Non-communicable diseases (NCDS) like cancer, diabetes and heart disease are a major challenge in St Kitts and Nevis. Data has demonstrated that NCDs are becoming an epidemic in the Federation with 83% of deaths being due to NCDs. We must do something about this to prevent our citizens from dying prematurely.

One approach to tackling NCDs is to focus on the next generation and ensure that children adopt a healthy lifestyle. We have to create a healthy environment at schools, in homes and within society so that children can make healthy choices.

Our Healthy Kids SKN campaign aims to raise awareness of the changes that children need to make in order to reduce their risk of developing an NCD later in life. We’re encouraging children, parents and teachers to focus on three main areas – eating healthily, drinking healthily and physical activity.

Eating Healthily

Junk food is everywhere so we must make a concerted effort to help children resist temptation and eat healthily. Children should eat a variety of foods to ensure they are getting enough nutrients to develop and grow. This includes consuming foods from all food types. In particular, parents should ensure that their children cut down on foods that are high in sugar, salt and saturated fat and introduce more fruits and vegetables into their diet.

Children should eat 5-7 portions of fruits and vegetables every day, and eat colourfully, and aim to eat different colours of fruit and vegetables.

Drinking Healthily

Children in the Caribbean drink large quantities of sugary drinks putting them at risk of becoming obese or overweight.  Caribbean children’s frequency of consuming sugary drinks was found to be amongst the highest out of 187 countries. Furthermore, teenagers (12 to 15-year olds) in Barbados, Jamaica, the Bahamas and Trinidad and Tobago reported drinking sugary drinks three times or more a day, and in St Kitts and Nevis, it was found that children consumed at least one carbonated soft drink a day.

Soft drinks are very high in sugar, for example, a can of coke contains 9.75 teaspoons (39g) of sugar and even juices contain high levels of sugar, a 330ml box of Rica Orange Juice contains 10.6 teaspoons of (42.2g) sugar – that’s more than coke!

We’re encouraging children to cut out the sugary drinks and drink water instead.

Physical Activity

For children to get healthy, they need to be active every day. The World Health Organisation recommends that children accumulate 60 minutes of moderate to vigorous-intensity physical activity every day.

We must get creative about physical activity as in St Kitts and Nevis, children are not active enough, over half of children, 58.4%, are physically inactive. We need fun approaches that don’t feel like work.

 

Working With Young People

We’re delighted to have worked with a young designer, Hadiya Lewis, to create the three graphics for this campaign. This is a great example of the talent and creativity that exists and how young people can contribute to communicating important health messages.

SKN Moves Support

We’re delighted that this initiative has been endorsed by SKN Moves and we’d like to thank the SKN Moves team for their support.

You can find out more about SKN Moves here

On 14^th November 2019, we were delighted to have been able to attend the Forum for Chronic Disease Prevention and Control which was hosted by the Taiwan International Cooperation and Development Fund in partnership with the Ministry of Health in St Kitts and Nevis.

This event aimed to bring together both local and international organisations working in the field to share their experiences, present their work and thus provide a platform to learn, share best practices, promote regional collaboration and identify the best way forward in tackling chronic diseases in St Kitts and Nevis.

This was a very important event as chronic diseases are a major cause of death in St Kitts and Nevis – 83% of deaths in the Federation are due to chronic diseases. Therefore, the prevention and control of these conditions is a major priority for the Ministry of Health and the ICDF is working towards supporting the government to strengthen its non-communicable disease (NCD) strategy.

Over the three days of the forum, in attendance were representatives from CARPHA, the Ministries of Health of Belize, St Vincent and the Grenadines and St Kitts and Nevis; the JNF Hospital in St Kitts; the St Kitts Diabetes Association, Community Health Centres in St Kitts and Nevis and the Taipei Veterans General Hospital.

We attended on the second day of this event. The theme for the day was: ‘Chronic Disease Management – Where to Go?’ This was an excellent and informative day featuring presentations from:

• Dr Bichara Sahely, Consultant Physician, Internal Medicine, JNF Hospital, St Kitts
• Dr Aljay Pierre, Medical Officer, Internal Medicine, JNF Hospital, St Kitts
• Dr Wei-Cheng Tseng, Taipei Veterans General Hospital
• Dr Hazel Laws, Chief Medical Officer, Ministry of Health, St Kitts
• Dr Marissa Carty, NCD Program Coordinator, Ministry of Health, St Kitts
• Mr Feng-Ta Tsai, Project Manager, Taiwan, ICDF

Together, the speakers provided an overview of the position around NCDs and made recommendations for what is required going forward if we are to effectively reduce the burden caused by NCDs. The take-home message of the day was the need for a greater focus on NCD prevention as most countries in the Caribbean will not be able to address NCDs with medical care alone.

The event ended with a very lively Q&A and panel discussion, giving the audience the opportunity to engage with the speakers and collectively explore solutions to addressing NCDs.

We very much enjoyed attending this event and found the presentations from Dr Sahely and Dr Pierre, particularly insightful. They both provided a very interesting perspective from doctors working on the frontline at the JNF Hospital to diagnose, treat and support patients.  They highlighted that there is much work to be done in the Federation and this will involve improvements and changes to the system to facilitate prevention, early diagnosis, better management of patients with NCDs and an improvement in the quality of care delivered.

We look forward to playing our own very small part in tackling NCDs and would like to thank the ICDF and Ministry of Health for organising this event.

From 2^nd April to 7th May 2019, we facilitated our first chronic disease self-management course in St Kitts giving us the opportunity to support members in our community who have been affected by non-communicable diseases (NCDs).

Data has demonstrated that NCDs are becoming an epidemic in St Kitts and Nevis with 83% of deaths in the Federation being due to these conditions. To prevent these premature deaths and ensure that those living with an NCD can live well and have a good quality of life, support, information and guidance are required.

Providing patients with self-management skills is an effective and empowering way to ensure that those affected by a chronic disease can take control and improve their health and wellbeing. The Chronic Disease Self-Management Course helps us achieve this outcome.

The course that we facilitated is part of the Stanford University Chronic Disease Self-Management Program (CDSMP). This is an evidence-based prevention and health promotion program that addresses common issues faced by people with chronic conditions. The program has been implemented in 19 countries showing several benefits including:

• Improved wellbeing
• Improved health of participants
• Fewer hospitalisations
• Fewer days spent in hospital

Last year, we took part in the CDSMP training program which was delivered by the Ministry of Health in St Kitts. We were honoured to have come through the process and are now certified CDSMP facilitators allowing us to implement a free program of support for members in our community with an NCD.

Over the six-week period from the 2^nd April to 7^th May, we were delighted to guide our 18 participants through key self-management techniques. These techniques included action planning, problem-solving, decision making, medication management, communication skills, pain management, healthy eating, physical activity and more.

What we like about the course is that it is very interactive. Participants had the opportunity to take part in various activities, share their experiences, learn from one another and support each other. There was also homework every week to ensure that participants could start practising their self-management techniques immediately in their day-to-day life. It was wonderful to see and celebrate their successes every week.

We had a very engaged group who were a pleasure to work with. They got involved, asked questions and were keen to make the necessary changes in their lives to improve their health.

Facilitating this course has been one of the most rewarding experiences we have had in a long time. It was so touching to hear participants share how their lives have been impacted by the course. We look forward to seeing them continue to make great progress in taking control and more effectively managing their health.

A big thank you to everyone who attended and if you live in St Kitts and have been affected by a chronic illness like diabetes or high blood pressure and would like to attend a chronic disease self-management course, please do get in touch with us by email or call 765 8702

Our next 6-week course is due to start in July, all are welcome to attend.

“Thank you for the life lessons you have shared. Anyone who attends this course will never be the same again. The teachings will always be on one’s mind and heart. We must make a change! Eating, exercising and managing our lives better and being in control, this is an awesome feeling” – CDSMP Course Attendee

 

 

 

Welcome to part two of our ‘Discussions on Managing Conflict of Interest’ blog. In part one we provided some background to conflict of interest (CoI) and the challenges faced by those aiming to tackle NCDs in the Caribbean. Here, in part two, we’ll be providing highlights from the Health Caribbean Coalition’s (HCC) conflict of interest meeting which we attended a couple of weeks ago.

The HCC’s Meeting

The HCC’s CoI meeting was a two-day regional event held on 26^th and 27^th March 2019 that had a focus on conflict of interest in the prevention and control of non-communicable diseases (NCDs) in the Caribbean, and the overall aim of the meeting was to begin to build regional capacity to identify and manage conflict of interest.

Regional Experiences of Conflict of Interest

The meeting started with an interesting and insightful look at regional experiences of CoI from both civil society and the public sector. From civil society, we heard from the Heart Foundation of Jamaica, the HCC and the Trinidad and Tobago Heart Foundation, and from the public sector, we heard from representatives from the Ministries of Health in Antigua, the Bahamas and Jamaica.  Collectively they touched on industry interference and conflict of interest. Some interesting points that were raised included:

• In the Caribbean, in most instances, we have to live with CoI and so approaching this area from the point of view of managing CoI is a more practical and realistic approach
• The difficulty of dealing with the “smallness” of the Caribbean – everyone knows each other and in our professional lives, in tackling NCDs, we may have to fight against people we know and respect
• Absolutes are unlikely to work except with the tobacco industry where globally the public health community does not partner with tobacco companies. For other industries, like the food and beverage industry, we must explore degrees of conflict of interest (low, medium and high) and degrees of partnership or engagement. Not every engagement will be detrimental to public health and we must understand how to manage conflict of interest whilst getting the most benefit out of any relationship or partnership
• What happens after a conflict of interest has been identified? What is the process for review? Is it an actual, potential or perceived CoI? What is the process for recusal?
• Should an organisation’s CoI policy be generic or specific?
• Some good practice with respect to disclosure forms:
  • All CoI policies should have a supporting disclosure form
  • Disclosure forms are valid for a year
  • The obligation is on the person who is disclosing to report any changes within that year
  • Have a process for checking the accuracy of a completed disclosure form
• Managing conflicts of interest – ensure that if you’re going into a partnership with industry that a lawyer reviews the MoU and any non-disclosure agreements to prevent any CoI issues; don’t be afraid to negotiate so you can minimise any risks or exposures.

WHO/PAHO Tool for Preventing and Managing CoI In Nutrition

A core part of the HCC’s meeting was to explore the tools and support that could be offered to organisations to identify and manage conflict of interest in order to build regional capacity. Therefore, during the meeting, attendees were introduced to WHO’s draft tool for preventing and managing CoI, including an abbreviated ‘scoping’ version of this tool developed by PAHO,  and a draft of the HCC’s CoI guide and policy.

The PAHO scoping tool provides a simple method to evaluate potential engagements and is divided into three areas that enable organisations to reflect on important issues before deciding on whether to enter into an engagement with an external entity.  These areas include:

• Actor alignment
• Engagement profile
• Assessing the risk and benefits

Additionally,  this scoping tool complements the more comprehensive decision-making tree developed as part of the WHO draft tool. This is a 6-step process that takes the user through a structured process for analysing a potential engagement to identify and manage conflict of interest. The steps include:

• Exploring the rationale for engagement
• Profiling, due diligence and risk assessment of the external actor and the potential engagement
• Balancing risks and benefits
• Risk management
• Monitoring, evaluation and accountability
• Transparency and communication

Both resources provide users with an objective and comprehensive method of identifying and assessing conflict of interest, whether an engagement should be pursued and if so, what measures can be introduced to manage any conflicts of interest.

The HCC’s CoI Guide and Policy

Finally, the HCC presented their draft CoI guide and policy which is aimed at their staff, volunteers, board members, advisors, interns and consultants. Their policy and guide aims to prevent, identify, avoid and manage CoI. It also aims to serve as a general guide for civil society organisations and individuals as they develop their own CoI policies, the idea being that CSOs can simply adapt the HCC policy to suit local needs and situations.

Our Thoughts

We thought this was an excellent meeting which gave us a lot of food for thought.

Conflict of interest is an area that we considered on a simple level, but this meeting allowed us to explore this subject in depth and fully appreciate the risks of not properly analysing the relationships that we seek to enter.

The meeting was very timely as over the past few months we’ve started to explore organisations that we can approach to support some of our activities and during this process, we have found it challenging to determine whether we should pursue forming relationships with an organisation that promotes both healthy and unhealthy food and beverages. Attending this meeting has given us some clarity and by using the knowledge we have gained from this meeting and the PAHO tool we believe we can make a better decision.

Conclusion

We encourage Caribbean civil society organisations working in the NCD field to explore developing an approach to tackling conflict of interest to safeguard the credibility and integrity of their work, and for further information, please do reach out to the Healthy Caribbean Coalition

On 26^th and 27^th March 2019, we joined representatives from across the Caribbean in attending the Healthy Caribbean Coalition’s workshop on conflict of interest (CoI). This event had a special focus on conflict of interest in non-communicable disease (NCD) prevention and control in the Caribbean.

This is going to be a two-part blog and in today’s piece we’re going to provide some background to conflict of interest and in part two we’ll provide some highlights from the HCC’s CoI meeting.

What is Conflict of Interest?

The World Health Organisation describes conflict of interest as:

“…circumstances where there is potential for a secondary interest to unduly influence, or where it may be reasonably perceived to unduly influence, either the independence or objectivity of professional judgement or actions regarding a primary interest.”

They also explain that:

“The existence of conflict of interest in all its forms does not as such mean that improper action has occurred, but rather the risk of such improper action occurring. Conflicts of interest are not only financial but can take other forms as well.”

Another definition of CoI comes from Public Health and Food and Beverage Industry Engagement: A Tool to Guide Partnership Opportunities and Challenges. They define CoI as:

“… where one engages in any private, personal or business undertaking or other activity in which one’s private or personal interest conflicts with one’s duties or responsibilities…”

For further clarity around the concept of CoI further explanations have been offered which categorise CoI into perceived, potential and actual and these are defined as follows:

• An actual conflict of interest occurs when there is a direct conflict between a person’s professional duties within an organisation and a competing interest or obligation, whether personal or involving a third-party.
• A potential conflict of interest arises where a person has an interest or obligation, whether personal or involving a third-party, that could conflict with their professional duties and responsibilities in the future.
• A perceived conflict of interest occurs where it could reasonably be perceived, or give the appearance, that a competing interest could improperly influence a person’s professional duties.

Additionally, CoI may be seen at the individual, institutional and structural levels.

By understanding and reflecting on these definitions we can recognise if we, or our organisation, may be conflicted. This will allow us to take steps to address this to ensure we are serving our primary interest – this is the one we committed to serve at the outset of our professional journey (in our case, improving the public’s health).

Conflict of Interest, the Caribbean and NCDs

Small Island Developing States (SIDS) like the Caribbean are presented with a unique set of circumstances which make the area of conflict of interest particularly challenging. The circumstances in question relate to the very small populations creating an unavoidable, overlapping, intertwined social and business environment. This means that individuals and organisations may have multiple competing interests.  Therefore, staff working in organisations aiming to prevent and control NCDs may, at some point, find themselves in a number of difficult situations when it comes to CoI. This may include:

• Having a family member, friend or close associate working in an industry that produces products that are risk factors for NCDs
• Being offered funding, sponsorship or resources from companies that produce unhealthy products in a landscape where there are very limited funding and sponsorship opportunities
• Exploring a partnership with a company that produces both healthy and unhealthy products
• Being invited to take part in health campaigns by companies who produce products that are risk factors for NCDs (with there being no other companies to partner with to reach such a large audience)
• Developing NCD prevention and control policies with individuals and entities who have competing interests

In larger countries there are multiple options when there is a need to partner with individuals and organisations to  implement projects to prevent and control NCDs so many of the above situations can be avoided. Therefore, their approach to conflict of interest centres on prevention.

In Small Island Developing States, many of these conflicting situations cannot be avoided so not-for-profit entities (as well as government departments) have to start to re-think their approach to conflict of interest, focusing on strategies to effectively manage conflict of interest.

The HCC’s Conflict of Interest Meeting

Historically, conflict of interest, in many cases, has been addressed with a global blanket approach that doesn’t delve into the complex, overlapping business and personal relationships as well as the challenging funding environment that exists in the Caribbean. A more bespoke approach is needed for the Caribbean and hence the HCC’s conflict of interest meeting brought organisations together for in-depth discussions on this issue. Time was also set aside to explore solutions through the review and testing of a new conflict of interest tool being developed by WHO/PAHO as well as the review of a conflict of interest policy and guide being developed by the HCC. This meeting was very informative and we were delighted to have attended.

Coming Up Next Time

In part two of this blog we’ll summarise the highlights from the meeting, but in the meantime, for further information on conflict of interest you can explore the documents in our reference list below. We also encourage anyone working in public health in a Small Island Developing State to develop an approach to managing CoI to ensure the  credibility and integrity of their organisation remains intact.

References

1. The Healthy People and Communities Steering Committee’s Multi-Sectoral Partnerships Task Group, 2014. Public Health and Food and Beverage Industry Engagement A Tool to Guide Partnership Opportunities and Challenges, Ontario, Canada: The Healthy People and Communities Steering Committee’s Multi-Sectoral Partnerships Task Group, May 2014.
2. University of Southern Queensland. Conflicts of Interest. [Online]. Available at <https://www.usq.edu.au/hr/empcond/conflicts> [Accessed on 3^rd April 2019]
3. WHO, 2016. Framework of Engagement With Non-State Actors. [Meeting Proceedings] 28^th May 2016. Sixty-Ninth World Health Assembly.
4. WHO, 2015. Addressing and managing conflicts of interest in the planning and delivery of nutrition programmes at country level. Report of a technical consultation convened in Geneva, Switzerland, on 8–9 October 2015.

In October 2018,  we began consulting with the F.I.T. Wellness Center in Nevis to assist with the development and implementation of their NCD Prevention Action Plan, part of their NCD Prevention Programme.

On 27^th November 2018, we were delighted to join F.I.T. in the launch of their NCD Prevention Action Plan and  the announcement of their upcoming National Weight Loss Campaign.

The launch took the form of a press conference and was attended by the major media outlets in Nevis. The event was chaired by Mr David Walwyn, Director of the F.I.T Wellness Center and featured on the panel were:

• Hon. Hazel Brandy-Williams, Junior Minister for Health, who provided an overview of NCDs in Nevis
• Dr Judy Nisbett, Chief Medical Officer for Nevis, who discussed the cost of NCDs, this included direct and indirect costs as well as the impact NCDs have on families
• Nadine Carty-Caines, Programme Coordinator, Health Promotion Unit, Ministry of Health, who took the press through all the statistics on NCDs in Nevis
• Dr Raymond Moving, Internal Medicine, Alexandra Hospital, who explained the complications of NCDs focusing particularly on diabetes
• Dr Samir Anadkat, Obesity and Diabetes Specialist, Professor (Neuroscience & Anatomy), Medical University of Americas, Nevis, who explored prevention and addressed some of the myths around weight loss
• David Walwyn, Director, F.I.T. Wellness Centre, who spoke about F.I.T’s approach to tackling NCDs in Nevis
• Abi Begho, Public Health Project Manager, Lake Health and Wellbeing, who discussed the upcoming National Weight Loss Campaign and also announced the slogan competition for the campaign

Why Focus on NCDs?

Non-communicable diseases (NCDs) such as diabetes, hypertension, heart disease and cancer are a major health challenge in St Kitts and Nevis with 83% of deaths in the Federation being due to these conditions.

One of the key factors driving NCDs in St Kitts and Nevis is the high rate of obesity. In 2012, PAHO reported that 32.5% of secondary school children in St Kitts and Nevis were overweight and 14.4% were obese and a more recent report published by UNICEF in 2017 stated that 26% of children in St Kitts and Nevis were obese. We know that children who are overweight or obese are more likely to become overweight or obese adults and this puts them at a high risk of developing NCDs like diabetes, heart disease and cancer. Obesity rates in St Kitts and Nevis in adults aged 25 to 64 is high with a 2008 study stating that 33.5% of adults in this age group were overweight and 45% were obese.

F.I.T. has developed its answer to NCDs by developing its NCD Prevention Action Plan which will focus on supporting residents of Nevis to get fit, healthy and lose weight, and thus reduce their risk of developing an NCD. A core part of the action plan is the National Weight Loss Campaign which will start in January 2019.

The National Weight Loss Campaign

The National Weight Loss Campaign aims to help residents of Nevis lose weight through a fun six-month weight loss challenge that will support participants in getting active and eating a healthier diet. Participants will be guided through the six-month period with advice, tips, healthy recipes, fun events and one-to-one support. There will also be prizes for the person who loses the most weight in their category, recognition of those who have succeeded in losing their target weight and we’ll be following specific people on their weight loss journey.

Technology will play an important role in the campaign and we’ll be creating a web-based health portal where participants can come together, support each other, ask questions, share pictures and videos and receive tips and advice from experts in health and fitness. The health portal will consist of a forum and a chat facility, so we can keep in touch with all participants and provide them with support every step of the way.

How The Public Can Get Involved in the National Weight Loss Campaign

The National Weight Loss Campaign is open to everyone in Nevis – old, young, male and female. If an individual would like to lose weight or would like some support in adopting a healthier lifestyle then they are welcome to take part.

The public can register for the campaign by emailing admin@fitwellnesscenter.com or calling (869)-662-8749

Businesses Can Get Involved Too

Businesses are strongly encouraged to take part in the National Weight Loss Campaign by either registering a team of their staff to get involved in the six-month weight loss challenge or they can play an instrumental role in improving the health and wellbeing of our community by becoming a corporate partner or sponsor.

For more information about this, businesses in Nevis can contact David Walwyn by email  or phone (869)-662-8749.

Who is Behind this Initiative?

The National Weight Loss Campaign is an initiative of the FIT Wellness Center led by Mr David Walwyn with support from the Ministry of Health and Lake Health and Wellbeing

More Information

F.I.T. Wellness Center 
Website www.fitwellnesscenter.com
Phone number: 9869) 469-3481 or (869) 662-8749
Email: admin@fitwellnesscenter.com

Ministry of Health, Health Promotion Unit
Phone: (869) 469-5521, (869) 469-8010, (869) 469-7470
Email: healthpromotion@niagov.com

Lake Health and Wellbeing
Website: www.lakehealthandwellbeing.com
Phone: (869) 667 0079
Email: info@lakehealthandwellbeing.com

On 1^st November, we attended the national consultation on the impact of sugar sweetened beverages (SSBs). This event was organised by the Ministry of Health in collaboration with the Pan American Health Organisation (PAHO) as an early step towards the development of the nation’s strategy for reducing the public’s consumption of SSBs.

The Ministry’s strategy for SSBs forms just a small part of their non-communicable disease (NCD) prevention plan which outlines actions that are needed to create a healthy environment and promote exercise.

Speakers Set the Scene

During the consultation we heard from an excellent panel of speakers which included:

• Mrs Delores Stapleton-Harris, Permanent Secretary, Ministry of Health
• Hon Wendy Phipps, Minister of State with Responsibility for Health, Community Development, Social Services and Gender Affairs
• Dr Godrey Xuereb, PAHO/WHO Representative for Barbados and the Eastern Caribbean
• Dr Keisha Liddie, District Medical Officer
• Dr Lisa Powell, Professor and Director of Health Policy and Administration, School of Public Health, University of Illinois
• Dr Marissa Carty, NCD Coordinator, Ministry of Health

Together the panel outlined the need for the development of a strategy on SSBs, reminding the audience that in St Kitts and Nevis NCDs, such as diabetes, cancer, heart disease and high blood pressure, are a major health challenge with 83% of deaths in the Federation being attributed to these conditions.

Hon Phipps described how NCDs are not only a threat to the health of the nation but are a significant socio-economic issue. Whilst Dr Xuereb provided information on the need for a SSB policy stating that it is just one of many strategies to improve the health of a nation and help countries achieve the sustainable development goal (SDG) on health. He stated that in order to achieve the SDG on health it is important to focus on improving the health of children as currently, in the Caribbean, childhood obesity is very common and is a major factor in children developing NCDs. He explained that what is driving NCDs is the increased consumption of sugar, and the major source of sugar is SSBs – SSBs make up 40% of children’s sugar intake with 70% of children in the Caribbean drinking one or more SSBs per day. He stated that data from Barbados, Mexico and Chile has shown that increasing the cost of SSBs through taxation has reduced the consumption of SSBs and therefore this is an effective strategy in tackling NCDs.

We also heard from Dr Keisha Liddie who presented a very in-depth and comprehensive situational analysis of St Kitts and Nevis. Dr Liddie described the data and trends for NCDs in the Federation showing the increase in the incidence of specific NCDs year on year and their impact on the nation. Finally, Dr Powell explored the economics, practicalities and important considerations when introducing a tax on SSBs and provided a number of recommendations which included:

• Implement a 20% SSB tax
• Include all forms of SSBs in the taxation strategy e.g: soda, energy drinks, sports drinks, fruit drinks, sweetened teas/coffees, sweetened water and beverage powders/syrups). Exclude zero calorie beverages
• Apply the tax to all imported and domestically produced SSBs
• Earmark the tax revenue for public health initiatives with an emphasis on nutrition and physical activity
• Carry out public awareness and education to inform the public about the SSB tax and its objectives
• Ban the sale of SSBs in schools
• Ban the sale of SSBs in hospitals and government buildings
• Regulate the marketing of SSBs in and around schools
• Develop a drinking water infrastructure in schools that provide reusable water bottles to school children
• Provide local agricultural products as snacks in schools
• Promote the implementation of school gardens as a learning tool and to improve access to fruits and vegetables
• Explore appropriate sponsors for youth sports that align with the objectives of improving health
• Provide funding to increase activity spaces

St Kitts and Nevis’ Proposed Approach to SSBs 

Dr Marissa Carty outlined the Ministry’s initial ideas on their approach to reducing the consumption of SSBs and gave the audience the opportunity to provide feedback on all the policy areas. The Ministry’s proposed policy imperatives include:

• A 40% tax on SSBs (update: the proposed tax is now 32%)
• The tax will apply to calorically sweetened beverages including carbonated drinks (sodas), sweetened carbonated water, sugar sweetened juices, sports drinks, energy drinks, tea and coffee drinks, sweetened milk/milk alternatives, milk powdered blended drinks, powdered drink mixes and drink mix syrups
• Sugar would no longer be zero rated when it comes to tax
• Excluded from the tax would be: fresh fruit juice (no sugar added), unsweetened milk/milk alternatives, infused water, unsweetened carbonated drinks and non-caloric sweetened drinks
• Alternatives to SSBs will be suggested to the public. These would include: fruit/vegetable infused water unsweetened water, plain water, unsweetened carbonated water, unsweetened herbal (bush) tea and artificially non-caloric sweetened beverages
• The tax revenue will be used to provide: a water infrastructure, water fountains in schools, reusable water bottles in schools, healthier school meals, public health campaigns, National Health Insurance, implementing a marketing ban to children and policy development for safe school zones.

Our Thoughts

We 100% support the government’s approach to SSBs as there is a need to tackle childhood obesity in St Kitts and Nevis and by reducing SSB consumption this can be achieved.

We believe a 40% (or 32%) tax is sufficiently high enough to deter consumption of all SSBs, anything lower than this could lead to consumers simply replacing expensive SSBs for more affordable SSBs. There was some evidence of this in Barbados where the tax is 10% and this suggested that this level of taxation wasn’t high enough to deter consumers from buying the lower priced SSBs.

We think it is important that the revenue raised from the SSB tax should fund public health initiatives particularly those that are aimed at childhood obesity and so we applaud the Ministry’s suggestions on the use of the tax revenue. We would also like to see the tax revenue being used to make healthy foods more affordable to ensure that parents and guardians don’t encounter any barriers to adopting healthy eating practices. It is also important for there to be full transparency on the expenditure of the tax revenue so that the public can be confident that the funds have been used to benefit the public’s health.

Next Steps

The Ministry of Health will collate the feedback received from this consultation as well as the consultation conducted in Nevis and continue to engage with key stakeholders to develop their SSB policy. This will then have to be approved by Cabinet.

We look forward to seeing this policy develop and will support the Ministry in any way that we can to see this policy developed, approved and implemented.

A couple of weeks ago government representatives from across  the world met in Montevideo, Uruguay for the World Health Organisation’s Global Conference on NCDs (Non-communicable diseases, e.g: cancer, diabetes,  cardiovascular disease etc).  The objectives of the conference were: to guide countries on how to reach sustainable development goal target 3.4 by 2030; to launch a new set of global initiatives to help countries accelerate progress in tackling NCDs; to share and exchange experiences; and to discuss how the health sector can be a key example of the benefit of enhancing policy coherence to achieve the sustainable development goals.

Making A Commitment to Tackle NCDs

At this conference governments endorsed the Montevideo Roadmap 2018-2030 on NCDs as a Sustainable Development Priority. By endorsing this roadmap they have made a commitment to take significant steps towards reducing the premature deaths due to NCDs by a third. They recognised that NCDs are one of the major challenges of the 21^st century and that progress to tackle them has been uneven and insufficient. The roadmap states that 15 million 30 to 69 year olds per year die from a NCD and 80% of these premature deaths occur in developing countries.  There are a number of challenges associated with tackling NCDs and with this is mind they committed to the following actions:

• Reinvigorate political action
• Enable health systems to respond more effectively to NCDs
• Increase significantly the financing of national NCD responses and international cooperation
• Increase efforts to engage sectors beyond health
• Reinforce the role of non-State actors
• Seeks measures to address the negative impact of products and environmental factors harmful for health and strengthen the contribution and accountability of the private sector and other non-State actors
• Continue relying on WHO’s leadership and key role in the global response to NCDs
• Act in unity

Our Thoughts

We were delighted to see world leaders come together and make this commitment and look forward to seeing these actions being taken forward.

We’re particularly happy to see that efforts will be made to engage with a variety of stakeholders. As a small organisation that is passionate about improving the health and well-being of our community we do get frustrated at the lack of engagement with grassroots organisations. We have many times reached out to local and national governments with our enthusiasm and ideas, ready to play a role but have received lukewarm responses or no responses at all. We hope that governments will see the value of working with small organisations and we have been grateful for the funding provided by Croydon Council, Sports England, Macmillan and Eli Lilly for some of the work we’ve conducted on NCDs. We look forward to continuing to work in this area and making our own small contribution.

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You can read the complete Montevideo Roadmap below.