The 2007 Caribbean Community Port-of-Spain Declaration on noncommunicable diseases: an overview of a multidisciplinary evaluation

Improving household nutrition security and public health in the CARICOM, 2018–2022

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 Americas. Creating enabling environments to improve dietary diversity would help reduce obesity and diet-related NCDs. The Improving Household Nutrition Security and Public Health in the CARICOM project aimed to increase dietary diversity in the Caribbean, and to determine and implement effective, gender-sensitive interventions to improve food sovereignty, household food security, and nutrition in CARICOM states. Primary quantitative and qualitative research, scoping reviews, stakeholder engagement, implementation of interventions and dissemination activities were undertaken. This paper describes the overall project design and implementation, discusses challenges and limitations, and presents core achievements to inform further work in Small Island Developing States throughout CARICOM to advance the nutrition agenda in the Caribbean. The results of the project’s research activities are presented in other papers published in this special issue on nutrition security in CARICOM states.

Implementation of a community-based low-calorie dietary intervention for the induction of type-2 diabetes and pre-diabetes remission: a feasibility study utilising a type 2 hybrid design

Objectives

The aims of this feasibility study were to (1) examine the implementation of a community-based health advocate (CHA) training programme to develop the clinical skills needed to support a diabetes remission protocol based on a low-calorie diet (LCD) and (2) investigate if participant weight loss can be achieved and diabetes remission induced under these conditions.

Methods

This tripartite study followed a type 2 implementation-effectiveness design. Three faith-based organisations (FBOs) were purposively selected as study sites. Implementation outcomes were guided by the Consolidated Framework for Implementation Research. During the pre-implementation phase, site ‘readiness’ to facilitate the intervention was determined from a site visit and an interview with the FBOs’ leadership. During the implementation phase, congregants could volunteer for the 10-week CHA training which included practical exercises in weight, glucose and blood pressure (BP) measurement, and a summative practical assessment. Acceptability and implementation effectiveness were assessed via survey. During the intervention phase, other congregants and community members with T2DM or pre-diabetes and overweight were invited to participate in the 12-week LCD. Anti-diabetic medication was discontinued on day 1 of the intervention. Clinical effectiveness was determined from the change in weight, fasting blood glucose (FBG) and BP which were monitored weekly at the FBO by the CHA. HbA1C was performed at weeks 1 and 12.

Results

The FBOs were found to be ready as determined by their adequate resources and engagement in health-related matters. Twenty-nine CHAs completed the training; all attained a passing grade at ≥1 clinical station, indicating implementation effectiveness. CHA feedback indicated that the programme structure was acceptable and provided sufficient access to intervention-related material. Thirty-one persons participated in the LCD (11 T2DM:20 pre-diabetes). Mean (95%CI) weight loss was 6.0 kg (3.7 to 8.2), 7.9 kg in males vs 5.7 kg in females; A1C (%) decreased from 6.6 to 6.1, with a greater reduction in those with T2DM when compared to pre-diabetes. FBG decreased from 6.4 to 6.0mmol/L. T2DM remission rates were 60% and 90% by A1C<6.5% and FBG<7mmol/L respectively. Pre-diabetes remission was 18% and 40% by A1C<5.7% and FBG<5.6 respectively.

Conclusion

Implementation of a community-based diabetes remission protocol is both feasible and clinically effective. Its sustainability is to be determined. Adaptability to other disorders or other settings should be investigated.

Trial registration

NCT03536377 registered on 24 May 2018.

Global Health diplomacy for noncommunicable diseases prevention and control: a systematic review

INTRODUCTION

The prevention and control of noncommunicable diseases (NCDs) are one of the main challenges of healthcare systems around the world. In addition to the technical level, it requires political negotiations and solutions, such as global health diplomacy (GHD), which involves the participation of a wide range of actors and stakeholders and innovative international health partnerships. This review aimed to draw lessons for strengthening linkages with a wide range of actors and stakeholders from the GHD literature for NCDs, and how policymakers and political leaders can effectively use international health partnerships to beat NCDs.

METHODS

This research was a systematic review of the literature on GHD for NCDs. All relevant articles published in English were identified by searching PubMed, Web of Science, Scopus, and Embase databases, Google and Google Scholar search engines, and the reference lists of identified articles as well as a number of special journals. 30 articles that met the inclusion criteria were analyzed using content analysis in MAXQDA 10. The Global Health Diplomacy Pyramid and Blouin and Dubé's (2010) analytical framework for examining negotiations were used to classify the data.

FINDINGS

30 articles have been published on GHD for NCDs. Five key themes, i.e. the specific problem requiring global collective action, key actors, their interests in the problem, potential negotiation process, and potential scenarios for collective action and 46 sub-themes were identified. Moreover, given the importance of collaboration on NCDs in the international arena, actors were categorized into three groups based on the GHD Pyramid: (1) core diplomacy, (2) multi-stakeholder diplomacy, and (3) informal diplomacy.

CONCLUSION

Development and adoption of a global policy to tackle the rise in NCDs in developed and developing countries require policymakers and political leaders that participate in GHD. Successful developments in global health policy depend on the performance of and respectful relationships among the stakeholders, and global health diplomats need to understand the complexities of the institutional structures and functional relationships of the international institutions involved in health.

Global Implementation of Obesity Prevention Policies: a Review of Progress, Politics, and the Path Forward

PURPOSE OF REVIEW

This review describes policy and regulatory strategies to prevent obesity and summarizes worldwide progress and impediments to scaling up strategies globally.

RECENT FINDINGS

While there is considerable variation in the breadth and depth of uptake of recommended strategies, the adoption of effective obesity prevention policies has been slow and inconsistent. There is broad consensus that strong government, corporate, and consumer actions, including regulatory measures, are needed to advance obesity prevention policies. Governments have lacked sufficient will to take necessary action, the food industry has actively worked to thwart policies to protect its commercial interests, and consumers have not exerted sufficient influence or demand to produce change. Advancing obesity prevention will require the use of effective strategies to shape and influence the information environments and political environments towards messages and actions to support public health. Greater emphasis is needed on reducing the influence of commercial interests, mobilizing civil society, and targeting vulnerable populations through equity-focused frameworks.