1. The Chronic Disease problem in the Caribbean – civil society perspective Twelfth OECS Health Ministers Meeting, 11 th September 2009 Prof. Trevor A. Hassell Chairman of the Healthy Caribbean Coalition, Chairman of the National Commission for Chronic Non Communicable disease, Barbados

2. “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”

3. Source: CAREC, based on mortality reports from countries CARICOM Member States 2000 2001200220032004 Year 0 20 40 60 80 100 120 140 Rates per 100,000 population Heart Disease Stroke Diabetes Injuries Hypertensive Diseases Cancers HIV/AIDS

4. 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

5. Potential Years of Life Lost <65years by Main Causes, 2000 & 2004, CARICOM Countries (minus Jamaica) 010000200003000040000500006000070000 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

6. Disability Adjusted Life Years (000) 2002

7. Mortality Attributable to Select Risk Factors (Latin America & Caribbean) from DCP2 0100200300400500 Unsafe sex Physical inactivity Low fruits & veg High cholesterol Tobacco Alcohol Obesity High BP Attributable Deaths (thousands)

9. Prevalence (%) of diabetes among adults in the Americas Source: Pan Am J Public Health 10(5), 2001; unpublished (CAMDI), Haiti (Diabetic Medicine); USA (Cowie, Diabetes Care)

10. Caribbean Trends in Diabetes Mortality 20 30 40 50 60 70 80 Rate/100,000 1985199019952000 Male Female

11. From community surveys, the prevalence of hypertension in adults 25-64 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%.

12. 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

13. Estimated Economic Burden ($US Million, 2001) BAHBARJAMTRT Diabetes 27.337.8208.8494.4 Hypertension 46.472.7251.6259.5 Total 76.7110.5460.4753.9

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

15. Caribbean Initiatives and Reports  Caribbean Commission on Health and Development Report  Nassau Declaration, CARICOM Heads of Government, 2001  Caribbean Charter for Health Promotion  Caribbean Cooperation in Health initiative 1,11, 111  Caribbean Regional Plan for Prevention and Control of NCDs and Injuries, 2008-2012, PAHO  Heads of Government of CARICOM Summit and Declaration against CNCDs, 2007

17. 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

18. 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

19. 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

20. 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

21. 21 Individual responsibility Changes to the "toxic" environment COMMUNITY AND CIVIL SOCIETY Complementary approaches to chronic disease prevention POLICY ENACTMENT HEALTH CARE AND DOCTOR

22. 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

23. 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

24. www.healthycaribbean.org