Chronic Disease Policy in Barbados: analysis and evaluation of policy initiatives Promoting Healthy Living in the Americas: Multi- sectoral Interventions to reduce health risks factors Washington, DC, November 18th, 2013 Trevor Hassell, MBBS, FRCP, FACC. Chairman National NCD Commission, Barbados

NCD policies - Barbados Barbados National Strategic Plan for Health, Strategy for the Prevention and Control of Chronic NCDs, 2004 Strategic Plan for the National Chronic Non Communicable Disease Commission, 2009 – 2012 Regional and international commitments, plans and declarations

Outline Challenges and opportunities in the design and implementation of multi-sectoral NCD policies Strategies used to involve stakeholders in the implementation of these policies /activities Next steps in the future implementation of multi-sectoral policies Concluding remarks

Challenges and opportunities in the design and implementation of multi- sectoral NCD policies An analysis of The National NCD Commission Barbados TA Hassell, Chairman of the NCD Commission Chronic Disease Policy in Barbados: Analysis and Evaluation of Policy Initiatives. C Guell, TA Samuels, TA Hassell and N Unwin Personal observations

Challenges to NCD policy implementation - Government Apparent low priority by Non health sectors of Government NCDs not fully incorporated in National Development agenda Linkage between NCDs and climate change, saving of foreign exchange, greening of Barbados and energy conservation not recognised NCD policy and stakeholder action not significantly informed by National NCD Surveillance data Perceived communication gap between Ministry of Health and health NGOs Nonexistence of a National NCD communication plan Absence of an NCD health economist

Challenges to NCD policy implementation – Civil society NGOs often lack the capacity to contribute effectively Absence of a strong tradition of health advocacy NGOs consider themselves to be on the periphery of policymaking Insufficient information about evidenced based best practice by NGOs Limited monitoring and reporting by health NGOs Absence of tradition of collaboration between often competing disease specific NGOs NCD effort not prioritised by non-health sectors of civil society – a few exceptions

Challenges to NCD policy implementation - Private Sector Not appreciative of their role in addressing the NCD challenge Not aware of the financial cost of NCDs to their companies Priority given to financial issues at the expense of NCD engagement

Opportunities - 1 Very high level of awareness of policy makers and the public on the health burden imposed by NCDs Genuine political commitment and formulation of strategic policy frameworks by Ministry of Health to address NCDs Since 2002 the need for multi-sector response has been recognised by Government Longstanding commitment to surveillance by Ministry of Health Chronic Disease Research Centre, plays a major role in raising awareness Regional civil society alliance formed to contribute to the response to NCDs

Opportunities - 2 Inclusion of the issue of NCDs in Protocol VI of the Social Partnership - a permanent arrangement of government, labour and private sector in the Barbados governance structure NCD medication provided free of cost at point of use - National Drug Service Barbados has been signatory to, and actively participated at the regional and international level in the multi-stakeholder approach A mechanism established 5 years ago to effect a multi- stakeholder approach to NCDs – the National NCD Commission

National NCD Commission Established in 2007 Appointed by the Minister of Health and Cabinet of Barbados Multi-sectoral: government, civil society and private sector representation (education, agriculture, academia, retired persons, health NGOs, business community, labour union, physical activity, media, medical and nursing professions, private health insurance sector and Faith based) Technical support provided by the staff of the Ministry of Health Funding provided out of the budget of the Health Promotion Unit, Ministry of Health Terms of Reference

The Commission’s Terms of Reference Advise the Minister of Health on NCD policies and legislation Broker and promote effective involvement in programme implementation Assist in the mobilization of resources. Recommend relevant research and education programmes Promote collaboration and partnerships Review the National Strategic Plan for Health Monitor regional and international trends Assist the Ministry of Health in commissioning studies Recommend to the Minister of Health a legal, policy and service framework that encourages and promotes behaviour change and the prevention of NCDs.

Strategies Multi-sectoral collaboration Policy recommendation Stimulation of behavioural change to effect risk factor reduction Public education and outreach Advocacy and facilitating the national dialogue Over-arching focal point for all matters related to NCDs at the National level

Promoting healthy living: multi- stakeholder interventions Legislation to ban sale of tobacco to minors Legislation to prohibit smoking in public places Provision of tax concessions for healthy lifestyle interventions Public education: “The Get Healthy Barbados” television series and Public service advertisements Consultations with school canteen operators, itinerant vendors and the manufacturing sector Inclusion of the issue of NCDs in Protocol VI of the Social Partnership

Promoting healthy living: multi- stakeholder interventions National consultation on NCDs Presentations to staff of Ministry of Foreign Affairs and to various Sub-Committees of Cabinet of Barbados Oversight of the Barbados National Registry  Advocacy  Quality control  Promotion Active engagement in Caribbean Wellness Day National Nutrition Improvement and Population Salt Reduction Programme

Seminars PSAs Meetings with food producers Advertisements on buses Nutrition booklet for schools Seminars PSAs Meetings with food producers Advertisements on buses Nutrition booklet for schools Publication and funding of No Salt booklet for opinion Leaders Drink & food reformulation Publication and funding of No Salt booklet for opinion Leaders Drink & food reformulation NNI & Population Salt reduction NCD Commission and Government Academia Private sector Civil society Salt the Difficult Choice Improve Labelling Raise Awareness Reduce Salt in Food Promoting Healthy Living: multi-stakeholder intervention Health of the Nation Study Educational Outreach

Next steps Finalisation by the NCD Commission of National NCD Strategic Plan Review of NCD Commissions at a Regional NCD Multi-stakeholder meeting, 22 nd November 2013 Review of the role of a regional NCD civil society alliance (HCC) to determine how best that organisation may contribute to facilitating the involvement of stakeholders at the country level in NCD Policy In-depth assessment of effectiveness of NCD policies and programmes Appointment of NCD Health economist Secure funds to develop and promote a comprehensive long-term national multi-sector approach to NCDs Host a National NCD consultation to determine and obtain commitments of stakeholders to further NCD policy action

Concluding Remarks Much has been achieved: much needs to be done For the most part stakeholders are aware of the adverse health and to a lesser extent development impact of NCDs Challenge to translate knowledge into action leading to full incorporation of the NCD response into the National development agenda by:  Greater political leadership, including appropriate policies and enactment and enforcement of legislation  More effective initiatives by strengthened, better informed, and empowered civil society  Increased commitment by private sector to create healthy workplaces  Greater technical and financial support of international organisations and donor agencies to all sectors in the response to NCDs