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