexico City, November 2011

24. Country: Health Systems topics
Epidemiologic Surveillance. - National Surveys, 2001 & 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, de Noviembre del 2011
Regional workshop Economics of Prevention of NCD and RF Mexico City, November 2011

25. 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

26. 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)