Transcript nevis mortality by category 2006 - 2008

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
RATIONALE FOR DATA USE
• Planning Starts With Data
• Operational Data drive Analysis
• Without Data, One Is Opinionated
• No Measure, No Manage, No Money
A: OBJECTIVE HEALTH
Life Expectancy, Mortality,
Morbidity/Disability
POPULATION AND BIRTHS
2001
Pop.
2002
2003
2004
2005
2006
2007
2008
46,325 47,280 48,035 48,720 49,350 49,990 50,640 51,300
Live
Births
803
758
738
654
668
662
690
709
Birth
Rate
17.3
16.0
15.4
13.4
13.5
13.2
13.6
13.8
Teen
Births
168
140
145
117
128
135
105
107
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)
HEALTH INDICATORS
Date
Estimate
Source
Infant Mortality Rate7
2008
11.3
Min. of Health
Maternal Mortality Ratio8
2008
141
Min. of Health
Teen Motherhood (%)
2008
15
Min. of Health
Dental Caries (%)9
2008
70
Min. of Health
Excess Weight (% adults)
2008
78
STEPS (WHO)
Hypertension Prevalence (% adults)
2008
34.5
STEPS (WHO)
Diabetic Prevalence (% adults)
2008
20
Min. of Health
Mental Illness Prevalence (% pop) 10
2008
1.2
Min. of Health
HIV Incidence (per 10, 000 pop)
2008
2.2
Min. of Health
Homicide (per 10, 000 pop)
2008
4.6
PPRO11
Persons per Physician
2008
840
Min. of Health
Calorie Intake (kcal per capita)
2003
2960
CFNI12
Major Morbidities
Adults
Children
1.Excess Weight
1.Cavities
2.Hyperlipidemia
2.Gastroenteritis
3.Hypertension
3.RTIs
4.Diabetes
4.Excess Weight
5.Schizophrenia
5.Asthma
6.Depression
7.Substance Use
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)
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
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.
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
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.
MORTALITY
TREND ANALYSIS
Mortality Category
2001 2002 2003 2004 2005 2006 2007
2008
Total deaths
375
353
374
398
361
373
353
359
Crude mortality rate
(per 1,000 population)
8.1
7.5
7.8
8.2
7.3
7.5
7.0
7.0
Infant deaths
10
17
13
11
9
9
14
8
Neonatal deaths
5
15
11
10
8
9
14
8
Infant mortality rate
(per 1,000 lb)
12.5
22.4
17.6
16.8
13.5
13.6
20.3
11.3
Neonatal mortality
rate (per 1,000 lb)
6.2
19.8
14.9
15.3
12.0
13.6
20.3
11.3
Maternal deaths
2
0
2
0
0
1
0
1
Late fetal deaths
15
6
15
12
11
11
7
12
18.3
7.9
19.9
18.0
16.2
16.3
10.0
16.6
Late fetal death rate
(per 1,000 lb)
Mortality Category
2001 2002 2003 2004 2005 2006 2007
2008
Total deaths
375
353
374
398
361
373
353
359
Crude mortality rate
(per 1,000 population)
8.1
7.5
7.8
8.2
7.3
7.5
7.0
7.0
Infant deaths
10
17
13
11
9
9
14
8
Neonatal deaths
5
15
11
10
8
9
14
8
Infant mortality rate
(per 1,000 lb)
12.5
22.4
17.6
16.8
13.5
13.6
20.3
11.3
Neonatal mortality
rate (per 1,000 lb)
6.2
19.8
14.9
15.3
12.0
13.6
20.3
11.3
Maternal deaths
2
0
2
0
0
1
0
1
Late fetal deaths
15
6
15
12
11
11
7
12
18.3
7.9
19.9
18.0
16.2
16.3
10.0
16.6
Late fetal death rate
(per 1,000 lb)
Mortality Category
2001 2002 2003 2004 2005 2006 2007
2008
Total deaths
375
353
374
398
361
373
353
359
Crude mortality rate
(per 1,000 population)
8.1
7.5
7.8
8.2
7.3
7.5
7.0
7.0
Infant deaths
10
17
13
11
9
9
14
8
Neonatal deaths
5
15
11
10
8
9
14
8
Infant mortality rate
(per 1,000 lb)
12.5
22.4
17.6
16.8
13.5
13.6
20.3
11.3
Neonatal mortality
rate (per 1,000 lb)
6.2
19.8
14.9
15.3
12.0
13.6
20.3
11.3
Maternal deaths
2
0
2
0
0
1
0
1
Late fetal deaths
15
6
15
12
11
11
7
12
18.3
7.9
19.9
18.0
16.2
16.3
10.0
16.6
Late fetal death rate
(per 1,000 lb)
Category 2001 2002 2003 2004 2005 2006 2007 2008
Total deaths
375
353
374
398
361
373
353
359
1-4-years
7
5
2
1
1
3
6
2
5-9-years
3
3
0
0
2
0
0
2
10-14-years
2
1
2
2
2
1
0
0
15-19-years
2
5
6
8
1
3
4
4
20-59-years
78
75
72
82
82
87
92
94
60-79-years
132
116
149
142
111
118
108
120
≥ 80 years
141
130
130
152
153
147
129
127
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.
LEADING DEATH CATEGORIES - SKN
• 2006-2008
1. Circulatory System Disorders (34%)
•
Heart Disease; Stroke
2. Other Diseases (27%)
•
Diabetic Complications
3. Neoplasms (18%)
4. External Injuries (12%)
•
Homicide
LEADING CONDITION / DISEASE CAUSES OF DEATH
• Adults
1. Heart Disorders
2. Stroke-related
Disorders
3. Diabetes
Complications
4. Homicide
• Children
1. Prematurity
2. Congenital Anomalies
[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%).
2006 MORTALITY CATEGORIES BY PERCENTAGE
100%
1%
1%
20%
28%
80%
10%
3%
60%
40%
47%
1%
23%
Other
8%
1%
9%
2%
0%
St. Kitts
External
Perinatal
42%
46%
20%
18%
1%
Ill - Defined
Circulatory
Neoplasm
14%
5%
Nevis
17%
2%
St. Kitts &
Nevis
Communicable
2007 MORTALITY CATEGORIES BY PERCENTAGE
120%
100%
0%
0%
25%
32%
80%
60%
40%
13%
4%
32%
20%
21%
0%
6%
St. Kitts
Ill - Defined
0%
13%
Other
27%
External
13%
13%
7%
30%
30%
Perinatal
Circulatory
Neoplasm
13%
5%
Nevis
19%
5%
St. Kitts &
Nevis
Communicable
2008 MORTALITY CATEGORIES BY PERCENTAGE
100%
80%
1%
32%
2%
1%
17%
28%
11%
2%
60%
40%
13%
2%
12%
2%
40%
33%
35%
20%
14%
0%
17%
3%
Other
External
Perinatal
Circulatory
Neoplasm
24%
5%
St. Kitts
Ill - Defined
4%
Nevis
St. Kitts & Nevis
Communicable
NEVIS MORTALITY BY CATEGORY 2006 - 2008
120%
Ill - Defined
100%
80%
60%
1%
0%
28%
32%
17%
13%
11%
2%
8%
1%
2%
42%
External
Perinatal
13%
40%
Other
40%
Circulatory
30%
20%
0%
14%
5%
Nevis 2006
13%
5%
Nevis 2007
24%
3%
Nevis 2008
Neoplasm
Communicable
B: SOCIAL & ECONOMIC
DERTERMINANTS OF HEALTH
Demographic and Socioeconomic Data
Date
Estimate
Source
Population
2008
51, 300
Statistical Unit
Life Expectancy at Birth (years)
2006
73
WHO1
GDP (US$ x 106)
2009
566
CSO, EECU ECCB2
GDP per capita (US$)
2009
11,000
GDP Growth (%)
2008
3.2
IMF
% GDP
2009
3.3
Min. of Health
Per Capita ($US)
2008
370
Min. of Health
Human Development Index
2006
51
UNDP4
Poverty Rate (%)
2008
21.8
CDB5
Dependency Ratio (%)
2008
51.9
WHO
GINI Coefficient
2008
0.445
IMF6
Public Sector Debt (% GDP)
2008
178
IMF
Government
Health Exp.
Min. of Health3
COMPARISIONS
HOSPITAL MORTALITY
2006
2007
2008
JNF
3.4
3.2
3.0
Alexandra
3.4
3.9
5.2
SKN
Hospitals
3.4
3.4
3.5
SKN
USA
Life Expectancy
73
79.4
Infant Mortality
11.3 (2008)
6.7 (2006)
7.8
8.3
7 (2008)
5.4
Hospital beds per 1000
5.5
3.1
% Immunization Coverage – Measles @ 12m
99
92
GINI Coefficient
0.445 (2008)
0.463 (2007)
Per Capita Public Exp
3.3 (2009 est)
7.8 (2007)
11, 000
45, 840
51.9
49.7
% Low Birth Weight
General Mortality Rate - All Causes
Gross National Income per Capita (US$ ppp)
Dependency Ratio (100 pop)
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
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
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
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
HEALTH RISKS
[WHO]
• 25% of all deaths caused by
– Childhood underweight
– Unsafe Sex
– Alcohol Misuse
– Unsafe Drinking Water
– Poor Sanitation & Hygiene
– High Blood Pressure
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
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
 Universality
 Equity
 Sustainability
 Strategies
 Effective Stewardship
 Primary Health Care
 Health Promotion
 Integrated Service Delivery
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
EXPECTED OUTCOMES: By 2015
Life Expectancy
72  80 y
Infant & Maternal Mortality (5 year mean) [Nevis]
< 10 [≤3] & < 3 [≤ 1]
Morbidity
Adult Overweight
Mental Illness
External Injuries
HIV Seroprevalence
< 60%
Fully Staffed
 by 20%
< 2%
Dependency Ratio
55%  < 50%
Government’s subsidy of secondary+ care:
90%  50%
Service Features
•High Quality; Impactful; Affordable & Sustainable; Satisfactory
THE FINAL ANALYSIS
GOOD HEALTH
Primary Care
EC $$$
Secondary Care
EC $$$$
Tertiary Care +
US$$$$$
Disease/Injury
Prevention/Early Intervention
Impairment
Major
Disorder/Disability
Dependency
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THANK YOU FOR YOUR ATTENTION