COUNTRY PROFILES ON NONCOMMUNICABLE DISEASES

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1 COUNTRY PROFILES ON NONCOMMUNICABLE DISEASES

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3 COUNTRY PROFILES ON NONCOMMUNICABLE DISEASES

4 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to Editorial Services, Area of Knowledge Management and Communications (KMC), Pan American Health Organization, Washington, D.C., U.S.A.. The Health Surveillance and Prevention and Control area/chronic s project (Cronic@paho. org) will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. Pan American Health Organization, 2012 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. rights are reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. reasonable precautions have been taken by the Pan American Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the Pan American Health Organization be liable for damages arising from its use. Suggested citation: Pan American Health Organization. Country Profiles on ncommunicable s. Washington, D.C.: 2012

5 INDEX OF COUNTRIES Antigua and Barbuda...1 Argentina... 3 Bahamas...5 Barbados... 7 Belize...9 Bolivia Brazil Chile Colombia Costa Rica Cuba Dominica Dominican Republic Ecuador...27 El Salvador Grenada Guatemala Guyana...35 Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Puerto Rico...51 Saint Kitts and Nevis Saint Lucia...55 Suriname...57 Saint Vincent and The Granadines Trinidad and Tobago Uruguay Venezuela... 65

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7 INTRODUCTION This compendium of country profiles summarizes the epidemiological situation and capacity within Ministries of Health for noncommunicable disease prevention and control (NCD) in Latin America and the Caribbean (LAC). National NCD program managers from Ministries of Health who were designated to participate in the CARMEN 2012 biennial meeting provided the country capacity information contained in this report, by responding to a written survey conducted by the Pan American Health Organization (PAHO) between March April, Information presented in these reports is also from the PAHO publication NCDs: Basic Indicators, 2011 as well as the PAHO mortality database. Each country profile provides demographic information, data on NCD risk factors and premature mortality, national policies and plans, surveillance, health services and medicines related to NCDs.

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9 NCDs IN ANTIGUA AND BARBUDA Sociodemographic indicators Men Women Total population (thousands): 87.9 Average annual deaths (thousands): 0.5 Life expectancy at birth (years): Total: 75.5 Male: 73.5 Female: 77.6 Adult literacy rate (%): 99.0 Gross National Income US$ per capita: 12,130.0 % of population covered by any type health insurance:... Burden of disease PREMATURE DEATHS (2007) RISK FACTORS 37.3% Cancer 6.4 % Diabetes Mellitus 110 premature deaths (<70 yrs) 9.1 % Chronic Respiratory 47.3 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 22.0 % of all deaths Prevalence (%) of: Total Males Females Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? te: : t applicable.

10 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram t applicable CERVICAL CANCER Cervical cytology or PAP tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam t applicable t applicable SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy t applicable CVD MANAGEMENT DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER t applicable Cardiac bypass t applicable Angioplasty t applicable Home care for with terminal or advanced disease NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen Oral morphine Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011).»» Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Ena Henry, Statistician/NCDs Focal Point, Ministry of Health, Antigua & Barbuda.

11 Sociodemographic indicators NCDs IN ARGENTINA Men Women Total population (thousands): 40,764.6 Average annual deaths (thousands): Life expectancy at birth (years): Total: 76.0 Male: 72.2 Female: 79.7 Adult literacy rate (%): 97.7 Gross National Income US$ per capita: 7,550.0 % of population covered by any type health insurance: 62.0 Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females 44.2 % Cancer 65,487 premature deaths (<70 yrs) 5.2 % Diabetes Mellitus 11.9 % Chronic Respiratory 38.7 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 20.8 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? 3

12 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram CERVICAL CANCER Cervical cytology or PAP HPV DNA testing Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular t applicable Mammography t specified COLORECTAL CANCER Fecal occult blood test Digital exam SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Angioplasty DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Home care for with terminal or advanced disease t applicable NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers t applicable Beta blockers t specified Statins t applicable Tamoxifen Oral morphine 4 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Sebastián Laspiur, Health Promotion and NCDs DIrector, Ministry of Health, Argentina.

13 NCDs IN BAHAMAS Sociodemographic indicators Men Women Total population (thousands): Average annual deaths (thousands): 1.9 Life expectancy at birth (years): Total: 75.7 Male: 72.5 Female: 78.6 Adult literacy rate (%):... Gross National Income US$ per capita:... % of population covered by any type health insurance: 51.4 Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females 35.0% Cancer 566 premature deaths (<70 yrs) 8.3 % Diabetes Mellitus 3.4 % Chronic Respiratory 53.4 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 29.8 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? tes: : t available. 5

14 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram CERVICAL CANCER Cervical cytology or PAP tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular HPV DNA testing t specified Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination t specified t specified Mammography t specified COLORECTAL CANCER Fecal occult blood test Digital exam SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Angioplasty DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Home care for with terminal or advanced disease NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen Oral morphine 6 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Delon Brennen, Deputy Chief Medical Officer, Ministry of Health, Bahamas.

15 Sociodemographic indicators NCDs IN BARBADOS Men Women Total population (thousands): Average annual deaths (thousands): 2.4 Life expectancy at birth (years): Total: 74.3 Male: 72.1 Female: 76.6 Adult literacy rate (%):... Gross National Income US$ per capita:... % of population covered by any type health insurance: 25.0 Burden of disease PREMATURE DEATHS (2006) RISK FACTORS Prevalence (%) of: Total Males Females 44.0 % Cancer 475 premature deaths (<70 yrs) 6.7 % Chronic Respiratory 11.4 % Diabetes Mellitus 37.9 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 20.4 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? 7

16 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram t applicable CERVICAL CANCER Cervical cytology or PAP tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam t applicable SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Angioplasty DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Home care for with terminal or advanced disease t applicable NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen Oral morphine 8 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Kenneth S George, Senior Medical Official, Ministry of Health, Barbados.

17 NCDs IN BELIZE Sociodemographic indicators Men Women Total population (thousands): Average annual deaths (thousands): 1.2 Life expectancy at birth (years): Total: 76.1 Male: 74.7 Female: 77.6 Adult literacy rate (%):... Gross National Income US$ per capita: 3,740.0 % of population covered by any type health insurance:... Burden of disease PREMATURE DEATHS (2007) RISK FACTORS 32.6 % Cancer 301 premature deaths (<70 yrs) 18.6% Diabetes Mellitus 6.6 % Chronic Respiratory 42.2 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 25.1 % of all deaths Prevalence (%) of: Total Males Females Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? tes: : t applicable 9

18 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram t applicable CERVICAL CANCER Cervical cytology or PAP tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam t applicable SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy t specified Diagnostic mammography Chemotherapy t applicable Radiotherapy t applicable CVD MANAGEMENT DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER t applicable Cardiac bypass t applicable Angioplasty t applicable Home care for with terminal or advanced disease t applicable NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen t specified Oral morphine 10 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Aisha Andrewin, Epidemiologist & NCDs Focal Point, Ministry of Health, Belize.

19 NCDs IN BOLIVIA Sociodemographic indicators Men Women Total population (thousands): 10,088.1 Average annual deaths (thousands): 72.9 Life expectancy at birth (years): Total: 66.8 Male: 64.5 Female: 69.1 Adult literacy rate (%): 90.7 Gross National Income US$ per capita: 1,630.0 % of population covered by any type health insurance:... Burden of disease PROPORTIONAL MORTALITY (2008)* RISK FACTORS 35 % Communicable, maternal, perinatal and nutritional conditions 8 % Injuries 19 % Other NCDs 22 % Cardiovascular 8 % Cancers 5 % Respiratory s 3 % Diabetes NCDs are estimated to account for 57 % of all deaths * Estimates based on a combination of country life tables, cuase of death models, regional cause of death partterns, and WHO and UNAIDS program estimates Prevalence (%) of: Total Males Females Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? 11

20 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI t specified Blood pressure t specified Blood glucose t applicable Blood lipids t specified Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT t specified Blood pressure monitoring t specified Blood glucose monitoring t specified Blood lipids monitoring t applicable HbA1C t applicable Diabetic foot examination t specified Electrocardiogram t applicable CERVICAL CANCER Cervical cytology or PAP HPV DNA testing Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER t specified t specified t specified t specified tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. Clinical examination t applicable Mammography t applicable COLORECTAL CANCER Fecal occult blood test t applicable Digital exam t applicable SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy t free Diagnostic mammography t free Chemotherapy t free Radiotherapy t free CVD MANAGEMENT Cardiac bypass t specified Angioplasty t specified DIABETES MANAGEMENT Eye exams t specified Photocoagulation for retinopahty Dialysis OTHER Home care for with terminal or advanced disease t specified t applicable NON COMMUNICABLE DISEASES MEDICINES Insulin t free Aspirin t free Metformin t free Glibenclamide t free Thiazide diuretics t free ACE inhibitors t free Calcium channels blockers t free Beta blockers t free Statins t free Tamoxifen t free Oral morphine t free 12 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Proportional mortality: WHO. NCD Country Profiles, Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Absalón Pacheco Mercado, NCD National Program Coordinator, Ministry of Health and Sports, Bolivia.

21 NCDs IN BRAZIL Sociodemographic indicators Men Women Total population (thousands): 196,655.0 Average annual deaths (thousands): 1,261.1 Life expectancy at birth (years): Total: 73.7 Male: 70.3 Female: 77.1 Adult literacy rate (%): 90.0 Gross National Income US$ per capita: 8,070.0 % of population covered by any type health insurance: 100 Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females 35.3 % Cancer 347,494 premature deaths (<70 yrs) 7.9 % Diabetes Mellitus 8.1 % Chronic Respiratory 48.7 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 27.6 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? t specified Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? t specified Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? 13

22 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram CERVICAL CANCER Cervical cytology or PAP HPV DNA testing Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Angioplasty DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Home care for with terminal or advanced disease t specified NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide t specified Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen Oral morphine 14 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Deborah Carvalho Malta, NCDs Coordinator, Ministry of Health, Brazil.

23 NCDs IN CHILE Sociodemographic indicators Men Women Total population (thousands): 17,269.5 Average annual deaths (thousands): Life expectancy at birth (years): Total: 79.2 Male: 76.1 Female: Adult literacy rate (%): Gross National Income US$ per capita: 9,470.0 % of population covered by any type health insurance: 89.0 Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of a : Total Males Females 50.4 % Cancer 19,522 premature deaths (<70 yrs) 6.3 % Diabetes Mellitus 6.4 % Chronic Respiratory 36.8 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 19.9 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults b Fruit and vegetable intake in adolescents b Binge drinking among adults Low physical activity in adults c Low physical activity in adolescents d Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: adults aged 25-64; b: % who eat 5 servings of fruit and vegetables per day; c: physically active for <600 met minutes; d: physically active less than 60 min per day in 5-7 of the last 7 days; Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? 15

24 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score a DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram CERVICAL CANCER Cervical cytology or PAP HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography b COLORECTAL CANCER tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular; a: as part of the preventive medicine examination; b: all women years of age. t applicable t applicable Fecal occult blood test t applicable Digital exam t applicable SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Cardiac bypass t specified Angioplasty t specified Home care for with terminal or advanced disease NON COMMUNICABLE DISEASES MEDICINES 16 Sources: Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen a Oral morphine a Sociodemographic indicators and adolescents risk factors: Pan American Health Organization. n communicable disease project, health inforamtion and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Adult risk factors and hypertension and diabetes prevalence: NCDs surveiilance unit, Department of epidemiology, Ministry of Health of Chile, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). te: Patients under the GES plan (Guaranteed Health Plan). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by María Cristina Escobar Fritzsche, NCDs Department Chief, Ministry of Health, Chile.

25 NCDs IN COLOMBIA Sociodemographic indicators Men Women Total population (thousands): 46,927.1 Average annual deaths (thousands): 260,6 Life expectancy at birth (years): Total: 73.8 Male: 70.2 Female: 77.5 Adult literacy rate (%): 93.2 Gross National Income US$ per capita: 4,990.0 % of population covered by any type health insurance: 84.9 Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females 42.3 % Cancer 59,080 premature deaths (<70 yrs) 6.6 % Diabetes Mellitus 7.9 % Chronic Respiratory 43.3 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 22.7 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? 17

26 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring t applicable HbA1C t applicable Diabetic foot examination t applicable Electrocardiogram t specified CERVICAL CANCER Cervical cytology or PAP HPV DNA testing Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. t specified Fecal occult blood test t specified Digital exam t specified SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass t specified Angioplasty t specified DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty t specified Dialysis t specified OTHER Home care for with terminal or advanced disease t specified NON COMMUNICABLE DISEASES MEDICINES Insulin t specified Aspirin t specified Metformin t specified Glibenclamide t specified Thiazide diuretics t specified ACE inhibitors t specified Calcium channels blockers t specified Beta blockers t specified Statins t specified Tamoxifen t specified Oral morphine t specified 18 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Fernando Ramírez Campos, NCDs Subdirector, Ministry of Health and Social Protection, Colombia.

27 NCDs IN COSTA RICA Sociodemographic indicators Men Women Total population (thousands): 4,726.6 Average annual deaths (thousands): 20.4 Life expectancy at birth (years): Total: 79.4 Male: 77.0 Female: 81.9 Adult literacy rate (%): 96.1 Gross National Income US$ per capita: 6,260.0 % of population covered by any type health insurance: 87.6 Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females Current adult tobacco smokers % Cancer 3,549 premature deaths (<70 yrs) 7.2 % Diabetes Mellitus 6.3 % Chronic Respiratory 39.3 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 17.4 % of all deaths Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? tes: : t applicable. 19

28 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram CERVICAL CANCER Cervical cytology or PAP tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Angioplasty DIABETES MANAGEMENT Eye exams t specified Photocoagulation for retinopahty t applicable Dialysis t specified OTHER Home care for with terminal or advanced disease NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen Oral morphine 20 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Margarita Claramunt Garro, NCDs Focal Point, Ministry of Health, Costa Rica.

29 NCDs IN CUBA Sociodemographic indicators Men Women Total population (thousands): 11,253.7 Average annual deaths (thousands): 83.9 Life expectancy at birth (years): Total: 79.2 Male: 77.2 Female: 81.2 Adult literacy rate (%): 99.8 Gross National Income US$ per capita: 5,550.0 % of population covered by any type health insurance: Burden of disease PREMATURE DEATHS (2007) RISK FACTORS 46.1 % Cancer 21,386 premature deaths (<70 yrs) 4.6 % Diabetes Mellitus 5.6 % Chronic Respiratory 43.8 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 25.5 % of all deaths Prevalence (%) of: Total Males Females Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? te: : t applicable. 21

30 Country capacity PREVENTIVE HEALTH SERVICES AT THE PRIMARY LEVEL OF CARE CVD RISK ASSESSMENT BMI Blood pressure Blood glucose Blood lipids Individual risk management with a validated CV risk score DM AND CVD MANAGEMENT Blood pressure monitoring Blood glucose monitoring Blood lipids monitoring HbA1C Diabetic foot examination Electrocardiogram CERVICAL CANCER Cervical cytology or PAP tes: HPV: Human Papillomavirus; DM: Diabetes mellitus; CVD: Cardiovascular disease; CV: Cardiovascular. HPV DNA testing t applicable Visual inspection techniques (VIA) VIA & cryotherapy in a single visit BREAST CANCER Clinical examination Mammography COLORECTAL CANCER Fecal occult blood test Digital exam SPECIALIZED CARE CANCER DIAGNOSIS AND TREATMENT Colposcopy Diagnostic mammography Chemotherapy Radiotherapy CVD MANAGEMENT Cardiac bypass Angioplasty DIABETES MANAGEMENT Eye exams Photocoagulation for retinopahty Dialysis OTHER Home care for with terminal or advanced disease NON COMMUNICABLE DISEASES MEDICINES Insulin Aspirin Metformin Glibenclamide Thiazide diuretics ACE inhibitors Calcium channels blockers Beta blockers Statins Tamoxifen Oral morphine 22 Sources: Sociodemographic indicators and risk factors: Pan American Health Organization. n communicable disease project, health information and analysis project and sustainable development and environment area: n communicable diseases in the Americas: Basic indicators 2011, Washington DC, USA, Premature mortality: PAHO/WHO Mortality Information System (updated on May 2011). Country capacity: 2012 Country Capacity Survey in preparation for the CARMEN meeting, completed by Orlando Landrove Rodríguez, National NCD Program Coordinator, Ministry of Health, Cuba.

31 NCDs IN DOMINICA Sociodemographic indicators Men Women Total population (thousands): 73.0 Average annual deaths (thousands): 0.6 Life expectancy at birth (years): Total: 76.0 Male: 73.0 Female: 79.1 Adult literacy rate (%):... Gross National Income US$ per capita: 4,900.0 % of population covered by any type health insurance:... Burden of disease PREMATURE DEATHS (2007) RISK FACTORS Prevalence (%) of: Total Males Females 41.1% Cancer 107 premature deaths (<70 yrs) 5.6 % Diabetes Mellitus 9.3 % Chronic Respiratory 43.9 % Cardiovascular Premature deaths from NCDs (<70 yrs) account for 17.8 % of all deaths Current adult tobacco smokers Adolescent tobacco smokers Fruit and vegetable intake in adults a Fruit and vegetable intake in adolescents a Binge drinking among adults Low physical activity in adults b Low physical activity in adolescents c Overweight among adults (BMI ) Obesity among adults (BMI 30) Overweight among adolescents (BMI>+1SD) Obesity among adolescents (BMI>+2SD) Children <5 overweight Adults with diabetes mellitus Adults with raised BP and/or taking medication tes: a: % who eat 5 servings of fruit and vegetables per day; b: physically active for <600 met minutes; c: physically active less than 60 min per day in 5-7 of the last 7 days; BP: Blood pressure. Country capacity POLICIES & ACTION PLANS SURVEILLANCE Is there an integrated NCD policy? Is there a budget? Is there an operational multisectoral mechanism to coordinate the NCD policies? Is there an integrated NCD action plan? If the answer is yes, does it have: Budget? Measurable outcomes? Monitoring and evaluation component? Communications component? a NE Is there dedicated staff? Does the information system include specific data on? Specific cause of mortality Hospital based morbidity Risk factors surveys Are there disease specific registries? Is there a unique personal identifier? Use of data for policy making and planning? Are there plans for specific diseases? Established mechanisms for data dissemination? tes: a: Draft plan; NE: t specified. 23

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