CARICOM Heads of Government Summit on Chronic Diseases

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CARICOM Heads of Government Summit on Chronic
Diseases

• Presentation of Prime Minister Denzil Douglas

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Overview of Presentation

• Global situation with Chronic NCDs
• Caribbean situation and costs
• Caribbean Response
• Exploding common myths
• Review of effective interventions
• The Way Forward
• Addressing the risk factors
• Globalisation and health

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Globalisation and HealthTHE MALADIES OF
AFFLUENCE
The Economist, August 11th 2007
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• The poor world is getting the rich worlds
  diseases
• Europeans have been exporting their maladies
  throughout history. They seem to be doing it
  again, but in a new way. In the past the problem
  was infection. Now illnesses associated with
  Western living standards are the fastest growing
  killers in poor and middle-income countries.
  Chronic disease has become the poor worlds
  greatest health problem.
• The Economist, August 11, 2007

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Chronic Diseases and their Causes

• Chronic Diseases
• Heart Disease, Stroke, Cancer, Diabetes, Chronic
  Respiratory Disease
• ?
• Biological Risk Factors
• Modifiable overweight, high cholesterol, high
  blood sugar, high blood pressure
• Non-modifiable Age, Sex, and Genetics
• ?
• Behavioral Risk Factors
• Tobacco use, physical inactivity, unhealthy diet,
  alcohol abuse
• ?
• Social and Environmental Determinants
• Social, economic and political conditions such as
  income, living and working conditions, physical
  infrastructure, environment, education,
  agriculture, and access to health services
• ?
• Global Influences
• Globalization of food supply, urbanization,
  technology, migration

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Distribution of Deaths by Major Cause in the World
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Distribution of Deaths from Infectious and
Chronic Disease by Income Category, 2005
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Source CAREC, based on mortality reports from
countries
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Leading Causes of Death in CARICOM Countries by
Sex, 2004 (MINUS Jamaica)
MALES
FEMALES

1. Heart Disease
2. Cancers
3. Diabetes
4. Stroke
5. Hypertension
6. HIV/AIDS
7. Influenza/pneumonia
8. Injuries and violence

• Heart Disease
• Cancers
• Injuries and violence
• Stroke
• Diabetes
• HIV/AIDS
• Hypertension
• Influenza/pneumonia

Source CAREC, based on country mortality reports
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Disability Adjusted Life Years (000) 2002
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Prevalence () of diabetes among adults in the
Americas
Source Pan Am J Public Health 10(5), 2001
unpublished (CAMDI), Haiti (Diabetic Medicine)
USA (Cowie, Diabetes Care)
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Caribbean trends in Diabetes mortality
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A consequence of Diabetes
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Amputations at the QEH 2002-2006
Diabetic Non diabetic
Male 308 116
Female 379 120
Total 995 236
Source A. Hennis, 2007
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Age adjusted death rates/100,000 population from
Diabetes (2000)
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• From community surveys, the prevalence of
  hypertension in adults 25-64 years of age was
• Barbados 27.2
• Jamaica 24.0
• St. Lucia 25.9
• The Bahamas 37.5
• Belize 37.3
• Trinidad TBD
• Control of blood pressure would reduce the death
  rates from Cardiovascular Disease by about
  15-20.

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Age adjusted death rates/100,000 population from
Hypertension (2000)
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Projected national income lost from NCDs (
2005-2015)
Projected
National
Income
Lost
from
NCDs


2005
-2015,
USBN
600
500
400
300
200
100
0
Bra
Can
Chi
Ind
Nig
Pak
Rus
UK
Tan
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Possible 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
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Total cost of DM and H/T as percent of GDP
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Exploding the Myths

• Myth Chronic diseases are a problem of the rich
  countries
• Fact Non-communicable disease account for more
  than half the burden of disease and 80 of the
  deaths in the poorer countries which carry a
  double burden of disease.

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Developing countries carry a double disease
burden
Percentage of deaths by cause
Low- and Middle-income countries
High-income countries
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Exploding the Myths

• Myth NCDs are a problem only of the elderly
• Fact Half of these diseases occur in adults less
  than 70 years of age and the problems often
  begin in the young e.g., obesity
• Myth NCDs affect men more than women
• Fact NCDs affect women and men almost equally
  and globally, heart disease is the largest cause
  of death in women.

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Exploding the Myths

• Myth NCDs cannot be prevented
• Fact If the known risk factors are controlled,
  at least 80 of heart disease, stroke and
  diabetes and 40 of cancers are preventable, and
  in addition there are cost-effective
  interventions available for control.

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Exploding the Myths

• Myth people with NCDs are at fault and to be
  blamed because of their unhealthy lifestyles
• Fact individual responsibility, while important,
  only has full effect where people have equal
  access to healthy choices. Governments have a
  crucial role to play by altering the social
  environment to help make the healthy choice the
  easy choice.

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Exploding the myths

• Myth my grandfather smoked and lived to 90
  years, and everyone has to die of something
• Fact While some people who smoke will live a
  normal lifespan, the majority will have shorter,
  poorer quality lives. And yes, everyone has to
  die, but death does not need to be slow, painful
  or premature, as is so often the case with NCDs

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What works?

• A small shift in average population levels of
  several risk factors can lead to a large
  reduction in chronic diseases
• Population wide approaches form the central
  strategy for preventing and controlling chronic
  disease epidemics, but should be combined with
  interventions for individuals
• Many interventions are not only effective, but
  suitable for resource constrained settings

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Finland Dramatic Declines in NCD Mortality
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Relation of fitness to mortalityTT, St. James
Cardiovascular Study

• 1309 men had blood sugar, cholesterol, fitness
  measured at baseline and then followed up
  carefully for 7 years.
• Unfit men compared with fit men were
• - 3.6 times more likely to die
• - 2.5 times more likely to have a heart
• attack

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Caribbean Responses

• Since the 1960s, history of collective action in
  health, formalized in 1986 as the Caribbean
  Cooperation in Health (CCH) initiative.
• Countries, CAREC, CFNI and CHRC, CARICOM
  secretariat, PAHO/WHO and partners have had
  successes e.g.,, malnutrition and
  gastroenteritis, vaccine preventable diseases,
  HIV/AIDS (p (PANCAP).
• CCH now entering 3rd phase major thesis that
  Caribbean health can be improved through actions
  taken universally and collectively.
• Current priorities for action under CCH include
  chronic diseases where the cited goals are to
  reduce deaths by 2 per year and to reduce
  serious, costly complications such as amputations
  or renal failure.

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Caribbean Responses Summarised
Source PAHO Survey of NCD National Response
Capacity, 2005
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Addressing the risk factors

• Tobacco and alcohol
• Increase taxes with proceeds to prevention and
  treatment
• Ban smoking in public places
• Ban smoking in all schools
• Ban cigarette and tobacco advertising near to
  schools
• Curtail promotion of alcohol products targeted to
  women and children
• Establish target dates for passage of the legal
  provisions in the FCTC already ratified.

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Addressing the risk factors

• Physical activity
• Have physical education compulsory in schools and
  provide the facilities
• Provide healthy, secure exercise spaces
• Provide wellness centers
• Give tax relief for worksite exercise facilities

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Addressing the risk factors

• Improve dietary practices
• Promote a standard of meals in public eating
  places eg. eliminating trans fats
• Provide healthy school meals
• Establish community based networks for training
  in preparation of health foods
• Mandate RNM to investigate the trade issues which
  impact negatively on healthy food imports
• Promote elimination of trans fats from Caribbean
  diets

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Addressing the risk factors

• In the case of cancer
• Primary prevention
• Eg screening and vaccination to prevent
• cervical cancer
• Promote screening for breast cancer

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Secondary prevention

• Screening programs for NCDs
• Provide health services with resources to apply
  the established cost-effective interventions
• Establish mechanisms to ensure availability of
  the medications necessary for the long term
  treatment of NCDs when they occur

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Critical other recommendations

• Establish national level Commissions on NCDs
• Mandate CAREC to establish a system of behavior
  and risk factor surveillance
• Insist on the updating of the Caribbean Regional
  Plan of Action for NCDs
• The Caribbean should name a CARIBBEAN WELLNESS
  DAY

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• Involve Partners
• PAHO/WHO
• Financial institutions
• Caribbean social partners private sector and
  civil society
• Monitoring and evaluation
• Designate CARICOM/PAHO as the joint Secretariat
  with responsibility for monitoring and reporting
  progress in the control of the NCDs.

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The way forward

• First We can utilize the policy instruments at
  our disposal
• legislation
• taxation
• regulation
• Second We should establish partnerships
• Third We must take personal responsibility and
  lead by example

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CONCLUSIONS

• The Caribbean has a very serious problem -
  getting worse
• Economically and socially, it is not sustainable
• There are cost-effective interventions that work
  why not utilise them?
• We must put into effect National and
  Caribbean-wide (CCH) plans
• It is CRITICAL to strengthen health services to
  for management and control of chronic diseases
• Deepened partnership with public and private
  sector, and civil society absolutely needed