The Chronic Disease problem in the Caribbean – civil society perspective

Twelfth OECS Health Ministers Meeting, 11th September 2009

Prof. Trevor A. Hassell

Chairman of the Healthy Caribbean Coalition, Chairman of the National Commission for

Chronic Non Communicable disease, Barbados

“Three primary risk factors (tobacco, poor diet and physical inactivity) and three intermediate risk factors (hypertension, obesity and diabetes) lead to three diseases (heart disease, lung disease and cancer) resulting in 50% of all deaths”

Source: CAREC, based on mortality reports from countries

Crude Mortality Rates (per 100,000 population) for Select Diseases: (2000-2004)

CARICOM Member States

2000 2001 2002 2003 2004Year

0

20

40

60

80

100

120

140

Rate

s pe

r 100

,000

pop

ulati

on Heart Disease

Stroke

Diabetes

Injuries

Hypertensive Diseases

Cancers

HIV/AIDS

Leading Causes of Death in CARICOM Countries by Sex, 2004 (excluding Jamaica)

1. Heart Disease2. Cancers3. Injuries and violence4. Stroke5. Diabetes6. HIV/AIDS7. Hypertension8. Influenza/pneumonia

1. Heart Disease2. Cancers3. Diabetes4. Stroke5. Hypertension6. HIV/AIDS7. Influenza/pneumonia8. Injuries and violence

MALES FEMALES

Source: CAREC, based on country mortality reports

Potential Years of Life Lost <65years by Main Causes, 2000 & 2004, CARICOM Countries (minus Jamaica)

0 10000 20000 30000 40000 50000 60000 70000

Chronic Disease

HIV/AIDS

Injuries

Y2004

Y2000

Note: Chronic Disease includes heart disease, stroke, cancer, diabetes, hypertension, chronic respiratory disease

‘Injuries’ includes traffic fatalities, homicide, suicide, drowning, falls, poisoning

Source: CAREC, based on country mortality reports

Disability Adjusted Life Years (000) 2002

Mortality Attributable to Select Risk Factors (Latin America & Caribbean) from DCP2

0 100 200 300 400 500

Unsafe sex

Physical inactivity

Low fruits & veg

High cholesterol

Tobacco

Alcohol

Obesity

High BP

Attributable Deaths (thousands)

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Source: Pan Am J Public Health 10(5), 2001; unpublished (CAMDI), Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care)

Caribbean Trends in Diabetes Mortality

20

30

40

50

60

70

80

Rat

e/10

0,00

0

1985 1990 1995 2000

Male

Female

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%

CARICOM

Control of blood pressure would reduce the death rates from Cardiovascular Disease by about 15-20%.

Hypertension

Uncontrolled hypertension contributes to 45% of all ill health from CVD

Hypertension uncontrolled in 80% of hypertensive Barbadians

49 anti-hypertensive drugs available in Barbados National Formulary

Estimated 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

Estimated Cost of Diabetes and Hypertension as percent (%) of GDP

Caribbean Initiatives and Reports

Caribbean Commission on Health and Development Report

Nassau Declaration, CARICOM Heads of Government, 2001

Caribbean Charter for Health Promotion Caribbean Cooperation in Health initiative 1,11, 111 Caribbean Regional Plan for Prevention and Control of

NCDs and Injuries, 2008-2012, PAHO Heads of Government of CARICOM Summit and

Declaration against CNCDs, 2007

Purpose

To bring together a wide spectrum of partners from throughout the CARICOM countries – civil society, the business community, educators and researchers, policy makers to plan civil society’s response to the CNCD pandemic

Objectives

Provide a forum for cross section of representatives from various sectors of society to learn about CNCDs and consider how best to tackle them

Build capacity in important elements of civil society Identify and promote evidence based best practices

for addressing the CNCD epidemic in the Caribbean Strengthen capacity of civil society to monitor

implementation of the POS Summit Declaration Consider resource mobilization

Recent initiatives Ratification of the FCTC Establishment of NCD Commissions Recognition of Annual Caribbean Wellness Day National Chronic Disease Registry, Barbados Risk Factor Surveillance Healthy Caribbean Coalition public education

campaign National Nutrition improvement and salt reduction

Recent initiatives

CNCD National Summits held in Dominica and St. Lucia Blood Pressure Monitoring initiative in barber shops and

hairdressing salons developed in St. Kitts Completion of STEPS survey for CNCDs and risk factors in

Barbados, Dominica, BVI and St. Kitts and Nevis Grenada completed a Workplace Wellness Summit (Part 1) Expert consultations on Cancer Registries in Barbados,

Antigua and Barbuda and Grenada

21

Individual responsibility

Changes to the "toxic" environment

COMMUNITY AND CIVIL SOCIETY

Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention

Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention

POLICY ENACTMENTHEALTH CARE AND DOCTOR

Areas of support and recommendations for further action

Establishment of NCD Commissions in all OECS countries

Ratification and full implementation of FCTC by all OECS countries

Implementation of a population salt reduction programmes in OECS countries

Support by OECS Governments for HCC led public education campaign on NCDs

Areas of support and recommendations for further action

Support for Annual Caribbean Wellness Day Acceptance of Caribbean Civil Society

Declaration and Action Plan for tackling NCDs Official recognition of the Healthy Caribbean

Coalition by OECS Ministers of Health

www.healthycaribbean.org