1. The role of CNCD Commissions in tackling chronic diseases – The Barbados Experience
Dominica National Commission on CNCDs Capacity Building Workshop, 19 January 2010
Professor Trevor A. Hassell,
Chairman Commission for CNCDs, Barbados

2. The burden of the CNCDs - Barbados
Quarter of men and more than a third of women live with one or more CNCD
Five leading causes of death are CNCDs
Heart disease and stroke rank among leading causes of death
22% of Barbadian adults are hypertensive and 17.5% are diabetic
Diabetes and hypertension account for 20% of primary care consultations
Overweight/obesity: 60% of women and 1/3rd men

3. “ Three primary risk factors ( tobacco, poor diet and physical inactivity) and three intermediate risk factors (hypertension, obesity and diabetes) lead to three diseases (heart disease, lung disease and cancer) all resulting in some 50% of all deaths.”

4. Changes to the "toxic" environment COMMUNITY AND CIVIL SOCIETY
Complementary approaches to chronic disease prevention
Individual responsibility
Changes to the "toxic" environment
HEALTH CARE
AND DOCTOR
POLICY ENACTMENT
COMMUNITY AND CIVIL SOCIETY

5. Support for the CNCD Commission -local
The Barbados Strategic Plan for Health,
Strategy for the prevention and control of CNCD & Cabinet Note (2005) 26/MH.03, Ministry of Health, Barbados (2004);
International Consultation on a Strategy for the Prevention and Control of CNCD for Barbados; Ministry of Health, Barbados (2005)
“Healthy Hearts for life”. Report of the Task Force on the Development of Cardiovascular Services (Jan. 2007); Ministry of Health, Barbados

6. Support for the CNCD Commission - regional
Heads of Government of CARICOM Summit and Declaration against CNCDs, 2007
Healthy Caribbean 2008 Chronic Disease Conference: a wellness revolution event

8. CARICOM Heads of Government Summit on Chronic Non-Communicable Diseases (CNCDs), 15 September 2007
adopted a fourteen-point declaration committing the region to collective action to stop the epidemic of CNCDs
**Infrastructure: Secretariat / CCH3 / Regional Plans, M & E;
**National Commission, NCD Focal Point in MOH 
**Advocacy, Communications, Social marketing
 **Sustainable Financing 
**Surveillance, including Gender dimensions

9. Priorities of the Summit
Tobacco (FCTC)
Healthy Eating (DPAS):
Trans Fat, Trade, Labeling
Active Living (DPAS)
Population-wide activities
Schools/workplaces etc.
2nd Saturday in Sept: “Caribbean Wellness Day”
Screening and integrated management

11. Purpose
To bring together a wide spectrum of partners from throughout the CARICOM countries – civil society, the business community, educators and researchers, policy makers to plan civil society’s response to the CNCD pandemic

12. Participants Anguilla Antigua Aruba Bahamas Barbados Belize BVI
Agriculture 3
Business 5
Education 3
Faith Based 4
Finance 7
Food Industry 2
Gov./Policy 13
H C Providers 11
Health Finance 3
Labour 5
Legal 1
Media 9
NGO/CNCD 35
Pharma 3
Reg./Pol 6
Service Clubs 3
Sports/PA 3
Urban Dev. 3
Youth 3
Anguilla
Antigua
Aruba
Bahamas
Barbados
Belize
BVI
Cayman islands
Dominica
Grenada
Guyana
Jamaica
Montserrat
St. Lucia
Trinidad and Tobago
St. Kitts

13. Outcomes Active Caribbean Workshop
Caribbean Civil Society Declaration on CNCDs
Caribbean Civil Society Action Plan for tackling CNCDs,
Conference Report produced as a Technical Report of the Chronic Disease Research Centre, UWI
Creation of a Caribbean civil society coalition for tackling CNCDs - Healthy Caribbean Coalition
Website:
Co-sponsorship of upcoming University Diabetes Outreach Conference, Jamaica, 2010
CNCD media campaign for Barbados and the OECS

14. Summary of the Declaration
10 point preamble and 12 point declaration
Preamble recognizes the contribution of the CNCDs both to ill health & disease and excessive financial burden, but appreciates that much can be done
Declares inter alia:
Support for Heads of Government of CARICOM Declaration on CNCDs
Need to establish a Caribbean Civil society CNCD coalition
Stresses the need for increased advocacy
Promotion of healthy lifestyles
Public education and media campaigns
Seeks to hold Governments accountable

15. Summary of the Action Plan
Action lines:
Establishment of Caribbean CNCD coalition
Advocacy
Support for Caribbean Wellness Day
Development of a communication strategy
Public education programme
Risk factor reduction
Support for country level activities

16. The National Commission for CNCDs, Barbados
Established January 2007
Inter-sectoral body
14 members and 4 ex-officio members
Volunteers paid small stipend
Meetings held monthly
Professional, administrative and secretarial support provided by staff of the Health Promotion Unit
No budget allocated to the Commission at start up

17. The Commission’s mandate
Advise Minister of Health on CNCD policies and legislation
Broker involvement of all sectors in program implementation
Assist in mobilisation of resources to facilitate implementation of programs
Recommend relevant research
Promote collaborations and partnerships
Monitor regional and international trends
Facilitate commissioning of audits /evaluation of CNCD programs
Recommend to Minister of Health framework that encourages and promotes behaviour change to prevent CNCDs

18. Membership of NCCNCD, Barbados
Professor Trevor Hassell MD., Chairman
Professor Henry Fraser MD., Dean Faculty of Medical Sciences  
Mr. David Neiland , Businessman, the private sector
Mr Orlando Scott, trade union movement
Mr Wilfred Beckles, Barbados Association of Retired Persons
Mr. Michael Gaskin, teacher, physical education
Mr Adrian Randall , CEO, Heart & Stroke Foundation of Barbados
Dr Elliott Douglin MD., Representing Faith based organisations
Mrs. Sophia Cambridge, Advertising and media
Ms Candace Waldron, Youth Representative
Ms Zonia Phillips, Food and Nutrition advocate
Mr Barton Clarke Chief Agricultural Officer, Ministry of Agriculture
Mrs Wendy Griffith-Watson, Chief Education Officer
Mrs. Ena Harvey, IICA

19. Strategic Plan: Objectives
Internal action:
Improved management of NCCNCD
Improved CNCD data management
External action:
Health promotion
Reduction of CNCD risk factors
Quality CNCD treatment and care

20. Strategic Plan: Vision, mission and values
Vision: to be a leader in all major national developments related to CNCDs in order to achieve reduction in CNCDs
Mission: Advises on, facilitates and promotes evidence based best practices in Prevention and Control of CNCDs
Values: Transparency, inclusiveness, respect for all views, adoption of evidence based practices, accountability, and collaboration

21. Strategic plan: key strategies
Strategic management issues
Epidemiological data, Health Information System and research
Measures to support reduction of risk factors
Health promotion
Quality treatment and care

22. Strategic management issues
Advisory body guiding and assisting a highly motivated group of operational partners
Driving CNCD interventions in collaboration with:
Public and private sector
Government and NGOs
Professional and voluntary bodies
Community based organizations
Regional and international bodies

23. Epi- data, Health Information Systems and Research
Increasing access to data on CNCDs
Strengthening functional links with CDRC/UWI
Using the BNR as a priority data source to inform actions of the CNCD Commission
Increasing surveillance capacity of Ministry of Health
Using Health Information System

24. Measures to support reduction of risk factors
Declare CNCDs a national priority
Enhance the role of the commission with the public
Giving the public access to CNCD data
Inform the public of standards in treatment and care
Support on-going educational programmes targeting health care professionals

25. Health promotion
Integrate health promotion strategies in the planning process
Improve inter-sectoral collaboration
Lobby where necessary for high impact
Influence legislation and regulation

26. Quality treatment and care
Establish standards for CNCD treatment and care

27. Indicators of success Organizational and management structures
Budgetary funds allocated to CNCDs increased by 10%
Administrative staff added to MOH to support Commission
Secretariat established
Epi- data, HIS and research
Implementation of annual surveillance reporting system for CNCDs
Regular outputs from BNR
Repeat BRFS survey in 2010
Establishment of a web portal for CNCDs

28. Indicators of success Risk factor reduction Health promotion
Complete adoption of at least 3 articles of FCTC by end of 2009
National population salt reduction policy articulated and programme implemented by 4th quarter of 2009
Support for CME of health professionals
Working relationship with National Nutrition Centre
Health promotion
Representation of CNCDs at the level of the Social partnership
Sustained highly visible public education programme on CNCDs
Quality treatment and care
Annual training given to health care professionals in CNCD protocols

29. Tobacco exposure Significantly increase tax on tobacco products
Remove duty free concessions on tobacco products at the ports of entry
Ban sale of tobacco products to minors
Ensure that warning labels on tobacco products meet international standards
Ban smoking in public places
Prohibit cigarette advertising at point of sale

30. Physical inactivity
Make materials and aids used in exercise and physical activity more affordable for personal use….VAT exemption
Enact policies to facilitate development of small community gyms
Create tax incentives for property developers to create safe recreational spaces in communities
Increase physical activity in schools
Enact legislation and policies to make the city and the country more conducive to walking and riding

31. Hypertension and blood pressure control
Continue to make blood pressure lowering drugs available at an affordable cost at point of delivery….Drug formulary
Produce a more cost effective and more rational range of antihypertensive drugs
Seek to provide delivery of care of hypertension by primary care doctors using the chronic care medical model
Population salt reduction using a voluntary and collaborative approach informed by national policy

32. Diabetes and blood sugar control
Enhance the provision of drugs, syringes, needles for diabetics…drug service
Provide blood glucose test strips
Provide tax concessions or zero rate glucometers

33. National Chronic Disease Registry
An initiative of the Ministry of Health, executed on contract by the Chronic Disease Research Centre
Sub-registries of acute myocardial infarction, stroke, and cancer, related risk factors and outcomes
Aims to inform and guide prevention and intervention strategies, and optimal resource use
Model for the region
Complementary to PAHO/STEPS Risk Factor surveillance program

34. The Commission and the Barbados National Registry
Chairman of the Commission has a “direct interest” in the outputs of the Registry
Commission facilitates and supports the work of the Registry
Commission monitors and evaluates the operations of the Registry
The Registry supports the information needs of the Commission

35. The Commission and the Barbados National Registry
The Commission in conjunction with the CMO will :
Provide input to any public health, medical and epidemiological issues arising from that work
Design and implement public awareness and communication strategies about the contribution of the Registry to population health status improvement
Design and implement “professional awareness strategies” to inform and engage the medical and related professions in the activities of the Registry

36. Barbados Behavioural Risk Factor Survey (STEPS): 25 years and older
Tobacco exposure
8.4% current smokers
Physical activity
51% low level of physical activity
Eating habits/diet
95% ate less than 5 servings of fruit and vegetables per day

37. Caribbean Wellness Day
Introduced by Heads of Government of CARICOM
Held on the 2nd Saturday in September
Focus attention throughout the region on the chronic diseases
Coordinated by the CNCD Commission
All sectors of the community invited to participate, private sector, government, trade unions, civil society, the academic and educational institutions, faith based organisations

38. National Nutrition Improvement and Salt Reduction Program
Survey of population salt intake: initial and follow up
Healthy nutrition policies and actions in schools
Taxation policy around healthy food and beverages
Public education campaign on radio, TV, and print media
Reformulation of food and drinks
“Salt choice the difficult choice”
Workshops and seminars for health care providers
Barber shop screening project

39. The National Chronic Non-Communicable Disease Commission Logo

40. Nutrition guidelines for schools
Produced 2009
A tool for use in schools to assist teachers and students in best practice nutrition
Distribution of guidelines and implementation, 2010

41. Activities of the Commission
Healthy Caribbean 2008 civil society conference
Initiated service contracts with health NGOs
Contributed to the Heads of Government of CARICOM Summit, 2007
Contributor and lead role in development of Cabinet paper on CNCDs
Consultation on trans fats / Faith based workshop
Several lectures and presentations - CMOs and Ministers of Health, OECS; New Delhi, India; Washington, USA
Publication of brochure “Battling the hidden enemy”
CNCD media campaign for Barbados and the OECS

42. Thank You