H t Add th Ch ll i H

Caribbean Commission on
Health & Development
H
How
tto Add
Address th
the Challenges
Ch ll
in
i Health
H lth
and Development
By
George Alleyne
Conference on the Caribbean-A 20/20 Vision
g
DC
Washington
June 20, 2007
Caribbean Commission on
Health & Development
The Nassau Declaration
CARICOM Heads of Government-2001
¾ “The health of the Region
g
is the wealth of the
region”.
¾ The Heads declared that they were “cognizant of the
critical
iti l role
l off health
h lth in
i the
th economic
i development
d
l
t
of our people”.
¾ Mandated the formation of a “Task
Task Force
Force”
¾ Specific purpose—” to review and help to propel
health to the center of the development process”.
Caribbean Commission on
Health & Development
Caribbean Commission on
Health & Development
Epidemiologic transition
Pestilence and famine
Receding Pandemics
Degenerative and man-made diseases
20
40
40
50
Life expectancy (years)
60
60
80
Caribbean Commission on
Health & Development
Infant mortality rate
1980
2004
The Americas
37.8
20.1
North America
11.2
6.7
Caribbean
36.9
17.3
IMR—Infant deaths/1000 live births
Life expectancy at birth ( years)
Life expectancy
1980
2004
68.8
73.5
74.6
74.8
68.1
73.5
Caribbean Commission on
Health & Development
I
Infant
mortality trends total (per 1,000 live births).
100
90
80
70
IMR 100
00 lb
60
English Caribbean 3th Quartile
E li h C
English
Caribbean
ibb
M
Median
di
English Caribbean 1st Quartile
Barbados
50
40
30
20
10
0
19501955
19551960
19601965
19651970
19701975
19751980
19801985
Periods
Source: UN Population Division. World Population Prospects: The 2004 Revision
19851990
19901995
19952000
20002005
Caribbean Commission on
Health & Development
Childhood malnutrition
Caribbean Commission on
Health & Development
Lymphatic filariasis
Caribbean Commission on
Health & Development
The Commission’s Report: main challenges
¾ “Disease” problems—
Noncommunicable disease
HIV/AIDS
Sequelae of injury and violence
¾ Health system problems
g
Management
Human resources
¾ The case for health insurance; health tourism
Strengthen the public health infrastructure
Caribbean Commission on
Health & Development
Major
j causes of death in the Caribbean
1.
2
2.
3.
4.
5.
6.
7.
1980 (%)
Heart Disease
Cancer
Stroke
Injuries
Hypertension
ARI
Diabetes
- 20
- 12
- 11
- 8
- 6
- 5
- 4
1.
2.
3.
4.
5
5.
6.
7.
2000 (%)
Heart Disease
Cancer
Stroke
Diabetes
Injuries
HIV/AIDS
Hypertension
-
16
15
10
10
7
6
6
Caribbean Commission on
Health & Development
Disability Adjusted Life Years (DALYs) 2001
400000
350000
300000
250000
CD
NCD
200000
150000
100000
50000
0
Jam
Trt
Bar
Guy
Caribbean Commission on
Health & Development
Prevalence of obesity, diabetes and
h
hypertension
t
i adults>20
d lt 20 years; circa
i
2000
Obesity
Diabetes
Hypertension
Weighted
Average
A
Average
17.7%
5.5%
20.5%
18 1%
18.1%
5 5%
5.5%
20 9%
20.9%
Maximum
25.2%
8.4%
26.1%
Minimum
14.4%
3.9%
14.9%
SD
3 4%
3.4%
1 2%
1.2%
2 9%
2.9%
Source-R.Suarez et al. PAHO
Caribbean Commission on
Health & Development
Trends in Adult
Ad lt Overweight/Obesity
O er eight/Obesit
in the Caribbean
60
Prevalence (%)
50
40
30
Male
Female
20
10
0
1970s
1980s
YEARS
1990s
Caribbean Commission on
Health & Development
Weighted
g
Prevalence of Overweight/
g Obesity*
y
by Age Group & Gender
80
70
60
Male
60.6
Female
50
40
30.6
30
20
10
0
15-24 25-34 35-44 45-54 55-64
Age (years)
65+
Total
BMI>=25kg/m2
Source—R.Wilks
Caribbean Commission on
Health & Development
Caribbean Commission on
Health & Development
Amputations at the QEH 2002-2006
Diabetic
Non diabetic
Male
308
116
Female
379
120
Total
995
236
Source A. Hennis, 2007
Caribbean Commission on
Health & Development
Caribbean Commission on
Health & Development
Caribbean Commission on
Health & Development
Caribbean Commission on
Health & Development
AIDS cases CAREC Member Countries
3000
2662
2539
2518
2500
2374
2565
Number of Cases
2028
2000
1808
1892
1925
1527
1500
1274
1023
1000
871
532
Years
20
003
20
002
20
001
20
000
19
999
19
998
19
997
19
996
19
995
19
994
19
993
19
992
19
991
19
990
402
19
989
305
19
988
19
984
19
987
19
983
195
19
986
13
113
19
985
2
28
19
982
500
0
633
Caribbean Commission on
Health & Development
Caribbean Commission on
Health & Development
Principal causes of mortality
(% of total mortality)
CAUSE OF DEATH
AGE GROUPS
15 24
15-24
25
25-44
44
HIV/AIDS
13.6
28.5
HOMICIDE
19.8
10.2
MVA’S
9.2
4.7
SUICIDE
45
4.5
2
2.7
7
Caribbean Commission on
Health & Development
Migration of nurses
¾ The Caribbean is losing~400 nurses per annum
through out-migration to Canada, UK and the USA
¾ The cost of training these nurses is estimated to be
US$ 15-20 million per annum-a significant transfer of
resources from the Caribbean. Remittancs only
partly go into national budgets, while the cost of
t i i is
training
i in
i some cases fully
f ll governmentt financed
fi
d
(Caribbean Conference on Temporary Movement
Movement, 2005)
Caribbean Commission on
Health & Development
IIn Latin
L ti America
A
i and
d the
th Caribbean,
C ibb
the
th
Total (Direct and Indirect) cost of
Di b t and
Diabetes
dH
Hypertension
t
i ffor 2005
was estimated at 39.1 billion US dollars.
The total cost of Diabetes and
Hypertension due to Obesity was 22.7
billion US dollars---58%
Caribbean Commission on
Health & Development
Economic Burden of Diabetes and
H
Hypertension
t
i
iin the
th B
Bahamas
h
(2002)
($US Million)
Direct cost…………………. 31.5
Indirect cost……………...
26.8
Total………………………..
58.3
Caribbean Commission on
Health & Development
Non Health
Expenditures
9,3%
Adm inistration
19,2%
Personal Health
Expenditures
46,0%
Public Health
pe d tu es
Expenditures
25,5%
AIDS expenditure in Barbados,2004
BDS$ 10.3 M—0.37 GDP (Barbados National AIDS Accounts)
Caribbean Commission on
Health & Development
Government Expenditure on Health as
%GDP
~1976
1986
~2004
MDC’s
2.6
2.6
2.8
Other
Countries
3.3
3.7
4.7
CARICOM Ave
3.0
3.4
3.9
Can/USA
7.3/7.4
Caribbean Commission on
Health & Development
% 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
49
4.9
Physical inactivity 7.3
73
Low fruit and veg. 4.6
intake
Alcohol
7.2
Caribbean Commission on
Health & Development
Polic instruments
Policy
instr ments to be considered re NCDs
¾
¾
¾
Legislation---food
L
i l ti
f d labeling
l b li
food imports
Taxation------ increase on tobacco
reduce on fruits and vegetables
increase on alcohol
Regulation---advertising to school children
exercise in schools
healthy school meals
Caribbean Commission on
Health & Development
Combat tobacco use
¾
¾
¾
¾
Tax tobacco products: triple exise taxes
Ban smoking in public places
Adequate warning on cigarette packages
Ban smoking in the work place (NB the dangers of
second hand smoke
¾ Provide replacement and cessation tools for those
who wish to quit
Caribbean Commission on
Health & Development
Price of cigarettes and consumption in S. Africa
1.3
Real price
1.2
0.08
1.1
0.07
1
0.9
0 06
0.06
Consum ption
Per adult
0.05
0.8
0.7
1970 1972 1974 1976 1978 1980 1982 1984 1986 1988
Year
Source: Saloojee 1995
Real Pric
ce
er adult (in pack
ks)
Cigarette consumption pe
0.09
Caribbean Commission on
Health & Development
Intensifying the actions to control the epidemic of
HIV/AIDS
Prevention , treatment and care, special attention to:
-devoting a higher percentage of funding to
prevention of risky sexual behaviour
g the social and gender
g
issues
- addressing
-battling stigma and discrimination
-legislation especially as regard labor laws
-scaling up treatment
Caribbean Commission on
Health & Development
Registered n
nurses--------------6,625
rses
6 625
Vacancies------------------------ 2,810
Vacancy rate
rate---------------------42.4%
42 4%
(Hewitt,2004)
Proposals
A managed migration program
Temporary migration-Mode
migration Mode 4 (WTO/GATS)
Caribbean Commission on
Health & Development
The health challenges to “Development”.
“Development”
economic---cost of diseases, direct & indirect
----impact
impact on productivity
education
poverty and poverty reduction
Addressing the challenges
leadership
partnership, internal and external
Caribbean Commission on
Health & Development
September 14,
14 2007
Regional Summit of Heads of Government to
discuss NCDs exclusively
R i
Regional
l action
ti on
tobacco
trade policy
obesity, diet, physical activity