FORUM ECONOMIC MINISTERS MEETING
FORUM ECONOMIC OFFICIALS MEETING
25-27 April 2018
STANDING AGENDA ITEM:
UPDATE ON NON-COMMUNICABLE DISEASES ROADMAP
|Summary of Issue
|This paper which has been prepared by the Pacific Community (SPC), provides an update on the progress of regional and country efforts towards the implementation of the Non-Communicable Diseases (NCD) Roadmap.
The inaugural Joint Forum Economic and Pacific Health Ministers Meeting held in Honiara, Solomon Islands in 2014 approved the NCD Roadmap. The Ministers committed to five key areas and to develop multi-sectoral country-specific roadmaps including:
- Strengthening tobacco control by an incremental increase in excise duties to 70% of the retail price of cigarettes over the medium term;
- Considering an increase in taxation of alcohol products;
- Considering policies that reduce consumption of local and imported food and drink products that are high in sugar, salt and fat content and directly linked to obesity, diabetes, heart disease and other NCD in the Pacific through targeted preventative measures, taxes and better regulation;
- Improving the efficiency and impact of the existing health budget by reallocating scarce health resources to targeted primary and secondary prevention of cardiovascular disease and diabetes, including through the Package of Essential NCD Interventions (PEN) and ‘very cost-effective interventions’ (‘best buys’); and
- Strengthening the evidence base for better investment planning and programme effectiveness to ensure interventions work as intended and provide value for money.
- Progress at Regional Level
- At the Twelfth Pacific Health Ministers Meeting (PHMM) held in August 2017 in Rarotonga, Cook Islands, Ministers reaffirmed their commitment to enhance the implementation of the Pacific NCD Roadmap including through strengthening multi-sectoral NCD coordination and fiscal measures to reduce tobacco and alcohol consumption and improve diets, and directing some of the additional funds into health improvement.
- The Pacific Monitoring Alliance for NCD Action (MANA) has been formally established to improve access to and use of data. MANA has developed a monitoring ‘Dashboard’ of actions to prevent and manage NCD and the Dashboard was endorsed by PHMM in 2017. The MANA Coordination Team collaborated with national NCD focal points in Pacific Island countries and territories (PICTs) to complete MANA Dashboards for all PICTs. As of December 2017, Dashboards have been completed and endorsed for 11 PICTs.
- The PHMM of 2017 recognised the importance of effectively tackling the growing burden of child obesity in the Pacific. This represents a considerable threat to future health. They recommended the need for actions at national level, in line with the WHO Commission on Ending Childhood Obesity recommendations (ECHO).
- The inaugural Pacific Diabetes Associations Meeting was held in September 2017 in Nadi, Fiji to strengthen Pacific Diabetes Associations and enhance multi-sectoral collaboration for addressing the diabetes epidemic. Participants committed to strengthen the governance, role and function of diabetes associations in order to establish sustainable and robust associations to tackle diabetes. Participants identified future focus areas, potential collaborative initiatives, and areas where support is needed to strengthen their associations.
- In an effort to engage youth as part of multi-sectoral engagement in addressing NCD, regional training workshop was conducted to improve youth’s knowledge on NCD; strengthen the role of youth in responding to NCD crisis; expand the creativity of youth; and develop skills on NCD, media and communication competency. This initiative provided opportunities to develop a network of NCD youth ambassadors in the Pacific.
- PHMM adopted the Tobacco Free Pacific by 2025 target and work is ongoing to support PICTs with implementation. An MOU was signed between WHO and the Oceania Customs Organisation to work together to address the illicit trade in tobacco. An MOU was also signed with South Pacific Tourism Organisation, which will include efforts to increase smoke-free tourism and protect workers from second-hand smoke. A meeting for selected PICTs was held in March 2017 to consider this issue further.
- Building legal capacity in the Pacific to address NCD is ongoing. Government representatives from PICTs participated in intensive legal training programme in 2017 in Melbourne that addressed the NCD burden and the role of the law in preventing and controlling NCD; particularly in the context of developing coherence between health, trade and investment laws, policies and sectors.
- To address healthy diet and foster knowledge exchange, the Pacific nutrition workshop was held in 2017. During the workshop, Pacific nutritionists reviewed and accepted the revised regional Pacific guidelines for healthy living, which can be adopted or adapted at national level. The guidelines were developed as a policy tool to provide guidance particularly on the types and amounts of food, food groups and dietary patterns that aim to meet nutrient needs for health. There are also ongoing efforts to update food safety regulations requiring nutrient labelling on processed foods. Interventions to control the sale and access to sugar sweetened beverages (SSBs) and other less healthy options in the school setting are widespread and require ongoing enforcement.
- Efforts have continued to increase the efficiency of spending on health services for NCD, with continued implementation of PEN and “best buys” in primary health care, tailored to the specific health challenges, capacities, and resources of individual countries. Challenges remain in ensuring the necessary budget provision for essential medicines which can reduce the need for more expensive tertiary care later.
- In an effort to strengthen regional multi-sectoral approaches, the Pacific Regional UN thematic group on NCD brings together UN agencies and SPC to discuss NCD-related work for improved collaboration.
- Progress at country level
- Tobacco control: Between 2015 and 2017, Commonwealth of Northern Mariana Islands (CNMI), Cook Islands, Fiji, Federated States of Micronesia (FSM), Palau, Papua New Guinea (PNG), Republic of Marshall Islands (RMI), Solomon Islands, Tokelau, Tonga, New Caledonia and Wallis and Futuna increased taxes on tobacco products, and Cook Islands and Palau have conducted tobacco tax impact studies. Kiribati, PNG, Tonga, Tuvalu, Vanuatu, and FSM have strengthened tobacco control legislation.
- Taxing unhealthy food and drinks: A number of countries have used taxation on specific foods to support health promotion since 2015. For example Fiji, Marshall Islands, PNG, Niue, Wallis and Futuna, and Vanuatu increased taxes on SSBs; Tonga on turkey tails and instant noodles; and Vanuatu on sugar and sausages.
- Alcohol control: Cook Islands, Fiji, PNG, New Caledonia, Niue, Palau, RMI, Samoa, Tonga and Vanuatu have increased taxes on alcohol 2015-17. Programmes to prevent harmful use of alcohol and policy measures such as strengthening restrictions on access to retailed alcohol are underway in many PICTs.
- Physical activity and diet: Many PICTs have been implementing awareness programmes on physical activity and diet including tackling salt intake and resources have been developed regionally to support this.
- PEN protocols: Cook Islands, Fiji, French Polynesia, FSM, Kiribati, Nauru, Niue, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu have ongoing work to tailor the use and monitoring of protocols. Costing and planning tools have been developed to assist with ensuring sufficient resources for medicine, equipment and staffing and countries are being supported in the use of these.
- NCD-related data: Efforts to improve the availability and accessibility of NCD-related data have advanced with Chuuk (FSM), Kiribati, Solomon Islands, Nauru, Tonga, Tokelau, and Tuvalu completing STEPS surveys 2015-17. A hybrid survey has been undertaken in CNMI, Palau, RMI and American Samoa. Global school-based student health or tobacco surveys have been undertaken, between 2015-17 in Cook Islands, Fiji, French Polynesia, Samoa, Tokelau, Tonga, Wallis and Futuna, and Vanuatu. A cost of NCD study has been completed in Fiji, and a similar study is underway in Samoa.
- Multi-sectoral approach: Cook Islands, Fiji, Tonga, and Vanuatu launched their new NCD multi-sectoral plans. PNG, Nauru and Solomon Islands are in the process of finalising their NCD plans. Kiribati, RMI, French Polynesia and Tuvalu are working on new multi-sectoral NCD plans. Fiji, Cook Islands, Kiribati and the Solomon Islands have approved country NCD Roadmap. Vanuatu developed a National Roadmap for NCD. RMI and FSM convened a high level multi stakeholder consultation meeting.
- Pacific Diabetes Associations: Cook Islands initiated the establishment of a national diabetes association; Solomon Islands, Vanuatu and Nauru are in the process of reactivating their associations; Fiji has further strengthened its association; Tonga is processing for registration as a non-governmental organization to strengthen governance and function; and Guam has improved collaboration with department of health.
- Youth and NCD: Youth groups from different PICTs are finalising their short films, music and social media messages to help behavior change among youth and general public. For example, Wallis and Futuna has developed a documentary film that helps to improve healthy food consumption; Fiji, New Caledonia and French Polynesia have produced short films which address healthy living; and Vanuatu composed songs to address NCD risk factors. Each film will be disseminated though social media and used as advocacy and health promotion materials in the region.
The Pacific Community, Suva
3 April 2018