Kenneth S George MBBS DM MPH From Risk to Disease Adapted from the - - PowerPoint PPT Presentation

Kenneth S George MBBS DM MPH

From Risk to Disease

Adapted from the WHO

Leading causes of death (mortality) in Barbados

1.

Cardiovascular Disease - stroke and heart attack

2.

Diabetes Mellitus and its complications including blindness, amputations and kidney failure

3.

Cancer - breast, cervix prostate colon, stomach and lung NCDs cause more deaths that HIV/AIDS, infectious diseases, accidents and homicides combined

Polyclinic visits for NCDs (morbidity)

Diagnosis 2010 2011 2012 Diabetes Mellitus 23,273 24,667 24,292 Hypertension 39,774 42,518 41,381 IHD/CAD 793 854 896 Lipid disorders 9,335 11,089 11,814 Stroke 224 246 348 Cancer Breast 52 72 67 Cancer cervix N/A 7 6 Cancer Prostate 191 330 418 Cancer Colon/rectum 27 N/A 44 Social and Economic Development Report 2012

Risk Factors in Barbados - Behavioral

2007 2012

 Current Smokers Tobacco

 All 8.4% – M 14.4% and F 2.2%

 Alcohol in the last 30 days

 All 23.9% – M 42.1% and F 16.9%

 Binge drinking

 All 13.8% M 21.9% and F 9.7%

 < 5 servings F&V

 All 95.4% - M 96.6% and F 94.3%

 Current Smokers Tobacco

 All 8.8% - M 15.6% and F 4.9%

 Alcohol in the last 30 days

 All 40.8% - M 56.6% and F 32.0%

 Binge drinking

 All 12.1% - M 23.9% and F 5.6%

 < 5 servings F&V

 All 81.2% – M 80.1% and F 81.8%

Risk Factors In Barbados - Biological

2007 2012

 Mean BMI (kg/m2)  All 27.7- M 26.1 and F 29.1  Overweight

 All 65.2% - M 54.6% and F 74.3%

 Obesity

 28.5% - M 20.3% and F 35.5%

 Hypertension

 All 41.5% - M 41.2% and F 41.8%

 Diabetes Mellitus  All 14.9% - M 12.7% and F 16.7%  Mean BMI (kg/m2)

 All 28.1 – M 26.5 and F 29.0

 Overweight

 All 64.3% - M 56.6% and F 68.8%

 Obesity

 All 32.9% M 22.1% and F 39.3%

 Hypertension

 All 38.8% - M 40.1% and F 38.1%

 Diabetes Mellitus

 All 16.9% - M 16.7% and F 17.0%

Barbados National Registry

 Stroke 2009 – 559 (322 females & 237 males)

2010 – 584 (323 females & 261 men)

 Acute MI and Sudden Death 2010

2010 – 347 (181 females & 166 males)

 Outcomes are poor with 47% of all heart attacks and 1/5 of all strokes die

prior to reaching hospital

 2009-2011 BNR data suggest mortality and CFR of MI is stable or declining

however increases are note for stroke

 80-90% of persons with confirmed stroke and heart attack had diabetes,

hypertension or both as risk factor(s)

Risk Factors in Children (GSHS 2012)

OVERWEIGHT

 Combined- 31.9%  Males- 31.6%  Females- 32.2% F)

OBESITY

 Combined- 14.4%  Males-13.7%  Females-15.1%

 Less than 5% of the sample reported ‘hunger’.

NCD Risk Factors in Children - Dietary

Fruit and vegetable (F&V) consumption:

 12.7% reported eating 5 or more servings per day over a 30 day period  15 % reported no F & V within the last month

Other unhealthy practices:

 18.5 % of students reported consumption of ‘fast food’ 3 or more days per

week

 73.3% of students reported drinking 1 or more carbonated beverage per day.

NCD Risk Factors Children - Exercise

Children (5–17 years) should accumulate at least 60 minutes of moderate- to vigorous PA daily (WHO). Barbadian children:

 Combined- 28.2%  Males 34.5%  Females 22.1%  70.1% were considered physically inactive

Students engaged in at least 3 hrs. sedentary activity:

 Combined- 65.3%  Males- 59.7%  Females- 70.7%

CSO Interactions

Civil Society and the Non-state Actors

Strengths of Civil Society

 Advocacy and harnessing public opinion  Highlighting public health priorities (sometimes less well know

conditions)

 Usually perceived as a credible and unbiased source of information  Health education and health promotion  Fund raising – many international organization prefer national funding

through civil society

 Provision of primary prevention services  Watch dog role

Why engage civil society?

 Government cannot on its own provide all solutions  To engage groups that traditionally governments cannot always reach  To harness, change and manage public opinion  To act as a source of non political information sharing  To complement the work of government through support for public health

policy, programme development and provision of services

Faith Based Organizations

 23 FBOs  Have a large captive and engaged audience  Approximately 70% of persons actively identify with a religious

• rganization

 Many religious doctrine support healthy lifestyle choices  Have a wide array of health care professional that can spearhead

interventions

 Usually have available infrastructure for health promoting activities e.g.

transport and physical infrastructure

Faith Based Organizations

 Declaration of Bridgetown 2013 - Multi faith declaration on NCDs  Faith Based Tool Kit  Screening and simple diagnostics activities  Willing to use good wholesome nutrition and exercise in every day

practice (e.g. SDA)

 Using the media to discuss risk factor reduction and other NCD

prevention interventions

Academia

 The Ministry of Health has had a working relationship with the University

• f the West Indies (Chronic Disease Research Center, CDRC) for over a

decade

 Barbados National Registry 2008 (multi disease registry)  Behavior Risk Factor Survey 2007  The Health of the Nation Study 2012  Population based salt intake study  The costing of cardiovascular disease  Physical activity and exercise study

Non Governmental Organizations

 Heart and Stroke Foundation - rehabilitative interventions post stroke and heart

attack, support of tobacco prevention and control and community outreach

 Diabetes Foundation of Barbados – Maria Holder Centre for Diabetes Care  Diabetes Association of Barbados – community outreach, screening etc.  Barbados Cancer Society support of tobacco prevention and control initiatives,

national screening and diagnosis and the National Cancer Plan for Barbados

 Cancer Support Services – Family and community support including

bereavement counselling, palliative care and some primary care screening

 Barbados Asthma Association

Trade Unions

 From the Inception (2007)the Trade Unions have been represented on the

National NCD Commission Barbados

 The Barbados Workers Union and more recently the National Union of

Public Workers are all on board

 NCD fully are integrated into the of the Social Partnership – a tripartite

governance body including government, the private sector and the trade unions

 Protocol 6 and 7 - Guiding document for the umbrella of trade unions  Several outreach programmes including workplace wellness, screening for

NCDs and health and safety in the workplace (SHAW 2005)

Service Clubs, Associations and Registered Charities

 LIONS – community screening and support for annual World Health Day

activities

 Rotary  Kiwanis  The Maria Holder Trust  Brewster Trust  Sandy Lane Charitable Trust

Monitoring and Evaluation of Civil Society

 NGO health desk was created in 2011  To provide a global picture of health NGO activities in Barbados  To act as a communication channel between NGO community and

government wherein they can access technical, surveillance and other resources

 Audit of all health related NGOs was completed in 2012  Managing fee for service and other contractual agreements  Due to human resource challenges the desk has been dormant but efforts

are again being made to reactivate the desk

Useful approaches

 ‘All of Government’ - health, agriculture, education, urban planning and

development, transport, commerce and small business, finance, poverty alleviation, elderly care and youth and sport

 ‘All of Society’ - Government, Private Sector and Civil Society  ‘Health in all policies’ – Healthy public policy at a national level

involving all sectors

Thank you