Concern over NCDs

TWO Fridays ago marked a decade since the call to action which saw the historic launch of the Strategic Plan of Action for the Prevention and Control of Chronic Non-Communicable Diseases (NCDs) for countries of the Caribbean Community (CARICOM).

The initiative was taken in September 2007, amidst growing concerns, that the Caribbean epidemic of Chronic NCDs was the worst in the region of the Americas, causing premature loss of life, lost productivity and spiraling health care costs. The health conditions contributing the burden of disease were cited as cardio-vascular disease (including heart disease, stroke, hypertension, diabetes, cancer and asthma).

In light of this, the Caribbean Cooperation in Health Initiative, approved by Health Ministers in 1986, made NCDs a priority concern.
By 2005, the Caribbean Commission on Health and Development reported that the number of deaths from diabetes, hypertension and heart disease combined was 10 times higher than the number of deaths from Acquired Immunodeficiency Syndrome (AIDS) and declared NCDs a “super priority” effectively spurring the CARICOM Health Ministers to action.

But 10 years later, the Caribbean region is still recorded as having the highest burden of NCDs in the Americas, according to PAHO’s study: ‘Monitoring Compliance with high-level commitments in Health: The case of the CARICOM Summit on Chronic Non-Communicable Diseases.’ (October 2016).

Studies carried out at the level of the PAHO and CARICOM determined that the root causes of the epidemic were unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol, driven by social determinants and global influences.

ROADMAP FOR ACTION
The launch of this Strategic Plan of Action was intended to form a roadmap for action and resource mobilisation at both the regional and country levels.
Driven by this daunting concern about the heavy burden of disease and the multi-sectoral causes of the risk factors for these conditions, CARICOM Heads of Government on September 15, 2007 convened a summit on NCDs, with joint support from the CARICOM Secretariat and PAHO/WHO. A 15-point Declaration of Port-of-Spain was issued under the theme: “Uniting to stop the epidemic of Non-Communicable Diseases.”

This approach was lauded as a ‘first-in-the-world event’ in which Heads of Government took policy decisions to prevent and control NCD epidemic. The Strategic Plan of Action Summit Declaration outlines a framework for policies and programmes across several government ministries.

Essentially, these were to be undertaken in collaboration with the private sector, academia and the community, buttressed by region-wide sustained information and communication by media and Primary Health Care Professionals (PHC ) aimed at creating supportive environments “to make the right choice the easy choice.”

PRIORITY ACTION
Over the ensuing years, there was a hype, as Caribbean nations zestfully grappled to put systems in place to comply with specific measures aimed at reducing the debacle.
Leading the list of priority actions for the reduction of risk factors was “No Tobacco”; No harmful use of alcohol and the mandatory ratifying of WHO Framework Convention on Tobacco Control in all Caribbean countries by 2011; 100% (enclosed) ‘smoke-free’ public spaces to be declared in at least eight countries by 2013; A complete ban on Tobacco ads, promotion and sponsorship in at least seven CARICOM countries by 2013, among other things.

And quite deservingly, a high premium was also placed on ‘Healthy Eating’, placing emphasis on trans-fat, fats and sugar content, making it mandatory for model nutritional standards for schools, workplaces and institutions to be developed by 2013. CARICOM countries were called upon to adapt and implement food-based dietary guidelines; for nutrition on labels to be displayed on foods and snacks offered for sale; as well as the elimination of trans-fat from the food supply chain by 2015, aimed at bringing about a drastic reduction of sugar and fats in the diet.

Also targeted was the reduction of salt, with 80 per cent of large manufacturers following the Caribbean Association of Industry and Commerce (CAIC) pledge to reduce salt and fat content of processed and prepared foods (including in schools, workplaces and fast food outlets) by 2013), among other things.

And, in a bid to reduce primarily childhood obesity, high on the agenda was the holding of Annual Caribbean Wellness Day celebrations to take place in 12 CARICOM countries by 2011, and for the establishment of new and safe recreational spaces by 2012.
A decision was taken for senior health personnel, NCD Programme Managers and Primary Health Care (PHC) professionals to be trained in NCD programme quality improvement, based on national guidelines, among other things.

The Strategic Plan of Action also defined a strategic role for Media and Social Communication, spelling out that capacity should be built for media (health journalists and reporters to empower them to be more effective behavior change and communications agents.

Meanwhile, Integrated Programmes were mooted, especially for schools, workplaces and faith-based settings, calling for at least a 20 percent increase in the number of schools with healthy meal choices and physical education programmes by 2013. There was also a call for at least a 50% increase in the number of workplaces with healthy food choices and Wellness Programmes, including screening and management of those at high risk by 2013.

Back then, there were, and even today, continues to be a strong political will and willingness on the part of CARICOM leaders to do all that is considered necessary to win the fight against Chronic non-communicable diseases, but within constraints and so, pathetically, the measure of success anticipated has not been realised.

COMPLIANCE ASSESSMENT RESULTS
In March 2010, Chair of the Healthy Caribbean Coalition, Trevor Hassell, made an assessment of compliance with the commitments acquired during the CARICOM Summit. He concluded that almost three years after the 2007 Summit, compliance was modest and mixed. Barbados, Guyana, Jamaica and Trinidad and Tobago showed the highest compliance, with Haiti, Montserrat and Turks and Caicos recording the lowest.

As early as 2008, then Guyana’s Minister of Health, and President of the World Health Assembly, Dr. Lelslie Ramsammy, advocated for NCDs to be given a more prominent place on the global public health agenda and made the subject of an additional MDG.

As mandated in the Declaration of Port of Spain, the first Caribbean Wellness Day was celebrated on September 13, 2008 to commemorate the anniversary of the CARICOM Summit, with support from PAHO. In July 2009, CARICOM Heads of Government endorsed the Caribbean Wellness Day slogan of “Love That Body”. Notably, there has been a surge of interest in Caribbean Wellness Day, with the majority of CARICOM countries staging fitness activities in observance of the day, each year.

HOLISTIC APPROACH NEEDED
A number of initiatives continue to be taken at the political level, with leaders moving energetically towards realising success, but at the domestic level … the masses of the people seemed not to have gotten the importance of the message or, to have adopted a ‘matter of fact’ approach. This is even as children, who could not clearly understand the detrimental consequences, continue to consume dangerous amounts of sugars, salt, trans-fat at fast food establishments. On the other hand, the younger ones, abysmally unaware, continue to consume sugar-loaded snacks carefully packed in their lunch kits by sometimes ‘unsuspecting parents’. And, in relation to tobacco too, many men and boys continue to puff tobacco as if it were ‘going out of style’.

The media, (health journalists and reporters) need to do more to empower the masses to be more effective behavior change and communications agent.
As Guyana continues to work toward the control of NCDs, the Tobacco Control Bill was recently passed in Parliament, the aim of which is to control the smoking of tobacco in public spaces. The Bill seeks to adopt and implement tobacco-control policies in accordance with the World Health Organisation’s (WHO) Framework Convention on Tobacco Control (FCTC). According to Minister within the Ministry of Health, Dr, Karen Cummings, non-communicable diseases (NCD) – many of which are caused by smoking — accounted for over 70 percent of Guyana’s public health budget for 2017.

LEADERS RENEW COMMITMENT
There was a breath of fresh air when at the 38th CARICOM Summit held in Grande Anse, Grenada, last July, CARICOM Heads renewed their commitment to frontally address NCDs in their countries.

Placing a high premium on the need for a holistic approach to be taken in the bid to bring NCDs under control, Secretary-General, Ambassador Irwin LaRocque, made the point that regardless of the rules and regulations put in place by governments with the aim of controlling chronic non-communicable diseases, the bottom line is that each time we engage in risky behaviours that endanger our lives, we are responsible for our health.
Albeit, Ambassador La LaRocque said member states would continue to do what they have to do including, embarking on more public education and utilising a holistic approach to address the issue.

In the document: “Monitoring compliance with high-level Commitments in Health: The case of the CARICOM Summit on Chronic Non-Communicable Diseases”, by T Alafia Samuels, John Kirton & Jenilee Guebert, concluded that: “The CARICOM Summit was successful in several ways. It was the first Summit of Heads of Government to focus on the problem of NCDs and it resulted in multiple collective, multilateral commitments for implementation of policies and actions pertaining to NCD control. Although there is room for improvement, countries fulfilled some important commitments acquired at the summit.

The CARICOM Summit sparked interest in a global summit on NCDs and resulted in the UN high-level meeting on NCDs. An accountability mechanism based on annual reporting is critical for monitoring progress and highlighting areas in need of correction.”

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