The global and national burden and threat of non-communicable diseases (NCDs) constitutes a major public health challenge of the 21st century that undermines the social and economic development worldwide and in Jamaica. Urgent action is required to mitigate their impact in Jamaica and the rest of the world. In recognition of this global threat the World Health Organization (WHO) has recommended that NCDs be given priority consideration and that member states develop a national policy framework for the prevention and control of major NCDs and their risk factors. In September 2007 the heads of Government of CARICOM states held a summit in Port of Spain and issued a declaration calling upon governments and civil society to urgently address the threat of NCDs in the region. Following up on the Port of Spain Declaration, Caribbean governments lead an initiative, which culminated in a High Level Meeting of the United Nations (UN) in September 2011. The Political Declaration from that meeting called upon world leaders to commit to the implementation of multi-sectoral, cost-effective, population-wide interventions to reduce the impact of the common NCDs.
There is an estimated 63% of deaths globally due to NCDs, mainly due to cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%) and diabetes (3.5%). These disease share four common behavioural risk factors: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. In Jamaica, for last three decades, NCDs have emerged as the leading cause of morbidity and mortality. Data from the Statistical Institute of Jamaica (STATIN) show that for 2009, diseases of the circulatory system, neoplasms, endocrine and metabolic diseases and disease of the respiratory system accounted for approximately 60% of death among men and 75% of deaths among women. Recent national surveys have also documented an increase in the four major behavioral risk factors and NCDs such as diabetes, hypertension and obesity among Adults. The World Economic Forum estimates the economic burden from life lost due to the four major NCDs was $22.8 trillion in 2010 and if business as usual continues we expect this to increase to $43.3 trillion in 2030. In Jamaica, the 2001 estimated cost (direct and indirect) for diabetes and hypertension alone was US$460,442,870 or 5.87% of the Gross Domestic Product. A World Bank study showed that total economic burden on individuals, including indirect income loss, is estimated at JM$47,882 million (US$641 million) annually in Jamaica during 2006 and 2007. The prevalence of both diabetes and hypertension have increased over eight years (2000 – 2008) by 9.7% and 20.6% respectively and by extension the economic burden.
In addition to these four major NCDs, Violence and injuries, Sickle Cell and Mental Health disorders are also major public health burdens for Jamaica. Data from the Data from the Jamaica health and Lifestyle Survey 2007-2008 revealed that one in 4 Jamaicans 15 – 74 years old suffer from depression and was found to be more frequent in people with chronic diseases, 12% of Jamaicans reported having sustained serious injury in the past five years, 6% of which were motor vehicle accidents.
National studies on violence related injuries showed that direct medical cost (J$2.1 billion) of injuries due to interpersonal violence accounted for about 12% of Jamaica’s total health budget while productivity losses due to violence-related injuries accounted for approximately J$27.5 billion or 160% of Jamaica’s total health expenditure and 4% of Jamaica’s Gross Domestic Product. This translates into the cancellation of one in every three elective surgeries at our major trauma hospital, Kingston Public Hospital.
Sickle Cell Disease (SCD), an inherited disorder of the oxygen carrying protein haemoglobin, is also a common hereditary public health problem in Jamaica, due to the relatively high prevalence of the disease and frequent use of the health care services by affected persons.
Jamaica is also facing a demographic transition with and increasing ageing population. A recent study reported that there is an increase in NCDs amongst this population. Promotion of Healthy aging starts in childhood.
Although morbidity and mortality from non-communicable diseases mainly occur in adulthood, exposure to risk factors begins in early life, from in utero. Many of the interventions to tackle the major risk factors for NCDs lie outside of the traditional health sector and require a multisectoral approach that includes a whole of government and whole of society response. Below are some recommended actions for sectors.