Heads of Government of the Caribbean Community (CARICOM) convened in Port-of-Spain, Trinidad and Tobago on Saturday, 15 September 2007 for a Regional Summit on Chronic Non-Communicable Diseases (NCDs) under the theme, Stemming the Tide of Non-Communicable Diseases in the Caribbean. The Right Honourable Owen Arthur, Prime Minister of Barbados and Chairman of the Conference of Heads of Government was Chairman.

Heads of Government in attendance were: Hon. Baldwin Spencer, Prime Minister of Antigua and Barbuda; Rt. Hon. Hubert A. Ingraham, Prime Minister of the Commonwealth of The Bahamas; Hon. Roosevelt Skerrit, Prime Minister of the Commonwealth of Dominica; Hon. Bruce Golding, Prime Minister of Jamaica; Hon. Dr. Lowell Lewis, Chief Minister of Montserrat; Hon. Dr. Denzil L. Douglas, Prime Minister of St. Kitts and Nevis; Hon. Stephenson King, Prime Minister of Saint Lucia; Dr. the Hon. Ralph Gonsalves, Prime Minister of St. Vincent and the Grenadines; His Excellency Drs. Runaldo R. Venetiaan, President of the Republic of Suriname; and Hon. Patrick Manning, Prime Minister of the Republic of Trinidad and Tobago.

Also present were Hon. Jose Coye, Minister of Health of Belize; Sen. the Hon. Ann David Antoine, Minister for Health, Environment and Ecclesiastical Relations of Grenada; the Hon. Dr. Leslie Ramsammy, Minister of Health of the Republic of Guyana; the Hon. Robert Auguste, Minister of Health of the Republic of Haiti.

Anguilla was represented by Hon. Evan Mc Neil Rogers, Minister of Health.

OPENING

The opening session was addressed by H.E. Edwin Carrington, Secretary-General of CARICOM; the Rt. Hon. Owen Arthur, Prime Minister of Barbados and Chairman of CARICOM; the Hon Patrick Manning, Prime Minister of Trinidad and Tobago; and the Hon. Dr. Denzil Douglas, Prime Minister of St Kitts and Nevis and Lead Head of Government with responsibility for Health including HIV and AIDS.

The CARICOM Secretary-General lauded the Heads of Government for their bold initiative in convening this first ever Summit of Heads of Government on the issue of the NCDs and thereby affirming their commitment to the Nassau Declaration (2001) which proclaimed that “The Health of the Region is the Wealth of the Region”.

The Secretary-General pointed to the seminal report of the Caribbean Commission for Health and Development (CCHD), which made the Region more aware that the increasing burden of the NCDs had threatened to overwhelm the already overstretched health services. He noted that the solutions revolved around primary prevention based on a comprehensive programme, which was the most cost effective approach to contain the emerging epidemic. He further stated that the challenge of the Heads of Government was to “develop a blueprint for an integrated strategy for prevention and control of NCDs.”

He acknowledged and thanked the Pan American Health Organisation, the Government of Canada, the Canadian Public Health Agency and the Commonwealth Secretariat which supported the Summit and underscored the vital importance of partnerships.

The Secretary-General concluded by appealing to the continued commitment of Heads of Government, the stakeholders at the national and regional levels and also the development partners, charging them to seize the opportunity to “leave a legacy of a healthier Region by making the Summit “memorable for setting in motion the structure by which we not only stem the tide, but by which we truly unite to stop the epidemic of the Non-Communicable Diseases in the Region.”

In his remarks, the Rt. Hon. Owen Arthur, Prime Minister of Barbados and Chairman of CARICOM, outlined the progress made in trade in the CARICOM Single Market and Economy (CSME) but hastened to point out that comparable progress had to be made in the social sphere to sustain the progress made in regional integration, hence the absolute necessity of a coordinated regional public/private partnership programme to stem NCDs.

Prime Minister Arthur acknowledged that the health challenges in the Region were daunting, remarking that the Community was in no doubt that the costly complications, morbidity and mortality produced by this epidemic could only be reduced by a comprehensive regional approach.

The Hon. Patrick Manning, Prime Minister of Trinidad and Tobago, in his remarks, underscored the gravity of the problem of NCDs and asserted the need for the Region to have a clear understanding of the factors that put the Caribbean peoples at risk in order to devise appropriate responses.

Prime Minister Manning posited that the high mortality rate in the Region caused by NCDs, and the social and personal costs combined with the financial implications “are sufficient and necessary justifications for the Summit and a call for focused policy-oriented effective, result-producing decisions and actions that are required now.”

The effort, he added, required collective regional cooperation and creative imagination, in adjusting our lifestyles and providing health infrastructure to speed up the management and control of NCDs.

In a comprehensive PowerPoint presentation, the Hon. Dr. Denzil Douglas, Prime Minister of St. Kitts and Nevis, and Lead CARICOM Head of Government with responsibility for Health underscored the enormity of Chronic Non-Communicable Diseases in the Caribbean. He explained that 63 per cent of deaths worldwide in 2005 were attributable to NCDs, with heart diseases being the most culpable. He attributed the root causes of NCDs to both behavioural and biological factors but emphasised that several of those factors such as obesity, high cholesterol, high blood sugar, high blood pressure Tobacco use, physical inactivity, unhealthy diet, and alcohol abuse were modifiable. He further explained that several of the risk factors were rooted in global influences.

Prime Minister Douglas focused on the myths ascribed with NCDs, noting that “Non-communicable disease accounted for more than half the burden of disease and 80 per cent of the deaths in the poorer countries which carried a double burden of disease.” He stressed that NCDs affected both males and females, young and old and argued that if the known risk factors were controlled, at least eighty percent of heart disease, stroke and diabetes and forty percent of cancers were preventable, in addition to there being cost-effective interventions available for control.

Prime Minister Douglas further stated that “individual responsibility, while important, only has full effect where people have equal access to healthy choices.” Therefore Governments had a crucial role to play by altering the social environment to help make the healthy choice the easy choice.

Dr Douglas enumerated several critical actions and recommendations which should be implemented to manage and prevent the diseases, including primary strategies such as government policies to effect behaviour change; social policies to provide enabling environment and secondary strategies such as the provision of screening programmes and health services with resources to apply the established cost-effective interventions; the establishment of mechanisms to ensure availability of the medications necessary for the long-term treatment of NCDs when they occur; the establishment of a system of behaviour and risk factor surveillance; and the institutionalisation of a Caribbean Wellness Day.

He exhorted the Summit to implement appropriate legislation, fiscal and regulatory measures and promote public/private sector partnerships to stem the tide of the NCDS. The texts of the presentations of the Secretary-General, Prime Ministers Arthur and Manning and the PowerPoint presentation of Prime Minister Douglas can be accessed by clicking on the name of the speaker.

EXPERT PANEL PRESENTATION

Heads of Government received presentations by an Expert Panel chaired by Sir George Alleyne, OCC, Chairman of the Caribbean Commission on Health and Development (CCHD), which comprised four leading experts in the field of NCDs - Dr. Keith Hansen, Head of Latin America and the Caribbean, the World Bank; Professor Prabhat Jha, Chairman of the International Obesity Task Force and Mr. Vincent Atkins, Senior Economist in the Agricultural Trade Negotiating Programme, Caribbean Regional Negotiating Machinery (CRNM).

The Summit was informed that the World Bank had just issued a major publication on NCDs and noted the global nature of the epidemic and the effect of the diseases on the poor nations of the world. They recognised the need for financial measures to protect the poor against the impact of NCDs, as well as economic and social arguments for prevention and control of the diseases. They noted the World Bank’s pledge to lend its technical expertise to the Caribbean effort. They recognised that need for financial measures to protect the poor against the impact of NCDs.

Heads of Government also noted that smoking was a major cause of death and a big cause of poverty. They also received convincing evidence on the effectiveness of measures to both reduce smoking and prevent the young from starting, the chief of these being increasing taxes on tobacco. It was recognized that the Caribbean could save thousands of lives by vigorous anti-tobacco measures such as tax increases, banning smoking in public places and strong warnings on packages of cigarettes.

In respect of obesity, Heads of Government received information on how obesity and its related chronic diseases were related to changes in the socio-economic environment in the Region. They noted that the current adult population was twice as likely to develop diabetes and high blood pressure at any level of obesity. They agreed that actions by governments, he proffered, were the key to inducing positive change.

Heads of Government took cognisance of the scope for using trade policy measures and economic incentives to promote good nutritional practices in CARICOM and agreed that regional governments should utilise flexibilities in the external trade agreements to promote policies which encourage use of healthy foods.

Interventions by Heads of Government

Heads of Government of the Caribbean Community agreed that immediate collective actions were necessary to manage and control NCDs. These included research and data collection; integrating lifestyle management into the formal education system; the empowerment of individuals to secure consumer behaviour change; pursuance of trade regulations such as appropriate labelling; and the banning of transfats. They outlined specific actions taken in their respective countries to combat NCDs and also agreed to commit to the recommendations and declaration made to, and by the Summit in order to effect a ‘Wellness Revolution’ throughout the Caribbean. It was also agreed that the Task Force on Functional Cooperation would take into consideration the Summit’s decisions in respect of appropriate actions to deal with NCDs.

Interventions by Partners

Heads of Government received with gratitude the support pledged by three of the partners in attendance.

They received with pleasure the commitment made by Dr. Mirta Roses Periago, Director of the Pan American Health Organisation, that PAHO would provide training and capacity-building for countries and Regional Health Institutions (RHIs) to monitor the epidemic and the risk factors and to plan appropriate responses using appropriate mechanisms; assist with the preparation of a revised Caribbean Regional Plan for NCDs Prevention; mobilise resources and partners to aid the fight, jointly with the CARICOM Secretariat and within a year, convene an inter-disciplinary group to evaluate the impact of the Summit as part of the monitoring and evaluation and follow up to the Summit.

Heads of Government welcomed the statement made by Dr. Catherine Le Gales-Camus, Assistant Director-General, NCDs and Mental Health, World Health Organisation, in which she committed the WHO to including the Caribbean in an impending global action plan for the prevention and control of chronic diseases. The action plan would be presented in January 2008.

They also welcomed the commitment of the University of the West Indies that the University’s medical and research faculties would continue to provide Governments with evidence-based research to enable them to formulate appropriate policies necessary to curtail NCDs. They noted the recommendation that Member States include a line item for research in their respective health budgets.

Heads of Government noted the statement by Ms. Caroline Antsy, Director, Caribbean Unit, World Bank, that CARICOM Heads of Government had to lead the world in designing policies which would effect the ‘Wellness Revolution.’ They also noted the importance of setting targets which could be measured continually to evaluate impact, as well as the impact which social marketing could have on the eating and exercise habits of the Caribbean population. They further noted the World Bank’s support for the inclusion of a target on NCDs as one of the United Nations Millennium Development plus Goals for the Caribbean.

DECLARATION OF PORT- OF- SPAIN

In emphasising the centrality of functional cooperation and collective actions to Community development and the enhancement of the wellbeing of Caribbean peoples, the Conference agreed to issue a Declaration, titled Uniting to Stop the Epidemic of Chronic NCDs which is attached below.

APPRECIATION

Heads of Government expressed their appreciation to the Government and people of Trinidad and Tobago for the excellent arrangements put in place and the warm hospitality extended to Delegates. They also recorded their gratitude for the support and participation of the regional and international partners.

Port-of-Spain
Trinidad and Trinidad and Tobago
15 September 2007

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DECLARATION OF PORT-OF -SPAIN: UNITING TO STOP THE EPIDEMIC OF CHRONIC NCDs

We, the Heads of Government of the Caribbean Community (CARICOM), meeting at the Crowne Plaza Hotel, Port-of-Spain, Trinidad and Tobago on 15 September 2007 on the occasion of a special Regional Summit on Chronic Non-Communicable Diseases (NCDs);

Conscious of the collective actions which have in the past fuelled regional integration, the goal of which is to enhance the well-being of the citizens of our countries;

Recalling the Nassau Declaration (2001), that “the health of the Region is the wealth of Region”, which underscored the importance of health to development;

Inspired by the successes of our joint and several efforts that resulted in the Caribbean being the first Region in the world to eradicate poliomyelitis and measles;

Affirming the main recommendations of the Caribbean Commission on Health and Development which included strategies to prevent and control heart disease, stroke, diabetes, hypertension, obesity and cancer in the Region by addressing their causal risk factors of unhealthy diets, physical inactivity, tobacco use and alcohol abuse and strengthening our health services;

Impelled by a determination to reduce the suffering and burdens caused by NCDs on the citizens of our Region which is the one worst affected in the Americas;

Fully convinced that the burdens of NCDs can be reduced by comprehensive and integrated preventive and control strategies at the individual, family, community, national and regional levels and through collaborative programmes, partnerships and policies supported by governments, private sectors, NGOs and our other social, regional and international partners;

Declare -

• Our full support for the initiatives and mechanisms aimed at strengthening regional health institutions, to provide critical leadership required for implementing our agreed strategies for the reduction of the burden of Chronic, Non-Communicable Diseases as a central priority of the Caribbean Cooperation in Health Initiative Phase III (CCH III), being coordinated by the CARICOM Secretariat, with able support from the Pan American Health Organisation/World Health Organisation (PAHO/WHO) and other relevant partners;

• That we strongly encourage the establishment of National Commissions on NCDs or analogous bodies to plan and coordinate the comprehensive prevention and control of chronic NCDs;

• Our commitment to pursue immediately a legislative agenda for passage of the legal provisions related to the International Framework Convention on Tobacco Control; urge its immediate ratification in all States which have not already done so and support the immediate enactment of legislation to limit or eliminate smoking in public places, ban the sale, advertising and promotion of tobacco products to children, insist on effective warning labels and introduce such fiscal measures as will reduce accessibility of tobacco;

• That public revenue derived from tobacco, alcohol or other such products should be employed, inter alia for preventing chronic NCDs, promoting health and supporting the work of the Commissions;

• That our Ministries of Health, in collaboration with other sectors, will establish by mid-2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80% of people with NCDs would receive quality care and have access to preventive education based on regional guidelines;

• That we will mandate the re-introduction of physical education in our schools where necessary, provide incentives and resources to effect this policy and ensure that our education sectors promote programmes aimed at providing healthy school meals and promoting healthy eating;

• Our endorsement of the efforts of the Caribbean Food and Nutrition Institute (CFNI), Caribbean Agricultural Research and Development Institute (CARDI) and the regional inter-governmental agencies to enhance food security and our strong support for the elimination of trans-fats from the diet of our citizens, using the CFNI as a focal point for providing guidance and public education designed toward this end;

• Our support for the efforts of the Caribbean Regional Negotiating Machinery (CRNM) to pursue fair trade policies in all international trade negotiations thereby promoting greater use of indigenous agricultural products and foods by our populations and reducing the negative effects of globalisation on our food supply;

• Our support for mandating the labelling of foods or such measures as are necessary to indicate their nutritional content through the establishment of the appropriate regional capability;

• That we will promote policies and actions aimed at increasing physical activity in the entire population, e.g. at work sites, through sport, especially mass activities, as vehicles for improving the health of the population and conflict resolution and in this context we commit to increasing adequate public facilities such as parks and other recreational spaces to encourage physical activity by the widest cross-section of our citizens;

• Our commitment to take account of the gender dimension in all our programmes aimed at the prevention and control of NCDs;

• That we will provide incentives for comprehensive public education programmes in support of wellness, healthy life-style changes, improved self-management of NCDs and embrace the role of the media as a responsible partner in all our efforts to prevent and control NCDs;

• That we will establish, as a matter of urgency, the programmes necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organisation (CAREC/PAHO);

• Our continuing support for CARICOM and PAHO as the joint Secretariat for the Caribbean Cooperation in Health (CCH) Initiative to be the entity responsible for revision of the regional plan for the prevention and control of NCDs, and the monitoring and evaluation of this Declaration.

We hereby declare the second Saturday in September “Caribbean Wellness Day,” in commemoration of this landmark Summit.