Minister Updates: STEPS Well Bermuda Survey

Mr. Speaker,

I rise today to offer an update on the STEPS to a Well Bermuda survey which is ongoing in our community.

This is an historic survey for Bermuda, and we anticipate it will provide essential health information about our community. However, we need the help of all in the community to successfully complete the survey and provide this vital information.

Members of this Honourable House will be aware that chronic non-communicable diseases such as diabetes and cardiovascular disease and cancers contribute the greatest proportion of the total burden of disease in Bermuda – and are, by far, the leading cause of death.

The tragedy, Mr. Speaker, is that many of these conditions and their complications can be prevented.

And, as we know, effective action to prevent and control these diseases depends on timely access to accurate and reliable information about the prevalence of these diseases and their associated risk factors.

This information is vital to both informing where resources should best be targeted and also for monitoring and evaluating the impact of any actions taken.

Mr. Speaker, STEPS to a Well Bermuda utilizes the Pan-American Health Organization’s STEPwise approach to chronic diseases risk factor surveillance as a simple, standardized method for collecting, analyzing and disseminating data for chronic disease risk factors.

The STEPs risk factor surveillance is a sequential process; it starts with gathering information on key risk factors using a questionnaire (STEP 1), then moves to simple physical measurements, such as height, weight, waist circumference and blood pressure (STEP 2) and then to the collection of more complex clinical samples for biochemical analysis (STEP 3).

STEPs to a Well Bermuda also incorporates enhanced biochemical analysis for persons with increased risk for diabetes (STEP 3a), and objective assessments of oral health and physical activity (STEPs 4a and b).

STEPS to a Well Bermuda builds on previous surveys for Bermuda which relied only on self-reported information. While those surveys had their benefits, inaccuracy in self-reporting can result in underestimation or overestimation of the prevalence of risk factors, health behaviours, and chronic diseases in the population.

Ideally, self-reported data should not be used as the only data source and the STEPS survey will give Bermuda objective measures to evaluate the health status of the population.

Additionally, because the STEPS methodology is being consistently applied internationally, it will allow Bermuda to benchmark our population health against other countries.

Health surveys, such as STEPs to a Well Bermuda, through the use of self-reported information together with a range of objective physical and biochemical measures, will provide important information on the prevalence of various health conditions and physical and biochemical characteristics of our population.
We will also gain insights on the relationship between the risk factors and selected conditions, and social determinants of health.

Mr. Speaker, trained interviewers entered the field in November 2013 with a goal of conducting interviews at 2,656 households. As of 28thMay 2014, 990 households have been reached with 727 completed surveys. With continued efforts, it will not be long before we are near the half-way mark!

I would like to publically thank the interviewers for the important work they are doing in the field. It hasn’t been an easy task but the data collected will help us tackle chronic diseases and their associated risk factors. The importance of this data cannot be understated.

For example, preliminary analysis of STEP 3 results indicate that up to 24% of participants had fasting blood glucose levels in the upper normal range (101-125 mg/dl). These persons were referred for further testing in STEP 3a (oral glucose tolerance test) which resulted in the identification of a number of previously undiagnosed diabetics.

Additionally, 11% of participants during this study period had raised fasting blood glucose levels (≥126 mg/dl) indicative of diabetes and 40% of participants had elevated (21%) or high (19%) cholesterol. These preliminary results indicate the need for this survey, as it helps to determine public health priorities in chronic disease prevention.

Mr. Speaker, common, preventable risk factors underlie most chronic diseases.

The basis of chronic disease prevention is the identification of the major common risk factors, as the risk factors of today are the diseases of tomorrow.

A ‘risk factor’ refers to any attribute, characteristic, or exposure of an individual which increases the likelihood of developing a chronic non-communicable disease.

The major (modifiable) behavioral risk factors identified by the World Health Organization include tobacco use, harmful alcohol consumption, unhealthy diet (low fruit and vegetable consumption), and physical inactivity.

The major biological risk factors identified are overweight and obesity, elevated blood pressure, raised blood glucose, abnormal blood lipids and its subset, raised total cholesterol.

Surveillance of these core risk factors is necessary as they have the greatest impact on chronic disease mortality and morbidity.

Mr. Speaker, it is very important for households that have been selected for the survey to participate in STEPS to a Well Bermuda.

Even if you feel you are in good health or had a physical recently, your participation is essential as it will help to shape the picture of Bermuda’s health status.

Mr. Speaker, I implore the public, if one of our interviewers comes to your home, please participate.

Also, if you have been selected but were previously unable to participate, you can still take part by contacting the STEPS office on 278-4523 or steps@gov.bm.

The results of this study will provide many benefits to the population, including:

• Assisting with health services planning;
• Determination of public health priorities;
• Predicting future caseloads of chronic diseases; and
• Implementation, monitoring and evaluation of population-wide interventions.

Mr. Speaker, I have to take a moment to recognize our international partners who are supporting this project, including:

• the Pan American Health Organization [PAHO];
• the Caribbean Public Health Agency [CARPHA];
• the University of the West Indies; and
• the University of Cambridge.

Our public health partners include:

• the Bermuda Hospitals Board, Chronic Disease Management Centre; and
• the Bermuda Diabetes Association.

Finally, STEPS to a Well Bermuda is also supported by Bermuda Cancer and Health and the Bermuda Heart Foundation/CORE.

In closing I would like to thank all of our partners who are working to make this study a success…and also to strongly encourage members of the public to participate if called upon. We need your participation to reach our community goals.

Thank you, Mr. Speaker.

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