Friday 17^th November was the second annual Caribbean Alcohol Reduction Day. This year’s theme was: Drink Less, Reduce Cancer and to mark the day the Healthy Caribbean Coalition, in collaboration with PAHO, CARPHA and CARICOM, hosted a webinar on Alcohol and Cancer in the Caribbean.  This was a very informative and interesting webinar which featured three speakers:

• Dr Kevin Shield – Alcohol Consumption and Cancer in the Caribbean
• Dr Maristela Monteiro – Alcohol Policies in the Caribbean
• Dr Rohan Maharaj – Alcohol use among the elderly in the Eastern Caribbean: Associations with NCDs and psycho-social issues

Alcohol Consumption and Cancer in the Caribbean

The first presentation was delivered by Dr Kevin Shield. He started by providing some background into cancer in the Caribbean explaining that the latest data, from 2012, shows that in the Caribbean about 21,000 new cancer cases are diagnosed every year and just over 13,000 deaths per year in the region are due to cancer.  When we look at the number of cancers in the Caribbean caused by alcohol, it is estimated to be 650 cancer cases per year or put another way 3.1% of all cancers diagnosed in the Caribbean are due to alcohol consumption. Looking at the number of cancer deaths in the Caribbean due to alcohol, 2.9% of all cancer deaths are due to alcohol consumption or 387 deaths per year.

Dr Shield  stated that in the Caribbean, on average, an adult consumes 1.2 alcoholic drinks per day, but there is a difference amongst countries with some countries drinking less and other drinking significantly more.

Dr Shield explained the  link between cancer and drinking stating that numerous studies have been conducted that have determined how drinking causes cancer. Data suggests that alcohol causes cancer in the following ways:

• By our bodies converting alcohol into a cancer-causing chemical (i.e. a chemical that can damage our DNA)
• By affecting our hormone levels and various pathways in the body

Through research links have been found between alcohol and cancers of the mouth, upper throat, food pipe, voice box, breast, bowel and liver.  The number one cancer impacted by alcohol is breast cancer.

Based on all of these factors the  International Agency for Research on Cancer  has classified alcohol as a type 1 carcinogen, which means there is the highest level of evidence to suggest that it does cause cancer. So drinking is a major problem.

The question then is: how can we prevent the cancers that are caused by alcohol? The solution is to reduce alcohol consumption and Dr Shield stated that there are three cost effective and feasible approaches that can be taken:

• Restrictions on access
• Banning advertising
• Increasing excise taxes

This presentation ended on a fairly positive note highlighting that many Caribbean countries have not fully introduced these three measures which means that there is potential to make a huge difference in tackling alcohol and cancer in the Caribbean.

Alcohol Policies in the Caribbean

We then heard from Dr Maristela Monteiro who gave an overview of alcohol policies in the Caribbean. She started by explaining that as part of the voluntary global non-communicable diseases target for 2025 there is a goal to reduce harmful use of alcohol by 10%.  WHO and PAHO, in consultation with a number of organisations, developed a global strategy to reduce harmful use of alcohol and they provided recommendations on 10 policy areas and countries are to try to implement as many as possible. They describe particular recommendations as “best buys” especially for low to middle income countries and these were the three areas mentioned by the previous speaker (restrict access to alcohol, enforce bans on advertising and raise taxes on alcohol).

Dr Monterio then went through each of these three policy areas giving an assessment of how successful Caribbean countries have been with their implementation. She started first with whether countries have a national alcohol policy in place.  Out of the 14 Caribbean countries that they looked at only three had some form of national policy.

Dr Monterio then looked at policies to restrict access to alcohol:

• Licensing: most Caribbean countries have a licensing system, 12 out of the 14 countries. Licensing systems restrict access by imposing rules and penalties to those who wish to sell alcohol such as not selling to minors, the license also has a fee and this may limit the number of businesses who choose to sell alcohol.
• Restrictions on hours, locations and days of sale of alcohol: only three Caribbean countries were fully compliant in this area.
• Minimum drinking age: most Caribbean countries have a minimum drinking age, only three don’t.  The majority of countries in the Caribbean with a minimum drinking age have set this at 18, some have set this at 16.  It was felt that 18 was a relatively low age restriction and this could be increased to 21 to have more of an impact.

Dr Monteiro then discussed taxation. She stated that in the Caribbean most countries have some taxation of alcohol, but these taxes were introduced many years ago and have not been adjusted for inflation. This means that taxation is not having the impact that it should as taxes are fairly low and are not acting as a deterrent.

Finally Dr Monteiro discussed restrictions on advertising and explained that this was the least developed area of policy in the Caribbean.  She explained that this is a major problem as 20% of students are exposed to alcohol advertising daily and research has shown that this is associated with an increase in alcohol consumption. She explained how persuasive these advertising campaigns are and some of the tactics used to encourage people to drink –  companies focus on alcohol as an antioxidant, that consuming alcohol causes weight loss and improves your mood (this communicates the message that alcohol is healthy)  and equating drinking alcohol to business success.

Action needs to be taken to address advertising as research as shown that youths are more exposed to advertising than adults so there is a concerted effort by the alcohol industry to reach young people and make them life-long drinkers.

Alcohol Use and the Elderly

Finally we heard from Dr Rohan Maharaj who summarised a very interesting piece of research carried out across four Caribbean countries on alcohol use and the elderly.  The research consisted of participants from Puerto Rico, Barbados, the US Virgin Islands and Trinidad. The data was collected from April 2013 to May 2015 and they determined whether people were ever-drinkers, current drinkers, problem drinkers or heavy drinkers and related this to various psycho-social and health issues.  Their main conclusions were:

• Generally there was wide use of alcohol across all participants
• 5-6% of participants were involved in potentially harmful alcohol use
• Males were more likely to be problem or heavy drinkers
• There was an association between alcohol use and stage 1 hypertension
• There was an association between alcohol use in ever-drinkers and cancer
• A higher proportion of those with lower educational achievement admitted to alcohol use
• Those who were employed were more likely to be drinkers (thought to be because they had more disposable income)
• Those who reported earlier initiation of sexual activity reported heavy drinking
• Those who had issues with domestic violence (current or past) had reports of problem drinking
• Heavy and problem drinkers tended to be lower educated males, living in Trinidad, married, physically active and employed with high rates of hypertension and being diabetic.

Dr Maharaj and his team will be doing a follow up study with participants in the next 2 to 3 years and this will give them the opportunity to further explore the link between alcohol use, cancer and other non-communicable diseases.

Conclusion

This was a very informative webinar  and it’s so important that we get some of this information out to the public as we know that many people are not aware of the link between cancer and alcohol consumption.

For more information you can listen to a recording of the webinar here

The Caribbean Tourism Organisation has declared 2018 as the Year of Wellness and Rejuvenation in the Caribbean. With this in mind The Lake Foundation in collaboration with Noire Wellness are exploring organising a fibroids wellness retreat and we would be grateful if you could complete the following survey.

This survey will help us understand if there is a need and interest in this type of event.  We want to determine whether this type of event would be a useful form of support for women affected by fibroids.

Any and all feedback is welcome and we would be very grateful if you could share this survey with anybody that you think would have an interest in this event.

Yesterday, we attended the CARICOM Marijuana Commission’s public consultation in Basseterre, St Kitts. This was an interesting, and at times heated, discussion which aimed to inform their report on marijuana use in the Caribbean.

The commission has been tasked with examining the health, social, economic  and legal issues surrounding the use of marijuana and to make recommendations to heads of government on whether the drug classification of marijuana should be changed. They will also make recommendations on, if marijuana is to be re-classified, what legal and administrative conditions should apply.

Yesterday’s consultation was one of many that the Commission has conducted throughout the Caribbean enabling them to reach a wide and diverse audience. In addition,  the Commission itself represents a range of stakeholders including commissioners from the fields of law, social work,  medicine, science, religion, law enforcement and psychology,  and they have youth representation.

Introduction by the Commission

In this public consultation we first heard from Prof Rose Marie Belle-Antoine who gave a brief introduction and provided some background into their work. She explained that the information obtained from the consultation would be combined with the information from other consultations, the St Kitts National Marijuana Commission and their own research on the medical, economic, social and legal implications to provide recommendations for policy changes to heads government in the Caribbean. She also mentioned that there was a need for public education on some of these issues as there are many people who are not informed about marijuana.  She explained the importance of looking at social justice issues (e.g. who gets arrested), gender issues (we hear a lot about the men but what happens to women and what is the impact on families), law enforcement (do they turn a blind eye to some marijuana use), the impact on productivity and addiction issues.

Prof Belle-Antoine also explained that internationally marijuana is classed as a narcotic so if the Caribbean re-classifies marijuana they would need to understand the implications for the Caribbean internationally – would we become a “rouge state.” Here she said we can learn some lessons from Jamaica who have already decriminalised marijuana.

Prof Belle-Antoine also touched on research being conducted in Barbados with prisons to understand if there is any real link between marijuana and crime.  She ended by stating that another important aspect of their work is understanding the  risks of marijuana use and what safeguards can be implemented.

The Public’s View

After Prof Belle-Antoine’s introduction the floor was then opened up to the public for comments and feedback. Overall the audience was in favour of legalising marijuana or decriminalising it. There was a feeling that it shouldn’t be illegal to use a plant  and that an adult should have the right to make an informed decision as to whether they use marijuana or not.  There was an overwhelming feeling that  vast amounts of data on marijuana already exists that give a clear picture of the  benefits and harms showing the benefits do outweigh the harms. Therefore many felt that a decision could already be made on whether we should reclassify marijuana, a report would delay things further. There was frustration about the consultation itself with a few people stating that it felt like “just talk.”

Several members of the public were able to give concrete examples of the use of marijuana for therapeutic purposes – chronic pain, nausea, cancer, liver disease etc. Many mentioned the historic and religious use of marijuana. One participant was able to provide a comparison between alcohol and marijuana showing that alcohol was significantly more harmful than marijuana – alcohol causes 1 million deaths a year and there has been no known death caused from marijuana itself.

The audience raised the huge economic potential in developing a safe marijuana industry in the Caribbean. It  was felt it could help to diversify our economies as many islands are heavily dependent on the tourism industry. It was highlighted how versatile marijuana is with one attendant showing the panel a book made from marijuana.  There was concern that if a marijuana industry is developed, large foreign companies would find a way to exploit our resource and no financial benefit would be reaped by Caribbean islands.

Conclusion

The evening ended with the commissioners answering some questions on the time-frame for the report and how much influence they would have on governments to implement their recommendations. The Commission explained that they are working as hard as they can to collate all the information and will produce a comprehensive report.  They stated that their report won’t be binding but they hope it would be influential and lead to change, but change does take time.

This was an interesting discussion and we do hope that the report published by the Commission will lead to change in the laws on marijuana and that we can develop a thriving industry that creates wealth for our nations.

Further Information

The CARICOM Marijuana Commission is still keen to hear from the public on this issue and is inviting anybody with an interest in this topic to submit their views to them in writing at marijuana@caricom.org

For more information on the work of the Commission, please visit their website http://caricom.org/marijuana-commission

Let us know what you think about this issue by leaving a comment below.

Every year, on 14^th November, the world comes together to recognise World Diabetes Day.  Created by the International Diabetes Federation and the World Health Organisation in 1991 to address the escalating threat that diabetes poses, this is a day that aims to raise awareness by reaching a global audience. This year’s theme is: ‘Women and Diabetes – Our Right to a Healthy Future.’  ‘Why the focus on women?’  You may ask. The stats say it all.

Women and Diabetes

Currently there are over 199 million women living with diabetes throughout the world and research suggests that this could rise to a staggering 313 million women by 2040. Diabetes is the ninth leading cause of death in women with 2.1 million deaths per year being due to this condition.  Forty per cent of women with diabetes, around 60 million women, are of reproductive age. The complication here is that women with diabetes are more likely to have fertility problems and without access to pre-conception planning there is a higher risk of death and illness for both mother and child during pregnancy.

Additionally, one in seven pregnant women develop gestational diabetes. This is a type of diabetes that only develops during pregnancy. If it is not managed properly it can negatively affect both the expectant mother‘s and baby’s health.  In most cases, after pregnancy, gestational diabetes resolves on its own, but the mother is then at a higher risk of developing type two diabetes.

Finally, women with type 2 diabetes are ten times more likely to have coronary heart disease than  women who don’t have diabetes.

Due to these facts and figures there is a need to focus on women, raise awareness and ensure that health services are equipped to address the specific needs of women with regards to diabetes.

Black Women and Diabetes

Black women are at a significantly higher risk of developing diabetes than their white counterparts. In the US, diabetes affects 25% of black women in the 55 and over age group and it is the fourth leading cause of death in black American women of all ages.

Black women in the UK are also at increased risk of developing diabetes  and diabetes rates in the Caribbean and Africa are also high.

It is thought that the increased risk in black women is due to multiple factors including genetics and black women being more likely to have high blood pressure,  to be obese and be physically inactive.

What Can We Do?

Diabetes can be prevented by adopting a healthy lifestyle. We should endeavour to:

• Maintain a healthy weight
• Eat a healthy diet
• Get active: it doesn’t have to be structured exercise, just anything that increases your heart rate such as gardening, brisk walking, dancing, cycling, playing with the kids

Let’s all spread the word about the prevention of diabetes so that we can stop more women, especially black women, from developing this condition.

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References

International Diabetes Federation

American Diabetes Association. Diabetes in African American Communities Advocacy Fact Sheet.

With 1 in 4 people in the UK suffering from a mental health issue, there is a need to find experienced counsellors who provide an effective and high quality service, OH Services does just that.

Founded in 2010 by counsellor Olivia Haltman, OH Services aims to support people through the difficult periods of their life. They are committed to providing a safe, confidential and non-judgemental environment where people can open up and get the support they need.

They provide one-to-one counselling, EMDR therapy, group therapy, workshops and seminars for adults and young people from all walks of life. They understand that people have different needs and deal with traumatic experiences in different ways, and therefore provide a tailored programme of support that ensures the right approach for each individual.

Founder, Olivia Haltman, is an accredited Integrative Humanistic Counsellor and an Eye Movement Desensitization Reprocessing (EMDR) Therapist.  She is also a member of British Association for Counselling and Psychotherapy (BACP), EMDR UK & Ireland and BAATN (Black and Asian Therapist Network). Ms Haltman has over 10 years experience working in the mental health sector having worked for organisations like Mind and established her organisation to support people who want to develop their lives on a personal level and reach their best potential. Of her approach to tackling mental health issues she says:

“I believe everyone is different, with unique needs and aspirations so I use an integrative approach to apply and integrate the most suitable solutions for my clients. Within my practice, I also apply (where necessary) a holistic approach to help clients enjoy the essential benefits of wellbeing and healing processes.”

OH Services works with a range of clients and issues, and if you’re experiencing some form of anxiety or trauma, or just need someone to talk you through an issue then please contact OH services. You can find their contact details here and for more information visit their website.

We are delighted to announce our next fibroids Twitter chat will be on  Wednesday  29th  November 2017 from 7pm-8pm (UK time). We will be joined by special guest Imani Sorhaindo with host, our own Abi Begho, founder of The Lake Foundation.

Imani Sorhaindo is a teacher, Curriculum Manager, Life Coach and Facilitator of the Ipswich Black Sisters Fibroid and Womb-Wellness Support Group.

Imani has been working as a community development worker for the upliftment of the African community for over 28 years.

Imani has her own personal life experience of working towards shrinking fibroids, and eradicating stress and toxicity through a range of life-changing techniques and lifestyle living including breathing, meditation and energy balancing.

Over the past 13 years she has been researching the world of women’s health; particularly around fibroids and healing. The Black sister’s fibroid group which she runs in Suffolk has been running for its first year; with pleasing results. She has recently delivered a short lecture at the Black History Walks Nzingha Lectures in London.

Imani is also half-way through writing her book around the theme ‘Holistic approaches towards the elimination of fibroids. In 2018, Imani will be hosting her first Fibroids conference in the Caribbean island of Dominica.

This Twitter chat has been organised to allow for an in-depth discussion with Imani on her personal experience with fibroids, her work facilitating the Ipswich Black Sisters Fibroids and Womb-Wellness Support Group, her upcoming book on holistic approaches to fibroids and her first fibroids conference in Dominica.

We’ll be putting questions to Imani and you can put your questions to her too. So if you have a burning question about fibroids or just want to get involved in the discussion then do join us on the day. To take part in the conversation please use the hashtag #FibroidsChat.

We look forward to tweeting with you!

We recently came across this really interesting video on TED and thought we’d share it with you.  In this video you’ll hear from Dr Elizabeth Wayne, a biomedical engineer, who discusses the work her lab is undertaking to explore a more effective method to treat cancer. They researching  how they can develop “a mean killing machine on wheels” by using cells in our immune system to target cancer cells.

The Healthy Caribbean Coalition published an excellent report on non-communicable diseases (NCDs) and trade policy in the Caribbean. This briefing document discusses how trade policies affect the public’s health and what needs to be done to ensure that policies have a positive effect on the health of countries’ citizens.

The report clearly explains, with examples, how specific policies can influence our health. For example, low taxes on items like sugary drinks, alcohol, tobacco and processed foods lowers their cost enticing the public to purchase them. The consumption of these items, over time, increases our risk of developing non-communicable diseases such as  type 2 diabetes, cancer and cardiovascular disease. The report details how policies like this in the Caribbean have had a detrimental effect with families shifting from a traditional plant-based, home-made diet to a processed, meat-based diet.

The report states that the Caribbean shockingly has the highest mortality due to NCDs in the Americas,  the Caribbean has some of the highest rates of obesity and there are significant levels of tobacco use and binge drinking.  There is an urgent need to address these issues and exploring trade policies is just one strategy that can be introduced to improve the public’s health.

The Healthy Caribbean Coalition’s report explores policies around three main areas:

• Unhealthy/healthy food
• Alcohol
• Cigarettes

These recommendations are based on global approaches such as the WHO Framework Convention for Tobacco Control, the WHO strategy to reduce alcohol consumption and the ICN2 Framework for Action. The HCC’s recommendations for the Caribbean are illustrated below.

This report was an excellent, comprehensive, clear and informative report that gives concrete actions that can be taken to tackle NCDs through policy changes.

You can download the report below.

Climate change has been a controversial topic since Al Gore’s 2006 documentary, an Inconvenient Truth, with people passionately defending both sides of the debate – climate change deniers and climate change believers.  Over the past year climate change has become very topical due to the United States pulling out of the Paris Agreement. This is an agreement that aims to facilitate a global response to climate change by “keeping a global temperature rise this century well below 2 degrees Celsius above pre-industrial levels and to pursue efforts to limit the temperature increase even further to 1.5 degrees Celsius.” Countries throughout the world have committed to working towards this aim and will report regularly on their emissions.

Why are we so concerned about climate change? Researchers have been able to demonstrate that climate change will have a significant impact on the weather, agriculture and a range of other areas. This week, The Lancet Countdown report has demonstrated the impact of climate change on our health.

What is the Lancet Countdown?

The Lancet Countdown is an international research collaboration consisting of 26 institutions tracking the world’s response to climate change and in so doing have been able to reveal the impact that climate change has on the public’s health.

Some of the research findings

In this week’s report, researchers stated that climate change is “already a significant public health issue and a looming global health emergency.”

Some of their key findings were:

• Between 2000 and 2016, the number of vulnerable people exposed to heatwave events had increased by around 125 million.
• Annual weather-related disasters increased by 46% from 2000 to 2013.
• Vectorial capacity for the transmission of dengue increased by 9.4% (Aedes aegypti) and 11.1% (Aedes albopictus) due to climate trends since the 1950s.
• The number of undernourished people in 30 countries vulnerable to climate change and highly dependent on regional food production has increased from 398 million in 1990 to 422 million in 2016.
• Over 803,000 premature and avoidable deaths in 2015 as a result of air pollution across 21 Asian countries, attributable to just one type of air pollution from coal power, transport and use of fossil fuels in the home.

The report highlights the progress that has been made to tackle climate change and this includes:

• Many countries now have a climate change risk assessment in place
• Over a third of countries in the study have developed plans to increase the climate resilience of their health infrastructure
• The total primary energy supply of coal peaked in 2013 and has been rapidly declining, showing a movement towards cleaner energy supplies

Prof. Anthony Costello, Co-Chair of the Lancet Countdown and a Director at the World Health Organization concluded that:

 “Climate change is happening and it’s a health issue today for millions worldwide. The outlook is challenging, but we still have an opportunity to turn a looming medical emergency into the most significant advance for public health this century.”

The Lancet Countdown will continue to report on climate change annually with the aim of ensuring that governments continue to pursue efforts to prevent climate change.

Our Thoughts

The Lake Foundation was happy to see this report published which provided an update on the progress being made to tackle climate change and clearly explained the impact on our health. It was sad to read that climate change is disproportionately affecting communities least responsible for climate change and those most vulnerable in society. We need to understand how we can encourage those that are most responsible for climate change to take responsibility and act now.  There is work to be done to discuss climate change with those who believe it doesn’t exist, many people with this view are very influential and there needs to be some form of compromise so that progress can be made.  The take home message should be that regardless of your view, we need to respect and take care of the planet.  Reducing pollution and preserving our wildlife is the right thing to do, you can’t really argue with that.

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For more information on the Lancet Countdown report please visit their website here

The Healthy Caribbean Coalition in collaboration with the NCD Alliance have released an  action plan for preventing childhood obesity in the Caribbean. This action plan is based on a number of frameworks developed by organisations around the world to ensure consistency. The plan aims to foster a collaborative approach to tackling childhood obesity with recommendations for civil society working in partnership with governments and the private sector.

This action plan is of utmost importance as a third of children in the Caribbean are overweight or obese. Children who are overweight or obese are at an increased risk of being overweight or obese adults and of developing a non-communicable disease (NCD) later in life.

The Priorities of the Plan

Rates of childhood obesity are increasing in the Caribbean; this needs to be addressed to improve the health of the Caribbean community. If left unchecked the Caribbean will see a huge increase in NCDs leading to avoidable ill-health and premature death. The Healthy Caribbean Coalition’s action plan aims to address this. Their plan focuses on seven priority areas. These include:

Trade and fiscal policies e.g. taxation of unhealthy food

Nutrition literacy e.g. mandatory front-of-package nutrition labelling

Early childhood nutrition e.g. interventions related to breastfeeding and complementary foods

Marketing of healthy and unhealthy foods and drinks e.g. banning of marketing of unhealthy foods and drinks to children

School and community based interventions e.g. mandatory physical activity in schools  

Resource mobilisation for interventions addressing childhood obesity

Strategic planning, monitoring and evaluation: e.g monitoring progress through the use of the CSO Childhood Obesity Prevention Scorecard

Next Steps

The Healthy Caribbean Coalition team, based in Barbados, will take the lead on implementing this action plan and will form a regional Steering Committee with members coming from the around the Caribbean representing the private sector, government and civil society organisations. They will also form a civil society organisation action network for childhood obesity prevention who will work on promoting relevant policies and interventions.

We’re really happy to see this action plan published. It provides a good foundation on which to start work on the prevention of childhood obesity in the Caribbean and we look forward to getting involved in this work.

More Information

For more information please visit the HCC website here, download the action plan below or email  hcc@healthycaribbean.org