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USCAHDR at CARICOM: New insights for improving U.S., Caribbean & global health

By Louis W. Sullivan, MD

CaricomI recently attended the 28th Meeting of the Council for Human and Social Development - Health (CARICOM) with Dr. Nigel Harris and other members of the U.S.-Caribbean Alliance for Health Disparities Research (USCAHDR) team. It was an excellent meeting. Dr. Harris’ last public update on the project’s progress was Spring 2015. This meeting offered the opportunity to highlight the USCAHDR team’s continued progress. I was pleased to see that CARICOM attendees (including leadership from PAHO and ministers of Health and other senior government officials from many Caribbean countries, and senior leaders from the National Institute for Minority Health and Health Disparities and the National Heart, Lung and Blood Institute of the NIH) found our research findings, comparing Caribbean and U.S. life expectancies most interesting.

The USCAHDR consortium’s current work won’t be completed until May 2016, but we’ve already identified a number of striking findings, especially from our novel analyses of mortality datasets reaching back to 1965 and including current (2013/14) data. Most significantly, the project has found that*:

  • While life expectancy has improved in all regions studied (North America, South and Central America and the Caribbean), Anglo-Caribbean gains were less than in other region. This finding is striking when you consider that in 1965, mortality and life expectancy for Anglo-Caribbean populations exceeded that of African-Americans and other Caribbean and Latin American countries’ populations.
  • In 1965, the life expectancy of the Anglo-Caribbean population exceeded that of African Americans by 1.5 years. Comparative results in 2009 were “inverted”, with life expectancy of African Americans exceeding that of Anglo-Caribbean populations by 0.6 years.
  • There are large differences in life expectancy among Anglo-Caribbean populations from nation to nation. For example, Trinidad & Tobago and Jamaica, showed little improvement in life-expectancy over the past 20 to 40 years, while Antigua and Barbados have done much better.
  • Beginning in 2000, marked differences were found in mortality trends between countries within the Caribbean with some showing substantial reductions in mortality while others showed little change – or even increases. Interestingly, the islands of Martinique and Guadeloupe (both French Caribbean nations) have low mortality, out-performing even the United States.
  • Non-communicable diseases (NCDs), particularly cardiovascular disease and diabetes, appear to responsible for a large percentage of these differences between Caribbean countries.

In addition, our researchers, comparing data (2000 forward) of White Americans with that of African-Americans, found:

  • The mortality and life expectancy differences between the two populations are shrinking, due in most part to reduction in African-American mortality figures
  • The gains in life expectancy made by African-Americans are largely attributable to gains made by African-American males.
  • When U.S. data are examined by state, regional differences in mortality figures for African-Americans and white Americans are found. For example, 2009 data shows African Americans in Massachusetts with better life expectancies than that of White Americans living in many Southern states at that time. These findings contrast with earlier findings from 2000 when African-Americans in nearly every U.S. state had higher mortality and shorter life expectancies than Whites Americans, regardless of state or region.
  • Reductions in mortality from cardiovascular disease and diabetes among African-Americans appear to contribute substantially to the reduced disparities in mortality between African-Americans and White Americans.

Life expectancy among Afro-Caribbean and US populations

Life expectancy (LE) among Afro-Caribbean and US populations showing
(a) LE at birth for women, (b) LE at birth for men, (c) the LE gap relative to African Americans: 1990–2009.
Source: American Journal of Public Health.
Note. The 6 Caribbean indicator countries were Antigua, Bahamas, Barbados, Grenada, St. Lucia, and St. Vincent and the Grenadines.

We are continuing to analyse the relative contribution of different causes of death to the trends outlined above. We were pleased to share these latest findings with CARICOM meeting attendees. Here are links to the five papers we have published to date:

Our goal for the USCAHDR consortium has been to identify and review chronic disease data and related health disparities between and within populations in the Caribbean and United States with the intention of informing the development of future interventions to improve health and reduce these health inequities. As I listened to the team’s CARICOM presentation and discussions, it was clear that our research and review has brought nuanced focus to certain underlying causes of health disparities across the region.

In some cases, our work has yielded more questions than answers. For example, why has there been life expectancy gains made by African-Americans in the last ten years (particularly males)? Why has there been remarkable improvement in life expectancy in French-speaking Caribbean countries – but less consistent progress in the Anglo-Caribbean? Why does the most recent data show such different trends in mortality between Caribbean countries? And if, as our work and that of others suggests, non-communicable diseases (NCDs), such as coronary artery disease and diabetes, are responsible for much of these differences, what are the next steps to improve health outcomes and life expectancy within Caribbean and U.S populations?

Our findings coincide with an evaluation of the impact of the CARICOM 2007 Port of Spain Declaration on NCDs, and they show which countries are doing well, and which are doing less well in reducing mortality from NCDs. USCAHDR findings can be used to help assess both the impact of policy measures taken in response to the Port of Spain Declaration and the challenges that different countries face in meeting the 2025 targets on NCDs (as part of the WHO Global Action Plan). Our USCAHDR findings, focused on chronic disease states, will help to highlight interventions needed in the poorly performing Caribbean nations and help to reduce health disparities within the region. We are eager to find appropriate avenues to apply the USCAHDR findings to efforts that will help to improve health outcomes not only in the Caribbean, but also in the United States.

Reducing health disparities, improving life expectancy, better understanding of population differences as they relate to chronic disease and health outcomes…. Our research, supported by NIMHD, is an important element of the global effort to improve the lives, the health and the productivity of our world. Stay tuned.

*Thank you to Dr. T. Alafia Samuels at the UWI for summarizing the USCAHDR consortium’s research findings.

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