1. CAPACITY BUILDING FOR DIABETES
PREVENTION IN JAMAICA
Mark Pereira, Ph.D.
Associate Professor & Director of Public Health Nutrition
Division of Epidemiology & Community Health
Petrona Lee, Ph.D.
Postdocoral Fellow
School of Public Health
University of Minnesota

2. Introduction to Capacity Building
2
 Two phases of capacity building described by Hawe, 2000
 Specific Capacity Building
 Delivery of specified, high quality services or responses
to particular situations or problems, such kidney
dialysis.
 Generalized Capacity Building
 System-wide solutions to new problems and responses
to unfamiliar situations, such as public health prevention
and control of chronic diseases in developing countries

3. Introduction to Capacity Building
3
 Generalized capacity building for public health
problems requires a diffused and complex set of
criteria, including:
 Characteristics of the work environment
 Nature of team interactions
 Quality of leadership
 Structure of health organizations
2/1/2013

4. Generalized Capacity Building
4
 System approach to public health
 Efficacy of resources directed at prevention and
treatment
 Comprehensive structure reassessment
 Developing a vision and mission, articulation to
stakeholders
 Short, intermediate, and longterm goal setting with buy-
in throughout
 Facilitate creative and strategic thinking at all levels
 Garnering and maintaining resources system-wide
 Persistent dedication to funding via
local, national, and international source
2/1/2013

5. Generalized Capacity Building
5
 Political Process -- direct, facilitate, and continually
refine mission-driven strategy
 Parish and parliamentary (central) levels, etc…
 Negotiation -- mediate resolutions, stakeholders and
resources, public health and medical
providers, employers, funding sources, etc…
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6. Generalized Capacity Building
6
 Social forecasting and
marketing
 Identify and interpret
emerging trends
 Create predictions and
build scenarios
 Media communications,
health communications,
risk communications,
community relations
2/1/2013

7. Generalized Capacity Building
7
Team-building competencies
Develop team-oriented structures and Systems, e.g.
service, entrepreneurial spirit, organizational learning, etc.
Facilitate development of team and work groups
Shared mission, vision, and values
Clear goals and objectives
Facilitation and mediation roles
Listening, dialogue, negotiating, rewarding, encouraging,
motivating, modeling integrity, credibility, enthusiasm,
commitment, honesty, caring, and trust

8. Moving out of the silo

9. First Steps Towards Capacity Building:
A Vision Diabetes Prevention in Jamaica
Introduction to the problem of diabetes in Jamaica by Dr.
Petrona Lee, a Jamaican-American at the UMN who had a
successful career in medical technology, and recently
obtained her PhD in environmental health sciences.
Dr. Lee was passionate about spending the rest of her
career addressing diabetes prevention through
community-based programs starting in the area she was
raised in, Trelawny.
2/1/2013

10. Type 2 Diabetes: Integration of Biology & Environment
G G Polygenic
G Economics & Culture
g
g ???
g ???Dietary
Epistasis
Physical inactivity
Intrauterine
effects ???
Body Composition
Lean mass
Intramusc. fat
Visceral fat Insulin
Economic Factors Resistance
β-cell deficiency
β-cell
insufficiency
Diabetes

13. Societal policies and processes influencing the population prevalence of diabetes
INTERNATIONAL NATIONAL/ COMMUNITY WORK/SCHOOL/ INDIVIDUAL POPULATION
FACTORS REGIONAL LOCALITY HOME
Public Leisure
Transport
Transport Activity/
Facilities
Globalization
Energy
Urbanization Public Expenditure
of Safety Labour
markets
Health Infections
Diabetes
Health
Care
&
Development
Worksite
Social security Food & Obesity
Sanitation Activity Food
intake :
Media Media & Nutrient
programs Culture Manufactured/ Family & density
& advertising Imported Home
Food
Education
School
Food & Agriculture/ Food &
Nutrition Gardens/ Activity
Local markets
National
perspective
Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999: http://www.iotf.org

14. Short Term Goals
14
 1. Determining the extent of diabetes in Jamaica
 The School of Public Health has diaspora agreement
with the Organization of Strategic Development in
Jamaica (OSDJ).
 Through our contacts with OSDJ, we were able to
obtain health data on diabetes in Jamaica.
2/1/2013

15. 15
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16. 16
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17. 17
“It is expected that these data will continue to inform
health policy in the coming years, including the
implementation of multi-faceted effective
interventions to tackle the NCD epidemic beyond the
mere health provider based approach.”
2/1/2013

18. Short term goals
18
 2. Identifying and involving stakeholders
 Medical providers, politicians, clinics, youths, adults, schools,
churches, local communities, persons with diabetes and their
families, etc.
 3. Obtaining funding
 Modest-sized grants for Dr. Lee’s continued mentoring and
activities on site in Trelawny.
 United States Department of Agriculture National Institute of Food
and Agriculture – grant application
2/1/2013

19. Intermediate Goals
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 1. Facilities and infrastructure
 Community-Based Trelawny Diabetes Center.
 A Wakefield church offered office space for a
temporary location.
 Staffing with trained personnel for
administration and protocol development
 Linkage to UMN
 2. Surveys of youth and adult obesity and
diabetes in Wakefield-Bunker‟s Hill-Deeside
area.
2/1/2013

20. Intermediate Goals
20
3. Develop working relationships with area
colleges/universities, schools, medical personnel,
parish councilors, community leaders and lay
persons.
 Last spring Dr. Lee visited with representatives from
several of the schools, churches and other community
leaders. The response was very positive.
 We submitted a proposal as part of a health
assessment package that was delivered by OSDJ to
the Jamaican Government..
2/1/2013

21. Intermediate Goals, cont.
21
4. Focus Groups and Pilot Studies with Jamaicans
 Filling gaps in translational nutrition research for diabetes
prevention and treatment
 Effects on glucose control, palatability, and satiety of
foods and meals prepared in culturally appropriate ways
 Breadfruit case-study
 Physical activity perceptions and opportunities
 The vast gender gap
 Blood glucose screening and monitoring
 Education, awareness
 Cultural barriers to checking blood sugar
2/1/2013

22. Intermediate / Long Term Goals
22
4. Long-terms substantial funding for training and
infrastructure
 National Institutes of Health Fogarty Training
Grant for Predocs and Postdocs
 Capacity building for non-communicable
disease prevention in lower and middle
income countries
 Permanent infrastructure grants
 USAID
2/1/2013

23. Breadfruit as a Model for Translational
Research and Capacity Building
The Breadfruit Project
 Contribute to science (antidiabetic properties?)
 Build collaborations across disciplines between
the U.S. and Jamaica
 Microeconomics, with long term potential for
broader economics
 Serve as a model for other projects with
Jamaican traditions

24. Health effects? Effects on blood sugar, etc.
Breadfruit flour as a gluten-free substitute for wheat flour.

25. http://www.treesthatfeed.org/

26. Trees That Feed Foundation
http://www.treesthatfeed.org/
Planting Trees to Feed People, Create Jobs and Benefit the Environment
 Helping local communities in developing countries achieve
sustainable food supplies, accessible markets, jobs, and
reforested environment
 Planting trees, educating, supplying equipment, fostering small
farmers and cooperatives, enabling commercial ventures
 Shade tolerant trees under canopies of larger trees, all bearing
fruit
 E.g., cocoa &coffee growing under breadfruit trees.
 Improving diets, independence from imported foods & chemicals
 Collaborating with government, NGOs, co-ops, service
clubs, churches, schools and community associations.

27. Beyond breadfruit, of course!

28. Jamaican Foods I’ve eaten this week
 Grains
 Rice and peas, Bun and cheese
 Vegetables
 Bammy, Renta yam…
 Fruits
 Mangoes (no. 11, etc.), Naseberry, Sweet Sop, Ackees,
Breadfruit, Bananas, Watermelon, Grapes, Jamaican apple
(Othaiete), Jamaican plum, Sugar cane
 Maybe it could be easy to be vegetarian in
Jamaica, but…
2/1/2013

29. Jamaican Foods I’ve eaten this week!
 Grains
 Rice and peas, Bun and cheese
 Vegetables
 Bammy, Renta yam…
 Fruits
 Mangoes (no. 11, etc.), Naseberry, Sweet Sop, Ackees,
Breadfruit, Bananas, Watermelon, Grapes, Jamaican apple
(Othaiete), Jamaican plum, Sugar cane
 Meat and fish
 Cod (with ackees), Cod fried, Snapper (steamed)
 Curry goat, stewed pork, jerk pork, jerk chicken
2/1/2013

30. Long Term Goals
 1. Develop a permanent Diabetes Prevention and
Management Center.
 A permanent site has been identified and committed
to the project.
 It‟s location is adjacent to the Wakefield Elementary School
with direct access from the main road.
 Preliminary architectural plans are being developed by a
Jamaican American in Minnesota and will be submitted to
the proper authorities in Trelawny.
2/1/2013

31. Goals of the Diabetes Prevention Center
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 A) Partner with the community to develop sustainable
strategies for preventing and managing diabetes
 B) Outreach with elementary schools and churches for
educating youths and families in optimal lifestyles
 C) Collaboration with area colleges and universities in
program development, education, research, and trainng.
 D) Research on diabetes surveillance as it relates
specifically to Jamaicans
 E) Education center for youths an adults
 F) Provision of basic clinical needs and screenings
 G) Support groups for diabetes prevention education
 H) Venue for „town hall‟ meetings and seminars
2/1/2013

32. Strategies for Long Term Goals
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 Microeconomic programs
 Stakeholders form collaborative groups determine
which enterprises are best needed for each
community.
 Real-estate, apartment rental, „bed-and-breakfasts‟
 Environmental activities that have synergistic
benefits
 Gardening, landscaping, as a benefit to the
environment, to the local residents, and as added
attraction for tourism.
2/1/2013

33. Long Term Goals
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Expand the project island-wide
 Networks and satellite offices, expanding technological
capacity and infrastructure
 Local control of the centers – BY Jamaicans FOR
Jamaicans
 Directors, coordinators, nurses, laboratory
technicians, endocrinologists, dietitians, administrator
s, office workers, grounds keepers, and community
entrepreneurs, etc.
2/1/2013

34. Summary
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 Using Capacity Building as a guide for diabetes prevention, we
are…
 Identifying needs for diabetes prevention, a community that
wants the service, potential stakeholders.
 Developing a working model and designing pilot projects.
 Exploring capabilities for receiving input from users, medical
professionals, academia and focus groups.
 Seeking financial and human resources to develop
programs, leadership, political competencies and encourage
local entrepreneurship.
 Planning sustainability through economic components and
capability for academic preparation of future professional
expertise 2/1/2013

35. Acknowledgements
35
 UWI and conference organizers
 Dr. John Finnegan, Dean, School of Public
Health, University of Minnesota
 Dr. Elizabeth Vernig, Associate Dean, School of
Public Health, University of Minnesota
2/1/2013

36. Thank you
36
As for me, all I know is that I know nothing.
- Socrates 2/1/2013