Islands Business - Cover Story/ Health: WHAT’S KILLING OUR ISLANDERS?

Diabetes and other lifestyle disease ac count for 70% of deaths in the Pacific

Dr Chen Ken

Health crisis in the islands

Pacific Island countries (PICs) are facing a health crisis. A middle-aged Fijian man dies from heart attack at the Colonial War Memorial Hospital (CWMH) in Suva; a chronic renal failure patient awaits his death at Princess Margaret Hospital in Funafuti; a man has his foot amputated in Rarotonga hospital because of diabetes; a Samoan woman suffers a stroke and scores of adults lose their sight due to cataracts in Tonga.

These stories are becoming all too common and may even become a norm for hospital visits in the Pacific. These diseases or complications are classified as Non-Communicable Diseases (NCDs) and they account for up to 70% of all deaths in the Pacific Islands.

Underneath these major diseases are common preventable risk factors of tobacco smoking, unhealthy diet and physical inactivity. If these factors are not addressed, they become diseases of tomorrow.

The World Health Organisation (WHO) has set a goal of reducing NCD rates globally by 2% per year until 2015.

To assist in meeting this goal, WHO is involved in three global initiatives: the Stepwise Approach to Surveillance of Risk Factors for NCDs (STEPS), the Framework Convention on Tobacco Control (FCTC) and the Global Strategy on Diet, Physical Activity and Health (DPAS).

STEPS It offers an entry point for low and middle-income countries to get started in NCD prevention and control activities. Fourteen PICs (Fiji, Tokelau, Samoa, Nauru, American Samoa, Marshall Islands, Micronesia, Cook Islands, Solomon Islands, Palau, Kiribati, Vanuatu, Tonga, Tuvalu) have undertaken STEPS surveys and are at different stages of progress.

STEPS have revealed a high prevalence of NCD risk factors in countries in the Pacific that must be addressed now to avert this crisis. These risk factors form the basis for national planning to reduce NCDs.

A quick look at some of the results reveals that tobacco is the number one preventable risk factor for NCDs. The prevalence of smoking is high throughout the region.

FCTC In Fiji alone, 37% of the population are smokers compared to only approximately 20% in developed countries.

In order to strengthen global tobacco control, WHO negotiated and endorsed the Framework Convention on Tobacco Control (FCTC), a major public health treaty that became international law in February 2005.

It lays the foundation for a comprehensive and meaningful global response to the tobacco-use epidemic.

So far, all PICs have ratified FCTC and have the obligation to comply with its regulations including the banning of advertising and sponsorship by the tobacco industry, forbidding sales to minors, increasing the size of health warnings on display area of cigarette packs and using taxation to reduce consumption and clamp down on smuggling.

In addition to legislation, the establishment of tobacco-free premises (tobacco-free villages, hospitals, ministries, sports complexes and organisations) is also an effective tobacco control strategy.

Nabila village in Fiji became the first tobacco-free village in the Pacific in September 2005 and won the “WHO World No Tobacco Day Award 2006”. This award acknowledges the efforts of senior citizens and leaders of Nabila village for their leadership and acknowledges the long-term commitment and support of all residents of Nabila village for their own health through tobacco control.

Since then, Nadrala village has become the second tobacco-free community and WHO is encouraging other villages throughout the Pacific to emulate these communities.

Hospitals, ministries, sports complexes and organisations can also set an example by becoming tobacco-free. Already two hospitals in Fiji, Colonial War Memorial Hospital (CWMH) and Tavua Hospital have been designated by the Ministry of Health as tobacco-free hospitals.

A critical lesson learned from tobacco control is the danger of waiting too long to act. It took 50 years from the first evidence of health risks due to tobacco smoking to establish international tobacco control programmes. Today, obesity is out of control and there is sufficient evidence to support the need for urgent action. The rate of adult overweight and obesity in PICs range from 50% in some countries to as high as 90% in others.

DPAS Realising the need for immediate action, WHO formulated the ‘Global Strategy on Diet, Physical Activity and Health’ (DPAS) in 2004 and the strategy was endorsed by its 191 Member States.

Although not law, it represents a framework of recommendations for actions put together by multiple stakeholders for healthy lifestyle with the UN organisations of FAO and UNICEF actively involved.

The DPAS recommends a prevention-oriented approach that emphasises the need for countries to develop coherent, multi-sectoral national strategies with a long-term, sustainable perspective. The goal of this approach is to make healthy choices the preferred alternatives at both the individual and community level for two of the major risk factors of NCDs—poor diet and physical inactivity. The strategy emphasises the need to limit consumption of saturated fats and trans-fatty acids, salt and sugars and increase consumption of fruit and vegetables and levels of physical activity.

It also addresses the role of prevention in health services; food and agriculture policies; fiscal policies; surveillance systems; regulatory policies; consumer education and communication including marketing, health claims and nutrition labelling; and school policies as they affect food and physical activity choices.

There needs to be a shift from being import dependent to increasing production and consumption of local foods especially more nutritious fruits and vegetables. This increased consumption of healthy foods should be complemented by a reduction in fat, sugar and salt intake, hence the call on food industries to create a supportive environment by offering healthy alternatives for the public. The recommendation for physical activity is ‘30 minutes of moderate intensity physical activity (e.g. brisk walking, home gardening) on most days of the week’. These recommendations form the basis of actions to reduce waistlines and together would lead to a reduced risk of NCDs and a more healthy population.

In the Pacific, amongst other strategies, WHO (with UNICEF) is working with countries to implement the strategy through school-based interventions as it provides a convenient setting for some of the healthy diet and physical activity behaviours to be learned early and shunning of unhealthy ones.

This involves both curriculum-based activities and the whole-of-school approach.

Reducing the mortality rates and incidence of NCDs will require sustained efforts on the part of all organisations and individuals interested in improving the quality of life in the Pacific.

• Dr Chen Ken is World Health Organisation Representative in the South Pacific