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Purpose: To present a descriptive framework that will provide the foundation for future exploratory research on the socioeconomic impact of Chronic Non‐Communicable Diseases (CNCDs) in Trinidad and Tobago. The paper also attempts to initiate discussions regarding the placement of greater emphasis on preventative health care. Methodology: Time series data was used to paint a picture of the changing epidemiological profile within the country. Secondary data was also utilised to illustrate changes in policy within the country. Data was obtained from various key stakeholders inclusive of Government Ministries and the Central Statistical Office of Trinidad and Tobago. Findings: CNCDs are the leading cause of death in Trinidad and Tobago and attempts have been made to address these issues. Recurrent expenditure continues to constitute the majority of health sector spending with programmes like the Chronic Disease Assistance Programme (CDAP) directly targeting the rise of CNCDs. However, at the time of writing, there appeared to be very few linkages between the various relevant stakeholders to facilitate the combination of their expertise which would undoubtedly aid in reducing the impact of CNCDs on the economic earning potential and social fabric of Trinidad and Tobago.

Twenty-first century has dawned with substantial achievements in population health outcome indicators in India. However, very little is known on patterns in causes of death in India. The paper aims to discuss this issue.

In this paper, data was drawn from two sources namely, National Family Health Survey (NFHS-1, 1992-1993 and NFHS-2, 1998-1999) and published reports of Survey of Cause of Death (Rural). Three-years moving average causes-of-death estimates were calculated based on World Health Organization classification of causes of death. Negative binomial regression models were fitted to capture the effect of socio-demographic and behavioural determinants of patterns in causes of death.

The leading causes of death were heart diseases, tuberculosis, asthma, paralysis, prematurity and cancer. Three-fifth of the deaths to children under the age of ten was from communicable, maternal, perinatal and nutritional conditions. On the other hand, about two-third persons aged 45 years and above were dying from non-communicable diseases. Female were at greater risk of dying from non-communicable diseases (IRR: 1.22, 95 per cent CI: 1.11-1.34, p < 0.001).

The epidemiologic transition in India has produced a shift in mortality from communicable, maternal, perinatal and nutritional conditions to non-communicable diseases, with little or no role played by injuries regardless of the level of all-cause mortality. Coupled with the effects of population age structures, other factors were also responsible for the bulk of the inter-regional disparities. These factors include differences in the populations’ health risks associated with the natural or built environments, prevalence of behavioural risk factors, or gaps in the capacities of health systems to respond to specific disease challenges, social stratification and others.

This paper described the trends, patterns and geographic variability in India’s causes-of-death profile in terms of communicable diseases, non-communicable diseases and injuries, and socio-economic and demographic determinants of patterns in the profile.

The purpose of this paper is to evaluate gender-related differences in the use of drugs for chronic diseases in undocumented migrants.

The authors analyzed the databases of two charitable organizations providing medical help and medicines to undocumented migrants. Data were available for 9,822 patients in the period 2014–2016. The authors grouped medicines according to the Anatomical Therapeutic Chemical (ATC) classification. We considered the ATC group as an indicator of a group of diseases.

Both males and females needed medicines for chronic diseases in a comparable manner. When we analyzed the age distribution, The authors noticed that males showed a tendency to begin to be affected at an earlier age; however, this cumulative difference was not statistically significant. But when we looked at six groups of drugs separately (cardiovascular, respiratory, anti-thrombotic, neurologic, psychiatric, anti-diabetic), the authors found that females always needed drugs for chronic diseases at a later age, always with a significant difference (p<0.0001 for cardiovascular, antithrombotic, antidiabetic and psychoactive drugs; p<0.002 for neurologic products; p<0.04 for drugs used in chronic respiratory conditions).

This is a retrospective study based on the analysis of existing databases, but the peculiar features of this population (undocumented migrants) do not allow at the moment controlled studies.

Our observations could be important when planning public health strategies, especially in the field of prevention.

This is the first report of gender differences in the use of medicines for chronic diseases within a large sample of undocumented migrants.

Barbados is at a very advanced stage of population aging. Health care services are designed to ensure universal access for all Barbadians but the contributing factors for older adults’ health care utilization are not well explored. This chapter examines gender differences in the correlates of seeking medical care among older adults in Barbados.

Logistic regression models were applied to data drawn from the 2000 Survey of Health, Well-Being and Aging of Older Adults in Latin America and the Caribbean (SABE), Bridgetown sample (n = 1,068).

Health needs, based on chronic conditions, were positively associated with seeking medical care for men and women. Different forms and directions of intergenerational support were associated with men and women seeking care. Among men, receiving financial support was positively associated with seeking care. Among women, providing financial support was associated with lower odds of seeking care while receiving instrumental support was associated with higher odds of seeking care.

Medical care is only one form of health care use and there is no specification of the nature of care or consultation. The sample is cross-sectional and limited to older adults in urban areas. The relative importance of enabling factors and health needs, especially, may differ across time and space within Barbados.

The study contributes to the literature on health care utilization among older adults within developing countries and highlights the pertinence of family relations influencing gender differences in health care utilization.

The substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.

A systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.

Chronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.

The present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.

Given the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

This paper aims to identify health-care entitlements that exist for asylum seekers with chronic non-communicable disease (CNCD) that promote their health and self-care, and to explore health policies, initiatives and programmes with the potential to foster self-care in this populace.

Narrative review of literature conducted by searching EMBASE, CINAHL, WEB OF SCIENCE and PSYCINFO databases for articles published from 2010 to 2021. Included articles focussed on policies, programmes or initiatives with the potential to promote health in adult asylum seekers residing in high-income countries. Studies inclusive of other migrant groups such as undocumented migrants and those with mental health conditions were excluded. Eleven studies fitting the inclusion criteria were assessed against the study objectives.

Free access to health-care services and pharmaceutical products, free access to food banks and supermarket model food banks, English and cooking lessons, community integration training sessions and culturally competent health-care workers were found to promote health and self-care. There is little research on self-care and health promotion in adult asylum seekers with CNCD. CNCDs represent high burden of disease in asylum seekers but have a low priority in reported research.

This narrative review is the first to explicitly focus on asylum seekers in high-income countries with CNCD, excluding mental health conditions, and to explore initiatives, programmes and policies that enhance health promotion to facilitate self-care in this populace.

Through the example of a “regulatory ranking” – an index produced with the aim to regulate the pharmaceutical market by pushing companies in the direction of providing greater access to medicine in developing countries – this chapter focuses on indexing and ranking as infrastructural processes which inscribe global problem spaces as unfolding actionable territories for market intervention. It foregrounds the “Indexal thinking” which structures and informs regulatory rankings – their aspiration to align the interests of different stakeholders and to entice competition among the ranked companies. The authors detail the infrastructural work through which such ambitions are enacted, detailing processes of infrastructural layering/collage and patchwork through which analysts naturalize/denaturalize various contested categories in the ranking’s territory. They reflect on the consequences of such attempts at reconfiguring global topologies for the problems these governance initiatives seek to address.

We are currently experiencing, in western societies, a new reality in health systems, the emergence of an epidemic of chronic diseases, which test and raise new challenges to the health systems. This exponential increase in chronic diseases has not been accompanied by updated training of health professionals in this area. The chronic illness implies a bilateral relationship, of commitment and compromise for life, in which the involvement of the sick person must be the rule. The scope of therapeutic education (TE) is making the person autonomous and helping them to maintain or improve their quality of life. To treat patients with chronic disease, health professionals need to adapt their knowledge to their new role in the therapeutic relationship. As for the methodology, a participative observational methodology will be carried out with the training of health professionals who work in this area. It is a descriptive work based on studies and works published by the main schools working in this area, with emphasis on the School of Geneve. The purpose is to identify the problem of chronic diseases, the challenges that patients and health professionals face and how to build educational projects, exploring the use of educational tools, including digital technology.