Kenneth S George MBBS DM MPH
From Risk to Disease Adapted from the WHO
Leading causes of death (mortality) in Barbados Cardiovascular Disease - stroke and heart attack 1. Diabetes Mellitus and its complications including blindness, 2. amputations and kidney failure Cancer - breast, cervix prostate colon, stomach and lung 3. 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 Current Smokers Tobacco All 8.8% - M 15.6% and F 4.9% All 8.4% – M 14.4% and F 2.2% Alcohol in the last 30 days Alcohol in the last 30 days All 40.8% - M 56.6% and F 32.0% All 23.9% – M 42.1% and F 16.9% Binge drinking Binge drinking All 12.1% - M 23.9% and F 5.6% All 13.8% M 21.9% and F 9.7% < 5 servings F&V < 5 servings F&V All 81.2% – M 80.1% and F 81.8% All 95.4% - M 96.6% and F 94.3%
Risk Factors In Barbados - Biological 2007 2012 Mean BMI (kg/m2) Mean BMI (kg/m2) All 27.7- M 26.1 and F 29.1 All 28.1 – M 26.5 and F 29.0 Overweight Overweight All 65.2% - M 54.6% and F 74.3% All 64.3% - M 56.6% and F 68.8% Obesity Obesity 28.5% - M 20.3% and F 35.5% All 32.9% M 22.1% and F 39.3% Hypertension Hypertension All 41.5% - M 41.2% and F 41.8% All 38.8% - M 40.1% and F 38.1% Diabetes Mellitus Diabetes Mellitus All 14.9% - M 12.7% and F 16.7% 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 organization 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 of 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
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