Healthy Ageing in the Caribbean State of Public Health Report 2019 The Caribbean Public Health Agency is the Caribbean Region’s collective response to strengthening and reorienting our health system approach so that we are equipped to address the changing nature of public health challenges, which threaten development. To obtain additional information, please contact: Caribbean Public Health Agency (CARPHA) 16-18 Jamaica Boulevard Federation Park Port of Spain, Trinidad and Tobago Tel: 868-299-0895 Fax: 868-622-2792 Email: [email protected] Website: www.carpha.org Suggested citation Caribbean Public Health Agency. State of Public Health. 2019. Healthy Ageing in the Caribbean. Port of Spain, Trinidad, and Tobago: CARPHA; 2020 ISBN 978-976-8114-39-6 © Caribbean Public Health Agency, 2020 2 | Contents Acknowledgements ............................................................................................................................... 7 Preface ....................................................................................................................................................... 9 Foreword ................................................................................................................................................ 10 Acronyms ............................................................................................................................................... 12 Executive Summary ............................................................................................................................ 14 Introduction .......................................................................................................................................... 23 Late life opportunities .................................................................................................................................................. 24 The Caribbean Region ................................................................................................................................................... 26 Outline of the report ...................................................................................................................................................... 30 References ......................................................................................................................................................................... 30 Chapter 1: Healthy Ageing Concepts and Principles ............................................................... 31 Concepts and principles of “Healthy Ageing” ...................................................................................................... 32 1. The Life Course Approach ...................................................................................................................................... 34 2. The Social Ecological Model ................................................................................................................................... 39 3. The Social Determinants of Health approach ................................................................................................. 43 4. Active Ageing ............................................................................................................................................................... 44 5. Human Rights, Ethics, and Principles of Public Health .............................................................................. 45 5.1 Human rights vulnerabilities of older persons ........................................................................................ 45 5.2 Quality of health care and health settings .................................................................................................. 47 5.3 The ethics of care .................................................................................................................................................. 48 5.4 Public health principles ..................................................................................................................................... 49 5.5 Human rights pertaining to ageing asserted in international agreements .................................. 50 6. Gender ............................................................................................................................................................................ 53 7. The Geriatric Giants: health conditions concentrated among older persons ................................... 55 Conclusion ......................................................................................................................................................................... 57 References ......................................................................................................................................................................... 58 Chapter 2: Global and regional strategies and plans of action on Ageing ....................... 62 Global and regional strategies and plans of action on ageing ...................................................................... 63 1.Global .............................................................................................................................................................................. 63 2. Regional ......................................................................................................................................................................... 71 Conclusion ......................................................................................................................................................................... 77 References ......................................................................................................................................................................... 77 Chapter 3: Demographic shifts and the ageing of Caribbean populations ...................... 80 Demographic shifts and the ageing of Caribbean populations .................................................................... 82 1. Population ageing: conceptual frameworks ................................................................................................... 82 2. Population ageing in the Caribbean ................................................................................................................... 85 3. Diversity in ageing patterns in the Caribbean ................................................................................................ 91 4. Migration and population ageing ........................................................................................................................ 94 5. Gender and ageing ..................................................................................................................................................... 95 6. Economic implications of population ageing............................................................................................... 100 Conclusion ...................................................................................................................................................................... 106 3 | References ...................................................................................................................................................................... 107 Chapter 4: Health conditions along the life-course and among older persons .......... 110 1. General profile of health in the Caribbean .................................................................................................... 112 2. Health along the life course ................................................................................................................................ 119 2.1 Premature mortality ........................................................................................................................................ 119 2.2 NCD risk factors ................................................................................................................................................. 123 2.2.1 Unhealthy diet ........................................................................................................................... 126 2.2.2 Tobacco use ................................................................................................................................ 129 2.2.3 Air pollution ............................................................................................................................... 130 2.2.4 Harmful use of alcohol ........................................................................................................... 131 2.2.5 Physical inactivity .................................................................................................................... 133 3. Health conditions among older persons ........................................................................................................ 135 3.1 Chronic and acute health conditions ......................................................................................................... 136 3.1.1 NCDs, chronic conditions and risk factors.............................................................................................. 136 3.1.2 Acute conditions ....................................................................................................................... 139 3.2 Geriatric Giants and functional abilities .................................................................................................