THE POS DECLARATION HEALTHY CARIBBEAN 2012 Dr. Fitzroy J. Henry CARIBBEAN FOOD AND NUTRITION...

THE POS DECLARATION

HEALTHY CARIBBEAN 2012

Dr. Fitzroy J. HenryCARIBBEAN FOOD AND NUTRITION INSTITUTE

(PAHO/WHO)

RALLYING FOR ACTION ON NCD

Kingston, JamaicaMay 28-29, 2012

OUTLINE OF PRESENTATION

• POS - PROGRESS

• POS - CHALLENGES

• POS - ROLE OF CIVIL SOCIETY

POS Progress Indicator Status by theme

1. Commitment2. Tobacco3. Nutrition4. Physical Activity5. Education/Promotion6. Surveillance7. Treatment

NCD Plan NCD Summit National NCD Commissions

NCD Commuica-tions Plan

NCD Budget0

10

20

30

40

50

60

70

80

90NCD Status -Commitment

In process/partial

In place

NCD Progress Indicator

Perc

enta

ge (%

)

FCTC ratified Smoke free public places

Bans on advert-ising & promo-

tion

Tobacco taxes0

10

20

30

40

50

60

70

80

90

100

NCD Status - Tobacco

In process/partialIn place


Perc

enta

ge (%

)

Food & Nutrition

Plan

Policy & standards

Labeling Trade agreements

Trans fat free food

supply

0

10

20

30

40

50

60

70

80NCD Status - Nutrition

In process/partial

In place


Perc

enta

ge (%

)

Mass PA in public spaces

Mandatory PA in schools

Mandatory PA in housing

0

10

20

30

40

50

60

70

80

90

NCD Status - Physical Activity (PA)



Perc

enta

ge (%

)

CWD celebrations ≥ 30 days media broadcast

≥ 50% public and private institutions

with PA and healthy eating programmes

0

10

20

30

40

50

60

70

80

90

100NCD Status - Education/Promotion



Perc

enta

ge (%

)

Global School Health Survey

Global Youth Tobacco Survey

Surveillance: STEPS

Minimum Data Set reporting

0

10

20

30

40

50

60

70

80

90

100NCD Status - Surveillance



Perc

enta

ge (%

)

QOC CVD/ Diab

etics demonstr

ation pro

ject

Chronic

Care M

odel/NCD tr

eatment p

roto

cols

0

20

40

60

80

NCD Status - Treatment

In progress/partialIn place


Perc

enta

ge (%

)

GUYBAR

TRTJAM BER

GRECAY

DOM STLSUR BEL

BVISKN

BAHANT

MONSVG

ANG TCIHAI

0

10

20

30

40

50

60

70

80

90

100

NCD Progress Indicator Status by country

In process/partial

In place

Country

Perc

enta

ge (%

)

SUMMARY OF PROGRESS • Barbados, number one country to fully

implement many of the plans (76%)• Other countries with high

implementation include Jamaica, Guyana and Trinidad and Tobago

• The least complying countries to the recommendations are Haiti, Anguilla and Turks & Caicos

POS Declaration:

essential

but

not sufficient

POS – NCD CHALLENGES

Highest Female (15yr+) Overwt/Obesity in the world (WHO 2011)

Rank Country %

1 Nauru 82

2 Tonga 81

3 Micronesia

79

4 Cook Is. 73

5 Samoa 72

6 Niue 70

7 Kuwait 67

Rank Country %

8 Barbados 63

9 Palau 62

10 Trinidad 61

11 Dominica 60

12 Egypt 59

13 USA 55

14 Jamaica 53

Main Causes of Death in the Caribbean

1980 (%)1. Heart Disease - 202. Cancer - 123. Stroke - 114. Injuries - 85. Hypertension - 66. ARI - 57. Diabetes - 4

Obesity Related = 53%

2000 (%)1. Heart Disease - 162. Cancer - 153. Stroke - 104. Diabetes - 105. Injuries - 76. HIV/AIDS- 67. Hypertension - 6

Obesity Related = 57%

0

20

40

60

80

(%

)

1970s 1980s 1990s 2000s

Male

Female

ADULT OVERWEIGHT/OBESITY TRENDS IN THE CARIBBEAN

Mortality from Coronary Heart Disease in Norway

POLICY GOALS - Norway

• Decrease fat from 40% to 35% through gradual alteration

• Decrease supply of fats replaced by foods containing starch, cereals and potatoes

• Limit the proportion of sugar in the energy supply

POLICY MEASURES TO ACHIEVE GOALS

(Norwegian Ministry of Agriculture, 1975)• Setting consumer and producer

price and income subsidies jointly in nutritionally justifiable ways

• Ensuring low prices for food grain, skimmed and low-fat milk, vegetables and potatoes

• Avoidance of low prices for sugar, butter & margarine

• Regulating food processing, labelling and marketing to promote provision and sale of healthy foods

• Public and professional education and information

Nutrients at Dietary Wholesale Level (Per Person Per Day)

1970 1975 1980 1985 1990 1993

Energy (kcal) Protein (g) Fat (g) Carbohydrate (total)

2860 85 126 352

2900 86 129 345

3170 94 135 390

3020 94 122 378

2910 94 111 377

2980 96 112 392

Starch (g) Sugar (g) Dietary fiber (g)

185 115 -

174 91 21

185 120 23

174 118 24

177 118 22

185 122 23

Percentage Distribution of Energy: Protein Fat Carbohydrate

12 39 49

12 40 48

12 38 50

13 35 51

13 35 52

13 34 53

Source: Norwegian Nutrition Council (1995)

Food Consumption at Wholesale Level (Kg Per Person Per year)

1970 1975 1980 1985 1990 1995 Cereals Potatoes, unrefined Potatoes, refined Vegetables

71 79 7 40

75 71 8 37

80 60 12 51

75 63 17 47

79 51 19 55

81 48 23 58

Fruits Meat Eggs Fish, approximate

67 43 10 30

74 52 10 35

75 55 11

-

85 54 13 -

72 54 11 40

81 59 11 40

Whole Milk (3.8%) Low Fat Milk (1.5%) Skimmed Milk (1.5%) Cheese

172 - 14 9

169 - 28 12

164 - 28 12

124 28 30 13

56 84 31 13

50 85 29 14

Butter Margarine, total Low Fat Margarine Oil & Other Fats

5.4 19 - 4.4

4.7 18 - 4.2

5.6 16 - 4.7

4.8 14 0.2 4.1

3.3 13 2.4 4.0

3.1 14 2.7 3.9

Source: Norwegian Nutrition Council (1995)

Mortality from Coronary Heart Disease in Norway

Energy Consumption/Person - Jamaica

1600

1800

2000

2200

2400

2600

2800

3000

1961-63 1971-73 1981-83 1991-93 2001-03 2005-07

Ca

lori

es

/ca

pu

t/d

ay

Goal

Sugar Consumption/Person - Jamaica

0

100

200

300

400

500

600

1961-63 1971-73 1981-83 1991-93 2001-2003 2005-2007

Cal

ori

es/c

apu

t/d

ay

Imported

Local

Goal

Consumption of Fats & Oils/Person - Jamaica

0

50

100

150

200

250

300

350

400

450

500

1961-63 1971-73 1981-83 1991-93 2001-2003 2005-2007

Cal

ori

es/c

apu

t/d

ay

Imported

Local

Goal

POS – NCD CHALLENGES

1. REFINED STRATEGY

2.COST OF INTERVENTION

Direct Cost of Diabetes & HypertensionCaribbean Countries Total Cost (DM & HTA) (US$ M) Total Cost (DM & HTA) (% PHEx)

Guyana 74.5 211.3

Jamaica 289.0 175.3

Suriname 42.3 122.2

St Vincent & Grenadines 12.2 83.0

Dominica 8.0 69.3

St Lucia 17.0 66.1

St Kitts & Nevis 4.9 47.9

Belize 19.6 47.8

Trinidad & Tobago 131.6 41.0

Barbados 38.1 31.6

Anguilla 1.6 30.5

Montserrat 1.1 27.2

Antigua/Barbuda 7.7 25.7

Grenada 6.0 25.5

BVI 2.6 18.4

Bahamas 34.8 17.6

GIVEN THE CHALLENGES

PRIORITIZE THE APPROACH:-

1. MORE EMPHASIS - To target Obesity/NCDs thru strategies on Food Availability, Accessibility & Consumption

2. Focus on Public Policies – Regulation, Standards and (dis) incentives

POS – NCD CONTROL

ROLE OF KEY ACTORS

1. INTERNATIONAL

2. NATIONAL

3. PRIVATE SECTOR

4. CIVIL SOCIETY

Who would make it?

TRANS FATS – CIVIL SOCIETY ACTION USA TODAY

INT’L NAT’L PRIVSEC

CIVIL SOC

Review taxation to enable access to healthier foods & recreation

XXX X

Importation restrictions, subsidies and taxes

X XXX

Regulate the amount of trans fat, sat fat salt and sugar content of foods

XXX XX X

Nutrient content disclosure; misleading ADs; restrictions on marketing practices in schools; promote marketing health foods.

X XXX XX

Density of fast food outlets; labeling and claims

XX XX XX

KEY ACTIONS TO COMBAT NCDsOBESITY PREVENTION - WHO SHOULD DO WHAT?


CIVIL SOC

Provide subsidies for rural and remote area transport of fresh foods.

XX X

Curb inappropriate advertising and promoting of nutrient poor foods

XX XX XXX

Reshape urban environment towards healthy options

XXX XX

Physical Education in schools XX XX XIncentives for using public transport; urban bicycle loan schemes

XXX X

Expand supply of relevant work force (nutritionists, etc.)

XXX

Develop effective media advertising and public education campaigns

XXX XXX

Enhance food labeling to healthier choices

X XX XX XXX

Embed PA and healthy eating in school, workplace and community

XX XXX

KEY ACTIONS TO COMBAT NCDsOBESITY PREVENTION - WHO SHOULD DO WHAT?


CIVIL SOC

Reshape consumer demand to low risk drinking – marketing etc

XX XXX x

Reshape supply to low-risk products - Taxation

X XXX x

Legislation on responsible serving of alcohol

XXX

KEY ACTIONS TO COMBAT NCDsALCOHOL - WHO SHOULD DO WHAT?


CIVIL SOC

Classify films RE: Smoking X XX XX XConsumer info - Larger and more warnings labeling etc.

X XXX XX

Increase frequency, reach and intensity of campaigns

X X XXX

Promote smoke-free policies in public places

X XXX XX

Ensure cigarettes become significantly more expensive

XX XX X

Regulate the supply of tobacco products and exposure to tobacco smoke

XXX

Ensure smokers are encouraged to quit when contacting health services.

XXX XX

KEY ACTIONS TO COMBAT NCDsTOBACCO - WHO SHOULD DO WHAT?

SUMMARY• POS: PROGRESS - ACHIEVEMENTS

• POS: CHALLENGES - COST & APPROACH

• POS: KEY ROLE OF CIVIL SOCIETY

THANK YOU

THE POS DECLARATION HEALTHY CARIBBEAN 2012 Dr. Fitzroy J. Henry CARIBBEAN FOOD AND NUTRITION...

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Transcript of THE POS DECLARATION HEALTHY CARIBBEAN 2012 Dr. Fitzroy J. Henry CARIBBEAN FOOD AND NUTRITION...