caribbean commission on health & development follow up report of the caribbean commission on...

Caribbean Commission on Health & Development

FOLLOW UP REPORT OF THE CARIBBEAN COMMISSION ON HEALTH AND

DEVELOPMENT

Presented to the 27th Meeting of the Caribbean Heads of Government

St.Kitts and Nevis July ,2006

George Alleyne


In the presentation of the CCHD one year ago, I emphasized that the major health /disease problems that the Caribbean would have to face in the immediate future were;

Non Communicable Diseases

HIV/AIDS

Injuries and violence


With respect to HIV/AIDS

“ Several recent developments in the Caribbean region ( in Bahamas, Barbados, Bermuda, Dominican Republic and Haiti ) give cause for guarded optimism-with some HIV prevalence declines evident among pregnant women, signs of increased condom use among sex workers and expansion of voluntary testing and counseling”.

(UNAIDS, 2005)


Estimated deaths from AIDS during 2004

Total: 3.1 (2.8 – 3.5) million

Western & Central Europe6 5006 500[<8 500][<8 500]

North Africa & Middle East28 00028 000

[12 000 – 72 000][12 000 – 72 000]

Sub-Saharan Africa2.3 million2.3 million

[2.1 – 2.6 million][2.1 – 2.6 million]

Eastern Europe & Central Asia60 00060 000[39 000 – 87 000][39 000 – 87 000]

East Asia51 00051 000

[25 000 – 86 000][25 000 – 86 000]South & South-East Asia

490 000490 000[300 000 – 750 000][300 000 – 750 000]

Oceania700700

[<1 700][<1 700]

North America 16 00016 000

[8 400 – 25 000][8 400 – 25 000]

Caribbean36 00036 000

[24 000 – 61 000][24 000 – 61 000]

Latin America95 00095 000

[73 000 – 120 000][73 000 – 120 000]

UNAIDS


3.1 million deaths from AIDS in the world in 2004

(30,000 in the wider Caribbean) (1137 in CMC’s in 2003)

35 million deaths from NCDs projected in the world in 2005

(30,785 in JA, TRT,GUY, BAR in 2001)


The reason for showing these data on AIDS and NCDs is not to seek any diminution of effort over HIV/AIDS. The Caribbean should be proud of what it has done and should continue.

The reason is to stimulate similar concern and ACTION with regard to NCDs at the level of the Heads of Government


Non communicable diseases 1-The evidence The relative and absolute magnitude of the problem The economics of the problem2-The possible solutions At the population level At the individual level


1980 (%)

1. Heart Disease - 20

2. Cancer - 12

3. Stroke - 11

4. Injuries - 8

5. Hypertension - 6

6. ARI - 5

7. Diabetes - 4

2000 (%)

1. Heart Disease - 16

2. Cancer - 15

3. Stroke - 10

4. Diabetes - 10

5. Injuries - 7

6. HIV/AIDS - 6

7. Hypertension - 6

Major causes of death in the Caribbean


Age Adjusted Death Rates For Selected Cardiovascular Conditions, late 1990’s, Per 100,000

Cause Bar TrT Cub Arg Can USA

Stroke 81.0 94.9 48.1 48.4 24.2 26.9

CHD 55.8 151.2 104.9 44.3 77.6 86.2

HHD 12.1 31.5 7.5 9.0 2.2 8.2

DM2 66.8 108.2 14.5 15.5 10.4 13.7

PAHO 2004, Page 87


Disability Adjusted Life Years (DALYs) 2001

0

50000

100000

150000

200000

250000

300000

350000

400000

Jam Trt Bar Guy

CD

NCD


Costs (US $ Million)for treatment of all diabetes and hypertension

Diabetes Hypertension TOTAL

Bahamas 23.311 37.203 60.514

Barbados 30.972 60.765 91.737

Jamaica 140.121 191.633 331.754


% deaths due to selected risk factors

BARBADOS % deaths GUYANA % deaths

High BP 17.6 High BP 18.8

High BMI

(Obesity)

8.8 High BMI

(Obesity)

10.0

Tobacco 7.4 Unsafe sex 7.9

High Cholesterol

5.9 Alcohol 7.2

Alcohol 5.5 High Cholesterol

6.0

Physical inactivity

4.5 Tobacco 5.7

Unsafe sex 4.0 Physical inactivity

4.3


% deaths due to selected risk factors

Jamaica % deaths T&T % deaths

High BP 21.3 High BP 20.6

High BMI

(Obesity)

14.0 High BMI

(Obesity)

17.8

Tobacco 7.7 High Cholesterol 9.6

Alcohol 5.1 Tobacco 8.4

Physical inactivity

5.0 Low fruit and veg intake

7.3

High Cholesterol 4.9 Physical inactivity 7.3

Low fruit and veg. intake

4.6 Alcohol 7.2


Population based policy interventions for control of NCD’s especially CVD.

1. Fiscal policies

2. Regulations and standards

3. Education and health promotion

4. Policies to workers and communities

5. Tobacco control


• Combat tobacco use --tax tobacco products

--restrict smoking in public places-

--provide replacement therapy and cessation tools

• Policies to promote exercise and healthy weights-NB physical ed. in schools

• Policies to reduce in the population intake of salt, unhealthy fats, and excess calories

Reduce death from Cardiovascular Disease


Source: Saloojee 1995

0.05

0.06

0.07

0.08

0.09

1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 Year

C

igare

tte c

on

su

mp

tio

n p

er

ad

ult

(in

packs)

0.7

0.8

0.9

1

1.1

1.2

1.3

Real

Pric

e

Consumption Per adult

Real price

Price of cigarettes and consumption in S.Africa


0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

High Income Upper MiddleIncome

Lower MiddleIncome

Low Income

Countries by income

Ave

rage

pric

e or

tax

per p

ack

(US$

)

0

10

20

30

40

50

60

70

80

Tax

as a

per

cent

age

of p

rice

Average price in US$Average tax in US$Tax as a percentage of price

Source: Jha and Chaloupka, 1999, 2000


Specific policy recommendations to the Heads of Government

1-Combat tobacco use tax tobacco products ban smoking in public places2-Target children make physical education compulsory ensure healthy school meals restrict advertising that promotes unhealthy diets3-Make regulations and standards ensure marketed foods show calorie & fat content regulate importation of fats (consult RNM)


Annual risk of recurrence

Aspirin vs. nothing 5% vs. 7%

Aspirin + BP↓ (diuretic & ACEI) vs. Aspirin alone

3% vs. 5%

Aspirin + BP↓ + statin (chol. lowering) vs. Aspirin + BP↓ alone

2% vs. 3%

Daily use of 3 or 4 generic drugs could prevent 2/3 of the risk of stroke or heart attack

recurrence, at least for several years.

Long term treatment after a non-fatal stroke or heart attack (secondary prevention)


And finally The Ministers of Health in COHSOD have

developed a Regional Strategic Plan which deals not only with the policy issues highlighted here, but with all aspects related to the control of NCDs. This plan is yet to be funded and made operational.

The Plan should be supported.


Specific policy recommendations to the Heads of Government

1-Combat tobacco use tax tobacco products ban smoking in public places2-Target children make physical education compulsory ensure healthy school meals restrict advertising that promotes unhealthy diets3-Make regulations and standards ensure marketed foods show calorie & fat content regulate importation of fats (consult RNM)

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