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Promise of Progress in the Pacific

Tuesday 11 November, 2014
by Alexandra Jones and Ebil Matsutaro

Pacific Island Countries and Territories (PICTs) bear the heaviest burden of non-communicable diseases (NCDs) globally, but there are promising signs that the region is also beginning to develop specific, multi-sectoral responses.

PICTs bear the heaviest burden of NCDs globally

PICTs have good reason to address NCDs from a multi-sectoral approach.  NCDs account for around 75% of all deaths in the Pacific Region. Rates of premature death are much higher than the global average. PICTS make up the top ten countries in the world for rates of overweight and obesity. Three of the top ten highest rates of tobacco use in the world are also in the Pacific region. 

NCDs impose a large - yet often preventable - cost on PICT economies. Rising NCD expenditure comprises more than 50% of the total health budget in many PICTs. Insufficient investment in prevention has led to unsustainable levels of treatment spending. Pacific Economic and Health Ministers have acknowledged that without decisive action, NCDs could undo the social and economic development gains of the last 20 years in the region. From a practical standpoint PICTs have fewer resources to deal with the challenge, making it important to deal with these alarming statistics through existing resources that can also be channelled to address NCDs.

By declaring a ‘crisis’, Pacific leaders have firmly added NCDs to the political agenda, resulting in increased momentum on a national and regional scale to control and reverse the impact of NCDs. Significant recent events provide detail of specific commitments, plans, and institutional partnerships intended to accelerate progress.

In July’s Honiara Statement, for instance, Pacific Economic and Health Ministers committed to five ‘best-buy’ actions common to the region, to be incorporated into country-specific roadmaps:

  • Strengthening tobacco control, including raising the excise duty on tobacco products to 70% of their retail price in the medium term;
  • Considering an increase in alcohol taxes to reduce the harmful consumption of alcohol;
  • Considering policies to reduce consumption of food and drink products high in sugar, salt and fat content and directly linked to obesity, diabetes, heart disease and other NCDs though targeted preventive measures, taxes and better regulation;
  • Improving the efficiency and impact of the health budget by reallocating scarce health resources to target prevention of cardiovascular disease and diabetes; and
  • Strengthening the evidence base for better investment planning and programme effectiveness.
 
Leaders also committed to facilitate other interventions as appropriate to specific country needs and capacities, including those described in a supporting NCD Roadmap document. 

Recommended interventions are also deliberately multi-sectoral, recognising the health sector alone cannot effectively reduce the burden of NCDs. Significantly, the NCD Roadmap highlights specific responsibilities for particular Ministries, for example: 

  • Leadership from the Prime Minister’s Office can display a sense of urgency, convene stakeholders, make decisions, remove policy obstacles, and hold stakeholders accountable for implementing commitments.
  • Ministries of Finance and Economic Policy can ensure effective use of scarce resources, and  design and implement strategic taxes to reduce consumption of unhealthy products  
  • Ministries of Health are central in targeting high risk groups within the health sector (for example, those already overweight, sedentary, smokers or insulin resistant), in strengthening health systems, and in increasing efficiency and impact of existing health budgets. 
 
The Roadmap also emphasises the significant role of Ministries of Trade. International trade provides both risks and opportunities among small and often remote PICTs, where imported goods as a share of GDP are twice the global average (59% vs 30%). While trade has provided economic growth, increasing availability of goods has also included rapid growth in imports of unhealthy foods, drinks and tobacco products. The Roadmap reiterates the ability of Pacific policy makers to restrict the import of unhealthy products on public health grounds, provided these measures are consistent with trade agreement rules. A ‘whole-of-Government’ approach is recommended, allowing leadership by the Prime Minister’s Office and specific involvement of the Ministry of Health in developing a country’s position on trade and taxation. 
 
The Pacific NCD Partnership, launched at the recent Small Island Developing States Conference, aims to strengthen and coordinate the necessary capacity and expertise to support PICTs to fulfil the commitments of the Honiara Statement and the NCD Roadmap. Country level activities are paramount, but regional collaboration and harmonisation of efforts with support of international partners will allow PICTs to draw on shared experience, capacity, and resources to address NCDs as a matter of urgency. 
 
Already there are promising signs: both Nauru and French Polynesia have taxes on sugary beverages. Tonga has recently increased taxes on tobacco, lard, and soft drinks, and decreased taxes on fresh fish. In Fiji, His Excellency Ratu Epeli Nailatikau recently opened a two day event on NCDs and the law with recognition of the ‘huge role’ legislation must play in achieving an NCD free Fiji.  In Palau, a two-day NCD multi-sectoral partners’ meeting is being held for stakeholders to brainstorm and eventually agree on a model for a multi-sectoral approach to addressing NCDs.  
 
Declaration of NCDs as a crisis has generated political recognition and momentum to develop regional partnerships, processes and plans for a pragmatic, multi-sectoral response, despite limited resources. In 2015, individual PICTs are due to report on progress in implementing country specific roadmaps. If such plans can translate early recognition into domestic activity with an impact on the ground, there is promise that Pacific leadership, in partnership with international support, can go a long way.  

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