INTERNATIONAL BUSINESS WEEK The Changing Dynamics:

Driving Innovation, Prosperity and Health Hilton Barbados Resort, October 8 – 9 2015

GLOBAL POPULATION GROWTH – KEY TO UNDERSTANDING THE FUTURE

T Alafia Samuels

Deputy Dean, Research and Graduate Programmes

Faculty of Medical Sciences

LIFE EXPECTANCY AND POPULATION COMPOSITION

Prepared by Ian Hambleton, CDRC, September 2015

International LE targets met by most countries

…population growth has dropped to replacement levels and life expectancy is relatively high…

A positive picture. But not the whole picture…

Regional LE in the Americas 1970 - 2010

Prepared by Ian Hambleton, CDRC, September 2015

Country LE in the Caribbean 1970 – 2010

“Monitoring variation within the Caribbean”

1965–70 2005–10

Prepared by Ian Hambleton, CDRC, September 2015

Aging

• Life Expectancy is increasing

• Populations are aging

• Age distributions vary – population pyramids

Population Pyramids

Population Pyramids in U.S. cities

Proportion of Population 60+

Four Key Drivers of Rapid Changes in Life Expectancy and Health Profiles

1) Demographic transition

– increasing population size, falling death rates, aging of the population, (migration).

2) Epidemiological (Cause of death) transition

– proportion of deaths shift from Communicable Diseases to Non Communicable Diseases and injuries, despite HIV.

3) Disability transition

– shift to diseases that cause disability but not substantial mortality.

4) Risk transition

– from poverty-related to “modernization” risks – physical inactivity, unhealthy eating, tobacco use and alcohol abuse

COMMUNICABLE DISEASES TO NON COMMUNICABLE DISEASES (NCD)

Mortality - Select Regions

14% 8% 13%

68%47% 56%29%

10%29% 30%

21%

15%

10% 6%

37%

7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Americas Europe SE Asia Africa

Communicable diseases Other NCDs

Preventable premature NCD deaths Injuries

Source: Dr. Ala Alwan, ADG, WHO: U.N. Briefing on NCDs, Feb 2010

Source: PAHO Basic Indicators 2012

Caribbean NCD mortality

• NCDs and their risk factors responsible for 78% of all deaths in 2010

• 76% of all premature deaths (ages 30 – 69) are caused by NCDs

• Premature deaths from NCDs in Caribbean more than double rates in North America

• NCDs are overwhelming health services

Top Ten Causes of Death in Barbados 2009 (Source: Barbados MOH Statistical Unit)

1 Ischaemic heart disease (heart attack)

2 Diabetes mellitus

3 Cerebrovascular disease (stroke)

4 Hypertensive heart disease

5 Prostate Cancer

6 Septicemia

7 Influenza

8 Colon, rectum and anal cancer

9 Unspecified cancers

10 Cardiac arrest

NCD RISK FACTOR PROFILES

NCDs: Risk factors 4 Diseases, 4 Modifiable Shared Risk Factors

Tobacco

Use

Unhealthy

diets

Physical

Inactivity

Harmful

Use of

Alcohol

Cardio-

vascular

Diabetes

Cancer

Chronic

Respiratory

Evolution of the Problem

Risk Transition

Poor nutrition now affects all parts of the worldPoor nutrition now affects all parts of the world

China Tanzania

Liang Liang smoking since age 1-1/2

Warning! Warning!

High Rates of Alcohol Abuse

• Binge drinking:

5+ drinks (men); 4+ (women) at one time in last 7 days

Among MEN

Barbados (2012) 25%

Dominica (2008) 33%

Trinidad & Tobago

(2012) 34%

The man problem

• Higher rates of alcohol abuse and tobacco use

• Higher rates of injuries

• Low health service utilization

• Worse control of chronic conditions

• Higher death rates at every age

18.9% 24.8%

40.9% 23.9%

40.2% 51.3%

0%

20%

40%

60%

80%

100%

Females Males

Among all patients with Diabetes, proportions with BP controlled

Not hypertensive HBP, Rx, controlled

BP >140/90

17.9% 27.9% 7.1%

23.3%

75.0% 48.8%

0%

20%

40%

60%

80%

100%

Women Men

Medication status in population with diabetes and uncontrolled BP

Undiagnosed Not taking Rx

On Rx, not controlled

ECONOMIC IMPACT OF NCDS

These data were provided by Dr. O. Abdullahi Abdulkadri

Economic Burden of Diabetes and

Hypertension in Selected Caribbean Countries

(2001)

0

2

4

6

8

10

The Bahamas Barbados Jamaica TRT

Perc

en

tag

e o

f G

DP

(%

)

DIABETES HYPERTENSION BOTH

THE RESPONSE TO THE NCD EPIDEMIC

In response to the NCD epidemic: September 2007 CARICOM Heads of Government issued

the groundbreaking Port of Spain Declaration:

Uniting to Stop the Epidemic of Chronic Non-communicable Diseases

With its global resonance, the Declaration paved the way

for: 2011 UN High-Level Meeting (UNHLM) on NCDs

World Health Organization’s international monitoring framework, with nine global targets and 25 indicators

Mandates and Commitments

The Declaration recommends:

• “All of Government” and “All of Society” response

• National, multi-sectoral NCD Commissions

• Risk factor reduction, including:

o implementation of Framework Convention on Tobacco Control (FCTC)

omulti-sectoral food and nutrition plan

opromotion of physical activity in schools and workplaces

• Improved quality of care for those living with NCDs

• Workplace Wellness Programmes

• Caribbean Wellness Day

CARICOM / PAHO

NCD plan for countries

PRESERVING YOUR WORKFORCE

Health risks increase health costs – The relationship between modifiable health risks and

health care expenditures:

Staff who are/have:

Depressed 70% higher annual health plan costs.

Stressed 46% higher annual health plan costs.

Obesity 21% higher annual health plan costs.

Smokers 20% higher annual health plan costs.

Not exercising 10% higher annual HPC

High Blood pressure 12% higher annual HPC

Elevated blood sugar 35% higher annual HPC

Source: Goetzel RZ, et.al (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database JOEM, 40(10):843-54.

The World Economic Forum: Workplace Wellness Alliance

• Workforce is affected by reduced productivity and

increased costs from chronic diseases; while the need for skilled talent rises as economies grow and mature.

• Public-private partnerships are key to managing NCDs

• The workplace can be used to drive the response required, bringing benefits to the employer, employee and community.

• Establish the underlying business rationale for investing in health and well-being – decrease costs and improve productivity

– ROI of US$ 3.27:$1 for wellness programmes (Baicker, Cutler, & Song, 2010).

• Private Sector Response Recommendations

• Start with simple worksite wellness focused on physical activity and healthy nutrition

• Follow up with Comprehensive wellness policy

• Private business sector - major role in multi-sectoral response through partnership with government and civil society “all of society”

• Offer healthier products

UWI MODEL FOR WORKPLACE WELLNESS

University of the West Indies Healthy Campus Initiative

Cave Hill 2010:

Health Risk Assessment, Workplace Wellness Program

St. Augustine 2014: Preventive Medicine Physician visits at

the workplace

Step 1 – Document risk Health Risk Assessment (HRA)

• Demographics

• Tobacco, Alcohol,

• Diet, Physical Activity

• Health and Illness

• Stress and Emotional Health

Point of Care Testing

Cardiochek PA

• Chol, HDL, glucose

Urinalysis

• Protein, ketones, blood, albumin

Physical Measurements

with Nurse

Preventive care Doctors

visit (30 minutes)

Step 2 – Analysis of risk

Activity Levels Among for 269 UWI CHILL staff:

NCD risk factor survey 2010

20%

5%

29%

33%

51%62%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Males (n=80) Females (n=189)

Inactive

Moderately active

Highly active

Step 3: Evidence-based Interventions

• Red Risk Group: – Living with NCD (HBP, diabetes)

– High healthcare expenses

– Disease Management

• Yellow Risk Group: – Multiple risk factors, No overt

disease

– On-going monitoring

• Green Risk Group: – Fewer risks.

– Workplace Wellness

Step 3: Evidence-

based Work place

Wellness program

Recommended: Disease Management

• Disease management programme for those workers living with hypertension, heart disease and diabetes. – Our doctors will come to the work place for

confidential medical follow up if required and requested by the client.

• Focused on – Newly diagnosed disease from workplace screening

– No personal physician

– Reluctant men

Something to Consider

The total Functional Capacity of your company is the sum of

all the capacities of your individual employees

Lift the functional capacity

of your people and you lift

the competitive advantage

of your entire company

References • Hambleton IR, Jeyaseelan S, Howitt C, Sobers-Grannum N, Hennis AJ, Wilks RJ,Harris

EN, MacLeish M, Sullivan LW; US Caribbean Alliance for Health Disparities Research Group. Cause-of-death disparities in the African diaspora: exploring differences among shared-heritage populations. Am J Public Health. 2015 Jul;105Suppl 3:S491-8

• Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, Murray CJ; Comparative Risk Assessment Collaborating Group. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med. 2004 Oct;1(1):e27.

• World Economic Forum: Working Towards Wellness, Accelerating the prevention of chronic disease

• Unwin N, Rose AMC, George KS, Hambleton IR, Howitt C. The Barbados Health of the Nation Survey: Core Findings. Chronic Disease Research Centre, The University of the West Indies and the Barbados Ministry of Health: St Michael, Barbados, January 2015

• Institute for Health Metrics and Evaluation. The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA: IHME, 2013.

• World Health Organisation: Global Burden of Disease 2004 update • Barbados Strategic Plan for the Prevention and Control of Non-Communicable

Diseases 2015-2019:National NCD Commission Barbados, December 2014 • Creating Healthy Workplace: Planning a Staff Wellness Progam: Scott and White

Healthcare • Healthy Caribbean Coalition: The Caribbean Private Sector Response to NCDS: A

Situational Analysis and Framework for Action • Pan American Health Organization: Advancing the NCD Agenda in the Caribbean • Shiyan Chao, World Bank: Economic Impact on NCDs in the Caribbean. Caribbean

Health Financing Conference, Jamaica, 2013

Contact Info

T. Alafia Samuels MBBS, MPH, PhD

Deputy Dean, Graduate Studies and Research

Senior Lecturer, Epidemiology and Public Health Faculty of Medical Sciences

University of the West Indies, Cave Hill Campus

Barbados

Tel (C) : (246) 238-2940

Tel (W): (246) 417-4174

Consultant: Chronic Disease Prevention and Control / Workplace Wellness Progams

“Make no small plans; they have

no magic to stir men’s blood”

Daniel Burnham, 1893