Kenneth S George MBBS DM MPH From Risk to Disease Adapted from the - PowerPoint PPT Presentation

Kenneth S George MBBS DM MPH

From Risk to Disease Adapted from the WHO

Leading causes of death (mortality) in Barbados Cardiovascular Disease - stroke and heart attack 1. Diabetes Mellitus and its complications including blindness, 2. amputations and kidney failure Cancer - breast, cervix prostate colon, stomach and lung 3. NCDs cause more deaths that HIV/AIDS, infectious diseases, accidents and homicides combined

Polyclinic visits for NCDs (morbidity) Diagnosis 2010 2011 2012 Diabetes Mellitus 23,273 24,667 24,292 Hypertension 39,774 42,518 41,381 IHD/CAD 793 854 896 Lipid disorders 9,335 11,089 11,814 Stroke 224 246 348 Cancer Breast 52 72 67 Cancer cervix N/A 7 6 Cancer Prostate 191 330 418 Cancer Colon/rectum 27 N/A 44 Social and Economic Development Report 2012

Risk Factors in Barbados - Behavioral 2007 2012  Current Smokers Tobacco  Current Smokers Tobacco  All 8.8% - M 15.6% and F 4.9%  All 8.4% – M 14.4% and F 2.2%  Alcohol in the last 30 days  Alcohol in the last 30 days  All 40.8% - M 56.6% and F 32.0%  All 23.9% – M 42.1% and F 16.9%  Binge drinking  Binge drinking  All 12.1% - M 23.9% and F 5.6%  All 13.8% M 21.9% and F 9.7%  < 5 servings F&V  < 5 servings F&V  All 81.2% – M 80.1% and F 81.8%  All 95.4% - M 96.6% and F 94.3%

Risk Factors In Barbados - Biological 2007 2012  Mean BMI (kg/m2)  Mean BMI (kg/m2)  All 27.7- M 26.1 and F 29.1  All 28.1 – M 26.5 and F 29.0  Overweight  Overweight  All 65.2% - M 54.6% and F 74.3%  All 64.3% - M 56.6% and F 68.8%  Obesity  Obesity  28.5% - M 20.3% and F 35.5%  All 32.9% M 22.1% and F 39.3%  Hypertension  Hypertension  All 41.5% - M 41.2% and F 41.8%  All 38.8% - M 40.1% and F 38.1%  Diabetes Mellitus  Diabetes Mellitus  All 14.9% - M 12.7% and F 16.7%  All 16.9% - M 16.7% and F 17.0%

Barbados National Registry  Stroke 2009 – 559 (322 females & 237 males) 2010 – 584 (323 females & 261 men)  Acute MI and Sudden Death 2010 2010 – 347 (181 females & 166 males)  Outcomes are poor with 47% of all heart attacks and 1/5 of all strokes die prior to reaching hospital  2009-2011 BNR data suggest mortality and CFR of MI is stable or declining however increases are note for stroke  80-90% of persons with confirmed stroke and heart attack had diabetes, hypertension or both as risk factor(s)

Risk Factors in Children (GSHS 2012) OVERWEIGHT  Combined- 31.9%  Males- 31.6%  Females- 32.2% F) OBESITY  Combined- 14.4%  Males-13.7%  Females-15.1%  Less than 5% of the sample reported ‘hunger’.

NCD Risk Factors in Children - Dietary Fruit and vegetable (F&V) consumption:  12.7% reported eating 5 or more servings per day over a 30 day period  15 % reported no F & V within the last month Other unhealthy practices:  18.5 % of students reported consumption of ‘fast food’ 3 or more days per week  73.3% of students reported drinking 1 or more carbonated beverage per day.

NCD Risk Factors Children - Exercise Children (5 – 17 years) should accumulate at least 60 minutes of moderate- to vigorous PA daily (WHO). Barbadian children:  Combined- 28.2%  Males 34.5%  Females 22.1%  70.1% were considered physically inactive Students engaged in at least 3 hrs. sedentary activity:  Combined- 65.3%  Males- 59.7%  Females- 70.7%

CSO Interactions

Civil Society and the Non-state Actors

Strengths of Civil Society  Advocacy and harnessing public opinion  Highlighting public health priorities (sometimes less well know conditions)  Usually perceived as a credible and unbiased source of information  Health education and health promotion  Fund raising – many international organization prefer national funding through civil society  Provision of primary prevention services  Watch dog role

Why engage civil society?  Government cannot on its own provide all solutions  To engage groups that traditionally governments cannot always reach  To harness, change and manage public opinion  To act as a source of non political information sharing  To complement the work of government through support for public health policy, programme development and provision of services

Faith Based Organizations  23 FBOs  Have a large captive and engaged audience  Approximately 70% of persons actively identify with a religious organization  Many religious doctrine support healthy lifestyle choices  Have a wide array of health care professional that can spearhead interventions  Usually have available infrastructure for health promoting activities e.g. transport and physical infrastructure

Faith Based Organizations  Declaration of Bridgetown 2013 - Multi faith declaration on NCDs  Faith Based Tool Kit  Screening and simple diagnostics activities  Willing to use good wholesome nutrition and exercise in every day practice (e.g. SDA)  Using the media to discuss risk factor reduction and other NCD prevention interventions

Academia  The Ministry of Health has had a working relationship with the University of the West Indies (Chronic Disease Research Center, CDRC) for over a decade  Barbados National Registry 2008 (multi disease registry)  Behavior Risk Factor Survey 2007  The Health of the Nation Study 2012  Population based salt intake study  The costing of cardiovascular disease  Physical activity and exercise study

Non Governmental Organizations  Heart and Stroke Foundation - rehabilitative interventions post stroke and heart attack, support of tobacco prevention and control and community outreach  Diabetes Foundation of Barbados – Maria Holder Centre for Diabetes Care  Diabetes Association of Barbados – community outreach, screening etc.  Barbados Cancer Society support of tobacco prevention and control initiatives, national screening and diagnosis and the National Cancer Plan for Barbados  Cancer Support Services – Family and community support including bereavement counselling, palliative care and some primary care screening  Barbados Asthma Association

Trade Unions  From the Inception (2007)the Trade Unions have been represented on the National NCD Commission Barbados  The Barbados Workers Union and more recently the National Union of Public Workers are all on board  NCD fully are integrated into the of the Social Partnership – a tripartite governance body including government, the private sector and the trade unions  Protocol 6 and 7 - Guiding document for the umbrella of trade unions  Several outreach programmes including workplace wellness, screening for NCDs and health and safety in the workplace (SHAW 2005)

Service Clubs, Associations and Registered Charities  LIONS – community screening and support for annual World Health Day activities  Rotary  Kiwanis  The Maria Holder Trust  Brewster Trust  Sandy Lane Charitable Trust

Monitoring and Evaluation of Civil Society  NGO health desk was created in 2011  To provide a global picture of health NGO activities in Barbados  To act as a communication channel between NGO community and government wherein they can access technical, surveillance and other resources  Audit of all health related NGOs was completed in 2012  Managing fee for service and other contractual agreements  Due to human resource challenges the desk has been dormant but efforts are again being made to reactivate the desk

Useful approaches  ‘All of Government’ - health, agriculture, education, urban planning and development, transport, commerce and small business, finance, poverty alleviation, elderly care and youth and sport  ‘All of Society’ - Government, Private Sector and Civil Society  ‘Health in all policies’ – Healthy public policy at a national level involving all sectors

Thank you