1. June 6 th, 2013 Aruba BERMUDA PERSPECTIVE The Hon. Patricia Gordon-Pamplin JP,MP Minister of Health and Seniors

2.  Background: Bermuda island  The Problem  Strategies  Current Interventions  Looking Ahead

4.  Island of 21 square miles in mid-Atlantic Ocean (700 miles east of North Carolina, USA)  UK Overseas Dependent Territory  Population: 64, 237 residents * 50, 565 Bermudians * 13, 516 Non-Bermudians * 11,492 approx. visitors * 22% population under age 20  Racial Composition: 54% Black, 31% white, 4% Asian, ~ 11% multi- racial

5.  Industries: finance, insurance and re-reinsurance, tourism  Median annual income: $106, 389 BMD  Household Expenditures: * Bread or Milk = $6 * 1 apple = $1.30 * Average home costs nearly $1 million * Average monthly rent $1700 (one bedroom)  Inflation rate 2.1 % (March 2013) Health & Personal care increased 7.7 %  Educational attainment: 29% four years college degree, 38% high school completion; 23% two years technical or vocational school, 8% no high school diploma

6.  Vision: “Healthy people, in healthy communities”  Ministry of Health and Seniors Mission: To serve as the Policy Directorate for Bermuda’s Health System  Department of Health Mission: To promote and protect the physical, psychological and social well being of the community, to enable the island’s residents to realize their optimum quality of life.

7. “Epidemic” levels of diabetes, overweight & obesity in adolescents and seniors (Health in Review, 2011)  School Health Assessments: 63% normal BMI 31% BMI > 85% centile (overweight) 6% below 5 th centile steady 5-year trend upward

8. Complications of Overweight and Obesity:  Heart disease : Leading cause of death; 41 % all deaths in Bermuda (2006)  Diabetes: rate at least 13% (Highest in OECD, twice OECD average, 6.3%)  Hypertension: ↑ 25% to 36% in 5 yrs. 18-34 yr. age group doubled to 13% Kidney failure: $24 mil/year spent on dialysis in Bermuda

9.  Health promotion & education  Healthy Policy development  Collaboration with public and private partners

10. 1. Well Bermuda: National Health Promotion Strategy Healthy Weight Action Plan * Move More Bermuda! * Celebrating Wellness * Childhood Wellness Action Group 2. Healthy Schools : Comprehensive School Health Program 3. Community Collaborations— there are many

11. National Health Promotion Strategy A unifying vision and voice A point of convergence for health promoters

12. Healthy People: Diseases & Conditions Healthy Weight, Heart health, Cancer, Diabetes, Kidney Disease, Sexual health, Asthma and Mental Health Healthy Families: Population Groups Parenting, Childhood, Seniors and Disability Healthy Communities: Environment Vector control, Smoke and drugs, Road safety, Stopping the Violence, Respect for the environment, and Emergency preparedness

13. Comprehensive School Health Program  Since 1997, is a partnership between the Ministry of Education and the Department of Health.  Coordinates school health services, programs and initiatives provided by the government and community health partners, thus reducing gaps and duplication.  Promotes health through eight interrelated components of health (CDC model for school health): Health Education; Physical Education; Health Services; Nutrition Services; Counseling, Psychological and Social Services; Healthy & Safe School Environment; Health Promotion for Staff; and Family, Parent and Community Involvement. Evaluation Annually, assesses 33/34 schools’ level of compliance to all school health policies and relevant Bermuda Laws through the Healthy Schools Components and Standards.

14.  Engagement with Bermuda Diabetes Association, Bermuda Heart Foundation, Bermuda Cancer & Health Centre, Child & Family Services, Bermuda Police Service, Child & Adolescent Services, Department of Youth, Sport & Recreation, Department of Drug Control, Churches, Insurance companies,….

18.  Research: STEPwise approach to chronic disease risk factor surveillance (WHO/PAHO supported)  Enhanced community assessments: * Agree on definitions * Increase number of children assessed for obesity / overweight * Implement Global School-based Student Health Survey  Policy Changes: * Advocate for a Healthy Environment * Mandate Physical Education Curriculum * Advocate Baby Friendly culture: Protect and support Breastfeeding * Standards of Health Care: Improve prevention and standardize health messages