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 1/3rd 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.”

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Individual responsibility

Changes to the "toxic" environment

COMMUNITY AND CIVIL SOCIETY

Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention

Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention

POLICY ENACTMENTHEALTH CARE AND DOCTOR

Support for the CNCD Commission -local

The Barbados Strategic Plan for Health, 2002-2012

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 2007adopted a fourteen-point declaration committing the

region to collective action to stop the epidemic of CNCDs

**Infrastructure: Secretariat / CCH3 / 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.– 2nd 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 3 Business 5 Education 3 Faith Based 4 Finance 7 Food Industry 2 Gov./Policy 13 H C Providers 11 Health Finance 3 Labour 5 Legal 1 Media 9 NGO/CNCD 35 Pharma 3 Reg./Pol 6 Service Clubs 3 Sports/PA 3 Urban Dev. 3 Youth 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: Support for Heads of Government of CARICOM Declaration on

CNCDsNeed to establish a Caribbean Civil society CNCD coalition Stresses the need for increased advocacyPromotion of healthy lifestyles Public education and media campaigns Seeks to hold Governments accountable

Summary of the Action Plan

Action lines:Establishment of Caribbean CNCD coalitionAdvocacySupport for Caribbean Wellness DayDevelopment of a communication strategyPublic education programmeRisk factor reductionSupport 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

Internal action:Improved management of NCCNCD Improved CNCD data management

External action:Health promotionReduction of CNCD risk factorsQuality CNCD treatment and care

Strategic Plan: Objectives

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: Vision, mission and values

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:

Public and private sectorGovernment and NGOsProfessional and voluntary bodiesCommunity based organizationsRegional 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

Organizational and management structures1. Budgetary funds allocated to CNCDs increased by 10%2. Administrative staff added to MOH to support Commission3. Secretariat established

Epi- data, HIS and research1. Implementation of annual surveillance reporting system

for CNCDs2. Regular outputs from BNR3. Repeat BRFS survey in 20104. Establishment of a web portal for CNCDs

Indicators of success

Risk factor reduction1. Complete adoption of at least 3 articles of FCTC by end of

20092. National population salt reduction policy articulated and

programme implemented by 4th quarter of 20093. Support for CME of health professionals4. Working relationship with National Nutrition Centre

Health promotion1. Representation of CNCDs at the level of the Social

partnership2. Sustained highly visible public education programme on CNCDs

Quality treatment and care1. Annual training given to health care professionals in CNCD

protocols

Indicators of success

Tobacco exposure

Significantly increase tax on tobacco productsRemove duty free concessions on tobacco products at

the ports of entryBan sale of tobacco products to minors Ensure that warning labels on tobacco products meet

international standards Ban smoking in public places Prohibit cigarette advertising at point of sale

Physical inactivity Make materials and aids used in exercise and physical

activity more affordable for personal use….VAT exemption

Enact policies to facilitate development of small community gyms

Create tax incentives for property developers to create safe recreational spaces in communities

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

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

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

Enhance the provision of drugs, syringes, needles for diabetics…drug service

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 : Provide input to any public health, medical and

epidemiological issues arising from that work Design and implement public awareness and

communication strategies about the contribution of the Registry to population health status improvement

Design 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 exposure8.4% current smokers

Physical activity51% low level of physical activity

Eating habits/diet95% ate less than 5 servings of fruit and

vegetables per day

Caribbean Wellness Day Introduced by Heads of Government of CARICOM Held on the 2nd 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