"It started not far from here, in fact just across the road. On 15th September, 2007, 13 CARICOM Heads of Government and Heads of State, (HOGs) met at the Crowne Plaza Hotel, Port-of-Spain, on the occasion of the historic, first ever Summit on Chronic Non-Communicable Diseases (NCDs) and agreed to address the epidemic of these diseases which was raging in the Caribbean and threatening the development of the countries. This resulted in the Declaration of Port of Spain, “Uniting to stop the epidemic of chronic NCDs (POSD).

The CARICOM HOGs continued to demonstrate their leadership when in 2009, the then Prime Minister of Trinidad and Tobago (TTO), Hon Patrick Manning, called for a Special Meeting on NCDs at the United Nations. This initiated a successful campaign by the CARICOM Ambassadors at the UN and the first High Level Meeting on the Prevention and Control of NCDs was held in September 2011. Thus, the global campaign to address NCDs as a development issue was established. The civil society Healthy Caribbean Coalition (HCC) emerged from these developments. Formed in 2008, the HCC now comprises over 65 Civil Society Organizations (CSOs) working in health and non-health areas.

The priority non communicable diseases currently are cardiovascular diseases, (CVD), mainly heart attack, stroke and coronary artery disease; diabetes, cancer, chronic lung disease and mental health disorders. These diseases share some common modifiable risk factors (RF) so that controlling one RF impacts positively on many diseases. The modifiable RFs are tobacco use, unhealthy diets, inadequate physical activity, harmful use of alcohol and air pollution.

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​COVID – 19 pandemic forced policy makers to address NCDs as the disease was much more severe and caused high mortality in persons with NCDs, in particular those with obesity. In addition, the pandemic slowed, and in some cases wiped out many of the gains in health system for addressing NCDs and highlighted the need to pay greater attention to mental health services. But we don’t need another epidemic for there to be acceleration of the response to NCDs.

Progress in the achievement of the CARICOM and WHO Plans for the prevention and Control of NCDS has been patchy. No CARICOM country is on track for achieving the NCD-related Sustainable Development Goal – SDG 3(Good health and Well-being).

The main NCD risk factors remain problematic in the region. In addition, overweight and obesity, in both adults and children, are of great concern. These conditions are driven by unhealthy diets that include significant consumption of sweetened beverages (SBs), and other ultra-processed products (UPPs), high in salt, fat and sugar and industrially-produced trans fats. The lack of adequate physical activity contributes to this situation. There has been reduction in tobacco use across the region, but the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS)—commonly called e-cigarettes or vapes—is gaining ground rapidly, particularly among young people. There is increasing recognition of the need to address alcohol use, especially given the Caribbean’s significant production of alcohol productsi. The Caribbean is experiencing a worsening epidemic of obesity and noncommunicable diseases (NCDs) and it has the worst rates of premature mortality from cardiovascular diseases in the region of the Americasii
The situation in Trinidad and Tobago (TTO), reflects the Caribbean picture:

• Heart disease is the leading cause of death. According to the Global Burden of Disease 2019 report, ischemic heart disease accounted for 1 in 5 deaths in the country. In real numbers, that's over 3,000 Trinidadians per year, many of them dying prematurely before the age of 70 years. We must be alarmed, not only by the mortality but by the impact on life expectancy. In 2023, the average life expectancy in Trinidad was around 73.6 years, lagging behind countries with similar income levels. One of the key reasons is the high burden of non-communicable diseases (NCDs), especially cardiovascular conditions.
 

The Numbers We Cannot Ignore - Let me share some other facts. In Trinidad and Tobago:
• High blood pressure, high cholesterol, obesity, diabetes are major risk factors and, on the rise, — in the 2024 Steps survey 15.8% persons had diabetes; 29% had hypertension, and 41% raised cholesterol
• More than 60% of adults are overweight or obese. Between 2011 and 2024 the prevalence in overweight and obesity increased by 24%.
• Even more worrying: Childhood obesity is rising rapidly. Between 2009 and 2019 prevalence of child obesity (ages 5 – 18) doubled (11% – 23%). Prevalence of obesity in ages 0 - 5 years is among the highest in the world. - Too many of our children are eating highly processed, sugary, salty foods and not moving enough. This means they are at risk of heart disease and diabetes from a young age.
• Alcohol consumption – there has been an increase overall of approximately 11% and TTO ranks among the top 10 countries in the Americasiv; alarming is that the increase among women is 12.5%
• Tobacco use has not increased but there has been increased vaping, especially among the youth
These numbers aren’t just statistics. This is not just a health crisis. It is a national development issue. Heart disease drains our economy through lost productivity, high hospitalization costs, and long-term disability. It burdens our families emotionally and financially.

It is evident that higher priority needs to be given to obesity because in addition to being a disease, it is a risk factor for many NCDs, - CVD, Type 2 diabetes and several cancers. Yes, obesity is a disease and not a matter simply of lack of will power of an individual. WHO defines overweight and obesity as “abnormal or excessive fat accumulation that presents a risk to health.” A body mass index (BMI) over 25 is considered overweight, and over 30 is obesev. WHO uses measurement of the waist circumference for measuring abdominal fat. A waist circumference above 80 cm for women and 94 cm for men is considered high, indicating an increased risk.

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It is my view, that with the development of the GLP-1s, addressing obesity through a multi-interventional approach makes reducing obesity, CVD and diabetes more probable. Of course, this assumes that governments can be as successful as they were in reducing the costs of HIV drugs. How did we get here – Sir Hilary Beckles has argued that the diet imposed on enslaved Africans in the Caribbean, with the forced consumption of salt and sweet foods and starchy food, has contributed to the high prevalence of non-communicable diseases like diabetes, hypertension, and obesity in the Caribbean.

For a time we ate what we grew, then we ate what others grew and now we eat what machines manufacture. More disturbing is that we are under the spell of the addictive food science and slick marketing of unhealthy products, especially to children. These are examples of the impact of CDOH.

What exactly is Commercial Determinants of Health (CDOH)?
WHO defines CDOH as the private sector activities that affect people's health, directly and indirectly, positively and negatively. It includes the production of goods and services, marketing and advertising and broader commercial environment.

World Heart Federation 2025 Report reveals that 44% of global NCD's are linked to commercial products and practices. This is through production and marketing of unhealthy food, tobacco products, and alcohol and includes the design and marketing of products that are harmful.

The whole of society approach calls for all sectors to work together to achieve health for all. This requires that we address CDOH through reforming governance approaches to eliminate conflict of interest, updating regulations, and strengthening legal and economic processes. CDOH influences the economic and social systems in countries.

TTO has not been standing still. Several policies and programs to promote heart health and reduction in NCDSs have been implemented:
• Chronic Disease Assistance Program – CDAP (one of the first in the Caribbean)
• TT Moves (2018)

• Ban of Sugar Sweetened Beverages (SSB) in schools – first in the Caribbean – partnership with Ministry of Education and National Parent Teachers Association
• Breast feeding initiative – in collaboration with Breastfeeding CSOs
• Expansion of Farmers markets – Ministry of Agriculture
• Improvements in diagnostics and tertiary treatment capability as new health centres and hospitals are opened; partnerships with private sector to extend selected services – including cardiac services – the External Patient Programs
• Implementation of HEARTS approach in all health centersvii. This PAHO initiated Program for prevention and control of cardiovascular disease can be adapted for the control of obesity and related risk factors:
o It focuses on prevention, not just treatment.
o It gives clear guidelines to doctors and nurses so they know how to treat high blood pressure and cholesterol properly.
o It ensures the same high-quality care whether you live in Diego Martin, Sangre Grande, or Penal.
o It promotes community tracking and follow-up, so we can catch problems early and keep people healthy longer.

TTO is fortunate to have been selected as front-runner country for the implementation of the WHO Acceleration Plan to Stop Obesity. This includes consideration of a set of policy recommendations proven to be effective, affordable, adaptable and scalable to deliver positive outcomes:
• Protection of individuals from the harmful advertising of unhealthy foods
• Taxes on unhealthy foods and reformulation of food products
• Promotion of physical activity and nutritional education in schools
• Greater integration of obesity prevention and treatment into the primary healthcare services
 

Being a front-runner means we can set the example for the Caribbean and other SIDS. But it also means that we have a responsibility — to act boldly and make sure these policies reach every woman, every child, every man… every community. The TTNCDA stands ready to support the Ministry of Health (MOH) in the implementation of the National Strategic Plan for the Prevention and Control of NCDs including this obesity initiative. The Alliance with its twelve members, which reflect all the diseases and the life course and among them there are 3 CSOs focused on heart issues.

The United Nations (UN) General Assembly Fourth High-level Meeting on the Prevention and Control of Noncommunicable Diseases(HLM4), is scheduled for 25 September 2025 with the overall theme “Equity and Integration: Transforming lives and livelihoods through leadership and action on noncommunicable diseases and mental health”. TTNCDA will be encouraging our Prime Minister to attend and is collaborating with HCC to support the CARICOM Secretariat for the preparations.

The HCC led civil society advocacy priorities for the UN HLM4 include:
1.Engaging communities and putting people first in the NCD response, in particular People Living with an NCD
2.Addressing the commercial determinants of health and conflict of interests
3.Accelerating implementation of healthy food environments to include: front of package labeling, taxation of unhealthy foods, incentives for healthy foods and products and regulation of sale and marketing
4.Implementation of WHO Framework Convention on Tobacco control (FCTC) and the WHO SAFER alcohol harm reduction measure
5.Strengthening and integrate community-based mental health services for all age groups
6.Promoting the use of all settings for physical activity – schools, community and workplaces
In conclusion, I urge you to remember that while policies may be agreed globally, at WHO and the UN, the implementation is local and that you are part of the process, as individuals and communities. You have the right to the conditions necessary for a healthy heart and healthy living.
•Know your numbers and family history - get regular checks
•Manage your mental stress
•Eat and drink less UPF and find ways to move your body
 

Thank you!"

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Dr. Karen Sealey

Feature Speaker, Director - Healthy Caribbean Coalition (2024-2026)

8th June 2025