The role of CNCD Commissions in tackling chronic

The role of CNCD Commissions in tackling chronic diseases – The Barbados Experience Dominica National Commission on CNCDs Capacity Building Workshop, 19 January 2010 Professor Trevor A. Hassell, Chairman Commission for CNCDs, Barbados

The burden of the CNCDs Barbados § Quarter of men and more than a third of women live with one or more CNCD § Five leading causes of death are CNCDs § Heart disease and stroke rank among leading causes of death § 22% of Barbadian adults are hypertensive and 17. 5% are diabetic § Diabetes and hypertension account for 20% of primary care consultations § Overweight/obesity: 60% of women and 1/3 rd men

“ Three primary risk factors ( tobacco, poor diet and physical inactivity) and three intermediate risk factors (hypertension, obesity and diabetes) lead to three diseases (heart disease, lung disease and cancer) all resulting in some 50% of all deaths. ”

Complementary approaches to chronic disease prevention Individual responsibility Changes to the "toxic" environment HEALTH CARE AND DOCTOR POLICY ENACTMENT COMMUNITY AND CIVIL SOCIETY 4

Support for the CNCD Commission local § The Barbados Strategic Plan for Health, 20022012 § Strategy for the prevention and control of CNCD & Cabinet Note (2005) 26/MH. 03, Ministry of Health, Barbados (2004); § International Consultation on a Strategy for the Prevention and Control of CNCD for Barbados; Ministry of Health, Barbados (2005) § “Healthy Hearts for life”. Report of the Task Force on the Development of Cardiovascular Services (Jan. 2007); Ministry of Health, Barbados

Support for the CNCD Commission regional § Heads of Government of CARICOM Summit and Declaration against CNCDs, 2007 § Healthy Caribbean 2008 Chronic Disease Conference: a wellness revolution event

CARICOM Heads of Government Summit on Chronic Non-Communicable Diseases (CNCDs), 15 September 2007 adopted a fourteen-point declaration committing the region to collective action to stop the epidemic of CNCDs § **Infrastructure: Secretariat / CCH 3 / Regional Plans, M & E; § **National Commission, NCD Focal Point in MOH § **Advocacy, Communications, Social marketing § **Sustainable Financing § **Surveillance, including Gender dimensions

Priorities of the Summit § Tobacco (FCTC) § Healthy Eating (DPAS): – Trans Fat, Trade, Labeling § Active Living (DPAS) – Population-wide activities – Schools/workplaces etc. – 2 nd Saturday in Sept: “Caribbean Wellness Day” § Screening and integrated management

Purpose § To bring together a wide spectrum of partners from throughout the CARICOM countries – civil society, the business community, educators and researchers, policy makers to plan civil society’s response to the CNCD pandemic

Participants § § § § § Agriculture Business Education Faith Based Finance Food Industry Gov. /Policy H C Providers Health Finance Labour Legal Media NGO/CNCD Pharma Reg. /Pol Service Clubs Sports/PA Urban Dev. Youth 3 5 3 4 7 2 13 11 3 5 1 9 35 3 6 3 3 § § § § Anguilla Antigua Aruba Bahamas Barbados Belize BVI Cayman islands Dominica Grenada Guyana Jamaica Montserrat St. Lucia Trinidad and Tobago St. Kitts

Outcomes Active Caribbean Workshop Caribbean Civil Society Declaration on CNCDs Caribbean Civil Society Action Plan for tackling CNCDs, Conference Report produced as a Technical Report of the Chronic Disease Research Centre, UWI § Creation of a Caribbean civil society coalition for tackling CNCDs - Healthy Caribbean Coalition § § § Website: www. healthycaribbean. org. § Co-sponsorship of upcoming University Diabetes Outreach Conference, Jamaica, 2010 § CNCD media campaign for Barbados and the OECS

Summary of the Declaration § 10 point preamble and 12 point declaration § Preamble recognizes the contribution of the CNCDs both to ill health & disease and excessive financial burden, but appreciates that much can be done § Declares inter alia: Ø Support for Heads of Government of CARICOM Declaration on CNCDs Ø Need to establish a Caribbean Civil society CNCD coalition Ø Stresses the need for increased advocacy Ø Promotion of healthy lifestyles Ø Public education and media campaigns Ø Seeks to hold Governments accountable

Summary of the Action Plan § Action lines: ØEstablishment of Caribbean CNCD coalition ØAdvocacy ØSupport for Caribbean Wellness Day ØDevelopment of a communication strategy ØPublic education programme ØRisk factor reduction ØSupport for country level activities

The National Commission for CNCDs, Barbados Established January 2007 Inter-sectoral body 14 members and 4 ex-officio members Volunteers paid small stipend Meetings held monthly Professional, administrative and secretarial support provided by staff of the Health Promotion Unit § No budget allocated to the Commission at start up § § §

The Commission’s mandate § Advise Minister of Health on CNCD policies and legislation § Broker involvement of all sectors in program implementation § Assist in mobilisation of resources to facilitate implementation of programs § Recommend relevant research § Promote collaborations and partnerships § Monitor regional and international trends § Facilitate commissioning of audits /evaluation of CNCD programs § Recommend to Minister of Health framework that encourages and promotes behaviour change to prevent CNCDs

Membership of NCCNCD, Barbados • • • • Professor Trevor Hassell MD. , Chairman Professor Henry Fraser MD. , Dean Faculty of Medical Sciences Mr. David Neiland , Businessman, the private sector Mr Orlando Scott, trade union movement Mr Wilfred Beckles, Barbados Association of Retired Persons Mr. Michael Gaskin, teacher, physical education Mr Adrian Randall , CEO, Heart & Stroke Foundation of Barbados Dr Elliott Douglin MD. , Representing Faith based organisations Mrs. Sophia Cambridge, Advertising and media Ms Candace Waldron, Youth Representative Ms Zonia Phillips, Food and Nutrition advocate Mr Barton Clarke Chief Agricultural Officer, Ministry of Agriculture Mrs Wendy Griffith-Watson, Chief Education Officer Mrs. Ena Harvey, IICA

Strategic Plan: Objectives § Internal action: ØImproved management of NCCNCD ØImproved CNCD data management § External action: ØHealth promotion ØReduction of CNCD risk factors ØQuality CNCD treatment and care

Strategic Plan: Vision, mission and values § Vision: to be a leader in all major national developments related to CNCDs in order to achieve reduction in CNCDs § Mission: Advises on, facilitates and promotes evidence based best practices in Prevention and Control of CNCDs § Values: Transparency, inclusiveness, respect for all views, adoption of evidence based practices, accountability, and collaboration

Strategic plan: key strategies § Strategic management issues § Epidemiological data, Health Information System and research § Measures to support reduction of risk factors § Health promotion § Quality treatment and care

Strategic management issues § Advisory body guiding and assisting a highly motivated group of operational partners § Driving CNCD interventions in collaboration with: ØPublic and private sector ØGovernment and NGOs ØProfessional and voluntary bodies ØCommunity based organizations ØRegional and international bodies

Epi- data, Health Information Systems and Research § Increasing access to data on CNCDs § Strengthening functional links with CDRC/UWI § Using the BNR as a priority data source to inform actions of the CNCD Commission § Increasing surveillance capacity of Ministry of Health § Using Health Information System

Measures to support reduction of risk factors § Declare CNCDs a national priority § Enhance the role of the commission with the public § Giving the public access to CNCD data § Inform the public of standards in treatment and care § Support on-going educational programmes targeting health care professionals

Health promotion § Integrate health promotion strategies in the planning process § Improve inter-sectoral collaboration § Lobby where necessary for high impact § Influence legislation and regulation

Quality treatment and care § Establish standards for CNCD treatment and care

Indicators of success § Organizational and management structures 1. Budgetary funds allocated to CNCDs increased by 10% 2. Administrative staff added to MOH to support Commission 3. Secretariat established § Epi- data, HIS and research 1. Implementation of annual surveillance reporting system for CNCDs 2. Regular outputs from BNR 3. Repeat BRFS survey in 2010 4. Establishment of a web portal for CNCDs

Indicators of success § Risk factor reduction 1. Complete adoption of at least 3 articles of FCTC by end of 2009 2. National population salt reduction policy articulated and programme implemented by 4 th quarter of 2009 3. Support for CME of health professionals 4. Working relationship with National Nutrition Centre § Health promotion 1. Representation of CNCDs at the level of the Social partnership 2. Sustained highly visible public education programme on CNCDs § Quality treatment and care 1. Annual training given to health care professionals in CNCD protocols

Tobacco exposure ü Significantly increase tax on tobacco products ü Remove duty free concessions on tobacco products at the ports of entry ü Ban sale of tobacco products to minors Ø Ensure that warning labels on tobacco products meet international standards Ø Ban smoking in public places Ø Prohibit cigarette advertising at point of sale

Physical inactivity ü Make materials and aids used in exercise and physical activity more affordable for personal use…. VAT exemption ü Enact policies to facilitate development of small community gyms § Create tax incentives for property developers to create safe recreational spaces in communities ü Increase physical activity in schools § Enact legislation and policies to make the city and the country more conducive to walking and riding

Hypertension and blood pressure control ü Continue to make blood pressure lowering drugs available at an affordable cost at point of delivery…. Drug formulary § Produce a more cost effective and more rational range of antihypertensive drugs ü Seek to provide delivery of care of hypertension by primary care doctors using the chronic care medical model § Population salt reduction using a voluntary and collaborative approach informed by national policy

Diabetes and blood sugar control ü Enhance the provision of drugs, syringes, needles for diabetics…drug service ü Provide blood glucose test strips § Provide tax concessions or zero rate glucometers

National Chronic Disease Registry § An initiative of the Ministry of Health, executed on contract by the Chronic Disease Research Centre § Sub-registries of acute myocardial infarction, stroke, and cancer, related risk factors and outcomes § Aims to inform and guide prevention and intervention strategies, and optimal resource use § Model for the region § Complementary to PAHO/STEPS Risk Factor surveillance program

The Commission and the Barbados National Registry § Chairman of the Commission has a “direct interest” in the outputs of the Registry § Commission facilitates and supports the work of the Registry § Commission monitors and evaluates the operations of the Registry § The Registry supports the information needs of the Commission

The Commission and the Barbados National Registry § The Commission in conjunction with the CMO will : üProvide input to any public health, medical and epidemiological issues arising from that work üDesign and implement public awareness and communication strategies about the contribution of the Registry to population health status improvement üDesign and implement “professional awareness strategies” to inform and engage the medical and related professions in the activities of the Registry

Barbados Behavioural Risk Factor Survey (STEPS): 25 years and older § Tobacco exposure ü 8. 4% current smokers § Physical activity ü 51% low level of physical activity § Eating habits/diet ü 95% ate less than 5 servings of fruit and vegetables per day

Caribbean Wellness Day § Introduced by Heads of Government of CARICOM § Held on the 2 nd Saturday in September § Focus attention throughout the region on the chronic diseases § Coordinated by the CNCD Commission § All sectors of the community invited to participate, private sector, government, trade unions, civil society, the academic and educational institutions, faith based organisations

National Nutrition Improvement and Salt Reduction Program § § § § Survey of population salt intake: initial and follow up Healthy nutrition policies and actions in schools Taxation policy around healthy food and beverages Public education campaign on radio, TV, and print media Reformulation of food and drinks “Salt choice the difficult choice” Workshops and seminars for health care providers Barber shop screening project

The National Chronic Non-Communicable Disease Commission Logo

Nutrition guidelines for schools § Produced 2009 § A tool for use in schools to assist teachers and students in best practice nutrition § Distribution of guidelines and implementation, 2010

Activities of the Commission § Healthy Caribbean 2008 civil society conference § Initiated service contracts with health NGOs § Contributed to the Heads of Government of CARICOM Summit, 2007 § Contributor and lead role in development of Cabinet paper on CNCDs § Consultation on trans fats / Faith based workshop § Several lectures and presentations - CMOs and Ministers of Health, OECS; New Delhi, India; Washington, USA § Publication of brochure “Battling the hidden enemy” § CNCD media campaign for Barbados and the OECS