FOUN 1210.9

Cost of Diabetes

2.3 times higher cost than people without diabetes; 8.75% of total health care costs related to diabetes. In the Caribbean. •Economic impact - enormous, with healthcare expenditure due to diabetes estimated at 263.2 billion USD for 2013. •Diabetes threatens the public health and economies of countries in the Region •Efforts in prevention and management must be intensified in order to surmount this growing problem

Diseases in TT

33 percent is Circulatory related. 16 percen is Endocrine, nutritional, and metabolic. 16 percent is Neoplasms.

What is Disease?

An abnormal state in which the body is not functioning normally. An unhealthy condition, illness, disorder. Scientifically identified health threat. Something that Interrupts or modifies the performance of the vital functions Is typically manifested by distinguishing signs and symptoms. Is a response to: environmental factors, specific infective agents, genetic defects.

What diseases are associated with Obesity

Arthritis, type 2 diabetes, high blood pressure, heart disease, liver complications, reproductive disorders, mood disorders, cancer risks.

Reach of Dengue?

Before 1970, only 9 countries had experienced severe dengue epidemics. • Now endemic in more than 100 countries in the regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific. • The Americas, South-East Asia and Western Pacific regions are the most seriously affected.

Deaths via non communicable diseases

Cardiovascular is 30 percent. Cancer is 13. Diabetes is TWO. Chronic Respirartory diseases SEVEN. OTHER CONDITIONS - 30. Injuries - NINE.

Caribbean people (CULTURE) are conditioned to a non healthy diet

Coming from an era of protein-energy malnutrition (PEM) when food choices favoured energy density (high fat, sugar and protein), coupled with many external influences, Caribbean people have become conditioned to a diet not considered to be healthy. We are now faced with the double burden of under-nutrition (pockets of PEM and iron deficiency anaemia persist) and over-nutrition (cancers, diabetes, hypertension) which threatens to erode all efforts at achieving food and nutrition security.

Why has dengue outbreaks increased?

Complexity has been increasing over the years due to several factors: unplanned urban growth water and sanitation problems climate change in some countries - simultaneous circulation of all four types of dengue -increases risk of serious cases and outbreaks

How does one combat obesity?

Comprehensive approach needed - all sectors - health, finance, foreign affairs, education, agriculture, law, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them. EXERCISE.

What are the three viruses affecting Latin America?

Dengue. Zika. Chikungunya

Dengue in the Caribbean

Disease is endemic in the Region Since its reintroduction in the 1980s, has caused cyclical outbreaks & epidemics every three to five years. Since the beginning of 2019, more than 2 million individuals in the region have contracted the mosquito-borne disease and 723 have already died from it in 2019.

Changing Concepts/Models of Health

Ecological, Psychological, Holistic. Ecological - • Health viewed as a dynamic equilibrium between human being and his environment • Disease considered as a mal-adjustment been human organism to environment Psychological - Views health as both a biological and social phenomenon • Focus on factors such as social, psychological, economic, political Holistic. - Synthesis of biomedical, psychosocial and ecological

Downsides of Modern Diet

Excess calories leading to obesity. •High fat (saturated fat and cholesterol of animal foods)/ •Low fibre/. •High sodium/ •Insufficient micronutrients notably the antioxidant vitamins and minerals e.g. iron, calcium, vitamins A and C

What is the biomedical model of health?

Focuses on the physical or biological aspects of disease and illness. It is a medical model of care practised by doctors and health professionals and is associated with the diagnosis, cure and treatment of disease. Matter relating to both biology and medicine. Forms the basis of health care. Defines health as the absence of disease.

Communicable diseases in the Caribbean

HIV. COVID. Dengue. Tubercolosis. Chickungyia

CErtain groups in the Caribbean are higher for HIV

Heterosexual transmission remains predominant mode of transmission. key populations at higher risk of HIV infection, like other regions: men who have sex with men female and male sex workers and their clients transgender young people

Burden of NCDs

Human & economic costs of death and disability associated with non-communicable diseases - tremendous burden on governments and wider society ➢related to health care costs ➢indirect costs caused by loss of productivity from disability and premature mortality • NCD deaths are 5 times more cf to other diseases • NCD deaths are 10 times more cf to deaths from HIV/AIDS (75 -85% deaths due to NCDs cf 8% communicable) • Each one has a higher increasing prevalence in women than in men.

But what is the modern Diet?

INclude high animal protein & fat, refined & processed foods, little fibre. Basically Fast Foods. Therefore Under-nutrition has declined and obesity more common. W

As it stands in 2017 38M deaths worldwide are from noncommincable diseases

In 2030 this number is expected to rise to 44M. This accounts for 68 percent of all deaths per year worldwide. Africa, the Middle East, and South East Asia are expected to see the biggest increases.

childhood obesity

In a child, having a BMI above the 95th percentile, according to the U.S. Centers for Disease Control's 1980 standards for children of a given age. It is PROJECTED to reach numbers of 254 million if nothing is done now to stop it. Globally has reached alarming levels - 'nightmare' - epidemic approx. 150 million. ➢ 250 million children worldwide forecast to be obese by 2030 ➢ More obese children in low- and middle-income countries than in high income countries. ➢ Impacts: quality of life as they face a wide range of barriers, including physical, psychological, and health consequences

Mobile health (mHealth)

Is as it says Mobile Health. It's portable health tools. tools have enhanced diabetes management and prevention and are likely to play an increasing role with the growth of smartphone ownership. Used to deliver text messages advising on health behaviours. Insulin management •Monitor glucose levels - Many mobile apps incorporate connected blood glucose meters

Dengue outbreaks in the caribbean

Last major regional outbreak of dengue occurred in 2009. • Since then, region has experienced two large outbreaks of mosquitoborne diseases, Chikungunya in 2014 and Zika in 2016 - unlikely to reoccur soon • Disease modelling - predicts another regional outbreak of dengue may occur in near future. In January 2019 - increase in cases compared to same period of 2018 • More recently - outbreak of Dengue in Jamaica has elevated the level of concern in other Caribbean islands

NCDs in the Caribbean

Main public health problem in the Caribbean - increase over past 30 - 50 years Now highest rate for mortality in the Americas (40% deaths under 70s) including premature deaths/ Responsible for between 39 - 77% percent of all deaths in the Caribbean region & will account for approximately 81 percent of deaths in the Caribbean by 2030. Heart disease - most deaths in most Caribbean countries & territories (13%-25%), followed by cancer (8%-25%), diabetes (4%-21%), & cerebrovascular disease (1%-13%). Countries of the Americas have world's highest prevalence of overweight and obesity, which is a leading risk factor for NCDs, especially diabetes

Categories of Disease

Non Communicable. Heart disease. Diabetics. Osteoporosis. Cancer Communicable. CORONAVIRUS! Chicken pox, measles, Influenza, Rabies.

Dengue Vaccine

Not completely viable. First dengue vaccine, Dengvaxia registered in 2015 and now licensed • In 2017 WHO recommended - use to with strict limitations regarding age and serostatus of the recipients, highlighting the necessity for a more safe and efficacious vaccine egional mass vaccination programmes were launched in the Philippines and Brazil, targeting 1 million people. • However, after reassessment of data from the clinical trials, in 2017 warning that the vaccine can increase the risk of severe dengue in particular circumstances. • Vaccination programme in the Philippines has been suspended, with information released to WHO by Sanofi raising questions about future use of Dengvaxia

When is World Diabetes day?

November 14. "every 8 seconds, someone dies from Diabetes" UN for 46 percent is believed to be undiagnosed.

HIV stats

Over 38M worldwide still live with HIV. with 1.7M new cases annually. with 600,000 HIV deaths in 2019 alone. OF these numbers, 36.2M are adults (19.2 are women, 17M are men, 1.8M are children).

In 2019, with climate change.

PAHO calls for countries in Latin America and the Caribbean to prepare for possible outbreaks of dengue. 28 February 2019. Little did they know that COVID Was around the corner. In October 2020, both CARPHA and PAHO raised alarms on the increase of mosquito borne diseases. In the midst of the COVID-19 pandemic, the Caribbean region is presently seeing an upsurge in the number of reported Dengue cases. This is of extreme concern, as some countries have declared outbreaks with reports of severe Dengue cases and Dengue related deaths," stated CARPHA Executive Director, Dr Joy St. John. In May of this year, CARPHA drew the Region's attention to potential outbreaks of Dengue as the rainy season approached. Increased rainfall leads to a proliferation of mosquito breeding sites, and an increase in mosquito vector populations. The Aedes aegypti mosquito, which transmits Dengue, Chikungunya and Zika viruses, is found throughout the Caribbean and is responsible for periodic outbreaks of disease. "In 2020, the Region's health systems have been focused on the COVID-19 response. However, current Dengue outbreaks have placed an additional burden on health systems, further taxing already limited resources." Dr. St. John added. "There is a strong and urgent need to bring the current Dengue situation under control."

What challenges or progress for HIV

Progress: advances in our scientific understanding of HIV and its prevention treatment years of significant effort by the global health community and leading government and civil society organizations Challenges: , too many people with HIV or at risk for HIV still do not have access to prevention, care, and treatment, and there is still no cure. HIV epidemic not only affects the health of individuals - impacts households, communities, and the development and economic growth of nations. Many of the countries hardest hit by HIV also suffer from other infectious diseases, food insecurity, and other serious problems.

Dengue can also be spread through sex

Spain confirms first case of dengue being spread by sex. Spanish health authorities on Friday confirmed a case of a man spreading dengue through sex. This is the first for a virus which, until recently, was thought to be transmitted only by mosquitoes. the case concerns a 41-yearold man from Madrid who contracted dengue after having sex with his male partner November 2019

Childhood obesity in Caribbean

Statistics show that more than 30 per cent of our Caribbean adolescents are overweight or obese, and risk developing noncommunicable diseases (NCDs) Major shift in diet moving away from staple foods that are indigenous to the region, towards foods that are highly processed. One in Three are obese. 10/14 Caricom countries have less than a 2 percent chance of achieving the WHO 2025 proposal.

HIV is STILL dominant, STILL an epidemic in the caribbeanm

Still a major health priority for Caribbean. Nearly 90% of new infections in the Caribbean in 2017 occurred in four countries - Cuba, Dominican Republic, Haiti and Jamaica. Additoonally, 87% of deaths from AIDSrelated illness occurred in the Dominican Republic, Haiti and Jamaica. Haiti alone accounts for nearly half of annual new HIV infections and AIDS-related deaths

Causes of Non Communicable diseases

Unhealthy Behaviours. Environment. Hereditary/Genes.

Dengue upsurge in 2020

Washington D.C., June 23, 2020 (PAHO)— More than 1.6 million cases of dengue have been reported in the Americas in the first five months of 2020, drawing attention to the need to continue eliminating mosquito vectors of disease even in the midst of the COVID-19 pandemic. Port of Spain, Trinidad and Tobago. 23 October, 2020. "In the midst of the COVID-19 pandemic, the Caribbean region is presently seeing an upsurge in the number of reported Dengue cases"

protein-energy malnutrition (PEM)

a condition characterized by loss of muscle and fat mass and an increased susceptibility to infection that results from the long-term consumption of insufficient amounts of energy and/or protein to meet the body's needs. BASICALLY Lack of proteins and/or calories. EAT MORE YA BISH.

BMI

a measure of body weight relative to height. Body Mass Index.

what is health

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

Non communicable diseases

are not infectious and cannot be passed from one organism to another. Caused by an infectious agent e.g. bacteria, virus, fungi or parasites and/or toxins. Can be air borne, spread through fluid contact, spread through surface contact.

sugar diabetes

diabetes mellitus.

Communicable diseases

diseases that can be passed from one organism to another, of the same or different species.

FActors impeding the successes against HIV

early initiation of sexual activity multiple sex partners for both male and female persistent social taboos about discussion of sex and sexuality with young people strong homophobia (Time magazine called "the most homophobic place on Earth" in 2006). growing sex tourism commercial sex work especially among young girls macho behaviour associated with poor partner communication sustained behavioural change has so far been negligible high risk behaviours of heterosexual men e.g. having unprotected sex with multiple partners

What is obesity

excessive accumulation of body fat

Obesity in the Caribbean

explosive increase in obesity - crisis level - prevalence of adult obesity in Latin America and the Caribbean (LAC) has tripled since 1975, affecting one in four adults • Prevalence in all age groups - • Increased to the point where it is now most important underlying

Dengue Fever

fever is a painful, debilitating mosquito-borne disease caused by any one of four closely related dengue viruses. These viruses are related to the viruses that cause West Nile infection and yellow fever. Over 400 million affected annually worldwide.

STDs

infectious diseases spread from person to person through sexual contact. Caused by more than 30 different bacteria, viruses and parasites • Spread predominantly by sexual contact, including vaginal, anal and oral sex. STDs rank in the top 5 disease categories in developing countries - prevalence is generally highest •More than 1 million people acquire a sexually transmitted infection (STD) EVERY DAY . •Four main diseases : chlamydia, gonorrhoea, syphilis and trichomoniasis. HIV? •Majority of STDs are present without symptoms •Profound impact on sexual and reproductive health worldwide

dis ease

lack of ease

Dimensions of Health

physical, social, intellectual, emotional, spiritual, environmental. Based on WHO definitions.

nutrition

the process of providing or obtaining the food necessary for health and growth.

How much has obesity increased since 1975?

tripled. •Rise in overweight and obesity - worldwide obesity has nearly tripled since 1975. • Obesity rates - increased in all ages and both sexes irrespective of geographical locality, ethnicity or socioeconomic status •Overall, about 13% of the world's adult population (11% of men and 15% of women) were obese in 2016.

What is the BMI formula?

weight (kg) / height (m^2)

IS Obesity an Epidemic?

yes. But the debate now ranges on if it should be recognized as a disease.

Ethics of migrants and care for HIV

• 2018: Prof. Antoine Dean , Law Faculty: migrants must be able to access HIV treatment without having to face discrimination. Antoine said harsh immigration practices caused people with HIV to run underground, adding that harsh treatment of migrants had increased three-fold. • "Antoine said because of stigma and discrimination there was a medical refugee system where people were leaving their own countries and going to neighbouring countries. She said that was why it was imperative to fight discrimination. December 2019: • UN AIDS regional Director: people in mobile populations are illtreated and even subjected to sexual trafficking • policies addressing the need to protect them which should include the availability of HIV treatment, because it would not only benefit the migrants but protect the host country from transmission • hopes TT will increase its efforts, and suggests increasing the number of testing sites and the availability of drugs

NCDs and Gender

• Clear gender-based disparities in risk behaviours and the effects of the epidemic ➢Women are 60% more likely to have diabetes than men and twice as likely to be obese e.g. Barbados. ➢Trinidad and Tobago, Dominica and Jamaica are among the top 14 countries in global female obesity. ➢Physical inactivity in women is significantly higher than in men. In Barbados 9 out of 10 women do not meet World Health Organisation activity recommendations. The rate for men is 6 in 10. ➢Men have lower rates of health service utilisation, worse control of chronic conditions, such as hypertension, and higher death rates from NCDs at every age. For example, men are much more likely to die from cardiovascular disease and diabetes. In Trinidad and Tobago the figure for premature male mortality from this condition was 135 per 100,000; for women a significantly lower 84 per 100,000 (2010). ➢Men have higher rates of harmful use of alcohol than women, with 1 in 5 men reporting binge drinking and 10% - 20% of men recorded as current tobacco smokers. Rates of tobacco use and alcohol abuse are half or lower in women. ➢In several countries the detection and control of high blood pressure is consistently worse in men compared to women.

Dengue's growth

• Escalation of dengue fever incidence in the Americas (including Caribbean) -number of cases increased five-fold between 2003 and 2013 (500,000 cases to 2.3 million) cf 1950s to the 1970s, the Americas were a virtually dengue-free zone • Illness in the Americas was estimated to cost $2.1 billion per year on average (in 2010) - US dollars • Caribbean - US$321 million per annum (2013)

What are traditional Diets?

• Traditional diets - low animal protein, high complex carbohydrates & fibre with 'reasonable' amount of fat