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Public Health Challenges in the Caribbean Mirta Roses Periago Director PAHO/WHO Nassau, Bahamas 28 February 2007 1 Disability Adjusted Life Years (Dailys) 2001 Caribbean Commission on Health and Development (CCHD) 2 CRUDE MORTALITY RATES FOR SELECT DISEASES BY YEAR: CAREC MEMBER COUNTRIES Heart Disease Cerebro Disease Cancers Diabetes Mellitus Hypertensive Disease Accidents ARIs HIV/AIDS 0 20 40 60 80 100 120 8590952000 YEAR RATES 3 Caribbean Commission on Health and Development (CCHD) Arising from WHO Commission on Macroeconomics and Health; Investigation of relationships between health, economic development, and poverty; CARICOM/PAHO collaboration; Chaired by former PAHO Director, report submitted to CARICOM. 4 Main messages (1) Recognize and promote the thesis that health is a productive asset and encourage further research in this field; The Caribbean must re-examine seriously the business case for development of health services targeted to foreign consumers; Intentional violence and injuries represent a huge burden to the health services; The lack of systems for regular collection of data, such as the SLS in Jamaica is a major hindrance to research on Caribbean problems. Caribbean Commission on Health and Development (CCHD) 5 The Caribbean as a whole must face squarely the enormous problem of obesity and its co-morbidities of the non-communicable diseases. This will involve major policy changes to effect prevention through attention to a) food security b) increasing physical activity of the population (These changes are spelled out in the Report) Caribbean Commission on Health and Development (CCHD) Main messages (2) 6 The Caribbean must continue and intensify the actions to control the epidemic of HIV/AIDS with special attention to: battling stigma and discrimination legislation especially as regard labor laws scaling up treatment devoting a higher percentage of funding to prevention measures ensuring that funds already available are spent Caribbean Commission on Health and Development (CCHD) Main messages (3) 7 Strengthen health systems infrastructure, paying special attention to; improving the management and maintenance of the physical facilities planning in the health sector strengthening surveillance systems for a) communicable diseases b) risk factors for the non-communicable diseases Strengthen public health infrastructure, specifically: ensuring the monitoring of the essential public health functions mandating training to advanced levels in public health by the University of the West Indies Caribbean Commission on Health and Development (CCHD) Main messages (4) 8 Address the issue of the export of nursing services as a regional problem: - modify the program of managed migration as endorsed by the Ministers of Health, by including the potential for trade in nursing services as an aspect of Mode 4 form of supply. The two forms of migration to be seen will be: a) permanent migration b) managed temporary migration (NB Countries are already encouraging FDI for nursing training) Caribbean Commission on Health and Development (CCHD) Main messages (5) 9 Health financing The practice of charging user fees should be discouraged, especially for public health and preventive services. It is regressive and bears heavily on the poor. However, when employed, it should be carefully targeted. Countries should aim at a health expenditure of at least 6% GDP The Caribbean should begin to examine the feasibility of a region wide health insurance Caribbean Commission on Health and Development (CCHD) Main messages (6) 10 Specific policy recommendations to the Heads of Government Combat tobacco use tax tobacco products ban smoking in public places Target children make physical education compulsory ensure healthy school meals restrict advertising that promotes unhealthy diets Make regulations and standards ensure marketed foods show calorie Our school policies have allowed the drastic reduction of physical education; Few employers/worksites have a policy to increase PA and wellness; Our transportation policies have favored the use of personal cars which discourage physical activity. 27 The “3 keys” to efficient management and prevention of chronic disease: 1) Clinical management in Primary Care 2) Population based interventions- inform, educate, facilitate pro-health choices 3) Macro-economic policies that go beyond one sectoral ministry 28 Issues involving regional action Health tourism; A Caribbean - wide approach to the problem of obesity; HIV/AIDS - continuing and expanding the effort as indicated; Strengthening the public health infrastructure; A policy on export of human resources-especially and urgently for nursing services; A Caribbean - wide health insurance; Strengthen existing mechanisms e.g. CCH; Dissemination of the Report. Caribbean Commission on Health and Development (CCHD) 29 Caribbean Cooperation in Health The CCH mechanism was developed for Member States to: Collectively focus action and resources towards the achievement of agreed objectives in priority health areas of common concern; and To identify approaches and activities for joint action and/or technical cooperation among countries in support of capacity-building for the achievement of the objectives. 30 Since 1993 CCH phases I and II have been completed and evaluated. CCH phase III is now being developed by Caribbean Member States, and includes each of the key priorities of the Caribbean Commission Report. CCH III also includes the critical issues of importance to the Caribbean that are reflected in the Global Health Agenda and the Health Agenda of the Americas (global commitments and agreements) Caribbean Cooperation in Health 31 Guiding Principles for CCH phase III Equity in access to prevention and treatment for all; Focus on the poor; Development of a subregional integrated resource mobilization strategy; Allocation of the required resources at the national level to facilitate the effectiveness of the subregional support: Caribbean Commission on Health and Development recommends a minimum of 6% of Gross Domestic Product (GDP) for government expenditure on health; Implementation of an international and regional agreements/policies: MDGs/WHO policy on diet and physical activity; Ratification of the FCTC; PAHO Guidelines for Essential Public Health Functions Caribbean Cooperation in Health 32 Subregional Program Areas Subregional Program Areas Chronic Diseases, Mental Health, Communicable Diseases, Strengthening Health Information Systems, Human Resource Management, Food and Nutrition, Environmental Health, Family and Community Health Services, Matrix HIV/AIDS Integrating HIV/AIDS with Sexual and Reproductive Health Programs (critical to the achievement of a number of the MDGs Indicators to capture mobile population within the context of the CSME 33 Priority Areas: HIV/AIDS Chronic Diseases Mental Health Crosscutting Areas: Information Systems Human Resource Management Health Promotion Priority Areas and Crosscutting Areas of CCH III 34 What is the DCPP? DCPP is an alliance of organizations/partners designed to review, generate and disseminate information on how to improve population health in developing countries. Fogarty International Center World Bank World Health Organization Bill & Melinda Gates Foundation Population Reference Bureau Partners 35 Objectives of DCPP (1) Inform health sector decision-making in developing countries to decrease illness, disability, death, and economic burden by: Developing an evidence base to inform decision- making by: Providing estimates of the cost-effectiveness and impact of single interventions and packages Collaborating in defining disease burdens globally and regionally Summarizing implementation experience in different regions and globally 36 Communicating major findings Suggesting the “best buys” and the “worst buys” in any given setting Disseminating the results widely to multiple audiences Stimulating national priority setting and program implementation Objectives of DCPP (2) 37 Combat Tobacco Use Tobacco-related diseases are the fastest-growing cause of disease and disability in developing countries. Tax tobacco products to increase consumers costs by at least 33% to curb smoking. Restrict smoking in public places and workplaces. Provide nicotine replacement therapy and other cessation tools. Ban tobacco advertising. DCPP 38 Reduce fatal and disabling injuries Injuries and violence caused more than 5 million deaths in 2001, with an especially heavy toll on young men. Promote use of seatbelts. Install speed bumps at dangerous intersections. DCPP 39 Ensure equal access to high-quality health care When women lack access to health care, the health of the whole family suffers. Encourage providers to treat the most common causes of bad health. Help providers choose the most cost-effective interventions. DCPP 40 What is it? An expression of the shared vision of the countries of the Americas for 10 years to make concrete improvements in health Proposed new long-term planning instrument that sets strategic goals to address health-sector needs in the Americas What is its purpose? To provide a collective framework for subregional and national planning & resource mobilization To maintain coherence among international players in the health sector To provide goals on a time-horizon that will allow for achievement of measurable impact, as well as frame PASBs own Strategic Plan Health Agenda for the Americas 2008-2017 41 Principles and values Human rights, universality, access, and inclusion. Pan American solidarity. Equity in health. Social participation Health Agenda for the Americas 2008-2017 (HHA) 42 Areas of action Strengthening the National Health Authority Tackling Health Determinants Harnessing Knowledge, Science, and Technology Strengthening Solidarity and Health Security Diminishing Health Inequities among and within Countries Reducing the Risk and Burden of Disease Increasing Social Pro