title: Policy initiatives, culture and the prevention and control of chronic non-communicable diseases (NCDs) in the Caribbean.
abstract: OBJECTIVE
  To explore interactions between disease burden, culture and the policy response to non-communicable diseases (NCDs) within the Caribbean, a region with some of the highest prevalence rates, morbidity and mortality from NCDs in the Americas.
  
  
  METHODS
  We undertook a wide ranging narrative review, drawing on a variety of peer reviewed, government and intergovernmental literature.
  
  
  RESULTS
  Although the Caribbean is highly diverse, linguistically and ethnically, it is possible to show how 'culture' at the macro-level has been shaped by shared historic, economic and political experiences and ties. We suggest four broad groupings of countries: the English-speaking Caribbean Community (CARICOM); the small island states that are still colonies or departments of colonial powers; three large-Spanish speaking countries; and Haiti, which although part of CARICOM is culturally distinct. We explore how NCD health policies in the region stem from and are influenced by the broad characteristics of these groupings, albeit played out in varied ways in individual countries. For example, the Port of Spain declaration (2007) on NCDs can be understood as the product of the co-operative and collaborative relationships with CARICOM, which are based on a shared broad culture. We note, however, that studies investigating the relationships between the formation of NCD policy and culture (at any level) are scarce.
  
  
  CONCLUSIONS
  Within the Caribbean region it is possible to discern relationships between culture at the macro-level and the formation of NCD policy. However, there is little work that directly assesses the interactions between culture and NCD policy formation. The Caribbean with its cultural diversity and high burden of NCDs provides an ideal environment within which to undertake further studies to better understand the interactions between culture and health policy formation.
authors.affiliation: Faculty of Medical Sciences, University of West Indies, Cave Hill Campus, Barbados. alafia.samuels@cavehill
authors.forename: T Alafia
authors.initials: TA
authors.lastname: Samuels
authors.forename: Cornelia
authors.initials: C
authors.lastname: Guell
authors.forename: Branka
authors.initials: B
authors.lastname: Legetic
authors.forename: Nigel
authors.initials: N
authors.lastname: Unwin
mesh_terms: D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control; D017691:Caribbean Region / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007391:International Cooperation / Q000331:legislation & jurisprudence*; D008017:Life Expectancy / Q000208:ethnology*; D008297:Male; D017202:Myocardial Ischemia / Q000208:ethnology / Q000401:mortality / Q000517:prevention & control; D015995:Prevalence; D012907:Smoking / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D012959:Socioeconomic Factors