June 6 th, 2013 Aruba BERMUDA PERSPECTIVE The Hon. Patricia Gordon-Pamplin JP,MP Minister of Health and Seniors

 Background: Bermuda island  The Problem  Strategies  Current Interventions  Looking Ahead

 Island of 21 square miles in mid-Atlantic Ocean (700 miles east of North Carolina, USA)  UK Overseas Dependent Territory  Population: 64, 237 residents * 50, 565 Bermudians * 13, 516 Non-Bermudians * 11,492 approx. visitors * 22% population under age 20  Racial Composition: 54% Black, 31% white, 4% Asian, ~ 11% multi- racial

 Industries: finance, insurance and re-reinsurance, tourism  Median annual income: $106, 389 BMD  Household Expenditures: * Bread or Milk = $6 * 1 apple = $1.30 * Average home costs nearly $1 million * Average monthly rent $1700 (one bedroom)  Inflation rate 2.1 % (March 2013) Health & Personal care increased 7.7 %  Educational attainment: 29% four years college degree, 38% high school completion; 23% two years technical or vocational school, 8% no high school diploma

 Vision: “Healthy people, in healthy communities”  Ministry of Health and Seniors Mission: To serve as the Policy Directorate for Bermuda’s Health System  Department of Health Mission: To promote and protect the physical, psychological and social well being of the community, to enable the island’s residents to realize their optimum quality of life.

“Epidemic” levels of diabetes, overweight & obesity in adolescents and seniors (Health in Review, 2011)  School Health Assessments: 63% normal BMI 31% BMI > 85% centile (overweight) 6% below 5 th centile steady 5-year trend upward

Complications of Overweight and Obesity:  Heart disease : Leading cause of death; 41 % all deaths in Bermuda (2006)  Diabetes: rate at least 13% (Highest in OECD, twice OECD average, 6.3%)  Hypertension: ↑ 25% to 36% in 5 yrs yr. age group doubled to 13% Kidney failure: $24 mil/year spent on dialysis in Bermuda

 Health promotion & education  Healthy Policy development  Collaboration with public and private partners

1. Well Bermuda: National Health Promotion Strategy Healthy Weight Action Plan * Move More Bermuda! * Celebrating Wellness * Childhood Wellness Action Group 2. Healthy Schools : Comprehensive School Health Program 3. Community Collaborations— there are many

National Health Promotion Strategy A unifying vision and voice A point of convergence for health promoters

Healthy People: Diseases & Conditions Healthy Weight, Heart health, Cancer, Diabetes, Kidney Disease, Sexual health, Asthma and Mental Health Healthy Families: Population Groups Parenting, Childhood, Seniors and Disability Healthy Communities: Environment Vector control, Smoke and drugs, Road safety, Stopping the Violence, Respect for the environment, and Emergency preparedness

Comprehensive School Health Program  Since 1997, is a partnership between the Ministry of Education and the Department of Health.  Coordinates school health services, programs and initiatives provided by the government and community health partners, thus reducing gaps and duplication.  Promotes health through eight interrelated components of health (CDC model for school health): Health Education; Physical Education; Health Services; Nutrition Services; Counseling, Psychological and Social Services; Healthy & Safe School Environment; Health Promotion for Staff; and Family, Parent and Community Involvement. Evaluation Annually, assesses 33/34 schools’ level of compliance to all school health policies and relevant Bermuda Laws through the Healthy Schools Components and Standards.

 Engagement with Bermuda Diabetes Association, Bermuda Heart Foundation, Bermuda Cancer & Health Centre, Child & Family Services, Bermuda Police Service, Child & Adolescent Services, Department of Youth, Sport & Recreation, Department of Drug Control, Churches, Insurance companies,….

 Research: STEPwise approach to chronic disease risk factor surveillance (WHO/PAHO supported)  Enhanced community assessments: * Agree on definitions * Increase number of children assessed for obesity / overweight * Implement Global School-based Student Health Survey  Policy Changes: * Advocate for a Healthy Environment * Mandate Physical Education Curriculum * Advocate Baby Friendly culture: Protect and support Breastfeeding * Standards of Health Care: Improve prevention and standardize health messages