Alcohol policy in the English-Speaking Caribbean: a civil society perspective

OBJECTIVE: Alcohol continues to be a significant cause of morbidity and mortality in the region. This paper summarizes the current alcohol policies in the English-speaking Caribbean (ESC) and compares it with the WHO 'best buys', to identify gaps and opportunities for policy change. DESIGN AND METHODS: A search of internet, W.H.O. and P.A.H.O. resources, national policies obtained through communication with representatives of regional civil society, government ministries and statutory bodies. RESULTS: All ESC countries have laws governing alcohol. Broadly, there are 4 distinct ways in which alcohol is represented in policies. 1. In legislation- not directly dealing with health, but with more of a social and economic focus; 2. As a distinct national policy- recognizing the health implications of alcohol; 3. In conjunction with mental health and non communicable disease (NCD) policies; 4. In conjunction with policies addressing illegal substance use. Generally the finding was that there were gaps and opportunities for Civil Society Organisations (CSOs) and policy makers in the alcohol landscape. These included an opportunity to advocate for a culturally sensitive comprehensive regional policy, working to encourage wider advertising and marketing restrictions, stricter enforcement of already passed legislation, and examining and disseminating best practices already present in the region, e.g. in The Bahamas and St. Kitts/ Nevis. There are also opportunities for greater restrictions for on-/off-premise sales, time and location restrictions, and institution of national maximum legal blood alcohol concentrations (BAC) when driving a vehicle. CONCLUSIONS: There are significant gaps in alcohol policy regionally. These represent opportunities for CSO.

Trends in stroke and acute myocardial infarction in Barbados, 2009–2013

OBJECTIVE: To describe trends in incidence, mortality and 28-day case fatality rate (CFR) for stroke and acute myocardial infarction (MI) in Barbados during the first 5 years of the Barbados National Registry for Chronic Non-communicable Disease (BNR). DESIGN AND METHODS: BNR data on strokes and acute MIs diagnosed nationwide were collected prospectively from data sources including public and private healthcare providers. Analyses included annual incidence and mortality rates per 100,000 (IR and MR), and 28 day post-event CFR, with 95% CI and trend estimation (fitting models to data using Poisson regression). RESULTS: Approximately 593 strokes and 349 acute MIs were registered annually with the BNR between 2009 and 2013, with a small 5-year decline in acute MI IR and a small 5-year increase in stroke IR by 2013. The MR for acute MI showed a small 5-year decline, but stroke MR increased significantly over the 5 years, from 78.9 (95%CI 68.8–90.0) in 2009 to 131.7 (118.8–145.8) in 2013 (p<0.03). Similar trends to MR were seen in CFR for both stroke and acute MI. CONCLUSION: We are cautiously optimistic about the (albeit non-significant) decline in IR, MR and CFR for acute MI, which could imply improvements in healthcare service provision. However, despite little change in stroke annual incidence, significant MR increase highlights the need for improved stroke care in Barbados. Thrombolysis for acute ischaemic stroke has only been available since the new stroke unit was implemented in late 2013; continued monitoring will allow assessment of this important initiative.