Mobilising for 2025 – A Caribbean Civil Society NCD Forum

July 6-7, 2023
Courtyard Marriott Hotel | Bridgetown, Barbados

Background

This meeting: Mobilising for 2025 – A Caribbean Civil Society NCD Forum represents a reconvening of face to face meetings of HCC member organisations and partners. The aim of the Forum is to bring together HCC member civil society organisations (CSOs) and key stakeholders to discuss NCD (including Mental, Neurological and Substance Abuse Disorders – MNSDs)[1] prevention and control priorities in the Caribbean as we reflect on where we are including current  progress and challenges and map a path forward to place the region back on track to meet SDG NCD Target 3.4: Noncommunicable diseases and mental health: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

Much work is needed as the most recent 2022 NCD Progress Monitor showed the Caribbean was significantly off track across most areas including risk factor interventions (WHO Best Buys and Recommended Interventions) and treatment indicators (management guidelines and drug therapies).  As a result, the NCD-related health and socioeconomic toll on our fragile economies continues to rise as we face the interconnected challenges of, climate change and food insecurity, exacerbated in our Small Island Developing States (SIDS) settings. From June 14-16, high-level officials from across the SIDS will convene in Barbados for the SIDS Ministerial Conference on NCDs and Mental Health where they will unite in their endorsement of what is anticipated to a be a bold action-oriented Political Outcome Document which recognizes the key health and development threats of NCDs, commercial determinants and climate change and presents concrete actions to tackle these threats as a SIDS community through a highly anticipated SIDS NCDs Roadmap.

The diverse array of civil society actors impacted by NCDs – including those representing: all chronic diseases, key groups such as people living with NCDs (PWLNCDs), young people, related lived experiences, climate change, food systems, and academia – have and continue to play a critical role in driving and supporting rights-based, equitable, evidence-informed NCD responses across the region.

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Accelerating the Removal of Ultra-Processed Products From Caribbean Schools – The Food in Our Schools Matters

July 4-5, 2023
Courtyard Marriott Hotel | Bridgetown, Barbados

This meeting: Accelerating the removal of ultra-processed products from Caribbean schools represents a reconvening of face-to-face meetings of Healthy Caribbean Coalition (HCC) member organisations and partners. The aim of the meeting is to support harmonised regional acceleration of robust evidence-informed policies which regulate the availability and marketing of ultra-processed products in school settings, by bringing together diverse stakeholders, including those from government, civil society and academia.  This meeting precedes a second meeting hosted by the HCC immediately following on July 6-7, 2023. The second meeting: Mobilising for 2025 – A Caribbean Civil Society NCD Forum aims to bring together HCC member civil society organisations (CSOs) and key stakeholders to discuss non-communicable disease (NCD) (including mental, neurological and substance use disorders – MNSDs)[1] prevention and control priorities.

The Caribbean has some of the highest adult obesity rates in the world and an emerging crisis of overweight and obesity is facing up to 1 in 3 children in the region[2]. Childhood overweight and obesity not only are associated with serious complications in childhood and adolescence, but they also track into adulthood, placing individuals at higher risk for NCDs. Like many other small developing states and low- and middle-income countries, the Caribbean region has experienced a nutritional transition driven by globalisation and trade liberalisation, resulting in a culture of diets characterized by excess consumption of ultra-processed foods high in fat, salt and sugar fueling skyrocketing rates of obesity and diet-related NCDs.  Children from this region consume more sugar-sweetened beverages than anywhere in the world and more than triple the global average. Dramatic increases in overweight and obesity in recent decades has been driven by overconsumption of ultra-processed foods high in sugars, fats and salt.  In response, there is an increasing momentum across the region towards the implementation of policies which restrict or altogether ban the availability of unhealthy foods and beverages in schools.

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The Healthy Caribbean Coalition was delighted with the endorsement of the 2023 Bridgetown Declaration on Non-communicable Diseases and Mental Health. The Bridgetown Declaration, developed by SIDS for SIDS, was prepared by co-chairs Barbados’ Ambassador and Permanent Representative to the United Nations and other International Organisations in Geneva, Matthew Wilson, and Ambassador of Fiji, Luke Daunivalu with inputs from SIDS member states and other SIDS stakeholders including civil society through extensive consultation. HCC and NCD ALLIANCE, in support of the process, developed a discussion paper, and participated in the consultative process.

A Response to the pre-final declaration was also developed which can be found here. HCC applauds this impressive political document, which contains strong language on: commercial determinants of health (CDOH) and associated actions to address the CDOH; strengthening and integration of mental health across NCD services; prioritization of childhood obesity prevention; implementation of WHO, Best Buy’s and  recommended interventions; strengthening, climate resilient health systems; innovative NCD financing; meaningful engagement of people living with NCDs, young people, and other key groups; and strengthening pathways and mechanisms for inter SIDS collaboration across all sectors – to highlight a few areas.

The Declaration is a bold and ambitious political action-oriented document, uniquely containing two annexes dedicated to providing important SIDS context and specific calls to action to drive the realization of the Declaration. SIDS Member States including Barbados, Belize, Montserrat and St. Vincent and the Grenadines, have already begun to commit to actions on NCDs and Mental Health. All Commitments can be found here. The Declaration will also feed into the upcoming 2nd UN High Level Meeting on Universal Health Coverage, the SIDS 2024 Meeting in Antigua and Barbuda, and the  2025 4th UN High Level Meeting on NCDs – amongst others.

Another perspective on the conference including Q&A’s with some of the delegates and the extensive media coverage can be found on this page SIDS Ministerial Conference on NCDs and Mental Health.

In this video, Ambassadors Luke Daunivalu (Fiji) and Ambassador Matthew Wilson (Barbados) present the 2023 Bridgetown Declaration to WHO Director-General.

Additional resources

SIDS commitments for NCDs and mental health

Small Island Developing States Data Portal

Noncommunicable diseases and mental health in small island developing states report

Here are some photos from the event

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While littering may not seem like a “big deal” on the contrary, the environmental impact can be quite large. According to the United Nations Environment Programme, the Caribbean is the second most plastic contaminated sea in the world (UNEP, 2019) with plastic bottles being the most common plastics found in our waters (Birds Caribbean, 2019). This can have major implications on marine life, such as lacerations, suffocation and other forms of injury or illness (IUCN, 2021). Plastic waste can be regarded as a “silent killer” leading to the death of seabirds throughout the Caribbean (Bird Caribbean, 2019). Plastic is also known to affect the nesting, breeding and feeding of these animals, which may have consequences for the food chain. While the long term impact is unknown, we owe it to the future generations to minimize exposure as much as possible.

It may seem easy to ignore what occurs in our ocean, after all it’s not always visible to the naked eye, however what happens in our oceans affects both human and planetary health. For instance, a plastic bottle in the ocean can break down over time into microplastics which are then consumed by fish in the sea. When fisherfolks are out in the ocean, they may catch the fish which is then sold at our local fish market for consumption to the general population. Plastics that are inappropriately discarded, can find their way into the human body. The United States National Ocean Service highlights that very little is known about microplastics and their impact on marine and human life (NOS, 2023). Therefore it is prudent that we act now and protect our oceans from plastic pollution, to protect our health and animal health.

Inappropriate disposal of plastic bottles is not only a concern for the marine environment, it also poses a threat on land as it can be used as a breeding ground for mosquitoes when water settles in discarded plastic waste. Mosquitoes are not only a nuisance, but pose many  threats to human health such as the spread of dengue fever, zika virus, chikungunya and other related diseases.

Another critical element to consider when discussing the impact of plastic pollution is the link between plastics and unhealthy foods high in salt, sugar and fat. The Big Food industry uses plastic packaging for many food and drink products and despite some actors’ ‘pledges’ to make their plastic packaging more sustainable, global reports [1] indicate that major players continue to use ‘more virgin plastic’ despite efforts to reduce their use. This equates to more plastic waste; the products and their packaging have long term health consequences for both humans and the planet. These ultra processed products have played a significant role in the nutritional transition that has occurred in the Caribbean fuelling high rates of NCDs and obesity. This is a reminder of the strong interlinkages between health and the environment and the need for synergistic solutions to address both of these issues.

Undoubtedly, plastic does more harm than good and it is time for us to think critically about our use and disposal of plastics and the harm to human and planetary health. We’ve made great strides in technological advancement and infrastructure, but we have the potential to create sustainable solutions to plastic pollution and address this crisis if we act now.

World Environment Day was celebrated on June 5 2023. Plastic production and related pollution presents a major threat to SIDS like those in the Caribbean. The urgency with which we need to collectively address this issue cannot subside.

Healthy Caribbean Youth (HCY), the youth arm of the Healthy Caribbean Coalition, is a regional group of young health advocates with various backgrounds who are passionate about promoting good health and supportive environments for children and youth.

[1] https://ellenmacarthurfoundation.org/press-release-progress-needs-fresh-...

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On Friday June 9th, 2023 the HCC and the Pan American Health Organization (PAHO) delivered a webinar, “Clearing the Air – Vaping and Youth in The Caribbean” to launch HCC’s new report, “Vaping Among Adolescents and Youth in The Caribbean: Situation, Policy Responses, and Recommended Actions”.

The report highlights that among individuals aged 13 to 15 years in the 35 PAHO Member States, the highest prevalence of current tobacco use (25.3%) was reported in the Caribbean, noting that ENDS/ENNDS use is also widespread and on the increase in the Caribbean.  The report also makes recommendations to CARICOM governments—and their key partners and stakeholders—for priority actions to prevent and reduce ENDS/ENNDS use and harms among young people in the Caribbean.

Panellists emphasised the urgency of taking action to combat youth vaping given its high prevalence use among adolescents in the Caribbean. Vaping, defined as the inhalation and exhalation of vapour created by an electronic device, which heats a liquid containing nicotine, flavourings, and chemicals, poses significant risks.

Download the report

See the promotional video for the report below.

CARICOM countries, most of which have ratified the WHO Framework Convention on Tobacco Control, are therefore urged to take swift action to implement regulatory measures to prohibit or restrict the manufacture, import, distribution, presentation, sale, and use of the vaping products, and to ensure that where tobacco control legislative provisions are already in place, but do not effectively address novel products, these laws are updated. Similarly, where no legislative measures are in place, countries are urged to take the relevant steps to ensure that new and emerging products including  ENDS/ENNDS are adequately regulated from the outset.

Read the press release.

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This NCD Civil Society Response in Support of the 2023 Bridgetown Declaration to be adopted this week, provides key messages and follow-up recommendations by the Healthy Caribbean Coalition and the NCD Alliance.

It represents civil society’s ongoing contribution to the development of the 2023 Bridgetown Declaration and accompanying Annexes for adoption at the Small Island Developing States (SIDS) Ministerial Conference on Noncommunicable Diseases (NCDs) and Mental Health (14-16 June 2023). The recommendations are the result of NCDA’s and HCC’s involvement in the process so far.

It is hoped that this Conference will be a turning point for SIDS, supported by the global community, to accelerate action on the largely preventable burden of NCDs, including mental, neurological and substance use disorders (MNSDs), that disproportionally impacts SIDS. People living in SIDS are at higher risk of dying prematurely from a major NCD, and SIDS show the highest rates of childhood and adult obesity worldwide.

Read the response document

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WHAT DOES A FOOD POLICY HAVE TO DO TO EARN THE TITLE ‘HEALTHY’ AROUND HERE?

Take a dive into some answers to that question!

WHY IS ‘PEOPLE OVER PROFIT’ A STATEMENT WE NEED TO GET BEHIND?

It seems obvious, right? We should always prioritise people over profit!

But in practice, our policymaking doesn’t seem to always live up to that principle, and that lapse is harming us all. Although it’s easy to spout that, “eating healthy is an individual’s responsibility”, how easy is it to make healthy choices in environments designed to push the unhealthy ones?

Healthy Food Policy makes a difference to our food environments; so just how crucial is it to the health of Caribbean people?

HOW CAN YOU MAKE ANY DIFFERENCE?

EVERYONE!

Share these campaign materials with your network so they understand these issues better.

GOVERNMENTS AND POLICYMAKERS!

You have a vital role to play.

• Establish clear guidelines— with transparent rules for public-private engagement and partnerships— to manage conflicts of interest and foster transparency.
• Invest in the implementation and enforcement of policies that are informed by sound, scientific evidence that is free from industry influence and any conflict of interest. Policies like
  • Mandatory front-of-package nutrition warning labels (FOPWL);
  • School environment regulations like regulating the sale and marketing of ultra-processed foods in and around schools;
  • Marketing restrictions, especially to children and adolescents; and
  • Fiscal policies such as a sugar sweetened beverages (SSBs) tax

These policies have been endorsed by CARICOM Heads of Government and recommended by WHO/PAHO, CARPHA, UNICEF, HCC, Ministries of Health and other key stakeholders. They’ve also been successfully implemented in several countries trying to reach the Sustainable Development Goals (SDGs) by 2030.

FOOD INDUSTRY HEADS!

Respect the independence of policymaking processes.

• Focus your efforts on ensuring more products follow national nutrition guidelines (or the PAHO Nutrient Profile Model);
• Quit marketing unhealthy food and drink products to children; and
• Adopt front-of-package warning labels that are backed by sound, international and regional scientific evidence.

CAMPAIGN AT A GLANCE

Launch Date: Monday | 1.MAY.2023

Locale: Regional/Caribbean

Type: Digital Media Campaign

Purpose:

• To advocate, and build support for healthy, evidence-informed food policies.
• To bring awareness to the potential of policy to improve lives through healthier food environments and a reduction in non-communicable diseases (NCDs).
• To highlight the impediments of industry interference and conflict of interest to policy development.

OUR PARTNERS

OTHER CAMPAIGNS

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On Thursday 27th April, 2023 almost 200 people took part in our webinar: Looking Back to Move Forward – Caribbean Youth Mental Health, reflecting on the ongoing progress and effects that the CYMHCTA has inspired in our Caribbean context and even internationally.

The objectives of the ‘Looking Back to Move Forward – Caribbean Youth Mental Health’ webinar were to:

1. To review the MHCTA objectives and their fulfillment
2. To highlight the primary and secondary effects of the MHCTA campaign
3. To highlight current and future regional efforts to better support youth mental health

Moderators

Neorgia Grant
HCY Member

Stephanie Whiteman
HCY Member and Project Lead MHCTA

Panelists

Gabrielle Edwards
HCY Member and MHCTA Lead in The Bahamas

Sahar Vasquez
HCY Member and MHCTA Lead in Belize

David Johnson
MHCTA Subcommittee Member and President and Founder, LUI OR

Simone Bishop-Matthews
HCY Member and MHCTA Lead in Trinidad and Tobago

Shannique Bowden
MHCTA Lead in Jamaica and Executive Director, JYAN

Dr. Karen Sealey
Chair TTNCDA, HCC Board Director and CSO Support to MHCTA team in Trinidad and Tobago

Ms. Jhanille Brooks
Mental Health and Psychosocial Support Consultant, UNICEF Jamaica

Maria Boyce-Taylor
Associate Director Client and Employee Engagement CIBC First Caribbean

Laura Lewis-Watts
Project Lead NCD Child Secretariat, NCD Child

Dr. Claudina Cayetano
Mental Health Regional Advisor, Noncommunicable Diseases and Mental Health, PAHO

Dr. Brian MacLachlan
Senior Consultant Psychiatrist, Psychiatric Hospital, Barbados

Find out more about the Caribbean Youth Mental Health Call to Action

Background

Mental health has been recognised as an integral element of overall health and as a basic and fundamental right,[1] however its limited prioritization and promotion in national health agendas or policies through the necessary financial and human resources, sends a contradictory message. The COVID-19 pandemic continues to expose the inequities – tolerated by our societies until now, not only in terms of our health but the socioeconomic areas linked to it.[2] Amidst the onset of this global pandemic, the mental health and well-being of groups such as health and frontline workers, women, young people, people living with pre-existing mental health conditions, racial and ethnic minorities, and people living in conditions of vulnerability, were particularly impacted.[2]

In light of this, youth from the Healthy Caribbean Coalition (HCC)’s youth arm – Healthy Caribbean Youth (HCY) and across the Caribbean region, embarked on a journey to advocate for and encourage more dialogue and action by our regional policymakers and the public, around the mental health and well-being of our children and youth.

On October 10th 2022, World Mental Health Day, the HCY, with support from youth advocates and civil society organizations across the region, launched the Caribbean Youth Mental Health Call to Action (CYMHCTA). It emphasized a renewed focus on youth mental health and wellbeing, by tailoring and transforming mental health systems in the Caribbean. Sparked by the concerns and experiences shared from youth and other key voices during two webinars held by the HCC, the CYMHCTA was conceptualised. To ensure adequate regional representation, stakeholders were consulted across ten (10) countries such as Antigua and Barbuda, Aruba, Barbados, Belize, Dominica, Guyana, Jamaica, St. Lucia, The Bahamas and Trinidad and Tobago. This document could not be possible without the valuable input and feedback from over 50 consultations held with various stakeholders, including youth advocates, youth organisations, national civil society organisations, private sector, secondary school students, primary and secondary school teachers and underrepresented groups such as persons living with non-communicable diseases (PLWNCDs), and representatives from Indigenous and LGBTQIA+ communities.

Under the slogan of “There’s no health without mental health”, the CYMHCTA took the region by storm. It garnered regional support from government officials, youth organizations, UNICEF Jamaica and the Caribbean Public Health Agency (CARPHA), as well as international organisations such as the Pan-American Health Organisation (PAHO). Youth from countries such as Barbados, Belize, Jamaica, The Bahamas and Trinidad and Tobago, spearheaded the movement in their respective countries and continue to advocate for the prioritization of the four (4) key calls highlighted in the CYMHCTA:

• Leadership-to prioritize integration of mental health into existing health policies and emergency plans and ensure youth are meaningfully engaged.
• Research-to inform mental health programming and policies.
• Regulations-to protect children and youth from health-harming products, harassment, stigma and discrimination.
• Services-to support the mental health and well-being of children and youth.

Since its launch, the CYMHCTA has amplified the voices of youth in the development of youth-focused mental health policies and plans. HCY members and other youth advocates, with support from in-country civil society organisations, continue to bolster, and foster, relationships with key policymakers. Consequently, being invited to high-level meetings with various national ministry representatives and other key stakeholders and; in the planning and development of youth-centered mental health programs and policies in Barbados and Trinidad and Tobago.

Register for the Looking Back to Move Forward – Caribbean Youth Mental Health webinar.

[1] “Policy for Improving Mental Health – PAHO/WHO.” 28 Feb. 2023, https://www.paho.org/en/documents/policy-improving-mental-health.

[2] “The forgotten victims of the pandemic: children and adolescents.” 13 Dec. 2021, https://www.cepal.org/en/insights/forgotten-victims-pandemic-children-and-adolescents.

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THE HONOURABLE KAY MCCONNEY
MINISTER OF EDUCATION, TECHNOLOGICAL AND VOCATIONAL TRAINING, BARBADOS

And
SENATOR DR. THE MOST HONOURABLE JEROME WALCOTT
MINISTER OF HEALTH AND WELLNESS BARBADOS

And
DR. THE HONOURABLE SONIA BROWNE
MINISTER OF STATE IN THE MINISTRY OF HEALTH AND WELLNESS BARBADOS

CONGRATULATIONS ON THE IMPLEMENTATION OF
BARBADOS NATIONAL SCHOOL NUTRITION POLICY

March 20th, 2023

Dear The Honourable Kay McConney, Senator Dr. The Most Honourable Jerome Walcott, and Dr. The Honourable Sonia Browne,

The Healthy Caribbean Coalition (HCC) extends congratulations to the Government of Barbados and the Ministries of Health and Education on the successful launch of the Barbados National School Nutrition Policy in February 2023 and the banning of the sale of beverages containing added sugars, artificial sweeteners or additives in schools beginning in the third term in April 2023. This significant policy action taken by the Government of Barbados delivers on national and regional commitments to tackle childhood overweight and obesity through a package of evidence-based policy measures including banning the sale and marketing of unhealthy foods and beverages in and around school settings. The Barbados National School Nutrition Policy, originally approved by Cabinet in May 2022, realises a commitment made by Honourable Prime Minister Mia Amor Mottley, at the 39th Summit of CARICOM Heads of Government and State in 2018 when Heads endorsed a number of priorities for the 3rd UN High Level Meeting on Noncommunicable Diseases (NCDs) including: “implementing policies geared to preventing childhood obesity, including health-promoting school environments”.

The HCC, both local and regional members, strongly support this policy measure which complements the recently increased sugar sweetened beverage (SSB) tax at 20% – as part of a wider strategy to combat the urgent health, economic and economic challenges posed by childhood and adult obesity and NCDs in Barbados.

As one of a growing number of countries regionally and globally prioritising NCD prevention through the implementation of regulations which meaningfully change food environments by reducing affordability and availability of ultra-processed foods high in sugars, salts and fats, Barbados is demonstrating tremendous leadership. The Caribbean has the highest NCD mortality rate in the Americas and 40% of these deaths occur prematurely before the age of 70 years affecting our most productive with dire socioeconomic consequences in a time when Caribbean populations are aging and placing significant strain on already vulnerable economies. Obesity is a major underlying factor which contributes to the development of NCDs, such as diabetes and cardiovascular disease. Two-thirds of Barbadians are either living with overweight or obesity and the corresponding figure for Barbadian children is one-third[i] placing these children on a trajectory for health complications in childhood and adolescence and increased risk of NCDs in adulthood.

Unfortunately, these figures show no sign of decline. Per the 2023 edition of the World Obesity Atlas[ii], Barbados is expected to see a 2.6% annual increase in adult obesity and a 4.7% increase in childhood obesity over the period 2020-2035. Overweight and obesity have a profound economic impact through loss of productivity, premature death and health care expenditure. By 2035, this is expected to cost Barbados US $305 million. It is imperative that bold policy action is taken immediately to reverse these alarming trends.

The 20% tax on SSBs and the National School Nutrition Policy are a step in the right direction. At least 73.3% of students aged 13-15 consume at least one carbonated soft drink per day, while 70.9% are not achieving WHO recommended levels of physical activity[iii]. As unhealthy diet and physical activity are major contributors to overweight and obesity, and related NCDs, we commend the National School Nutrition Policy for addressing both of these risk factors. Barbadians – adults and children – have a right to live, grow, work and thrive in environments which support healthy behaviours rather than encouraging unhealthy habits. Since 2016, Barbados has supported three key policy actions recommended by the Caribbean Public Health Agency (CARPHA), The Pan American Health Organization (PAHO)/WHO and the HCC – 1. Taxation of unhealthy foods while subsidising healthy options; 2. Improving the food (regulating the sale and marketing of ultra-processed foods) and physical activity environments in schools to specifically tackle childhood obesity; and 3. Maintaining support for a regional standard for the labelling of prepackaged foods which includes front of package ‘high-in’ warning labels to empower consumers to identify unhealthy foods and purchase healthier unprocessed or minimally processed foods. Such policy measures, when implemented effectively, create strong regulatory environments which support positive dietary behaviours, help drive product reformulation, and encourage manufacturers and retailers to increase the availability of affordable, healthier food and beverage options. Additionally, Barbados is a signatory to the Convention on the Rights of the Child (CRC), thereby underscoring the important role of government to ensure that those most vulnerable in the population – our children – are protected from continuous exposure to harmful environments that promote consumption of ultra-processed foods.

Finally, HCC commends Barbados’ continued commitment to a whole-of-government and whole-of-society NCD response. The National School Nutrition Policy is a product of the partnership between two Ministries with acknowledged ongoing strong support from civil society through the Heart and Stroke Foundation of Barbados and the Barbados Childhood Obesity Prevention Coalition.

We applaud the bold and visionary leadership of the Office of the Prime Minister, the Ministries of Health, Education and local civil society organisations and we pledge our continued support as Barbados implements its National School Nutrition Policy and related policies over the coming months and years.

The Board of Directors, staff and volunteers of the HCC, Technical Advisors and the 100+ HCC CSO Members

View/download the open letter here.

[i] https://data.worldobesity.org/country/barbados-17/report-card.pdf

[ii] https://www.worldobesityday.org/assets/downloads/World_Obesity_Atlas_2023_Report.pdf

[iii] https://cdn.who.int/media/docs/default-source/ncds/ncd-surveillance/data-reporting/barbados/gshs/2011_barbados_gshs_fs.pdf?sfvrsn=652e38c1_5&download=true

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WHY SHOULD WE CARE ABOUT YOUTH MENTAL HEALTH?

Half of all mental health disorders can be diagnosed by just age 14.

16 million adolescents aged 10-19 live with a mental disorder in Latin America and the Caribbean.

Anxiety Disorder is the second leading cause of disability among 10-14-year-olds.

READ THE CALL TO ACTION

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READ THE PLEDGE

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