global population growth key to ... population growth...international business week the changing...
TRANSCRIPT
INTERNATIONAL BUSINESS WEEK The Changing Dynamics:
Driving Innovation, Prosperity and Health Hilton Barbados Resort, October 8 – 9 2015
GLOBAL POPULATION GROWTH – KEY TO UNDERSTANDING THE FUTURE
T Alafia Samuels
Deputy Dean, Research and Graduate Programmes
Faculty of Medical Sciences
Prepared by Ian Hambleton, CDRC, September 2015
International LE targets met by most countries
…population growth has dropped to replacement levels and life expectancy is relatively high…
A positive picture. But not the whole picture…
Regional LE in the Americas 1970 - 2010
Prepared by Ian Hambleton, CDRC, September 2015
Country LE in the Caribbean 1970 – 2010
“Monitoring variation within the Caribbean”
1965–70 2005–10
Aging
• Life Expectancy is increasing
• Populations are aging
• Age distributions vary – population pyramids
Four Key Drivers of Rapid Changes in Life Expectancy and Health Profiles
1) Demographic transition
– increasing population size, falling death rates, aging of the population, (migration).
2) Epidemiological (Cause of death) transition
– proportion of deaths shift from Communicable Diseases to Non Communicable Diseases and injuries, despite HIV.
3) Disability transition
– shift to diseases that cause disability but not substantial mortality.
4) Risk transition
– from poverty-related to “modernization” risks – physical inactivity, unhealthy eating, tobacco use and alcohol abuse
Mortality - Select Regions
14% 8% 13%
68%47% 56%29%
10%29% 30%
21%
15%
10% 6%
37%
7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Americas Europe SE Asia Africa
Communicable diseases Other NCDs
Preventable premature NCD deaths Injuries
Source: Dr. Ala Alwan, ADG, WHO: U.N. Briefing on NCDs, Feb 2010
Caribbean NCD mortality
• NCDs and their risk factors responsible for 78% of all deaths in 2010
• 76% of all premature deaths (ages 30 – 69) are caused by NCDs
• Premature deaths from NCDs in Caribbean more than double rates in North America
• NCDs are overwhelming health services
Top Ten Causes of Death in Barbados 2009 (Source: Barbados MOH Statistical Unit)
1 Ischaemic heart disease (heart attack)
2 Diabetes mellitus
3 Cerebrovascular disease (stroke)
4 Hypertensive heart disease
5 Prostate Cancer
6 Septicemia
7 Influenza
8 Colon, rectum and anal cancer
9 Unspecified cancers
10 Cardiac arrest
NCDs: Risk factors 4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco
Use
Unhealthy
diets
Physical
Inactivity
Harmful
Use of
Alcohol
Cardio-
vascular
Diabetes
Cancer
Chronic
Respiratory
Risk Transition
Poor nutrition now affects all parts of the worldPoor nutrition now affects all parts of the world
China Tanzania
High Rates of Alcohol Abuse
• Binge drinking:
5+ drinks (men); 4+ (women) at one time in last 7 days
Among MEN
Barbados (2012) 25%
Dominica (2008) 33%
Trinidad & Tobago
(2012) 34%
The man problem
• Higher rates of alcohol abuse and tobacco use
• Higher rates of injuries
• Low health service utilization
• Worse control of chronic conditions
• Higher death rates at every age
18.9% 24.8%
40.9% 23.9%
40.2% 51.3%
0%
20%
40%
60%
80%
100%
Females Males
Among all patients with Diabetes, proportions with BP controlled
Not hypertensive HBP, Rx, controlled
BP >140/90
17.9% 27.9% 7.1%
23.3%
75.0% 48.8%
0%
20%
40%
60%
80%
100%
Women Men
Medication status in population with diabetes and uncontrolled BP
Undiagnosed Not taking Rx
On Rx, not controlled
These data were provided by Dr. O. Abdullahi Abdulkadri
Economic Burden of Diabetes and
Hypertension in Selected Caribbean Countries
(2001)
0
2
4
6
8
10
The Bahamas Barbados Jamaica TRT
Perc
en
tag
e o
f G
DP
(%
)
DIABETES HYPERTENSION BOTH
In response to the NCD epidemic: September 2007 CARICOM Heads of Government issued
the groundbreaking Port of Spain Declaration:
Uniting to Stop the Epidemic of Chronic Non-communicable Diseases
With its global resonance, the Declaration paved the way
for: 2011 UN High-Level Meeting (UNHLM) on NCDs
World Health Organization’s international monitoring framework, with nine global targets and 25 indicators
Mandates and Commitments
The Declaration recommends:
• “All of Government” and “All of Society” response
• National, multi-sectoral NCD Commissions
• Risk factor reduction, including:
o implementation of Framework Convention on Tobacco Control (FCTC)
omulti-sectoral food and nutrition plan
opromotion of physical activity in schools and workplaces
• Improved quality of care for those living with NCDs
• Workplace Wellness Programmes
• Caribbean Wellness Day
Health risks increase health costs – The relationship between modifiable health risks and
health care expenditures:
Staff who are/have:
Depressed 70% higher annual health plan costs.
Stressed 46% higher annual health plan costs.
Obesity 21% higher annual health plan costs.
Smokers 20% higher annual health plan costs.
Not exercising 10% higher annual HPC
High Blood pressure 12% higher annual HPC
Elevated blood sugar 35% higher annual HPC
Source: Goetzel RZ, et.al (1998, October). The relationship between modifiable health risks and health care expenditures: An analysis of the multi-employer HERO health risk and cost database JOEM, 40(10):843-54.
The World Economic Forum: Workplace Wellness Alliance
• Workforce is affected by reduced productivity and
increased costs from chronic diseases; while the need for skilled talent rises as economies grow and mature.
• Public-private partnerships are key to managing NCDs
• The workplace can be used to drive the response required, bringing benefits to the employer, employee and community.
• Establish the underlying business rationale for investing in health and well-being – decrease costs and improve productivity
– ROI of US$ 3.27:$1 for wellness programmes (Baicker, Cutler, & Song, 2010).
• Private Sector Response Recommendations
• Start with simple worksite wellness focused on physical activity and healthy nutrition
• Follow up with Comprehensive wellness policy
• Private business sector - major role in multi-sectoral response through partnership with government and civil society “all of society”
• Offer healthier products
University of the West Indies Healthy Campus Initiative
Cave Hill 2010:
Health Risk Assessment, Workplace Wellness Program
St. Augustine 2014: Preventive Medicine Physician visits at
the workplace
Step 1 – Document risk Health Risk Assessment (HRA)
• Demographics
• Tobacco, Alcohol,
• Diet, Physical Activity
• Health and Illness
• Stress and Emotional Health
Point of Care Testing
Cardiochek PA
• Chol, HDL, glucose
Urinalysis
• Protein, ketones, blood, albumin
Step 2 – Analysis of risk
Activity Levels Among for 269 UWI CHILL staff:
NCD risk factor survey 2010
20%
5%
29%
33%
51%62%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Males (n=80) Females (n=189)
Inactive
Moderately active
Highly active
Step 3: Evidence-based Interventions
• Red Risk Group: – Living with NCD (HBP, diabetes)
– High healthcare expenses
– Disease Management
• Yellow Risk Group: – Multiple risk factors, No overt
disease
– On-going monitoring
• Green Risk Group: – Fewer risks.
– Workplace Wellness
Recommended: Disease Management
• Disease management programme for those workers living with hypertension, heart disease and diabetes. – Our doctors will come to the work place for
confidential medical follow up if required and requested by the client.
• Focused on – Newly diagnosed disease from workplace screening
– No personal physician
– Reluctant men
Something to Consider
The total Functional Capacity of your company is the sum of
all the capacities of your individual employees
Lift the functional capacity
of your people and you lift
the competitive advantage
of your entire company
References • Hambleton IR, Jeyaseelan S, Howitt C, Sobers-Grannum N, Hennis AJ, Wilks RJ,Harris
EN, MacLeish M, Sullivan LW; US Caribbean Alliance for Health Disparities Research Group. Cause-of-death disparities in the African diaspora: exploring differences among shared-heritage populations. Am J Public Health. 2015 Jul;105Suppl 3:S491-8
• Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin RB, Murray CJ; Comparative Risk Assessment Collaborating Group. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med. 2004 Oct;1(1):e27.
• World Economic Forum: Working Towards Wellness, Accelerating the prevention of chronic disease
• Unwin N, Rose AMC, George KS, Hambleton IR, Howitt C. The Barbados Health of the Nation Survey: Core Findings. Chronic Disease Research Centre, The University of the West Indies and the Barbados Ministry of Health: St Michael, Barbados, January 2015
• Institute for Health Metrics and Evaluation. The Global Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA: IHME, 2013.
• World Health Organisation: Global Burden of Disease 2004 update • Barbados Strategic Plan for the Prevention and Control of Non-Communicable
Diseases 2015-2019:National NCD Commission Barbados, December 2014 • Creating Healthy Workplace: Planning a Staff Wellness Progam: Scott and White
Healthcare • Healthy Caribbean Coalition: The Caribbean Private Sector Response to NCDS: A
Situational Analysis and Framework for Action • Pan American Health Organization: Advancing the NCD Agenda in the Caribbean • Shiyan Chao, World Bank: Economic Impact on NCDs in the Caribbean. Caribbean
Health Financing Conference, Jamaica, 2013
Contact Info
T. Alafia Samuels MBBS, MPH, PhD
Deputy Dean, Graduate Studies and Research
Senior Lecturer, Epidemiology and Public Health Faculty of Medical Sciences
University of the West Indies, Cave Hill Campus
Barbados
Tel (C) : (246) 238-2940
Tel (W): (246) 417-4174
Consultant: Chronic Disease Prevention and Control / Workplace Wellness Progams