Friday, February 25, 2011
Senator the Honourable Therese Baptiste-Cornelis, Minister of Health delivered a presentation on behalf of CARICOM countries titled “Experiences in the Americas on intervention directed to the prevention and control of NCDs and Obesity” on February 24th 2011 during Panel 2 of speakers at the Regional High Level Consultation of the Americas on Non-Communicable Diseases (NCDs) and Obesity (Consulta Regional de alto nivel de Las Americas Contra Las Ecnt y La Obesidad) in Mexico City, Mexico.
Minister of Health Therese Baptiste-Cornelis with
Dr Margaret Chan, Director General of WHO at the Regional High Level Consultation
During her presentation the Honourable Minister of Health shared with the group, that healthy eating really is linked to economic factors, which are in turn linked to structural adjustment programs, which are in turn linked to income, which is in turn linked to ability to purchase healthy food. The risk behavior is unhealthy eating practices, but the social determinant that is at the genesis of that is economic & structural adjustment. She further identified some of the lessons learnt in combating NCD such as the need to conducting research in relation to NCDs by engaging national, regional and international partners and the utilization of multi-sectoral approaches to addressing NCDs. There was also a need to strengthen early detection mechanisms at primary care and the providing assistance for persons managing NCDs, to help achieve better control.
Minister of Health Therese Baptiste-Cornelis with
Dr Socorro Gross-Galiano PAHO-WHO Assistant Director
The Honourable Minister stated that Trinidad and Tobago is firmly of the view that chronic non-communicable diseases demand heightened attention by the international community. The country stand committed along with all its CARICOM partners’ call for indicators on non-communicable diseases to be integrated into the core Millennium Development Goals (MDGs) monitoring and evaluation system.
This meeting will define the position of the Americas on the prevention and control of NCDs which will be included within the Declaration of Mexico for discussion at the UN General Assembly Meeting in September 2011. The Regional High Level Consultation will also build information-sharing mechanisms and collaboration among the countries of the Americas on the social determinants of obesity and chronic diseases.
The Honourable Minister’s presentation is attached for your reference, as well as a photograph of the Honourable Minister at the Regional Consultation with Dr Margaret Chan -Director General of WHO ( wearing glasses). Also attached is a picture of the Honourable Minister at the Regional Consultation with PAHO/WHO Assistant Director Dr Socorro Gross-Galiano.
PRESENTATION BY SENATOR THE HONOURABLE
MINISTER OF HEALTH
REGIONAL HIGH LEVEL CONSULTATION OF THE AMERICAS ON NON-COMMUNICABLE DISEASES AND OBESITY
MEXICO CITY, MEXICO
FEBRUARY 24TH 2011
CARICOM SITUATION AT A GLANCE:
v TOTAL POPULATION : 15 Million
v MEAN PER CAPITA INCOME: US$8,116
v AVG LIFE EXPECTANCY: 72 years
v CATEGORISED as : Low-Middle Income Developing countries
The Caribbean reportedly has the highest prevalence of chronic non-communicable diseases (CNCDs) in the region of the Americas
v Diabetes mortality in Trinidad and Tobago and in Saint Vincent and the Grenadines is 600% higher than in North America (United States and Canada)
v Cardiovascular disease mortality rates in Trinidad and Tobago, Guyana, and Suriname are 84%, 62%, and 56% higher, respectively, than in North America
v In Barbados, the prevalence rate and mortality rate of diabetes-related lower extremity amputations are among the highest in the world
v Among adults 25–74 years old, the age-adjusted prevalence rates of hypertension for Jamaica, Saint Lucia, and Barbados were 17.5%, 18.3%, and 21.5%, respectively, with men younger than 55 years least likely to have their hypertension treated and controlled.
v Alcohol abuse among men is a significant and growing public health challenge with 4.5% of attributable deaths in this region compared with 1.5% globally
v In CARICOM member states, consumption of fats and sugars is 160% and 250% of requirements, respectively
v Physical inactivity levels in Jamaica, Trinidad and Tobago, and Guyana averaged 38%, 39%, and 56%, respectively, with greater levels of physical inactivity among the urban population and among professionals and clerical staff in all countries
v .... Coupled with low consumption of fruits and vegetables, these factors drive the obesity epidemic in the Caribbean
SOCIAL DETERMINANTS & THEIR IMPACTS
v Social determinants of health including urbanization, globalization, education, economic and structural adjustments along with the aging of the population have set the stage for increasing risk conditions.
v Some risk conditions of note include those related to:
v Food security and nutrition
v Access to supportive environments and programs like parks and green spaces in built communities
v Employment and income
v These in turn give rise to behavioural risk factors within communities and population groups such as unhealthy eating, physical inactivity, alcohol abuse among others.
v What impacts healthy eating really is linked to economic factors, which are in turn linked to structural adjustment programs, which are in turn linked to income, which is in turn linked to ability to purchase healthy food. The risk behaviour is unhealthy eating practices, but the social determinant that is at the genesis of that is economic & structural adjustment.
v The imperative therefore is to act closer to the source or genesis of the behavioural risk factors of chronic diseases
v That is to focus action on the determinants with emphasis on social determinants of NCDs
v Another recommendation is to strengthen population based strategies which affect groups of people, and not only focus on individual based strategies
CARIBBEAN LEADERSHIP ON NCDS
v Trinidad and Tobago – along with CARICOM member states - has continued to be a leader and advocate for joint strategic action on NCDS
v DECLARATION OF PORT-OF-SPAIN: UNITING TO STOP THE EPIDEMIC OF CHRONIC NCDs (2007)
v Signed by CARICOM Heads of Government, shows commitment at highest level of government for Public Health and NCD Prevention and Control in the Caribbean
v 2009 Summit of the Americas at which the CARICOM Heads of Government, called for inclusion of NCDs in the global agenda
v At 64th UN General Assembly, Trinidad and Tobago proposed that a “special session of the UN General Assembly on NCDs be convened at the earliest opportunity”
v In early 2010 the UN General Assembly endorsed a resolution -- initiated by CARICOM-- urging special attention by the international community focused on battling NCDs, which plague the lives of citizens.
KEY LESSONS LEARNT IN TRINIDAD AND TOBAGO
v Importance of :
1. creating a healthy public policy framework to support action on NCDs
2. enacting and enforcing legislation in support of health including
3. using regional strategies and resolutions of PAHO/WHO to guide development of local action on determinants of health and NCD prevention and control
4. conducting research in relation to NCDs by engaging national, regional and international partners
5. utilising multi-sectoral approaches to addressing NCDs
6. strengthening early detection mechanisms at primary care
7. providing Assistance for persons managing NCDs, to help achieve better control
CREATING A HEALTHY PUBLIC POLICY FRAMEWORK TO SUPPORT ACTION ON NCDS
v Continuously reviewing our policy agenda
o Currently in process of policy update and development in relation to population health inclusive of NCD and obesity prevention and control...
INTER-SECTORAL POLICIES EXAMPLES
v Policy on Poverty Eradication
v Policy on Education for all and free education up to tertiary level
v Policy of School Feeding and Milk Subsidy
v Ratification of Framework Convention on Tobacco Control
v Passage and Implementation of the Tobacco Control Act in 2010
v Policy on School Health
v Policy on NCDs
v National Food and Nutrition Policy (currently under review)
ENACTING AND ENFORCING LEGISLATION IN SUPPORT OF HEALTH
v Tobacco Control Act (2010)
o Trinidad and Tobago ratified the Framework Convention on Tobacco Control (FCTC) and through our national Tobacco Control Act, passed in February 2010, we have instituted measures to ban smoking in public areas and significantly limit the marketing and sale of tobacco products, especially to children.
v Breathalyser Act of 2009
o In an effort to align itself with international best practice, Trinidad and Tobago passed the Breathalyser law in 2009.
This provides the equipment and training to law enforcement officers to ensure that drivers are not operating their vehicles whilst under the influence of alcohol.
This effort not only makes the roads safer, but also aims to diminish the number of road fatalities and injuries, as well as reduce alcohol abuse.
GLOBAL AND REGIONAL STRATEGIES AND RESOLUTIONS (PAHO/WHO, CARICOM)
v An example is the Healthy Communities/Healthy Spaces (called Healthy Communities and Municipalities in Latin American Countries) utilised to implement settings-based interventions including:
o Healthy Spaces
HEALTH PROMOTING HEALTH CENTRES
v In Trinidad and Tobago, all refurbished Health Centres are constructed with a wellness centre attached that can be completely sealed off from the main building and made available to the community after regular hours.
o Focus is on re-orienting community health services to promote population health and well-being with the full participation of the community
WELLNESS CENTRE INITIATIVE
v In one model of this initiative, the community is invited to formally partner with the Community Health Services through the establishment of Wellness Management Committees or Partnership Boards.
v Programs implemented under this initiative include:
Structured physical activity 3 times per week
Health of the elderly
Chronic disease support groups
Community Education programs including parenting, nutrition, women’s health, men’s health
School Aerobic competition
Participation in Caribbean Wellness Day
CONDUCTING RESEARCH IN RELATION TO NCDS UTILISING NATIONAL, REGIONAL AND INTERNATIONAL PARTNERS
v Some initiatives include:
o Global School Health Survey (T&T) and Global Youth Tobacco Survey with support from PAHO and CDC
o Evaluation of School Meal Options and Survey of body mass index of school aged children with support from PAHO’s Caribbean Food and Nutrition Institute (CFNI)
v Some initiatives include:
o Targeted research and interventions of Diabetes in School Children with support from University of the West Indies (UWI) and local foundations
o Rapid Assessment of Primary Institutions in Trinidad and Tobago and Assessment of Primary School Students in T&T conducted by NADAPP (National Drug and Alcohol Abuse Prevention Programme)
UTILISING MULTI-SECTORAL APPROACHES TO ADDRESSING NCDS
v Established the CNCD Technical Advisory Committee:
o This has brought collaboration among the health, agriculture, education, trade and other government agencies with academic institutions, local and international NGOs to make further recommendations to the policy agenda, and recommend mechanisms for the implemented of cross sectional strategies for NCD prevention and control
v Inter-sectoral Tobacco Control Committee
v Smoking Cessation Committee
v Caribbean Wellness Campaign Inter-sectoral Committee
STRENGTHENING EARLY DETECTION MECHANISMS AT PRIMARY CARE
v Screening of school aged children for risk factors of NCDs, accompanied by supportive Nutrition and Obesity programmes to help students gradually build skills to reduce risk factors
v Introducing Point of Care testing at Primary Care Centres to facilitate early detection of biological risk factors of NCDs like high blood pressure, high blood sugars and elevated cholesterol
PROVIDING ASSISTANCE FOR PERSONS MANAGING NCDS, TO HELP ACHIEVE BETTER CONTROL
v Chronic Disease Assistance Program (CDAP) – provides free medication, testing supplies and monitoring equipment for persons with chronic diseases.
v Of great importance is the inclusion of non pharmacological management methods in the management of NCDs.
o Self Management, Screening, Nutrition and Physical activity are added to the treatment protocol in accordance with the Caribbean Guidelines for Managing Diabetes and Hypertension in Primary Care
CONCLUDING REMARKS – WAY FORWARD
v Commend the significant gains made by Member States on their national chronic disease programs and urge continuous cooperation among PAHO and Member States to promote inter-sectoral policy changes.
v We remain committed to cooperating with all countries in the region for our collective good health and well-being.
v Chronic non-communicable diseases demand heightened attention by the international community.
v Indicators on non-communicable diseases MUST be integrated into the CORE Millennium Development Goals (MDGs) monitoring and evaluation system.
v Arising from this meeting, CARICOM countries are committed to the following:
v Strong affirmation that NCDs are a threat to the development of all countries, are linked to several MDGs and must be given priority
v Awareness of the gender dimensions in all programmes aimed at the prevention and control of NCDs
v Recognition that a multisectoral response is required including a whole-of-government approach and collaboration with non-government actors – especially civil society, faith-based organizations, private sector and academia