Rudolph Cummings MD, MPH; Program Manager, Health Sector Development, CARICOM

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Addressing NCDs in the RegionThe Role of
CARICOM

• Rudolph Cummings MD, MPH Program Manager,
  Health Sector Development, CARICOM
• 17th February, 2013, Guyana

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Leading Causes of Death in CARICOM Countries by
Sex, 2004 (- 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

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Potential Years of Life Lost lt65years by main
causes, 2000
2004, CARICOM countries (minus Jamaica)
Source CAREC, based on country mortality reports
Note Chronic Disease includes heart disease,
stroke, cancer, diabetes, hypertension,
chronic respiratory disease
Injuries includes traffic fatalities, homicide,
suicide, drowning, falls, poisoning
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Chronic Diseases and their Causes
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NCD 4X4 NCD 4X4 Modifiable causative risk factors for NCDs Modifiable causative risk factors for NCDs Modifiable causative risk factors for NCDs Modifiable causative risk factors for NCDs
NCD 4X4 NCD 4X4 Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol
Noncommunicable diseases Heart disease and stroke ? ? ? ?
Noncommunicable diseases Diabetes ? ? ? ?
Noncommunicable diseases Cancer ? ? ? ?
Noncommunicable diseases Chronic lung disease ?
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Caribbeans leadership on NCD

• NCDs emerged as a priority
• CCH I Nassau Declaration CCHD
• 1986 2001
  2005
• Port of Spain Declaration 2007
• SUMMIT of the America and CHOGM 2009
• Mandate to elevate issue to UN
• UNHLM - CARICOM lead UN Res.64/265

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Mandates

• Global Strategy on Diet Physical Activity and
  Health
• FCTC
• WHA Res 58.22 Cancer prevention and Control

• Port of Spain Declaration
• Strategic Plan of Action for the Prevention and
  Control of NCDS
• NCD Progress Indicator Matrix

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POS NCD Summit Declaration (2007)

• WHAT TO DO
• Tobacco control (3,4)
• Healthy Eating (salt) (6,7,8,9)
• Physical Activity (10, 15)
• Treatment (5)
• WHERE TO DO IT
• Workplace (10)
• Schools (6)
• Faith based org.
• Communities

• HOW TO DO IT
• NCD Secretariat, Plan, ME (1, 14)
• NCD Commissions (2)
• Surveillance, Gender (11, 13)
• Partners private sector, civil society (P)
• Media Communications (12)
• Sustainable financing (4)
• PAHO and CARICOM support

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Strategic Plan - Guiding Principles

• The Caribbean Charter of Health Promotion
• Capacity building Member States through the
  CARICOM/PAHO NCD Secretariat
• Focus on Gender dimensions of the epidemic
• Multi-Sectoral/ Whole of Government Approach
• Integrated Approach to prevention and Control
  across the Life Course

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NCD 4X4 NCD 4X4 Modifiable causative risk factors for NCDs Modifiable causative risk factors for NCDs Modifiable causative risk factors for NCDs Modifiable causative risk factors for NCDs
NCD 4X4 NCD 4X4 Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol
Noncommunicable diseases Heart disease and stroke ? ? ? ?
Noncommunicable diseases Diabetes ? ? ? ?
Noncommunicable diseases Cancer ? ? ? ?
Noncommunicable diseases Chronic lung disease ?
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The Health Promotion Lens
Healthy Public Policy Supportive
Environments Reorient Health Services Empower
Communities Increase Personal Health
Skills Build alliances
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Diet and Nutrition

• Multi-sector Nutrition and Food security Plans/
  legislation
• Promote population and setting specific standards
  for meals
• Reduce Salt, Fat/ Trans Fat, Sugar consumption
• Age appropriate FBDGs
• Provide healthy school meals
• Establish standards
• Marketing of foods to children
• Packaging and Labelling of food products
• Scientific based Public Communication promoting
  healthy eating
• Pricing tariffs incentives for healthy foods
  (access, affordability)

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Physical Activity

• Mandate physical education in population settings
  legislation/ regulations/guidelines
• Increase safe public facilities that enable PA
• Scientific based public communication promoting
  PA
• Develop, implement and or scale up population
  setting based PA programmes
• Schools
• Workplaces
• Geriatric institutions etc

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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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Tobacco Control

• Monitor use of tobacco use and prevention
  policies
• Protect people from tobacco smoke in public
  places and workplaces
• Offer help to people who want to stop using
  tobacco
• Enforce bans on tobacco advertising, promotion
  and sponsorship
• Raise tobacco taxes and prices

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Cigarette price and consumption show opposite
trends (2)Real price of cigarettes and
consumption in South Africa, 1960-2003
Source Van Welbeck 2003
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Alcohol Control

• Legislation, policies
• underage drinking
• Use of alcohol by women of reproductive age
• Curtail advertising and promotion of alcohol
  products targeted to women and children
• Adopt measures in support of an appropriate
  monitoring system for the harmful use of alcohol
• Scientifically based population specific public
  communication

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Proposed CVD InterventionsSalt, tobacco,
treatment

• Globally,18 million deaths averted  at a cost of
  US1.10 per year
• Estimated 38,000 lives saved in CARICOM over 10
  years
• Would add an average of 2 years of life for every
  citizen
• Projected cost lt 1 of existing health budget.

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Commitment

• Establish national level Multi- Sectoral Bodies
  on NCDs
• Develop, implement and monitor multi-sectoral NCD
  national Plans
• Allocate resources for national NCD programmes

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Multi-sectoral Interventions

• Healthy Eating
• Trade policy, agri-food policies, fiscal policy,
• Ministries of Trade, Finance, Agriculture
• Private sector, Civil society, Consumer Affairs,
  Media
• Food manufacturers, importers, providers
• Fast food sector, Restaurants
• Physical Activity
• Urban Planners, Ministries of Transportation,
  Local Government, Education Chambers of
  Commerce, private sector
• Tobacco / Alcohol
• Attorney General, Ministries of Legal Affaires,
  Finance, Trade

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Surveillance and Research

• Establish Health information policy and systems
  for NCDs
• Annual reports Minimum Data Set
• Surveys STEPS , GSHS, GYTS etc
• Evaluate interventions
• Collaborate with academic and research
  institutions
• Ability to disaggregate data age and sex

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Education Promotion

• Caribbean Wellness Day
• National NCD Communication plans
• Scientific based population specific
  communication
• Incorporate prevention and control explicitly in
  poverty reduction and social and economic
  policies
• (www.healthycaribbean.org)

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Disease Management

• Chronic Care Model
• NCD treatment protocols age and gender
  appropriate
• Screening programs for NCDs
• Provide health services PHC
• Establish mechanisms to ensure availability of
  the medications necessary for the long term
  treatment of NCDs when they occur

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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

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Next Steps

• Evaluation of POS at 5
• Revise the NCD Progress Indicator Tool
• Establish a Regional Communications working group
  and Regional NCD Communication framework
• Revisiting Health School Initiative to address
  NCDs
• Focus on Children 2013 Regional Programmatic
  Framework for addressing NCDs among Children
• Make the healthy choice the easy Choice

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The Key to GUYANAs Success . . .
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CARICOM Health Sector Development, Human and
Social Development Directorate

• Dr. Rudolph Cummings
• Programme Manager
• rcummings_at_caricom.org
• Tel [phone] ext 2720

Ms. Renee Franklin Peroune Senior
ProjectOfficer rfranklinperoune_at_caricom.org Tel
2220001-75 ext 2232
https//www.facebook.com/cc.secretariat
www.caricom.org
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