1. CARICOM Regional Policy Dialogues in the Caribbean on Chronic Non- Communicable Diseases Dr. Rudolph O. Cummings MPH, Program Manager, Health Sector Development, Caricom Secretariat Montreal, May 2008

2. CARICOM Regional Situation Mortality and Morbidity

3. CARICOM

7. Potential Impact for BP and Cholesterol Control Barbados: (Hennis et al, 2002) >40 yrs, HBP prevalence = 55% Awareness = 63% Treatment = 54% Control = 19% treatment of those with chronic disease with aspirin and simple drugs to lower blood pressure and cholesterol (18 million deaths averted at a cost of $1.10 per year)

8. CARICOM POS NCD Declaration Update Report

9. CARICOM Achievements – Infrastructure – Secretariat, Plans, M&E (POS #1, 14) Regional –Summit implementation grant from Public Health Agency Canada: $507,000. (Spend by August 08) –PAHO/OCPC/CARICOM Secretariat Meets every 2 weeks, CMO’s chair, D/CFNI, D/CAREC Workplan drafted Sharepoint site under construction

10. CARICOM Monitoring and Evaluation (POS#13,11) Strengthen CAREC's Behavioural surveillance capacity –PAN AM STEPS NCD risk factor surveys, National NCD Capacity Survey, Global School Health Survey Training and execution Data analysis and use to monitor POS Declaration –Decentralization of WHO InfoBase to CAREC –Collaboration with UWI/CAREC on IDB funded surveillance project

11. CARICOM Monitoring and Evaluation (POS#13,14) cont’d Strengthen OCPC coordination capacity – Alafia Samuels on staff from April 1 st 2008 Case study preparation – draft completed –Monitoring and Evaluation Summit Evaluation Framework used to report - v2 now circulated Accepted by Heads in March 08 Process, Output, Indicators, Sources of Data Web-based reporting on sharepoint site (in process)

12. CARICOM Strengthening Country Capacity (POS#2) NCD Policy capacity building workshop for 10 ECC countries and Barbados, October 2007 CARMEN meeting in Bahamas Nov 4 – 8, 2007

13. CARICOM National NCD Summits (POS # 2) Dominica’s PM Skerritt convened National NCD Summit in Dominica 14 Dec 2007 Barbados already has an NCD Commission since January 2007 Trinidad formulating a “Healthy Lifestyles” initiative At Heads Inter-sessional March 08, 5 committed to convene NCD Summit –Guyana, Bahamas, Belize, St Vincent and Grenadines and St Kitts/Nevis

14. CARICOM Tobacco (POS #3,4) Countries who still need to ratify –Bahamas –Haiti –St Kitts and Nevis –St. Vincent & Grenadines –Suriname Letter of Intent to Gates for 5-yr, US$6 million to support Tobacco control in Caribbean, incl. legal support for drafting legislation (POS #3, #4)

15. CARICOM Status of CARICOM COUNTRIES PARTYSIGNED Ratified/Ac ceded/ etc Entry into force Deadline Article 11 Trinidad & Tobago 27 Aug 03 10 Aug 04 27 Feb 05 27 Feb 08 Jamaica 24 Sept 03 7 Jul 05 5 Oct 05 5 Oct 08 Guyana 15 Sept 05 14 Dec 05 14 Dec 08 Barbados 28 Jun 04 3 Nov 05 1 Feb 06 1 Feb 09 St. Lucia 29 Jun 04 7 Nov 05 5 Feb 06 5 Feb 09 Antigua & Barbuda 28 Jun 04 5 Jun 06 3 Sept 06 3 Sept 09 Dominica 29 Jun 04 24 Jun 06 22 Oct 06 22 Oct 09

16. CARICOM PARTY Entry into force Deadline Article 11 Deadline Article 13 Grenada 29 Jun 04 14 Aug 07 14 Nov 07 14 Nov 10 14 Nov 12 St Kits Nevis 29 Jun 04 St. Vincent & the Grenadines 14 June 04 Will ratify Bahamas 29 Jun 04 Suriname Belize Haiti Montserrat Status of CARICOM COUNTRIES

17. CARICOM SUPORTING THE CROSQ PROCESS Jamaica BoS designated to draft new regulations for packaging and labeling Draft standard circulated to member states for review and submission of comments Comments received from some member states Urgent need to strengthen the standard to meet the FCTC obligations CARICOM request to PAHO WDC and OCPC to support the process.

18. CARICOM Healthy Eating (POS # 6,7,8 9) Ministers of Agriculture of CARICOM, St. Ann Declaration, 9 October 2007 Implementing Agriculture and Food Policies to prevent Obesity and NCDs in CARICOM Use Regional and WTO agreements to ensure food security Support the CRNM to pursue fair trade policies Policies that explicitly incorporate nutritional goals Elimination of trans-fats from our food supply using CFNI as a focal point Labeling of foods to indicate their nutritional content; Public education for increased consumption of fruits and vegetables Food Security Plan for prevention and control of NCDs

19. CARICOM Active Living, Caribbean Wellness Day 20 th Sept 2008 (POS #6,10, 12,15 ) Policy dialogue on scaling up physical activity, with CDC 6- 7 May 2008 in POS – –To explore options for sustained physical activity –To present options to private sector meeting May 8 - 9 –To plan for CWD 2008 –Countries now have draft national plans

20. CARICOM Advantages of Risk Charts Simplified, clear message and Cue for lay and PHC workers Reorient perception : practitioners identify total risk Composite risk score : Process for fast-forwarding those at highest risk Risk approach/charts will guide intensification of management, and not reduce treatment goals. Practical for professionals and to patient Empowering of individuals with the information about their risk, how to reduce risk by moving from top right to bottom left in their age and sex category

21. CARICOM Next Steps CMOs approval in Surinam April 21 for MOH introduction Considered 4 instead of 5 levels ( green, yellow, orange, red) Availability of variables in PHC in the Caribbean? Cholesterol testing should be encouraged Pilot testing, perhaps through IDB Surveillance of DM QOC projects CHRC to produce “pocket guidelines” summaries of its existing Clinical Guidelines, and review the proposal to integrate with the Risk Charts to produce “Caribbean Cardiovascular Disease Guidelines”

22. CARICOM Media and Communications Media group established and working virtually Draft plan developed and under discussion Need to document Health Promotion and NCD Prevention and Control activities and initiatives in countries. Activities around World Health Day documented for the first time along sustainable transportation Public and private sharepoint site to share info e.g. TOR from Barbados NCD Commission, program from Dominica NCD Summit

23. CARICOM Involvement of Private Sector, Media (POS #12) CAIC engaged: Private Sector meeting 8-9 May 2008, POS –Hear the business case for Private Sector involvement in NCD prevention and control –Discuss options for interventions (CFNI proposals) –Design a Plan of Action and implementation mechanisms with partners Workplace Wellness incentive-based awards Healthy food policies (America’s / CARICOM Pledge) Media and communications Support for Caribbean Wellness Day-promote a park and biking and walking days

24. CARICOM Next steps First Caribbean Wellness Day – Sept 13 Caribbean 10k in July in Antigua Heads will demonstrate by example of walk to start point NGO forum in October to be coordinated in Barbados for Health NGOs –Prof. Hassel

25. CARICOM THANK YOU