Around three in four deaths in Suriname are caused by noncommunicable diseases (NCDs), such as cardiovascular diseases, cancers and diabetes.
Despite multiple global political commitments, almost every country on the planet is experiencing an unrelenting epidemic of NCDs, which now account for 7 of the 10 leading causes of death worldwide. Meanwhile, the world remains off-track to achieve United Nations Sustainable Development Goal Target 3.4, to reduce premature deaths from NCDs by one third by 2030.
But in the face of global struggles against this silent epidemic, this Caribbean nation is setting itself apart.
From global commitments to political action: a decade of hard work
Over the last 10 years, Suriname has supported strong action on NCDs. As the Minister of Health, Dr Amar Ramadhin, reflects:
“The whole of society is affected by NCDs as a health issue. But a health systems response to NCDs begins from the top, in the political realm.”
In 2011, 190 countries gathered together for the United Nations first "high-level" meeting on NCDs. After this meeting, the Government of Suriname assigned a special budget to its Ministry of Health to turn these discussions into action.
This action played out in three key ways.
Firstly, Suriname passed its Tobacco Control Act 2013 to achieve full compliance with WHO’s Framework Convention on Tobacco Control (WHO FCTC) in key mandates such as smoke-free environments, a total ban on tobacco advertising, promotion, sponsorship, and pictorial health warnings. The Act has informed the tobacco control policies of other Caribbean countries such as Guyana, and Antigua and Barbuda. In a bid to further prevent and control smoking-related diseases, Suriname has embarked on the FCTC 2030 project, to strengthen the implementation of policies, address tobacco industry interference, and improve services to help people quit smoking.
Secondly, the Ministry of Health created the country’s first ever National Action Plan for the Prevention and Control of NCDs for 2015–2020. This Plan sets targets to adopt local and national strategies that prevent NCDs, reduce alcohol and tobacco use, integrate NCDs within the country’s approach to chronic care, and strengthen Suriname’s ability to conduct surveillance and research into NCDs.
Thirdly, the country recognizes infant and maternal linkages between early nutrition, obesity and NCDs. Having found increasing noncompliance with the International Code of Marketing of Breastmilk Substitutes in recent years, the Government of Suriname has drafted national codes of practice for the marketing of formula milk and related products, and also for food products for infants and young children. Efforts to integrate and promote breastfeeding are also underway.
The Government of Suriname doesn’t plan to stop here. Further areas of action under consideration are a: tax on sugar-sweetened beverages; further increases in excise taxes on tobacco and alcoholic beverages; revision of education curricula to encourage healthy lifestyles; and the creation of safe spaces for people to exercise.
Dr Amar Ramadhin, Minister of Health for the Government of Suriname, leads a briefing on noncommunicable diseases [Credit: Dr Amar Ramadhin, PAHO/AMRO]
Keys to success
There are three lessons to be learnt from Suriname’s recent action to reduce NCDs.
Firstly, human rights are embedded in the country’s health delivery model, and services are extended to people throughout the country. Indeed, there is a renewed a focus on reaching the 80 000 people living in Suriname's dense rainforests: Dr Ramadhin explains:
“One of our priorities is strengthening primary healthcare for the very remote and hard-to-reach populations in the hinterlands of Suriname. We are now identifying and implementing changes in our policy and practices of Suriname’s health system, so we can respond better to challenges in primary health-care settings”.
Secondly, Suriname has worked actively with the Pan American Health Organization (PAHO) and WHO to identify best practices, using tools such as WHO’s "best buys" and "package of essential interventions" for NCDs, to develop clinical guidance and models for health financing. As one example, PAHO’s model for chronic care is being introduced by the Surinamese Government, to give long-term conditions the attention they deserve.
Thirdly, data and evidence are vital. PAHO is helping Suriname’s Ministry of Health build a database of the NCDs and related risk factors that cause the most illness and death in Suriname. Under the framework of the UN Interagency Task Force on NCDs and funded by the European Commission, PAHO working jointly with the Ministry of Health is also developing a case for investment in the prevention and control of NCDs and mental health conditions in Suriname. This case will help to quantify the economic benefits of further NCD interventions, and identify cost-effective areas for investment.
For Dr Bente Mikkelsen, Director for the Department of Noncommunicable Diseases at WHO, these three lessons can drive wider political action on NCDs:
“Governments seeking to protect their populations from debilitating and costly NCDs can learn much from Suriname’s approach. Building concerted political momentum informs what policies and evidence are most needed, where to allocate resources, and how to measure the successes of action”.