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ST. KITTS & NEVIS HEALTH SITUATION

ST. KITTS & NEVIS HEALTH SITUATION. Health Status Indicators & Socioeconomic Determinants of Health. PATRICK MARTIN CHIEF MEDICAL OFFICER 12/12. WHY HEALTH SITUATION ANALYSIS? A SYSTEM PERFORMANCE EVALUATION (“GUT CHECK ” ) PROMOTES EVIDENCE-BASED PROGRAMMING & DECISION-MAKING.

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ST. KITTS & NEVIS HEALTH SITUATION

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  1. ST. KITTS & NEVIS HEALTH SITUATION Health Status Indicators & Socioeconomic Determinants of Health. PATRICK MARTIN CHIEF MEDICAL OFFICER 12/12

  2. WHY HEALTH SITUATION ANALYSIS? • A SYSTEM PERFORMANCE EVALUATION (“GUT CHECK ” ) • PROMOTES EVIDENCE-BASED PROGRAMMING & DECISION-MAKING RATIONALE FOR DATA USE • Planning Starts With Data • Operational Data drive Analysis • Without Data, One Is Opinionated • No Measure, No Manage, No Money

  3. A: OBJECTIVE HEALTH Life Expectancy, Mortality, Morbidity/Disability

  4. POPULATION AND BIRTHS

  5. 2006 - 2008 • Life Expectancy @ Birth • Increased from 70 years in 2003 to 73 years in 2006 • Compared to 2001-2005 • Estimated population increased by 3.9% • Ave. # of live births decreased by 6.7% (724 to 687). • Net increase in population due to inward migration (death rate also dropped)

  6. CHRONIC NON-COMMUNICABLE DISORDERS • Dominated the epidemiologic profile since the early 1980’s. • Risk factor Survey (STEPS - SK, WHO, 2008) – Prevalence Findings • Adult Overweight - 75% • Hypertension - 36%. • Diabetic prevalence (est.) - 15-20% adults • Extrapolating from the public sector diabetic clinic register. • 80% due to obesity (2006 CCHD)

  7. NON-COMMUNICABLE DISORDERS External Injury • Violence-related injuries continue to increase. • JNF Hospital – Cases of assault (non-gunshot) and wounding • [2001-2005] = 3 x [1996 – 2000] • Homicides • 56 in 2006-2008 vs. 42 in 2001-2005 • Most were attributed to drug-trafficking gang activity (RSCNPF; UNODC) • The increase in homicide reflected in the increase in deaths of persons 20-59 years

  8. NON-COMMUNICABLE DISORDERS Mental Illness • Prevalence • ~ 1.2% of the total pop. registered in the public sector’s mental health program. • Major mental illnesses • Schizophrenia, Depression and Substance Abuse Disorders.

  9. MAJOR DISABILITIES • Mental/Neurological • Depression, Paranoia, Substance Abuse, Dementia, Epilepsy • Learning/Behavioral/Developmental • Reading, Mathematics • Conduct Disorders associated with Parental Dysfunction • Brain Disorders e.g. Cerebral Palsy • Diabetes-Related Amputations • External Injury-Related

  10. COMMUNICABLE DISEASES • Account for less than 5% of deaths. • HIV/AIDS • In 2006-2008, HIV incidence 40 cases; AIDS deaths 6; 2009 – 8 cases • in 2001-2005, 73 and 14. • Tuberculosis • 2006-2008 - Average annual incidence of 3 cases • 2005 - 1 case • No cases of the diseases covered by EPI • Endemic Vector-Borne Diseases • Dengue Fever - Outbreaks every 6-7 years. Dec. 2008 - 60 confirmed cases • Malaria and cholera are non-existent.

  11. MORTALITY TREND ANALYSIS

  12. MORTALITY • Average crude death rate decreased to 7 deaths per 1000 population compared to 7.5 in 2001-2005. • Absolute infant mortality decreased from average 12 to 10 deaths per year • Rate fluctuations reflect larger changes in the numerator (infant deaths) compared to the denominator (live births). • Neonatal (<28 days) deaths, especially in the first week of life, account for all infant deaths (80% in 2001 – 2005) • Deaths in this age group are largely due to conditions originating in the perinatal period, chief among them respiratory distress syndrome associated with the immature lungs of premature infants. • 2 maternal deaths; similarly for 2001-2005.

  13. LEADING DEATH CATEGORIES - SKN • 2006-2008 • Circulatory System Disorders (34%) • Heart Disease; Stroke • Other Diseases (27%) • Diabetic Complications • Neoplasms (18%) • External Injuries (12%) • Homicide

  14. LEADING CONDITION / DISEASECAUSES OF DEATH • Adults • Heart Disorders • Stroke-related Disorders • Diabetes Complications • Homicide • Children • Prematurity • Congenital Anomalies

  15. [2006 – 2008] vs. [2002 – 2005] Re Actual Deaths (No data for 2001) • Decreases • Communicable diseases (by 50%) • Circulatory disorders (37%) • Deaths due to heart diseases increased • Stroke syndromes remained unchanged • Perinatal conditions (20%) • Increases • Neoplasms (30%) • External injuries (33%).

  16. B: SOCIAL & ECONOMIC DERTERMINANTS OF HEALTH

  17. COMPARISIONS

  18. HOSPITAL MORTALITY

  19. MAJOR WORK AHEAD • Health Systems & Regulation • Financing – Universal Benefits Plan • Reduce personal bankruptcy • Reduce burden on treasury • Restructure of the National Health Authority • Legislation • Registration • Environmental Health • Pharmacy • Mental Health • Laboratory

  20. MAJOR WORK AHEAD • Other • Community Health Worker (Outreach) • Key to service delivery to homes • Patient Charter • Continuing Education Credits • Time-limited registration • Environmental Health Department • Food Safety; Effects of Climate Change; Port Health • Emergency Medicine Specialist • International best practices

  21. MAJOR WORK AHEAD • Reduction of Risk & Burden of Disease • Dietary Guidelines • Oral Health • Cavities the major infectious disease in children • Cancer Registry • Wellness Revolution esp Men • Active Ageing • Violence & Injury Prevention (VIP) • Youth Anger; Adult Conflict (Relationships; Politics) • Speeding; DUI; DWD • Substance Demand Reduction • Substance Culture

  22. HEALTH RISKS[WHO] • 75% of Coronary Heart Disease caused by • Alcohol Consumption • High Blood Glucose • Tobacco Use • Overweight • High Blood Cholesterol • Low intake of Fruit & Vegetables • Physical Inactivity

  23. HEALTH RISKS[WHO] • 25% of all deaths caused by • Childhood underweight • Unsafe Sex • Alcohol Misuse • Unsafe Drinking Water • Poor Sanitation & Hygiene • High Blood Pressure

  24. HEALTH RISKS[WHO] • 25% of child deaths caused by unsafe and unhealthy environments • 45% of cancer caused by 9 environmental & behavioural risks + 7 infections • 71% of Lung Cancer caused by Tobacco Smoking

  25. MINISTRY OF HEALTH POLICY OUTLOOK • Philosophy: “Nation’s Health Is Its Wealth” • Value Statement: Health Care is a Human Right and a contributor to individual wellbeing and national development • Principles  Quality  Equity Universality  Sustainability • Strategies  Effective Stewardship  Health Promotion Primary Health Care Integrated Service Delivery

  26. NATIONAL STRATEGIC PLAN - HEALTH Priority Areas 2008 – 2012 • Reducing Chronic Non-Communicable Diseases • Improving Mental Health and Reducing Substance Abuse • Prevention and Control of Sexually Transmitted Infections • Safeguarding Health of the Environment • Promoting the Health of the Family • Health Systems Development • Human Resource Development

  27. EXPECTED OUTCOMES: By 2015 • Service Features • High Quality; Impactful; Affordable & Sustainable; Satisfactory

  28. THE FINAL ANALYSIS Pr imary Heal thcare Primary Care EC $$$ GOOD HEALTH Disease/Injury Prevention/Early Intervention Impairment Major Disorder/Disability Dependency Secondary Care EC $$$$ Tertiary Care + US$$$$$

  29. THANK YOU FOR YOUR ATTENTION

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