1. INTRODUCTION
Non-communicable diseases (NCDs) have emerged as the leading cause of death globally. Of 56.9 million global deaths in 2016, 40.5 million, or 71%, were due to non-communicable diseases (NCDs). The four main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung diseases. The burden of these diseases is rising disproportionately among lower income countries and populations. In 2016, over three quarters of NCD deaths — 31.5 million — occurred in low- and middle-income countries with about 46% of deaths occurring before the age of 70 in these countries.
Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.0 million), respiratory diseases (3.9million), and diabetes (1.6 million). These 4 groups of diseases account for over 80% of all premature NCD deaths. Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD. Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs. These conditions are often associated with older age groups, but evidence shows that 15 million of all deaths attributed to NCDs occur between the ages of 30 and 69 years. Of these “premature” deaths, over 85% are estimated to occur in low- and middle-income countries. Children, adults and the elderly are all vulnerable to the risk factors contributing to NCDs. Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs: raised blood pressure, overweight/obesity, hyperglycemia (high blood glucose levels) and hyperlipidemia (high levels of fat in the blood). In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood pressure (to which 19% of global deaths are attributed), followed by overweight and obesity and raised blood glucose. NCDs threaten progress towards the 2030 Agenda for Sustainable Development, which includes a target of reducing premature deaths from NCDs by one-third by 2030.
NCD Mortality and Morbidity in Jamaica
In 2017, the top 5 causes of death in Jamaica were stroke, diabetes, ischaemic heart disease, Alzheimer’s disease and inter-personal violence. Nine of the top 10 causes of death were from NCDs. Premature mortality was due to stroke, diabetes, interpersonal violence, neonatal disorders and ischemic heart disease. Combining death and disability together, the top 5 risk factors contributing to DALYs (Disability Adjusted Life Years) were high plasma glucose, obesity, dietary risks, high blood pressure and tobacco use.
Global Response
In recognition of the global challenge from NCDs, the World Health Organization initiated a call to action in responding to NCDs with the passing of a resolution at the 53rd World Health Assembly in 2000 and the publication of a policy document on a Global Strategy for the Prevention and Control of Non-communicable Diseases. This has been followed by a number of global and regional initiatives and publications culminating with the holding of a United Nations High Level Meeting on Non-communicable Diseases in September 2011, with the leadership of the Caribbean countries and the acceptance of a political declaration calling on Heads of Government to reduce risk factors for NCDs and create health promoting environments, strengthen national policies and health systems, facilitate international cooperation, research and development, and monitoring and evaluation of NCDs.
Caribbean Response
The Caribbean epidemic of non-communicable diseases is the worst in the region of the Americas and also has the highest rates of premature mortality due to cardiovascular diseases (PAHO). In light of this high burden of NCDs, Heads of Government of the Caribbean Community (CARICOM) member countries met in Port of Spain in September 2007 and issued a declaration entitled “Uniting to Stop the Epidemic of Chronic Non-communicable Diseases”, now known as The Port of Spain Declaration. This declaration has proved instrumental and has served as a rallying cry to address the burden of NCDs and eventually led to the holding of the UN summit on NCDs.
Jamaican Response
In recognition of this global burden and threat of NCDs, the Ministry of Health & Wellness (MOHW) in Jamaica has had a focus on NCDs for several years and has implemented prevention and control programmes to combat this threat. The 2013-2018 strategic plan was built on the foundation of these programmes and policies and sought to ensure that Jamaica’s response to the NCD epidemic is robust, efficient and effective and will result in a significant reduction to the extent of the problem in the coming years.