The Experience of Building Momentum in GHD on
Chronic Disease Prevention and Control:
From the Caribbean toward the UN Summit 2011
Pan American
Health
Organization
C. James Hospedales,
Senior Advisor & Coordinator,
NCD Prevention & Control
PAHO/WHO
2005
Overview
• Background
• CARICOM Summit on Chronic Disease
• Lessons learned in GHD
• Next Steps towards the UN Summit
Pan American
Health
Organization
2005
CARMEN Network
32
Members
Argent, Anguilla, Ant&Barb, Arub
Barbados , Bahamas, Brazil, Can,
Colombia, Costa Rica, Cuba,
Curacao, Chile, Dominica,
Ecuador, El Salvador, Grenada,
Guatemala, Guyana, Jamaica
Mexico, Nicaragua, Panama,
Paraguay, Peru, Puerto Rico,
St Kitts & Nevis, St Lucia,
Trin. & Tobago, Uruguay
CARMEN SCHOOL
Prospective Members
Honduras, Venezuela, Bolivia
Collaborating members
SLU,USF,NHLBI,CDC, PHAC
AMNET, RAFA,ILSI,F&V
Pan American
Health
Organization
Special
2005
• USA-Mexico (border)
• Caribbean CARMEN
English-Speaking Caribbean; 14 countries, 7.5million people
Pan American
Health
Organization
2005
All is not well in Paradise
Pan American
Health
Organization
2005
UN High Level Meeting /Summit on
Chronic Diseases, September 2011
• Many things have contributed: What was the role of the
Caribbean in leading to this major opportunity for health?
Pan American
Health
Organization
2005
What has led the UN General Assembly
to convene the UN Summit in 2011?
May 2000
World Health Assembly endorses the 'Global strategy on the prevention and control of NCDs
September 2002
World Summit on Sustainable Development (Jo’burg) adopts 'Plan for Implementation‘ on NCDs
May 2003
World Health Assembly endorses the 'WHO Framework Convention on Tobacco Control'.
May 2004
World Health Assembly endorses the 'Global strategy on diet, physical activity and health'.
December2006
UN General Assembly adopts resolution A/RES/61/225 (develop national policies for diabetes)
September2007
Caribbean Community (CARICOM) Heads of Government adopt declaration on NCDs
May 2008
WHA endorses WHO 'Action Plan for the Global Strategy for the Prevention and Control of NCDs'.
April 2009
Summit of the Americas Conclusion includes Articles 28 and 29 on NCDs
November 2009
Commonwealth Heads Government issued a statement to combat NCDs.
January 2010
Drafting group led by the Caribbean Community convenes to develop a resolution on NCDs.
May 2010
A/RES/64/265 adopted unanimously by the UN GA; co-sponsored by 78 countries, including Canada and USA
Pan American
Health
Organization
2005
The CARICOM Heads Summit on NCDs,
Sept 15, 2007, Trinidad & Tobago
•
•
•
•
•
•
•
•
•
“We, the Heads of State of the Caribbean Community….”
15-point “Port of Spain Declaration”; multi-sectoral
Tobacco – Ratify and implement the WHO Framework Convention on Tobacco
Control: taxation, packaging, earmark some revenue for health promotion &
disease prevention, ban smoking in public places
Healthy Diet - Trade policies on food imports, agriculture policies, Healthy school
meals, Food labeling, reduce or eliminate trans fats
Physical activity-physical education in schools; physical activity in work places;
improve public facilities for physical activity
Health services - screening and management of NCDs to achieve 80% coverage by
2012; primary and secondary prevention, comprehensive health education
Monitoring - Surveillance of risk factors; monitoring of the actions agreed upon in
Declaration (CARICOM Secretariat, CAREC, UWI & PAHO/WHO)
Mobilizing Society - National Commissions on NCDs; including public, private
sector and civil society, media and communications industry
Caribbean Wellness Day – Second Saturdays in September
Pan American
Health
Organization
2005
WWW.CARICOM.ORG
What are the lessons learned in Global
Health Diplomacy from the CARICOM?
Pan American
Health
Organization
2005
Lessons Learned – from case study
and from reflection
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Progression and confluence of factors; not one single effort
Absolute need for evidence / data
Making the case: Speaking to head, heart and pocket
Political structure, and history of Caribbean cooperation in health
Importance of Champions: Political, technical, public health
“Pre-selling” by visiting countries/ Cabinets
PAHO-CARICOM collaboration
Country involvement in planning and preparation
Media and NGO involvement
International partners; especially Canada
Pan American
Health
Organization
2005
1. Progression and confluence of
factors; not one single effort
1. Nassau Declaration of 2001: “The Health of the Region is the
Wealth of the Region”, CARICOM Heads Conference
2. Caribbean Commission on Health and Development, 2003-05:
identified Chronic Diseases, HIV/AIDS, and injuries and
violence as “super priorities” for health
3. National level events, T&T, Barbados, Jamaica
4. Global /hemispheric awareness emerging
Pan American
Health
Organization
2005
2. Absolute need for evidence / data
• Caribbean Epidemiology Centre (CAREC) – mortality and
risk factor trends
• Caribbean Food and Nutrition Institute – dietary trends,
obesity trends
• University West Indies – economic impact data
• U of Toronto, W Bank, CARICOM Trade desk – tobacco,
financing issues, trade policy options, respectively
Pan American
Health
Organization
2005
2. Absolute need for evidence / data
• Caribbean Epidemiology Centre (CAREC) – mortality and
risk factor trends
• Caribbean Food and Nutrition Institute – dietary trends,
obesity trends
• University West Indies – economic impact data
• U of Toronto, W Bank, CARICOM Trade desk – tobacco,
financing issues, trade policy options, respectively
Data are necessary but not sufficient!
Pan American
Health
Organization
2005
3. Speaking to Head, Heart and Pocket
Potential Years of Life Lost <65yrs by cause,
CARICOM countries, 2000 & 2004
70000
60000
50000
40000
PYLL
30000
20000
10000
0
Chronic Diseases
Pan American
Health
Organization
HIV/AIDS
Injuries
NCDs: Biggest cause premature death
in the Caribbean
2005
Speaking to Head, Heart and Pocket
Potential Years of Life Lost <65yrs by cause,
CARICOM countries, 2000 & 2004
NCDs: Biggest cause
premature death
70000
60000
50000
40000
PYLL
30000
20000
10000
0
Chronic Diseases
HIV/AIDS
Injuries
45-yr old man with
diabetes and amputation
Pan American
Health
Organization
2005
Speaking to Head, Heart and Pocket
Potential Years of Life Lost <65yrs by cause,
CARICOM countries, 2000 & 2004
NCDs: Biggest cause
premature death
70000
60000
50000
40000
PYLL
30000
20000
10000
0
Chronic Diseases
45-yr old man with
diabetes and amputation
HIV/AIDS
Injuries
3-5% GDP loss due to
diabetes, hypertension in
T&T, Jamaica, Barbados
Pan American
Health
Organization
2005
Speaking to Head, Heart and Pocket
Potential Years of Life Lost <65yrs by cause,
CARICOM countries, 2000 & 2004
NCDs: Biggest cause
premature death
70000
60000
50000
40000
PYLL
30000
20000
10000
0
Chronic Diseases
HIV/AIDS
Injuries
45-yr old man with
diabetes and amputation
Tobacco control could save lives
and raise $150M revenue in CARICOM
Implement
tax/other
policies
$450
Current
Pan American
Health
Organization
3-5% GDP loss due to
diabetes, hypertension in
T&T, Jamaica, Barbados
200
$300
0
100
200
Revenue ($M USD)
300
400
500
600
Lives saved (000s)
700
2005
4. Political Structure, and History of
Caribbean Cooperation in Health
• A political structure that facilitated regional appreciation of the
problem and could mandate regional action, complementary to
national action.
• The Caribbean Community (CARICOM) is a formal political
structure supported by the Treaty of Chaguaramas and a
Secretariat
• Council of Human & Social Development; Ministers of Health &
others
• Conference of Heads of Government – twice yearly
• Caribbean Cooperation in Health – since 1986; polio, measles,
rubella elimination; regional health institutions
Pan American
Health
Organization
2005
5. Importance of Champions: Political,
Technical, Public Health
Dr Eddie Greene,
Asst Sec General
Human & Social Development
CARICOM
Dr Mirta Roses
D/PAHO
Pan American
Health
Organization
Sir George Alleyne
Chancellor UWI
Former D/PAHO
2005
Pan American
Health
Organization
2005
6. Pre-selling by visiting countries/
Cabinets
• Chairman or members of Commission on Health and
Development visited all CARICOM Countries and spoke to
Cabinet, PM, Parliament between 2004-2007
• Allowed individual persuasion and consideration of situation
of country
Pan American
Health
Organization
2005
7. PAHO/WHO-CARICOM Collaboration
– critical for success
Pan American
Health
Organization
2005
8. Country involvement in
planning and preparation
• Planning team included 4 CARICOM Chief Medical Officers
• Survey of national NCD capacity and policies
• Standard template for posters of national situation to be
presented at the Summit
• Progress reported regularly to Health Ministers
Pan American
Health
Organization
2005
9. Media and NGO Involvement
• Not as intensive as planned
• “One Caribbean Media” conglomerate printed free Summit
supplements and distributed in Sunday newspapers in most
territories prior to the Summit
• Media articles, interviews
• Healthy Caribbean Coalition born; a civil society alliance to
combat chronic disease and risk factors
Pan American
Health
Organization
2005
10. Importance of International Partners:
Special Role of Canada
• Public Health Agency of Canada provided a grant to PAHO
support the Summit implementation and preliminary steps after
• WHO Collaborating Centre on NCD Policy in PHAC provided
technical assistance with case study of 26 key informants on
perceptions of the Summit
• CIDA provided a grant to the CARICOM Secretariat to support
conduct of the Summit
Pan American
Health
Organization
2005
Lessons Learned – from case study
and from reflection
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Progression and confluence of factors; not one single effort
Absolute need for evidence / data
Making the case: Speaking to head, heart and pocket
Political structure, and history of Caribbean cooperation in health
Importance of Champions: Political, technical, public health
“Pre-selling” by visiting countries/ Cabinets
PAHO-CARICOM collaboration
Country involvement in planning and preparation
Media and NGO involvement
International partners; especially Canada
Pan American
Health
Organization
2005
Next Steps
• So you had the Summit; so what?
• Implementation is key and in countries lags behind political
statements
• Twice-yearly monitoring mechanism helps greatly
• Caribbean Wellness Day – amazing mobilization
• Application of lessons learned to South and Central America
• Healthy Caribbean Coalition – civil society alliance to
combat NCDs and risk factors – beginning a texting
campaign to create the “global demonstration”
• UN Summit
Pan American
Health
Organization
2005
NCD Progress Indicator Status / Capacity by Country in Implementing NCD Summit Declaration - September 2010
PO
S
NC
D #
NCD Progress Indicator
A
N
G
A
N
T
B
A
H
B
A
R
B
V
I
C
A
Y
D
O
M
G
R
E
G
U
Y
H
A
I
J
A
M
1,14
4
2
2
X
X
X
X
X
X
X
X
±
X
X
X
COMMITMENT
? ± ?
±
? ± X X
? X ?
?
? ± ?
?
X
X
X
X
?
±
?
X
?
X
±
?
?
±
?
?
X
X
X
X
12
NCD Plan
NCD budget
NCD Summit convened
Multi-sectoral NCD Commission
appointed and functional
NCD Communications plan
X
X
±
X
X
±
±
?
3
3
3
3
FCTC ratified
Tobacco taxes >50% sale price
Smoke Free indoor public places
Advertising, promotion & sponsorship bans
*
X
X
X
?
X
?
X
?
X
X
X
*
?
X
?
?
?
?
±
?
?
7
Multi-sector Food & Nutrition plan
implemented
Trans fat free food supply
Policy & standards which promote healthy
eating in schools implemented
Trade agreements utilized to meet national
food security & health goals
Mandatory labeling of packaged foods for
nutrition content
?
?
?
?
X
?
X
X
±
±
±
?
X
±
±
PHYSICAL ACTIVITY
?
? ±
?
?
?
X
7
7
8
9
6
10
10
Mandatory PA in all grades in schools
Mandatory provision for PA in new housing
developments
Ongoing, mass Physical Activity or New
public PA spaces
?
CWD multi-sectoral, multi-focal celebrations
?50% of public and private institutions with
PA & diet) programmes
?30 days media broadcasts on NCD control
/ yr (risk factors and treatment)
?
?
X
Surveillance: - STEPS or equivalent survey
- Minimum Data Set reporting
- Global Youth Tobacco Survey
- Global School Health Survey
American
X
X
X
?
X
X
?
?
X
?
11,
13,
14
Pan
Health
5
Chronic Care Model /
Organization
5
NCD treatment
protocols in ? 50% PHC facilities
QOC CVD or diabetes demonstration
project
± X ?
TOBACCO
? ? *
?
X
?
± ?
± X ?
NUTRITION
± ± X
?
X
X
12
B
E
R
X
±
?
±
X
15
10
B
E
L
X
?
?
?
X
±
EDUCATION / PROMOTION
? ? ? ? ? ?
X
X X
?
±
?
±
?
X
?
X
SURVEILLANCE
?
? ± ?
X X ? ?
? ? X ?
± ±
?
TREATMENT
? ± ± ± X
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X
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K
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X
2005
UN Summit on NCDs 2011
•
•
•
•
•
•
•
•
Unique policy window opening; think big
Need to Unite forces in NCDs, Risk Factors, H. Prom
Need roadmap/battle plan: before, during, after
Country by country advocacy campaign
Evidence - packaged to speak to head, heart & pocket
How do we create a “Global Demonstration”?
Champions, going viral, media advocacy
Be clear on “the ask”
Pan American
Health
Organization
2005
SICA Presidential summit
LAC Civil Soc
Obesity Forum
G-8 France
Pan American
Health
Organization
2005
“Running through the tape”… of the
UN Summit
Pan American
Health
Organization
2005
THANK YOU
OBRIGADA
MUCHAS GRACIAS
Pan American
Health
Organization
2005