2005 pan american health organization the experience of building momentum in ghd on chronic disease...

2005

Pan AmericanHealthOrganization

The Experience of Building Momentum in GHD on

Chronic Disease Prevention and Control: From the Caribbean toward the UN

Summit 2011

C. James Hospedales,

Senior Advisor & Coordinator,

NCD Prevention & Control

PAHO/WHO

The Experience of Building Momentum in GHD on

Chronic Disease Prevention and Control: From the Caribbean toward the UN

Summit 2011

C. James Hospedales,

Senior Advisor & Coordinator,

NCD Prevention & Control

PAHO/WHO

2005


OverviewOverview

• Background

• CARICOM Summit on Chronic Disease

• Lessons learned in GHD

• Next Steps towards the UN Summit

• Background

• CARICOM Summit on Chronic Disease

• Lessons learned in GHD

• Next Steps towards the UN Summit

2005


CARMEN Network CARMEN Network 32 MembersMembers

Argent, Anguilla, Ant&Barb, Aruba, Barbados , Bahamas, Brazil, Can, Colombia, Costa Rica, Cuba, Curacao, Chile, Dominica, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Jamaica Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico, St Kitts & Nevis, St Lucia, Trin. & Tobago, Uruguay

Prospective MembersProspective MembersHonduras, Venezuela, Bolivia

Special Special •USA-Mexico (border) •Caribbean CARMEN

Collaborating Collaborating membersmembersSLU,USF,NHLBI,CDC, PHACAMNET, RAFA,ILSI,F&V

CARMEN SCHOOL

2005


English-Speaking Caribbean; 14 countries, 7.5million people

2005


All is not well in ParadiseAll is not well in Paradise

2005


UN High Level Meeting /Summit on Chronic Diseases, September 2011UN High Level Meeting /Summit on Chronic Diseases, September 2011

• Many things have contributed: What was the role of the Caribbean in leading to this major opportunity for health?

• Many things have contributed: What was the role of the Caribbean in leading to this major opportunity for health?

2005


What has led the UN General Assembly to convene the UN Summit in 2011?

What has led the UN General Assembly to convene the UN Summit in 2011?

May 2000World Health Assembly endorses the 'Global strategy on the prevention and control of NCDs

September 2002 World Summit on Sustainable Development (Jo’burg) adopts 'Plan for

Implementation‘ on NCDsMay 2003 World Health Assembly endorses the 'WHO Framework Convention on Tobacco

Control'.May 2004

World Health Assembly endorses the 'Global strategy on diet, physical activity and health'.

December2006UN General Assembly adopts resolution A/RES/61/225 (develop national policies for diabetes)

September2007

Caribbean Community (CARICOM) Heads of Government adopt declaration on NCDs

May 2008WHA endorses WHO 'Action Plan for the Global Strategy for the Prevention and Control of NCDs'.

April 2009Summit of the Americas Conclusion includes Articles 28 and 29 on NCDs

November 2009Commonwealth Heads Government issued a statement to combat NCDs.

January 2010 Drafting group led by the Caribbean Community convenes to develop a resolution on NCDs.

May 2010A/RES/64/265 adopted unanimously by the UN GA; co-sponsored by 78 countries, including Canada and USA

May 2000World Health Assembly endorses the 'Global strategy on the prevention and control of NCDs

September 2002 World Summit on Sustainable Development (Jo’burg) adopts 'Plan for

Implementation‘ on NCDsMay 2003 World Health Assembly endorses the 'WHO Framework Convention on Tobacco

Control'.May 2004

World Health Assembly endorses the 'Global strategy on diet, physical activity and health'.

December2006UN General Assembly adopts resolution A/RES/61/225 (develop national policies for diabetes)

September2007

Caribbean Community (CARICOM) Heads of Government adopt declaration on NCDs

May 2008WHA endorses WHO 'Action Plan for the Global Strategy for the Prevention and Control of NCDs'.

April 2009Summit of the Americas Conclusion includes Articles 28 and 29 on NCDs

November 2009Commonwealth Heads Government issued a statement to combat NCDs.

January 2010 Drafting group led by the Caribbean Community convenes to develop a resolution on NCDs.

May 2010A/RES/64/265 adopted unanimously by the UN GA; co-sponsored by 78 countries, including Canada and USA

2005


The CARICOM Heads Summit on NCDs, Sept 15, 2007, Trinidad & Tobago

The CARICOM Heads Summit on NCDs, Sept 15, 2007, Trinidad & Tobago

• “We, the Heads of State of the Caribbean Community….”• 15-point “Port of Spain Declaration”; multi-sectoral• Tobacco – Ratify and implement the WHO Framework Convention

on Tobacco Control: taxation, packaging, earmark some revenue for health promotion & disease prevention, ban smoking in public places

• Healthy Diet - Trade policies on food imports, agriculture policies, Healthy school meals, Food labeling, reduce or eliminate trans fats

• Physical activity-physical education in schools; physical activity in work places; improve public facilities for physical activity

• Health services - screening and management of NCDs to achieve 80% coverage by 2012; primary and secondary prevention, comprehensive health education

• Monitoring - Surveillance of risk factors; monitoring of the actions agreed upon in Declaration (CARICOM Secretariat, CAREC, UWI & PAHO/WHO)

• Mobilizing Society - National Commissions on NCDs; including public, private sector and civil society, media and communications industry

• Caribbean Wellness Day – Second Saturdays in September

• “We, the Heads of State of the Caribbean Community….”• 15-point “Port of Spain Declaration”; multi-sectoral• Tobacco – Ratify and implement the WHO Framework Convention

on Tobacco Control: taxation, packaging, earmark some revenue for health promotion & disease prevention, ban smoking in public places

• Healthy Diet - Trade policies on food imports, agriculture policies, Healthy school meals, Food labeling, reduce or eliminate trans fats

• Physical activity-physical education in schools; physical activity in work places; improve public facilities for physical activity

• Health services - screening and management of NCDs to achieve 80% coverage by 2012; primary and secondary prevention, comprehensive health education

• Monitoring - Surveillance of risk factors; monitoring of the actions agreed upon in Declaration (CARICOM Secretariat, CAREC, UWI & PAHO/WHO)

• Mobilizing Society - National Commissions on NCDs; including public, private sector and civil society, media and communications industry

• Caribbean Wellness Day – Second Saturdays in September

WWW.CARICOM.ORG

2005


What are the lessons learned in Global Health Diplomacy from the CARICOM? What are the lessons learned in Global Health Diplomacy from the CARICOM?

2005


Lessons Learned – from case study and from reflection


1. Progression and confluence of factors; not one single effort

2. Absolute need for evidence / data3. Making the case: Speaking to head, heart and pocket4. Political structure, and history of Caribbean cooperation in

health5. Importance of Champions: Political, technical, public health6. “Pre-selling” by visiting countries/ Cabinets7. PAHO-CARICOM collaboration8. Country involvement in planning and preparation9. Media and NGO involvement10.International partners; especially Canada




2005




1. Nassau Declaration of 2001: “The Health of the Region is the Wealth of the Region”, CARICOM Heads Conference

2. Caribbean Commission on Health and Development, 2003-05: identified Chronic Diseases, HIV/AIDS, and injuries and violence as “super priorities” for health

3. National level events, T&T, Barbados, Jamaica

4. Global /hemispheric awareness emerging

1. Nassau Declaration of 2001: “The Health of the Region is the Wealth of the Region”, CARICOM Heads Conference

2. Caribbean Commission on Health and Development, 2003-05: identified Chronic Diseases, HIV/AIDS, and injuries and violence as “super priorities” for health

3. National level events, T&T, Barbados, Jamaica

4. Global /hemispheric awareness emerging

2005


2. Absolute need for evidence / data2. Absolute need for evidence / data

• Caribbean Epidemiology Centre (CAREC) – mortality and risk factor trends

• Caribbean Food and Nutrition Institute – dietary trends, obesity trends

• University West Indies – economic impact data

• U of Toronto, W Bank, CARICOM Trade desk – tobacco, financing issues, trade policy options, respectively





2005


2. Absolute need for evidence / data2. Absolute need for evidence / data








• U of Toronto, W Bank, CARICOM Trade desk – tobacco, financing issues, trade policy options, respectivelyData are necessary but not sufficient!

2005


3. Speaking to Head, Heart and Pocket3. Speaking to Head, Heart and Pocket

Potential Years of Life Lost <65yrs by cause, CARICOM countries, 2000 & 2004

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NCDs: Biggest cause premature death in the Caribbean

2005


Speaking to Head, Heart and PocketSpeaking to Head, Heart and Pocket

45-yr old man with diabetes and amputation


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3-5% GDP loss due to diabetes, hypertension inT&T, Jamaica, Barbados



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Tobacco control could save lives and raise $150M revenue in CARICOM

2005


4. Political Structure, and History of Caribbean Cooperation in Health

4. Political Structure, and History of Caribbean Cooperation in Health

• A political structure that facilitated regional appreciation of the problem and could mandate regional action, complementary to national action.

• The Caribbean Community (CARICOM) is a formal political structure supported by the Treaty of Chaguaramas and a Secretariat

• Council of Human & Social Development; Ministers of Health & others

• Conference of Heads of Government – twice yearly • Caribbean Cooperation in Health – since 1986; polio,

measles, rubella elimination; regional health institutions

• A political structure that facilitated regional appreciation of the problem and could mandate regional action, complementary to national action.

• The Caribbean Community (CARICOM) is a formal political structure supported by the Treaty of Chaguaramas and a Secretariat

• Council of Human & Social Development; Ministers of Health & others

• Conference of Heads of Government – twice yearly • Caribbean Cooperation in Health – since 1986; polio,

measles, rubella elimination; regional health institutions

2005


5. Importance of Champions: Political, Technical, Public Health

5. Importance of Champions: Political, Technical, Public Health

Dr Eddie Greene,Asst Sec GeneralHuman & Social DevelopmentCARICOM

Sir George AlleyneChancellor UWIFormer D/PAHO

Dr Mirta RosesD/PAHO

2005


2005


6. Pre-selling by visiting countries/ Cabinets

6. Pre-selling by visiting countries/ Cabinets

• Chairman or members of Commission on Health and Development visited all CARICOM Countries and spoke to Cabinet, PM, Parliament between 2004-2007

• Allowed individual persuasion and consideration of situation of country

• Chairman or members of Commission on Health and Development visited all CARICOM Countries and spoke to Cabinet, PM, Parliament between 2004-2007

• Allowed individual persuasion and consideration of situation of country

2005


7. PAHO/WHO-CARICOM Collaboration – critical for success

7. PAHO/WHO-CARICOM Collaboration – critical for success

2005


8. Country involvement in planning and preparation

8. Country involvement in planning and preparation

• Planning team included 4 CARICOM Chief Medical Officers

• Survey of national NCD capacity and policies

• Standard template for posters of national situation to be presented at the Summit

• Progress reported regularly to Health Ministers

• Planning team included 4 CARICOM Chief Medical Officers

• Survey of national NCD capacity and policies

• Standard template for posters of national situation to be presented at the Summit

• Progress reported regularly to Health Ministers

2005


9. Media and NGO Involvement9. Media and NGO Involvement

• Not as intensive as planned

• “One Caribbean Media” conglomerate printed free Summit supplements and distributed in Sunday newspapers in most territories prior to the Summit

• Media articles, interviews

• Healthy Caribbean Coalition born; a civil society alliance to combat chronic disease and risk factors

• Not as intensive as planned

• “One Caribbean Media” conglomerate printed free Summit supplements and distributed in Sunday newspapers in most territories prior to the Summit

• Media articles, interviews

• Healthy Caribbean Coalition born; a civil society alliance to combat chronic disease and risk factors

2005


10. Importance of International Partners: Special Role of Canada

10. Importance of International Partners: Special Role of Canada

• Public Health Agency of Canada provided a grant to PAHO support the Summit implementation and preliminary steps after

• WHO Collaborating Centre on NCD Policy in PHAC provided technical assistance with case study of 26 key informants on perceptions of the Summit

• CIDA provided a grant to the CARICOM Secretariat to support conduct of the Summit

• Public Health Agency of Canada provided a grant to PAHO support the Summit implementation and preliminary steps after

• WHO Collaborating Centre on NCD Policy in PHAC provided technical assistance with case study of 26 key informants on perceptions of the Summit

• CIDA provided a grant to the CARICOM Secretariat to support conduct of the Summit

2005










2005


Next StepsNext Steps

• So you had the Summit; so what?• Implementation is key and in countries lags

behind political statements• Twice-yearly monitoring mechanism helps greatly• Caribbean Wellness Day – amazing mobilization• Application of lessons learned to South and

Central America• Healthy Caribbean Coalition – civil society alliance

to combat NCDs and risk factors – beginning a texting campaign to create the “global demonstration”

• UN Summit

• So you had the Summit; so what?• Implementation is key and in countries lags

behind political statements• Twice-yearly monitoring mechanism helps greatly• Caribbean Wellness Day – amazing mobilization• Application of lessons learned to South and

Central America• Healthy Caribbean Coalition – civil society alliance

to combat NCDs and risk factors – beginning a texting campaign to create the “global demonstration”

• UN Summit

2005


NCD Progress Indicator Status / Capacity by Country in Implementing NCD Summit Declaration - September 2010 NCD Progress Indicator Status / Capacity by Country in Implementing NCD Summit Declaration - September 2010 POS NCD #

NCD Progress Indicator

A N G

A N T

B A H

B A R

B E L

B E R

B V I

C A Y

D O M

G R E

G U Y

H A I

J A M

M O N

S K N

S T L

S V G

S U R

T R T

T C I

COMMITMENT 1,14 NCD Plan X X ± ? ± ? ± X ? ? ? X ? ? ? ± ± ? 4 NCD budget X X X ? ± X X X ± X ± X X X ? X X ? 2 NCD Summit convened X X X ? X ? ? X ? ± ? X ? X ? X ? 2 Multi-sectoral NCD Commission

appointed and functional X X X ? ± ? ? X X ? ? X ± X ? X ± ?

12 NCD Communications plan X X ± ± X ? X X ± ± ? X ± X ± X X ? TOBACCO

3 FCTC ratified * ? ? ? ? * * ? ? ? ? X ? * ± ? ? ? ? * 3 Tobacco taxes >50% sale price X X X ? X ± X ? X ? ± X X ? X 3 Smoke Free indoor public places X ? X ? ± ? ? ? ? ? X ± X ? X ± ? 3 Advertising, promotion & sponsorship bans X X X ± X ? ? ? X ± X ? X X X ± ?

NUTRITION 7 Multi-sector Food & Nutrition plan

implemented ? ? ? ± ± X ? X ? ? ? X ? ? ± X ? X ± ?

7 Trans fat free food supply X X ± X X X 7 Policy & standards which promote healthy

eating in schools implemented ? ? ± ? X ± ± ? ± X X ±

8 Trade agreements utilized to meet national food security & health goals

± X ± X X X ?

9 Mandatory labeling of packaged foods for nutrition content

X X ± ± ± X X ± X

PHYSICAL ACTIVITY 6 Mandatory PA in all grades in schools ? ? ± ? ± X X X ? 10 Mandatory provision for PA in new housing

developments ? ? X X X X X

10 Ongoing, mass Physical Activity or New public PA spaces

X X ? ? ? ? X ± ? ? ? ? ? ? ? ?

EDUCATION / PROMOTION 15 CWD multi-sectoral, multi-focal celebrations ? ? ? ? ? ? ? ? ? ? ? X ? ? ? ? ? ? ? ? 10 ?50% of public and private institutions with

PA & diet) programmes X X X X ± ± X X X

12 ?30 days media broadcasts on NCD control / yr (risk factors and treatment)

? ? X ? X ± ? ? ? ± X X X

SURVEILLANCE Surveillance: - STEPS or equivalent survey X X ? ? ? ± ? X ? ± ± X ? ? ± X ± ± - Minimum Data Set reporting X X X X X ? ? X ? X X X X X X X ? ? X X - Global Youth Tobacco Survey X ? ? ? ? X ? ± ? ? ? ? ? ± ? ? ? ?

11, 13, 14

- Global School Health Survey ? ? ? ± ± ? ± ? ? X ? ± ? ? ? ? TREATMENT

5 Chronic Care Model / NCD treatment protocols in ? 50% PHC facilities

X ? ? ± ± ± X ± X ± ± X ? X ? X X ?

5 QOC CVD or diabetes demonstration project

± ? ? ± ± ± ? X ? ? ± ? ±

? X ? ?

2005


UN Summit on NCDs 2011UN Summit on NCDs 2011• Unique policy window opening; think big• Need to Unite forces in NCDs, Risk Factors, H.

Prom• Need roadmap/battle plan: before, during, after• Country by country advocacy campaign• Evidence - packaged to speak to head, heart &

pocket• How do we create a “Global Demonstration”? • Champions, going viral, media advocacy• Be clear on “the ask”

• Unique policy window opening; think big• Need to Unite forces in NCDs, Risk Factors, H.

Prom• Need roadmap/battle plan: before, during, after• Country by country advocacy campaign• Evidence - packaged to speak to head, heart &

pocket• How do we create a “Global Demonstration”? • Champions, going viral, media advocacy• Be clear on “the ask”

2005


SICA Presidential summit

LAC Civil Soc

G-8 FranceObesity Forum

2005


“Running through the tape”… of the UN Summit

“Running through the tape”… of the UN Summit

2005


THANK YOU

OBRIGADA

MUCHAS GRACIAS

2005 pan american health organization the experience of building momentum in ghd on chronic disease...

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