1. Caribbean Commission on Health & Development FOLLOW UP REPORT OF THE CARIBBEAN COMMISSION ON HEALTH AND DEVELOPMENT Presented to the 27 th Meeting of the Caribbean Heads of Government St.Kitts and Nevis July,2006 George Alleyne

2. Caribbean Commission on Health & Development  In the presentation of the CCHD one year ago, I emphasized that the major health /disease problems that the Caribbean would have to face in the immediate future were; Non Communicable Diseases HIV/AIDS Injuries and violence

3. Caribbean Commission on Health & Development With respect to HIV/AIDS  “ Several recent developments in the Caribbean region ( in Bahamas, Barbados, Bermuda, Dominican Republic and Haiti ) give cause for guarded optimism-with some HIV prevalence declines evident among pregnant women, signs of increased condom use among sex workers and expansion of voluntary testing and counseling”. (UNAIDS, 2005)

4. Caribbean Commission on Health & Development Estimated deaths from AIDS during 2004 Total: 3.1 (2.8 – 3.5) million Western & Central Europe 6 500 [<8 500] North Africa & Middle East 28 000 [12 000 – 72 000] Sub-Saharan Africa 2.3 million [2.1 – 2.6 million] Eastern Europe & Central Asia 60 000 [39 000 – 87 000] East Asia 51 000 [25 000 – 86 000] South & South-East Asia 490 000 [300 000 – 750 000] Oceania700 [<1 700] North America 16 000 [8 400 – 25 000] Caribbean 36 000 [24 000 – 61 000] Latin America 95 000 [73 000 – 120 000] UNAIDS

5. Caribbean Commission on Health & Development 3.1 million deaths from AIDS in the world in 2004 (30,000 in the wider Caribbean) (1137 in CMC’s in 2003) 35 million deaths from NCDs projected in the world in 2005 (30,785 in JA, TRT,GUY, BAR in 2001)

6. Caribbean Commission on Health & Development  The reason for showing these data on AIDS and NCDs is not to seek any diminution of effort over HIV/AIDS. The Caribbean should be proud of what it has done and should continue.  The reason is to stimulate similar concern and ACTION with regard to NCDs at the level of the Heads of Government

7. Caribbean Commission on Health & Development

8. Caribbean Commission on Health & Development Non communicable diseases 1-The evidence The relative and absolute magnitude of the problem The economics of the problem 2-The possible solutions At the population level At the individual level

9. Caribbean Commission on Health & Development 1980 (%) 1.Heart Disease - 20 2.Cancer - 12 3.Stroke - 11 4.Injuries- 8 5.Hypertension - 6 6.ARI- 5 7.Diabetes- 4 2000 (%) 1.Heart Disease- 16 2.Cancer- 15 3.Stroke- 10 4.Diabetes- 10 5.Injuries- 7 6.HIV/AIDS - 6 7.Hypertension- 6 Major causes of death in the Caribbean

10. Caribbean Commission on Health & Development Age Adjusted Death Rates For Selected Cardiovascular Conditions, late 1990’s, Per 100,000 Cause Bar TrT Cub Arg Can USA Stroke81.0 94.9 48.1 48.4 24.2 26.9 CHD55.8 151.2 104.9 44.3 77.6 86.2 HHD12.1 31.5 7.5 9.0 2.2 8.2 DM266.8 108.2 14.5 15.5 10.4 13.7 PAHO 2004, Page 87

11. Caribbean Commission on Health & Development Disability Adjusted Life Years (DALYs) 2001

12. Caribbean Commission on Health & Development Costs (US $ Million)for treatment of all diabetes and hypertension DiabetesHypertension TOTAL Bahamas 23.31137.20360.514 Barbados 30.97260.76591.737 Jamaica 140.121191.633331.754

13. Caribbean Commission on Health & Development % deaths due to selected risk factors BARBADOS % deaths GUYANA % deaths High BP17.6High BP18.8 High BMI (Obesity) 8.8High BMI (Obesity) 10.0 Tobacco7.4Unsafe sex7.9 High Cholesterol 5.9Alcohol7.2 Alcohol5.5High Cholesterol 6.0 Physical inactivity 4.5Tobacco5.7 Unsafe sex4.0Physical inactivity 4.3

14. Caribbean Commission on Health & Development % deaths due to selected risk factors Jamaica % deaths T&T % deaths High BP21.3High BP20.6 High BMI (Obesity) 14.0High BMI (Obesity) 17.8 Tobacco7.7High Cholesterol9.6 Alcohol5.1Tobacco8.4 Physical inactivity 5.0Low fruit and veg intake 7.3 High Cholesterol4.9Physical inactivity7.3 Low fruit and veg. intake 4.6Alcohol7.2

15. Caribbean Commission on Health & Development Population based policy interventions for control of NCD’s especially CVD. 1.Fiscal policies 2.Regulations and standards 3.Education and health promotion 4.Policies to workers and communities 5.Tobacco control

16. Caribbean Commission on Health & Development Combat tobacco use --tax tobacco products --restrict smoking in public places- --provide replacement therapy and cessation tools Policies to promote exercise and healthy weights-NB physical ed. in schools Policies to reduce in the population intake of salt, unhealthy fats, and excess calories Reduce death from Cardiovascular Disease

17. Caribbean Commission on Health & Development Source: Saloojee 1995 Price of cigarettes and consumption in S.Africa

18. Caribbean Commission on Health & Development Source: Jha and Chaloupka, 1999, 2000

19. Caribbean Commission on Health & Development Specific policy recommendations to the Heads of Government 1-Combat tobacco use tax tobacco products ban smoking in public places 2-Target children make physical education compulsory ensure healthy school meals restrict advertising that promotes unhealthy diets 3-Make regulations and standards ensure marketed foods show calorie & fat content regulate importation of fats (consult RNM)

20. Caribbean Commission on Health & Development. © Gaziano 2001

21. Caribbean Commission on Health & Development Annual risk of recurrence Aspirin vs. nothing5% vs. 7% Aspirin + BP↓ (diuretic & ACEI) vs. Aspirin alone 3% vs. 5% Aspirin + BP↓ + statin (chol. lowering) vs. Aspirin + BP↓ alone 2% vs. 3% Daily use of 3 or 4 generic drugs could prevent 2/3 of the risk of stroke or heart attack recurrence, at least for several years. Long term treatment after a non-fatal stroke or heart attack (secondary prevention)

22. Caribbean Commission on Health & Development And finally The Ministers of Health in COHSOD have developed a Regional Strategic Plan which deals not only with the policy issues highlighted here, but with all aspects related to the control of NCDs. This plan is yet to be funded and made operational. The Plan should be supported.

23. Caribbean Commission on Health & Development Specific policy recommendations to the Heads of Government 1-Combat tobacco use tax tobacco products ban smoking in public places 2-Target children make physical education compulsory ensure healthy school meals restrict advertising that promotes unhealthy diets 3-Make regulations and standards ensure marketed foods show calorie & fat content regulate importation of fats (consult RNM)