‘STEPS To A Well Bermuda’ Survey Launched

Good afternoon everyone,

And thank you for coming to today’s press conference to announce the commencement of the STEPS to a Well Bermuda survey.

Chronic diseases contribute the greatest proportion of the total burden of disease in the countries of Latin America and the Caribbean, including Bermuda.

Many of these conditions 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.

Additionally, population health surveys which contain physical measurements [and biochemical assessments] add substantially to the information about the state of health of a population.

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 approach encourages the collection of health information on a regular and continuing basis using a standard methodology to detect trends over time by age and gender using a representative sample of the adult population.

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 more complex collection of clinical samples for biochemical analysis [STEP 3].

STEPs to a Well Bermuda will also include enhanced biochemical analysis [STEP 3a], oral health surveillance [STEP 4a] and an objective measure of physical activity [STEP 4b] which expands on the core data collection.

Health surveys, such as STEPs to a Well Bermuda, provide important information on the prevalence of various health conditions and physical and biochemical characteristics of a population. They also provide data on the relationship between the risk factors and selected conditions, and social determinants of health.

Common, preventable risk factors underlie most chronic diseases.

The main chronic diseases attributable to the most common risk factors are heart disease, stroke, cancer, chronic respiratory diseases, and diabetes.

The key to controlling epidemics of chronic diseases is primary prevention based on comprehensive population-wide programs. The aim is to avert these epidemics wherever possible and to control them as quickly as possible where they are already present.

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.

There is also a distinct relationship between the core risk factors, the main chronic diseases and oral health… hence its inclusion in STEPs to a Well Bermuda.

In summary, STEPs to a Well Bermuda Survey uses self-reported information and a range of objective physical and biochemical measures, to:

• describe the prevalence and distribution of chronic disease risk factors and selected chronic diseases in the population,
• track the direction and magnitude of risk factor trends, and
• provide a sound evidence base to inform public health priorities for the prevention and control of chronic non-communicable diseases.

2656 households have been selected using simple random sampling. The ‘Kish Method’ will be used to randomly select one individual aged 18 and older from each household. Interviewers will be in the field from October through December.

It should be noted that there will be no interviewing during the holiday and New Year period as people’s normal behaviours may change. If necessary, interviewers will re-enter the field in January.

For STEPs to a Well Bermuda, all non-institutionalized persons, aged 18 years and older, who are resident in Bermuda at the time of the survey, are eligible to participate. Residency is defined as being present and intending to remain in Bermuda for at least six months.

Persons with limited capacity to consent and those who may be unwilling or unable to participate in STEPs 1, 2 or 3 due to mental and/or physical disability will be excluded from the study.

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

It must be noted that the survey does, in essence, provide a free health screening for participants. This health screening is not dissimilar to those provided by the Ministry of Health and Seniors at local health fairs.

Participants will also be given printouts of their physical and biochemical measurements which can be shared with their health care providers who can then decide on the most appropriate course of action given the results.

Bermuda is supported in this project by the Pan American Health Organization and the Caribbean Public Health Agency (CARPHA).

Public health partners include the Bermuda Hospitals Board, Chronic Disease Management Centre and the Bermuda Diabetes Association.

This project is also supported by Bermuda Cancer and Health and 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 encourage members of the public to participate if called upon.
Thank You.

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