Regional Workshop Economics of Prevention of Noncommunicable Diseases

Regional Workshop Economics of Prevention of Noncommunicable Diseases (NCD) and Risk Factors (obesity, physical inactivity and poor diets) Mexico City, November 14 -15, 2011 Rainford Wilks Tropical Medicine Research Institute, The UWI Jamaica Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Objective Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice § To provide an insight into the burden of CNCD (mainly CVD) and risk factors in Jamaica (Data come primarily from National Health Survey of 2008) NB: Data on cancer and respiratory diseases are available and more is being collected but I do not have these today Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Global Burden of CNCDs Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice • Globally CNCDs account for approximately 60% of all deaths and 43% of the burden of disease* • Burden of non-communicable diseases in Caribbean has escalated - accounting for 60% of disease burden * Global Burden of Disease and Risk Factors (WHO) Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Epidemiology Research Unit TMRI, UWI Leading causes of death in Jamaica over the last 50 years From Research to Policy to Practice Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Statistical Institute Of Jamaica Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Leading Causes of Death (Jamaica) - 1 Disease Cerebrovasc dis. 1998 1996 # Rate (1) 98. 8 (2) 56. 2 (2) 53. 3 Isch. Heart Dis. (3) 50. 5 (3) 51. 2 Hyperten. Dis. (4) 39. 8 (4) 42. 3 Epidemiology Research Unit -TMRI The University of the West Indies From Research to Policy to Practice (1) 109. 0 Diabetes mellitus Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Epidemiology Research Unit TMRI, UWI Mc. Caw-Binns et al (under review) Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Leading Causes of Death (Jamaica) - 2 Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice 1998 1996 Disease # Rate HIV disease (6) 23. 9 (11) 15. 8 Homicide/assault (5) 31. 3 (5) 31. 6 Heart failure (7) 20. 9 (7) 21. 0 Acute resp. infections (8) 19. 0 (6) 21. 6 Chronic lower resp (9) 8. 8 (8) 18. 0 Pulm. & other heart dis. (10) 18. 4 (10) 16. 8 Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Mc. Caw-Binns. Ciudad et deal. México, (under 14 -15 dereview) Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU CVD Risk Factors in Jamaica Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice § Jamaican Healthy Lifestyle Survey 2007 -2008 (15 -74 yrs old)* showed prevalence estimate of § § Hypertension 25. 5% Diabetes mellitus 7. 9% Obesity 25. 3% Salt added at table 6. 1% § These health conditions are associated with a high economic cost ** *Wilks et al 2009, **Ward E and Grant A, 2003 *http: //www. mona. uwi. edu/reports/health/JHLSII_final_may 09. pdf; Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Sex Specific Prevalence (%) of CNCDs Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Methods of Protein Preparation Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Fruits and Vegetables Consumption among Jamaicans Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Physical Activity Levels by Sex (%) Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Prevalence of Nutritional status by Sex Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Prevalence(%) of hypertension by BMI Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Prevalence (%) of Diabetes by BMI Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Prevalence(%) of High Cholesterol by BMI Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Awareness, Treatment & Control Levels (%) Male Female Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Total Hypertension Aware Treatment Control 30. 6 21. 0 31. 2 69. 6 57. 8 44. 9 50. 7 40. 0 41. 4 Aware Treatment Control 73. 2 66. 4 46. 8 78. 0 74. 9 42. 1 76. 1 71. 5 43. 9 High Cholesterol Aware Treatment Control 16. 6 13. 8 88. 4 12. 7 9. 9 68. 5 14. 0 11. 2 76. 3 Diabetes Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Alcohol and Substance Use Risk Behaviour Male Female Total 49. 2 3. 9 64. 3 3. 0 Alcohol Use Current 80. 1 Past 4. 0 Marijuana Use Current 22. 9 Past 22. 3 4. 4 10. 0 13. 5 16. 0 Current 22. 1 Past 23. 0 7. 2 10. 8 14. 5 16. 8 Cigarette Smoking Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Prevalence of Self-reported HA & Stroke in JHLS-II Overall Prevalence Heart Attack Stroke 0. 65 [0. 35 -1. 21] 11839 [4575 -19000] 1. 37 [1. 00 -1. 88 25000 [17000 -33000] 15 -34 0. 34 [0. 08 -1. 45] 0. 45 [0. 17 -1. 21] 35 -54 0. 29 [0. 06 -1. 28] 1. 31 [0. 68 -2. 52] 55 -74 2. 56 [1. 20 -5. 38 4. 50 [3. 02 -6. 65] Percentage % 95% CI Number of Persons 95% CI Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Age categories Ferguson et al. 2010 Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU COST OF CHRONIC DISEASES Cost Item Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice Diabetes (J$) Hypertension (J$) Hospitalization 135, 464, 269 (8%) 84, 753, 708 (7%) Clinic/Doctor’s Visits 332, 500, 000 (21%) 415, 652, 000 (33%) Drugs 113, 800, 284 (7%) 203, 519, 628 (16%) Laboratory/Diagnostic Tests 873, 487, 154 (54%) 357, 847, 984 (29%) Productivity Loss 156, 291, 630 (10%) 186, 339, 706 (15%) Total Economic Burden 1, 611, 543, 337 1, 248, 140, 027 Direct Cost (2002) Indirect Cost (2002) Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Estimated Economic Burden ($US Million, 2001) BAH BAR JAM TRT 27. 3 37. 8 208. 8 494. 4 Hypertensio 46. 4 n 72. 7 251. 6 259. 5 Total 110. 5 460. 4 753. 9 Diabetes Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF 76. 7 Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Country: National level policies implemented • Aimed to reduce the prevalence of chronic diseases (breast cancer, colo-rectal cancer, cardiovascular disease, diabetes, hypertension, other NCDs). Target population and year of implementation. • Intended to modify behaviors: – Alcoholism – Tobacco – Unhealthy diets – Physical inactivity – Salt Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF National Strategic Plan for the Promotion of Healthy Lifestyles In Jamaica 2004 -2008 - Addressed most issues listed - Current status uncertain Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

ERU Summary Epidemiology Research Unit TMRI, UWI From Research to Policy to Practice § Jamaica, like many middle income countries have a large burden of CNCD risk factors § The response to this scenario is sub-optimal § There are gaps in the situational analysis especially with respect to cancer and respiratory diseases but the former is being addressed § There are gaps in capacity, in particular health economics § There is a foundation on which to build and participate in initiatives such as this Workshop proposes Epidemiology Research Unit -TMRI The University of the West Indies Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Country: JAMAICA Basic statistics about Noncommunicable Diseases (NCD) • Burden of disease, available year and source. • Mortality rate, available year and source. • Prevalence of NCD, available year and source. • Indirect and direct costs, available studies and source. – Costs for medical attention. Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Country: Health Systems topics • Epidemiologic Surveillance. - National Surveys, 2001 & 2008. Next planned for 2015 • Provider of health services. – Medical units detection. – Nutritional counseling units. – Medical attention primary care. – Medical attention specialized services. • Financing resources for specific NCD programs available. • Human resources specialized in NCDs prevention and treatment. Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Country: Research in economic evaluation of NCDs • Studies developed or commisioned by Mo. H, objectives, information used, year and main results. • Basic economic information, including year and source of available information: • Average wage • Average monetary income (from household surveys) • Availability of paid sick leave • Level of sickness leave Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011

Key questions for the future work • • What are the obstacles, in terms of methodology and availability of information, to estimate the net impact of NCDs on economic variables? What characteristics (variables, conditions) do data collection methods need to consider in order to capture these effects? What statistical methods are most appropriate for the purpose? What are the direct and indirect costs incurred by national health systems as a result of NCDs? Is there an association between the magnitude of the impact and the structure of the model of care? What are the implications of potential cost increases from the rising prevalence of NCDs in the Region for the financing and structure of health systems? What are the links between NCDs on the one hand, and development, economic growth rates and human capital accumulation (e. g. , lost productivity due to disability, decline in labor supply, premature mortality, etc. ) on the other? What are the long-term advantages of investing to expand prevention measures to achieve overall improvements in health? (See Technical Note as reference) Taller Regional Economía de la prevención de ECNT y FR Regional workshop Economics of Prevention of NCD and RF Ciudad de México, 14 -15 de Noviembre del 2011 Mexico City, 14 -15 November 2011