CAPACITY BUILDING FOR DIABETES PREVENTION IN JAMAICA

Mark Pereira, Ph.D.Associate Professor & Director of Public Health Nutrition

Division of Epidemiology & Community Health

Petrona Lee, Ph.D.Postdocoral Fellow

School of Public HealthUniversity of Minnesota

Introduction to Capacity Building2

Two phases of capacity building described by Hawe, 2000

Specific Capacity Building

Delivery of specified, high quality services or responses

to particular situations or problems, such kidney

dialysis.

Generalized Capacity Building

System-wide solutions to new problems and responses

to unfamiliar situations, such as public health prevention

and control of chronic diseases in developing countries

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Generalized capacity building for public health problems requires a diffused and complex set of criteria, including:

Characteristics of the work environment

Nature of team interactions

Quality of leadership

Structure of health organizations

Introduction to Capacity Building

Generalized Capacity Building

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System approach to public health Efficacy of resources directed at prevention and

treatment

Comprehensive structure reassessment

Developing a vision and mission, articulation to stakeholders Short, intermediate, and longterm goal setting with buy-

in throughout

Facilitate creative and strategic thinking at all levels

Garnering and maintaining resources system-wide Persistent dedication to funding via

local, national, and international source

Generalized Capacity Building

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Political Process -- direct, facilitate, and continually

refine mission-driven strategy

Parish and parliamentary (central) levels, etc…

Negotiation -- mediate resolutions, stakeholders and

resources, public health and medical

providers, employers, funding sources, etc…

Generalized Capacity Building

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Social forecasting and

marketing

Identify and interpret

emerging trends

Create predictions and

build scenarios

Media communications,

health communications,

risk communications,

community relations

Generalized Capacity Building 7

Team-building competencies

Develop team-oriented structures and Systems, e.g. service, entrepreneurial spirit, organizational learning, etc.

Facilitate development of team and work groups

Shared mission, vision, and values

Clear goals and objectives

Facilitation and mediation roles

Listening, dialogue, negotiating, rewarding, encouraging,motivating, modeling integrity, credibility, enthusiasm, commitment, honesty, caring, and trust

Moving out of the silo

First Steps Towards Capacity Building:

A Vision Diabetes Prevention in Jamaica

2/1/2013

Introduction to the problem of diabetes in Jamaica by Dr.

Petrona Lee, a Jamaican-American at the UMN who had a

successful career in medical technology, and recently

obtained her PhD in environmental health sciences.

Dr. Lee was passionate about spending the rest of her

career addressing diabetes prevention through

community-based programs starting in the area she was

raised in, Trelawny.

Type 2 Diabetes: Integration of Biology & Environment

GG

G

gg

g

β-cell

insufficiency

Diabetes

Insulin

Resistance

β-cell deficiency

Intrauterine

effects

Economics & Culture

Economic Factors

Dietary

Body Composition

Epistasis

Polygenic

Physical inactivity

Lean mass

Intramusc. fat

Visceral fat

??????

???

COMMUNITY

LOCALITY

Agriculture/

Gardens/

Local markets

Health

Care

Public

Safety

Public

Transport

Manufactured/

Imported

Food

Sanitation

Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org

POPULATION

Diabetes

&

Obesity

WORK/SCHOOL/

HOME

School

Food &

Activity

Infections

Labour

Worksite

Food &

Activity

Leisure

Activity/

Facilities

Family &

Home

INDIVIDUAL

Energy

Expenditure

Food

intake :

Nutrient

density

Societal policies and processes influencing the population prevalence of diabetes

NATIONAL/

REGIONAL

Education

Food &

Nutrition

Urbanization

Health

Social security

Transport

Media &

Culture

Nationalperspective

INTERNATIONAL

FACTORS

Development

Globalization

of

markets

Media

programs

& advertising

Short Term Goals

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1. Determining the extent of diabetes in Jamaica

The School of Public Health has diaspora agreement with the Organization of Strategic Development in Jamaica (OSDJ).

Through our contacts with OSDJ, we were able to obtain health data on diabetes in Jamaica.

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“It is expected that these data will continue to inform

health policy in the coming years, including the

implementation of multi-faceted effective

interventions to tackle the NCD epidemic beyond the

mere health provider based approach.”

Short term goals

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2. Identifying and involving stakeholders

Medical providers, politicians, clinics, youths, adults, schools, churches, local communities, persons with diabetes and their families, etc.

3. Obtaining funding

Modest-sized grants for Dr. Lee’s continued mentoring and activities on site in Trelawny.

United States Department of Agriculture National Institute of Food and Agriculture – grant application

Intermediate Goals

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1. Facilities and infrastructure

Community-Based Trelawny Diabetes Center. A Wakefield church offered office space for a

temporary location. Staffing with trained personnel for

administration and protocol development Linkage to UMN

2. Surveys of youth and adult obesity and diabetes in Wakefield-Bunker‟s Hill-Deeside area.

Intermediate Goals

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3. Develop working relationships with area colleges/universities, schools, medical personnel, parish councilors, community leaders and lay persons.

Last spring Dr. Lee visited with representatives from several of the schools, churches and other community leaders. The response was very positive.

We submitted a proposal as part of a health assessment package that was delivered by OSDJ to the Jamaican Government..

Intermediate Goals, cont.

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4. Focus Groups and Pilot Studies with Jamaicans

Filling gaps in translational nutrition research for diabetes

prevention and treatment

Effects on glucose control, palatability, and satiety of

foods and meals prepared in culturally appropriate ways

Breadfruit case-study

Physical activity perceptions and opportunities

The vast gender gap

Blood glucose screening and monitoring

Education, awareness

Cultural barriers to checking blood sugar

Intermediate / Long Term Goals

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4. Long-terms substantial funding for training and

infrastructure

National Institutes of Health Fogarty Training

Grant for Predocs and Postdocs

Capacity building for non-communicable

disease prevention in lower and middle

income countries

Permanent infrastructure grants

USAID

Breadfruit as a Model for Translational

Research and Capacity Building

The Breadfruit Project

Contribute to science (antidiabetic properties?)

Build collaborations across disciplines between

the U.S. and Jamaica

Microeconomics, with long term potential for

broader economics

Serve as a model for other projects with

Jamaican traditions

Health effects? Effects on blood sugar, etc.

Breadfruit flour as a gluten-free substitute for wheat flour.

http://www.treesthatfeed.org/

Trees That Feed Foundation

http://www.treesthatfeed.org/Planting Trees to Feed People, Create Jobs and Benefit the Environment

Helping local communities in developing countries achieve

sustainable food supplies, accessible markets, jobs, and

reforested environment

Planting trees, educating, supplying equipment, fostering small

farmers and cooperatives, enabling commercial ventures

Shade tolerant trees under canopies of larger trees, all bearing

fruit

E.g., cocoa &coffee growing under breadfruit trees.

Improving diets, independence from imported foods & chemicals

Collaborating with government, NGOs, co-ops, service

clubs, churches, schools and community associations.

Beyond breadfruit, of course!

Jamaican Foods I’ve eaten this week

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Grains

Rice and peas, Bun and cheese

Vegetables

Bammy, Renta yam…

Fruits

Mangoes (no. 11, etc.), Naseberry, Sweet Sop, Ackees,

Breadfruit, Bananas, Watermelon, Grapes, Jamaican apple

(Othaiete), Jamaican plum, Sugar cane

Maybe it could be easy to be vegetarian in

Jamaica, but…

Jamaican Foods I’ve eaten this week!

2/1/2013

Grains

Rice and peas, Bun and cheese

Vegetables

Bammy, Renta yam…

Fruits

Mangoes (no. 11, etc.), Naseberry, Sweet Sop, Ackees,

Breadfruit, Bananas, Watermelon, Grapes, Jamaican apple

(Othaiete), Jamaican plum, Sugar cane

Meat and fish

Cod (with ackees), Cod fried, Snapper (steamed)

Curry goat, stewed pork, jerk pork, jerk chicken

Long Term Goals

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1. Develop a permanent Diabetes Prevention and Management Center.

A permanent site has been identified and committed to the project.

It‟s location is adjacent to the Wakefield Elementary School with direct access from the main road.

Preliminary architectural plans are being developed by a Jamaican American in Minnesota and will be submitted to the proper authorities in Trelawny.

Goals of the Diabetes Prevention Center

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A) Partner with the community to develop sustainable

strategies for preventing and managing diabetes

B) Outreach with elementary schools and churches for

educating youths and families in optimal lifestyles

C) Collaboration with area colleges and universities in

program development, education, research, and trainng.

D) Research on diabetes surveillance as it relates

specifically to Jamaicans

E) Education center for youths an adults

F) Provision of basic clinical needs and screenings

G) Support groups for diabetes prevention education

H) Venue for „town hall‟ meetings and seminars

Strategies for Long Term Goals

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Microeconomic programs

Stakeholders form collaborative groups determine

which enterprises are best needed for each

community.

Real-estate, apartment rental, „bed-and-breakfasts‟

Environmental activities that have synergistic

benefits

Gardening, landscaping, as a benefit to the

environment, to the local residents, and as added

attraction for tourism.

Long Term Goals

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Expand the project island-wide

Networks and satellite offices, expanding technological

capacity and infrastructure

Local control of the centers – BY Jamaicans FOR

Jamaicans

Directors, coordinators, nurses, laboratory

technicians, endocrinologists, dietitians, administrator

s, office workers, grounds keepers, and community

entrepreneurs, etc.

Summary

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Using Capacity Building as a guide for diabetes prevention, we are…

Identifying needs for diabetes prevention, a community that wants the service, potential stakeholders.

Developing a working model and designing pilot projects.

Exploring capabilities for receiving input from users, medical professionals, academia and focus groups.

Seeking financial and human resources to develop programs, leadership, political competencies and encourage local entrepreneurship.

Planning sustainability through economic components and capability for academic preparation of future professional expertise

Acknowledgements

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UWI and conference organizers

Dr. John Finnegan, Dean, School of Public

Health, University of Minnesota

Dr. Elizabeth Vernig, Associate Dean, School of

Public Health, University of Minnesota

Thank you

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As for me, all I know is that I know nothing.

- Socrates