Health Promotion Strategic Plan for NCDs in Jamaica 2020-2025

Objectives

Jamaica’s 2020-2025 Health Promotion Strategic Plan provides a Ministry of Health and Wellness-led collaboration framework for reducing non-communicable disease risk factors, promoting health across the life course and creating health-promoting environments.[1][2]It supports the national priority area of risk-factor reduction through health promotion and the Vision 2030 commitment to healthy lifestyles, within a wider framework covering integrated NCD and injury management, surveillance and research, public policy and advocacy, and leadership and capacity building.[1]The Ministry vision, “Healthy People, Healthy Environment”, emphasises accessible quality care, health information, healthy lifestyle choices and community participation.[3]

• Reduce exposure to tobacco use, harmful alcohol use, physical inactivity and unhealthy diets, while addressing social, environmental and economic determinants, health inequities, gender, equity and human rights.[4][5][6]
• Increase by 2025 awareness of hypertension and diabetes status among people aged 15 years and over to at least 80%.[7]
• Increase sufficient physical activity by 5% by 2025 through action for children, adults, schools, workplaces and communities.[8]
• Improve dietary health by increasing fruit and vegetable consumption by 5%, reducing sugar-sweetened beverage consumption by 5%, and reducing salt or sodium intake by 5% by 2025.[9]
• Reduce harmful substance use among people aged 13 years and over, including a 1% reduction among adults, a 3% reduction among young people, and an increase in the age of initiation to 14 years.[10]
• Develop and implement a five-year Mental Health Promotion Plan by 2025 to promote self-care, education, support, service access and supportive environments.[11]
• Strengthen health literacy, age-appropriate health checks, chronic disease care education and culturally appropriate communication on physical activity, diet, tobacco, alcohol, violence reduction and mental health.[12][13]

The strategy addresses cardiovascular diseases, cancer, chronic respiratory diseases and diabetes, alongside the behavioural risks that contribute to them.[4]Its focus reflects a substantial national burden: non-communicable diseases accounted for approximately 62% of deaths among Jamaican men and 74% among women in 2016.[4]It seeks to move beyond a narrow emphasis on diet and physical activity by pursuing comprehensive prevention across all risk factors and their determinants.[14]

Implementation

Implementation combines a multisectoral, settings-based and life-course model.[3][15]The Ministry of Health and Wellness sets policy, norms and standards and leads coordination with Regional Health Authorities, which deliver public health services and monitor service delivery across four health regions.[3]The approach applies the Social Ecological Model across individual, interpersonal, community, organisational and policy levels, and uses Healthy Settings principles of supportive environments, participation, partnership, empowerment and equity.[15]

• Deliver interventions from preconception and pregnancy through infancy, childhood, adolescence and adulthood, adapting messages and services to age-specific needs and critical transitions.[15][12]
• Use schools, workplaces, communities, health facilities and faith-based organisations as delivery settings for prevention, education, screening, referral and health promotion.[16][10]
• Expand Jamaica Moves through social marketing, school physical-activity breaks, National School Moves Day, workplace challenges, safe community activity zones and health promotion resources.[2][8]
• Implement the National School Nutrition Policy, promote healthy food preparation and label reading, support healthier vendors, conduct nutrition screening, and apply workplace nutrition guidance and food-and-nutrition policies.[17][18]
• Strengthen prevention and treatment of substance use through evidence-based school programmes, Screening Brief Intervention and Referral for Treatment, workplace cessation activity, community interventions and social marketing.[10][19]
• Provide mental health literacy, counselling access, employer support, community promotion programmes and psychosocial support, alongside a national mental health promotion plan.[11][20]
• Support enabling policies on food labelling, trans-fat reduction, unhealthy-food marketing to children, sugar-sweetened beverage taxation, and restrictions on tobacco and alcohol marketing and sales.[16][12]

Delivery requires collaboration among ministries and government agencies, Regional Health Authorities, schools, employers, universities, professional bodies, civil-society organisations, community and faith-based groups, private-sector organisations and international partners.[14][2]Named supporting institutions include the National Public Health Laboratory, National Health Fund, National Family Planning Board and National Council on Drug Abuse.[3]Specific governance structures beyond Ministry leadership, Regional Health Authority responsibilities and partner collaboration are not specified.[3][2]

Capacity building includes a five-year Ministry staff training plan, needs assessments and training for external partners, peer learning, webinars, certification and healthy-food training for school and workplace vendors.[12]Monitoring is to be established early through a monitoring and evaluation plan using programme data and national surveys, including the Jamaica Health and Lifestyle Survey and Global School-based Student Health Survey.[13][21]Quarterly reviews are intended to use findings to adjust implementation, followed by a mid-term evaluation and partner workshop and a final evaluation in 2025.[13]

• Track implementation of social marketing, training, school, workplace and community initiatives, as well as awareness of NCD status.[21][7]
• Measure school physical-activity delivery, including targets for 75% of cohort schools to implement three five-minute activity breaks, 60% to provide an additional activity hour and 50% of physical education teachers to receive training.[22]
• Assess workplace and community coverage, including targets for 80% of targeted workplaces to implement NCD-awareness initiatives and functional wellness committees, and 80% of targeted communities to implement NCD-status awareness initiatives.[7][23]
• Use training registers, rapid assessments, baseline and impact surveys, protocols, consultation reports and implementation records for substance-use and mental-health activities.[10][19][20]

No overall programme budget, detailed allocation, resource-mobilisation plan or funding-gap assessment is specified.[24][13]The plan nevertheless identifies prevention as economically valuable: implementing 17 World Health Organization-recommended interventions was projected to save lives, reduce medical and productivity losses, and generate a return of 2.10 Jamaican dollars for each dollar invested.[24]

Monitoring & Evaluation

The strategy establishes monitoring, evaluation and learning as a national non-communicable disease priority, with implementation monitoring intended to guide adjustment, assess progress against 2025 targets and inform future health-promotion planning.[3][1][13][21]

• Develop and implement a monitoring and evaluation plan during the initial implementation phase, drawing on programme monitoring and national survey data, including the Jamaica Health and Lifestyle Survey and the Global School-based Student Health Survey.[13][21]
• Review monitoring findings through quarterly meetings of key staff and use the results to determine programme adjustments.[13]
• Conduct a mid-term evaluation and partner workshop, followed by a final evaluation in 2025 to assess achievements and guide subsequent planning.[13]
• Strengthen the organisation of monitoring systems, capture programme outcomes and data more effectively, use existing analytical evidence, and increase research to validate health-promotion interventions.[14][6]
• Use progress reviews, SWOT analyses, key-informant interviews, consultation reports, training registers, rapid baseline and impact surveys, implementation records, manuals and monitoring tools to support programme learning and review.[24][5][10][19]
• Monitor alcohol advertising to support effective regulation of harmful alcohol use.[16]

Outcome monitoring includes population-level targets for 2025: at least 80% of people aged 15 years and over knowing their hypertension and diabetes status; a 5% increase in sufficient physical activity; 5% improvements in fruit and vegetable consumption; and 5% reductions in sugar-sweetened beverage and salt or sodium consumption.[7][22][9]The strategy also targets reduced harmful substance use among people aged 13 years and over, including a 1% reduction among adults, a 3% reduction among young people and an increase in initiation age to 14 years.[10]

• Track delivery of social marketing in schools, communities and workplaces; implementation of the monitoring plan; health-promotion training; workplace and community initiatives; and awareness of non-communicable disease status.[21][7]
• Measure school physical-activity delivery, including activity breaks, additional activity outside timetabled physical education, National School Moves Day, media messaging and teacher training. Targets include 75% of cohort schools implementing three five-minute breaks, 60% institutionalising an additional hour of activity and 50% of physical education teachers trained.[8][17]
• Assess nutrition implementation through healthier food provision, healthy-eating promotion, nutrition screening, workplace nutrition-environment assessments, dietary-guideline initiatives, baby-friendly hospitals and infant and young-child feeding support groups.[17][18]
• Track workplace implementation, including an NCD awareness initiative and functional wellness committee in 80% of targeted workplaces, physical-activity opportunities and incentives, and workplace nutrition measures.[7][25][26]
• Measure substance-use prevention through student reach, trained personnel, school implementation of Screening Brief Intervention and Referral for Treatment, workplace coverage, employee participation and reduced substance use. The school programme target is 147,250 students reached, while 70% of cohort schools should have trained personnel and 50% should implement the intervention.[10]
• Monitor mental-health promotion through school literacy programmes, workplace counselling access and community programmes or supportive environments, with targets including 20% of secondary schools each year and specified workplace and community coverage targets.[11][19][20]

Regional Health Authorities monitor and evaluate public-service delivery across Jamaica’s four health regions.[3]Although the strategy identifies surveys and multiple implementation indicators, the supplied material does not provide complete indicator definitions, baselines, data-quality arrangements, reporting formats, surveillance protocols or a detailed accountability structure.[1][15]

Costing & Financing

The strategy frames non-communicable disease prevention as an economic priority: the four major non-communicable diseases are estimated to account for approximately 15% of Jamaica’s health budget, and non-communicable diseases together with mental health conditions were estimated to impose a macroeconomic burden of US dollars 18.45 billion during 2015 to 2030.[24]

• Present prevention and control investment as cost-effective, with a reported return of 2.10 Jamaican dollars for every dollar invested.[24]
• Project that implementing 17 World Health Organization-recommended interventions could save more than 5,700 lives, restore 67,400 healthy life years, avoid more than 47.3 billion Jamaican dollars in labour-productivity losses and save more than 29.8 billion Jamaican dollars in direct medical costs.[24]
• Project an increase of 0.11 percentage points in gross domestic product by year five from implementation of the recommended interventions.[24]
• Allocate 20% of tobacco-tax revenue to the National Health Fund.[5]

Resource constraints are identified as implementation risks, including shortages of staff, funding, infrastructure, equipment and materials, and insufficient health-promotion funding.[14][6]The strategy therefore promotes sustainability through use of existing resources, best practice and intersectoral coordination, but does not specify associated financial commitments.[6]

No overall programme budget, costed implementation plan, activity-level allocation, unit cost, financing target, funding-gap estimate or resource-mobilisation plan is specified in the supplied material.[5][2][12]The anticipated reduction in health-system costs from stronger health promotion and chronic disease care is not quantified beyond the cited investment analysis.[13][21]