Posted by : Posted on : 02-Mar-2020

Implementing , translating knowledge and taking action on non-communicable diseases (NCD’s)

Speaking at the official dinner at the weekend in honour of the visiting Prime Minister of Papua New Guinea, the Hon. James Marape, who was on a three-day state visit to the Solomon Ialand’s capital Honiara, Prime Minister Manasseh Sogavare revealed, and not for the first time, some very alarming facts about NCD related deaths in the Solomons.

Prime Minister Sogavare said, “Non-communicable diseases have evolved as the single largest killer of people in the Solomon Islands.

“Nearly 8 deaths out of every 10 deaths in the Solomon Islands are due to Non-communicable diseases. These deaths are largely preventable.”

He went on to add, “We need to do more individually and together to help reverse the current NCD epidemic in our countries. We need to pull our people back from the jaws of death.”

I could not agree more with what Prime Minister Sogavare said but firstly let us look at the background to the ongoing NCD threats to health and then consider some possible steps that the SIG might take.

The background was effectively summarised during the 13th Pacific Health Ministers Meeting which was held in Papeete last August.

On that occasion, the Pacific Community’s Director-General Dr Colin Tukuitonga highlighted, in his opening speech that the Pacific is known for its subsistence living, communal farming practices and self-sufficiency when it comes to fresh farm produce.

He then said, “But the region also has a growing reputation as having one of world’s highest Non-communicable disease (NCDs) rates. For centuries the Pacific way of life has proved to be a model of healthy living practices and harmony with the environment. Sadly, the emergence of modern unhealthy diets, climate change and other environmental factors that influence unhealthy lifestyles and behaviours has dramatically impacted the health of Pacific people.”

 He added, “NCDs are the leading cause of premature death and disability in the Pacific. Pacific Islands countries and territories are among the top ten with the highest rates with type 2 diabetes and obesity in the world. Childhood obesity is also an emerging public health concern across the Pacific. They pose a major threat to health and sustainable development across the region.”

In 2015, some answers as to how to tackle the NCD threat surfaced in a paper released by the Australian National University with the title ‘How Can We Strengthen Governance of Non‐communicable Diseases in Pacific Island Countries and Territories?’

 Yes, in 2015, five years ago!

 Taking a few extracts from the ANU paper they said, quote:

 “Pacific island countries and territories (PICTs) are some of the most geographically isolated in the world. Most have small populations and economies. In addition to the economic challenges that they face because of isolation and size are the risks of climate disaster and the challenge of noncommunicable diseases (NCDs), including cardiovascular disease, cancer, diabetes and tobaccorelated diseases. This article builds on knowledge about the key features that characterise effective national responses to NCDs, as embodied in the World Health Organization's Global Action Plan for the Prevention and Control of Non communicable Diseases 2013–2020.”

 It seeks to identify some promising strategies for strengthening the governance and law reform processes that will be required to enhance the capacity of small island states to reduce NCD risks in their populations.”

 “The leading NCDs that impact on health systems include heart disease and stroke, cancer, diabetes and chronic respiratory diseases.

These are driven by a cluster of inter‐related risk factors including tobacco use, harmful use of alcohol, poor diet (excess intake of saturated fat, salt and sugar), obesity and lack of physical activity. This article considers how strengthened governance at national and regional levels might assist PICTs to make progress in implementing the regulatory and legal reforms that are needed to reduce risk factors and disease outcomes across PICTs. The challenge that NCDs pose for PICTs will be relevant to all SIDS, which comprise over one quarter of the countries in the world.”

 “ Countries with small populations need to preserve their precious human resources. NCDs affect people during their productive years, interrupting paid employment, imposing care demands that prevent other family members from working, and further weakening household finances. In the Pacific, health expenditure is primarily financed by the government—with assistance from development partners. Evidence from Samoa, Tonga and Vanuatu suggests that expenditure on health in PICTs is already substantial as a share of total government expenditure, placing constraints on further growth in the absence of revenue‐generating policies, such as higher taxes on tobacco, alcohol and sugary drinks.”

 “An important goal for PICTs, in making progress on the prevention and control of NCDs, is to implement the World Health Organization (WHO)'s Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020.”

 “The action plan sets out a range of cost‐effective priorities (‘best buys’) covering tobacco use, harmful use of alcohol, improving diet and physical activity One notable feature of these evidence‐based, cost‐effective interventions is that they can be expected to alter patterns of consumption and lifestyle risks across the population, without the need to engage directly and specifically with each individual. By contrast, individually focused lifestyle interventions that seek to support or encourage individuals to choose a healthier lifestyle are likely to be very cost‐ineffective, yielding only trivial benefits to population health.”

 “At the Joint Forum Economic and Pacific Health Ministers Meeting in Honiara in July 2014, Economic and Health Ministers from Pacific Island Forum countries agreed that NCDs are ‘financially unsustainable’ and committed to develop country‐specific roadmaps covering the following five priorities Strengthening tobacco control;

Considering an increase in taxation of alcohol products;

Reducing consumption of unhealthy food and drink;

Improving efficiency of existing health expenditure; and

Strengthening the evidence base to ensure optimal use of resources.”

The ANU paper referred to ends by saying

“ PICTs options despite what is contained in the NCD Roadmap Report, the fact remains that PICTs are constrained by their lack of resources, including physical infrastructure, health workforce and sustainable financing. Small countries cannot do everything. The WHO's ‘best buys’ and the Roadmap priorities may be costeffective, but this does not mean that implementing them creates cost savings. On the contrary, implementation inevitably costs money, and where health budgets are severely limited, governments may be forced to choose between treating people who are sick, and seeking to reduce the future burden of NCDs and associated expenditures.”

Despite this, raising taxes may be politically challenging for governments: ‘Whether seeking to raise taxes, or to implement other regulatory responses governments will also face resistance from tobacco, alcohol and processed food industries and potentially from other countries, including development partners For all these reasons, the challenge PICTs face is not the lack of knowledge about the policies that could make a difference, but implementation: translating knowledge into actions at the country

Yours sincerely

Frank Short

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