Not enough done in the Pacific

• For more information, contact the Secretariat of the Pacific Community (Richard Thomson; richardt

October 2009 Issue

   




Death is inevitable, but in the Pacific it does not need to be slow, painful or premature.
This was the message at a major gathering on non-communicable diseases (NCDs), which claim 75 percent of lives in the region.
NCDs include heart disease, stroke, cancer, diabetes and respiratory diseases. Injuries from accidents also account for a significant level of deaths or disability.
Not enough is being done to reduce the incidence of NCDs, Dr Colin Tukuitonga told health administrators, specialists and development partners brought together in Nadi, Fiji, in August by the Secretariat of the Pacific Community (SPC) and World Health Organisation (WHO).
The two organisations are leading the 2-1-22 regional initiative on NCDs (two organisations, one team, 22 countries) under the Pacific Framework for the Prevention and Control of Non-communicable Diseases.
Dr Tukuitonga—a former head of surveillance and prevention of chronic diseases at WHO and now CEO of New Zealand’s Ministry of Pacific Islands Affairs—talked frankly about progress to-date and what needs to be done to turn the tide.
Vision had to be turned into action, he said. “We have been very busy, but are a little short on achievements.”
“I think we should be shifting the focus to supporting countries and focus on fewer things and accountability instruments,’ he said.
“We should think about engaging communities as active partners. Schools are a good place to start.”
He said awareness in the region on non-communicable diseases was good to excellent.
Attitudes: However, his report card on what was being done was “must do better” on implementation and evaluation. Results in terms of process were “encouraging”, but “disappointing” on outcomes.
Dr Tukuitonga also touched on what he described as fundamental questions on attitudes to body size and food. “Do we really need 10 pigs when one will do? Do we really need to compete with others down the road? I do think we need to reflect as a people on what we are doing to ourselves.”
Delegates from 19 countries at the forum agreed that plans and policies on these diseases need to be converted into action in the community. Their list of recommendations included calls for more legislation, engagement with food importers, promoting key messages in schools, and following through with surveillance, monitoring and evaluation.
They reported on the state of NCDs in their country and on what they were doing to combat them. Six countries had NCD action plans in place, others were developing them, and all were at different stages of dealing with various mixes of challenges.
For example, the forum heard how Tonga has established an independent Health Promotion Foundation to tackle NCDs. Tobacco legislation has been passed and there are bans on smoking in public places and on selling single cigarettes to minors. Every new road constructed in Tonga must now have a footpath for safe walking.
In Samoa, a small grant scheme has supported community projects to improve and promote healthy living.
Vanuatu’s parliament has passed the Tobacco Act. The challenge now is to implement and enforce the provisions of the act. And in Nauru, the government has introduced a variety of physical activity, healthy diet and smoking control programmes.
Dr Tukuitonga said Pacific Islands countries and territories need to drive the agenda without over-reliance on development assistance. “If it’s really important, then we have to pay for it.”
Some countries spend less than five percent of GDP on health, resulting in chronic underfunding. The net effect is that programmes are not as strong as they might be.
The forum heard the cost of NCDs in Kiribati was estimated to be $16 to $17 million a year, but there was only $13.5 million in the health budget for these diseases. However, the government was addressing the problem through education programmes in schools and the community. There was political commitment to increased levels of exercise for government officials and promotion of a 30-minute walk five days a week.
Under the 2-1-22 Pacific NCD Programme, countries are encouraged to acknowledge their role in the fight against NCDs and take advantage of this regional support to develop and resource their own programmes.
The 2-1-22 initiative is funded by AusAID (AU$20 million) and NZAID (NZ$6 million). It provides support for countries developing and implementing NCD plans and promotes healthy lifestyles, community projects and clinical interventions (see http://www.spc.int/hpl).
Meanwhile, the good news according to SPC Deputy Director-General Mrs Fekitamoeloa Utoikamanu—who opened the forum with the WHO Representative in the South Pacific, Dr Chen Ken—is that NCDs are to a large extent preventable.
“These solutions are within our reach but we must be fully committed to doing something. We have to first help ourselves to make any significant impact,” she said.