TT Moves falls short on NCDs strategy

KENWYN NICHOLLS, MD

ON OCTOBER 28, the Eastern Regional Health Authority (ERHA), in collaboration with the Ministry of Health, hosted its Wellness in the East 5K Walk/Run and Health Festival. The festival was a feature event of the ministry’s TT Moves, a national campaign focused on reducing risk factors for non- communicable diseases (NCDs) by encouraging changes in behaviour, more specifically on healthy eating and regular exercise.

Earlier in the year, the North-Central and North-West RHAs hosted similar festivals, and in March tender notices went out for procurement of equipment to outfit six TT Moves mobile units to include health and food models, medical equipment, and physical education equipment. In addition, Health Minister Terrence Deyalsingh recently revealed that programme-appropriate signage was in the pipeline.

TT Moves was derived from the regional initiative, Caribbean Moves, the latter conceptualised at a breakfast meeting attended by Caricom heads of government at the Third UN High-Level Meeting on Non-Communicable Diseases in New York, September 2018. This meeting, co-sponsored by PAHO, the UWI Chronic Disease Centre, the Caribbean Public Health Agency (Carpha) and the Healthy Caribbean Coalition, was also attended by more than 25 ministers of health and other interested parties as far-flung as the Pacific.

The main objectives of the conclave were to celebrate the 11th anniversary of the 2007 Port of Spain Declaration (PoSD): Uniting against the Epidemic of Chronic Non-Communicable Diseases, and to explore how the 14 points of action agreed to in the declaration – and now obviously floundering – could be reinvigorated. Caribbean Moves became the chosen vehicle.

Essentially, Caribbean Moves is a health promotion programme aimed at changing the Caribbean culture towards a healthier lifestyle by encouraging the general population to adopt healthy eating habits, engage in regular exercise, and participate in routine age-appropriate health checks.

These ambitious initiatives were endorsed by Dr Tedros Adhanom Ghebreyesus, director-general of WHO, at the UN general meeting, and supported by the Caricom Secretariat, as well as the Caribbean Development Bank (CDB), in partnership with Carpha, the former committing in excess of US$175,000 to the project, and the latter, the executing agency, to develop a multi-sectoral, whole-of-society, socially-inclusive and gender-driven regional framework to implement Caribbean Moves.

Since its introduction, five Caricom states have launched “Moves” initiatives: Barbados, TT, St Kitts and Nevis, St Vincent and St Lucia.

On April 5, 2019, Mr Deyalsingh used his annual World Health Day address to launch TT Moves, describing the initiative as a “national health and wellness movement that will galvanise action by all towards a health revolution in TT.” Activities such as described in the opening paragraph were initially stymied by the pandemic (declared over by WHO as a public health emergency in May), but now evidently in full swing.

In his address the minister described TT Moves as another example of the commitment by the Government to move collectively from a focus on healthcare services to that of national wellness and a culture of health. He went on to cite multiple examples of such commitment over recent years. Noteworthy was that no mention was made of Year 1 action plans, as detailed in the document: National Strategic Plan for the Prevention and Control of Non-Communicable Diseases: TT 2017-2021, published by the ministry in 2017.

With the introduction of TT Moves two years after publicising the 2017-2019 Strategic Plan for the NCDs, the question that immediately arises is whether all action plans associated with the latter were scrapped, in pursuit of the “innovative and invigorative” approach promised by the former.

The term “promised” is not used cavalierly, given that the executing body for Caribbean Moves, Carpha, only recently presented significant components of the Caribbean Moves framework to CMOs, public health promotion co-ordinators and behaviour change and nutrition specialists, at a two-day consultation in Jamaica, assembled for such presentation.

To precis the outcome of the two-day consultation in Jamaica two weeks ago as summarised by Carpha: it showed that the region is moving closer towards the implementation of the initiative that is aimed at reducing the burden of NCDs.

Lack of clear execution plans from Caribbean Moves to guide TT Moves aside, success in reducing premature morbidity and mortality from chronic disease is reliant on an integrated approach that responds not only to interventions on major risk factors, but also the need to integrate primary, secondary and tertiary prevention, health promotion, and related across sectors and multiple disciplines.

The National Strategic Plan for Control and Prevention of NCDs 2017-2021 encompassed such integrated approach; TT Moves, strong on health promotion, does not. At worst, integrating the two approaches offers the best chance for TT to achieve Sustainable Developmental Goal (SDG) 3.4, and by 2030 reduce by one-third premature mortality from NCDs.