Mobilising and Empowering Health NGOs and Civil Society in response to the NCDs The Caribbean Health Summit. East Caribbean Conference of Seventh-Day Adventists. August 15, Hilton Hotel, Barbados. Prof. Timothy Roach Hon. Prof. Respiratory Disease, UWI Cave Hill. President, Barbados Cancer Society.

The Chronic Non-Communicable Diseases “the lifestyle diseases” Cardiovascular Disease Cancer Chronic Respiratory Diseases Diabetes

Leading Causes of Death in CARICOM Countries by Sex, 2004 (excluding Jamaica) 1.Heart Disease 2.Cancers 3.Injuries and violence 4.Stroke 5.Diabetes 6.HIV/AIDS 7.Hypertension 8.Influenza/pneumonia 1.Heart Disease 2.Cancers 3.Diabetes 4.Stroke 5.Hypertension 6.HIV/AIDS 7.Influenza/pneumonia 8.Injuries and violence MALESFEMALES Source: CAREC, based on country mortality reports

Source: CAREC, based on mortality reports from countries CARICOM Member States Year Rates per 100,000 population Heart Disease Stroke Diabetes Injuries Hypertensive Diseases Cancers HIV/AIDS

Potential Years of Life Lost <65years by Main Causes, 2000 & 2004, CARICOM Countries (minus Jamaica) 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) Unsafe sex Physical inactivity Low fruits & veg High cholesterol Tobacco Alcohol Obesity High BP Attributable Deaths (thousands)

The Problem “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”

Smoking Causes Death Smoking causes approximately: 90% of all lung cancer deaths in men 80% of all lung cancer deaths in women 90% of deaths from chronic obstructive lung disease

Smoking and Increased Health Risks Compared with nonsmokers smoking increases the risk of— Coronary heart disease by 2 to 4 times Stroke by 2 to 4 times Men developing lung cancer by 23 times Women developing lung cancer by 13 times Dying from chronic obstructive lung diseases* by 12 to 13 times

Smoking and Cancer Smoking causes the following cancers: acute myeloid leukemia kidney cancer cancer of the pancreas bladder cancer cancer of the larynx cancer of the pharynx cancer of the cervix lung cancer stomach cancer cancer of the esophagus cancer of the oral cavity

Tobacco New strategy focus children and inequalities. Tobacco free society Ban smoking in all public places -5 years Total ban -10 years Reintroduce above –inflation price escalator for tobacco products Tough new targets for tobacco smuggling

Adam Smith The wealth of nations 1776 Sugar, rum and tobacco are commodities which are nowhere necessities of life, which are become objects of almost universal consumption and which are extremely proper subjects of taxation.

OBESITY obesity begins in childhood

After a two-year tour of the United States, Michelangelo's David is returning to Italy... His tour sponsors were:

Humans are endowed with an ANCIENT PHYSIOLOGY moulded by famine... … especially when we do so little!.... and ill equipped to handle our modern food environment ….

The recommended diet vs the advertised diet Around three-quarters of food advertising to children is for sugary, fatty and salty foods. For every $1 spent by the WHO promoting healthy diets, $500 is spent by the food industry promoting unhealthy foods

The big Five – the foods that most concern us Snacks Fast foods Confectionery Sweetened cereals Soft drinks Energy-dense and salt rich foods: contribute high proportion of calories to the diet encourage passive over- consumption often displace other healthier foods.

Project key messages Most adults in the Caribbean are already overweight. Modern living insures every generation is heavier than the last – “Passive Obesity”. By % of men and 50% of women could be clinically obese. Without action, obesity related diseases will cost an extra £49.9 Billion per year The obesity epidemic cannot be prevented by individual action alone and demands a societal approach. Tackling obesity requires far greater change than anything tried so far, and at multiple levels; personal, family, community and population. Preventing obesity is a societal challenge, similar to climate change. It requires partnership between government, science, business, and civil society.

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

From community surveys, the prevalence of hypertension in adults 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%.

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 Rate/100, Male Female

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

Estimated Economic Burden ($US Million, 2001) BAHBARJAMTRT Diabetes Hypertension Total

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

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

Healthy Weight, Healthy Lives

2000s: solid evidence “The scientific evidence is compelling. Physical activity not only contributes to well-being, but is also essential for good health.” Professor Sir Liam Donaldson Chief Medical Officer, Department of Health

What makes a civil society network successful ? Integrity Independent of vested and ideological interests Dialogue not partnership that sells the soul Shared values and goals Connected – nexus - real time information Become a player- “plugged in” where it maters- act on the inside and the outside

What makes a civil society network successful? Movers and shakers-public health hero’s - calculated risks Non compromised charities, professional, consumer, social policy and academic groups Powerful individual members and patrons Common issues A social movement Strategic –smart and tactical Focus and clarity about goals

What makes a civil society network successful? Advocacy – clarity – always be the voice of reason and reasonableness – acting in the public interest –advocacy bullets Public opinion Play to strengths of different advocacy styles across membership Media links Ability to respond quickly Handling controversy Forum - hot topics – common positions

What probably makes a civil society network successful? Respect differences and have caveats to not necessarily represent everyone Handling controversy –rapid responses Human rights and freedoms Policy acumen Upstream - high impact : downstream - support Don’t delude your self – do things that matter.

What probably makes a civil society network successful? Marshalling and promulgating evidence and expertise Argue cost effectiveness and cost savings Rock solid ethics Leadership and co-ordination- clear priorities Cross sector and cross government Productive and respectful links to senior civil servants

What probably makes a civil society network successful? Mandates for change- social marketing mix - professional and political mandates Good governance: Wise governance –keep organisations and people linked Good organisation Work together- trust-solidarity Legal protections- cover your back Quality

What probably makes a civil society network successful? Representation Consultations- voice Transparency and openness Membership surveys - sensitive close working links Democratic working Collective bids Gossip, intelligence and ideas

What probably makes a civil society network successful? Power of a public interest alliance Energy, enthusiasm and passion Develop political acumen – nanny state arguments, children, ST benefits, cost savings, co-benefits Cross party political support for issues The hallmark/touchstone of an effective functioning democracy

The role of civil society in promoting the publics’ health Sustainable social change Trusted Independent Non ideological Advocacy – voice amplified by powerful alliances Voice of the less well reached Keeping public health a public good Population health measures

The role of civil society in promoting the publics’ health Countervailing force for the excesses of industry and unhelpful and unproven ideologies Champion of the public interest

Architecture and characteristics Cross government Multi-sectoral Environmental determinants Population and individual Whole systems impact Multiple interventions Natural experiments Lifecourse

51 Individual responsibility Changes to the "toxic" environment COMMUNITY AND CIVIL SOCIETY Complementary approaches to chronic disease prevention POLICY ENACTMENT HEALTH CARE AND DOCTOR