Samoan Minister of Finance, Hon. Sili Epa Tuioti’s remarks to the Side Event on “Non-communicable Diseases in the Context of the 2030 Agenda for Sustainable Development: Leaving No One Behind”

Conference Room XII (12) United Nations

New York, United States

18 July 2016


How Might Small Island Countries get out of the NCD Trap?


Small Island Developing States (SIDS) are particularly and especially affected by NCDs, with unacceptably high rates of morbidity and mortality. Development challenges like climate change and disasters, and economic instability, only compound the vulnerability of SIDS and prevent overall development gains.

From a health perspective, currently, NCDs account for around 75% of all deaths in the Pacific, including much higher rates of premature (below age 60) deaths in many Pacific countries than the comparable global average. The top 10 countries with the highest overweight and obesity rates in the world are Pacific Island Countries and Territories, in part due to the fact that three of the top ten worst rates of tobacco use in the world are in the Pacific region.

Economically, NCDs impose large – but often preventable – costs on already overstretched Government health budgets, and the economy more broadly. Countries can expect a further rise in the costs of treating NCDs in the coming years given the pipeline of risk factors in the Pacific, and the lack of investment in primary and secondary prevention to date. Overall NCD costs in the Pacific are expected to continue increasing, given the high level of risk factors for NCDs in the region and insufficient investments in primary and secondary prevention strategies to date. In this regard, Samoa reaffirms its support for the World Bank led study on the Economic costs of NCDs.

Pacific Islands Forum Leaders themselves have invested political capital by explicitly declaring the “Pacific is in an NCD Crisis”. Health, Finance and Economic, and Trade Ministers from the Pacific have made similar commitments.

A business as usual approach, combined with the existing high level of risk factors for NCDs, will inevitably lead to deteriorating health and living standards in the Pacific under the watch of current leaders, thereby undermining their political credibility and reputation.

But political leaders who take proactive action now to prevent and control the NCD crisis in the Pacific will significantly contribute to social and economic growth in their countries.

Following the adoption of the SAMOA Pathway in 2014, a multisectoral NCDs Partnership was established as well as the development of a NCD roadmap for the Pacific to be adapted to country context. The focus of a strategic response to the NCD crisis is centred on four key strategies common to all countries in the Pacific:

  • Strengthened tobacco control (including raising the excise duty on tobacco products to at least 70% of their retail price)); For Samoa more specifically, the percentage of adults who smoke tobacco daily fell from over one third (34.9%) in 2002 to just less than a quarter (24.4%) in 2013. The percentage of those adults with low physical activity fell from almost a half (48.8%) to less than one fifth (19.9%) over the same period.
  • The National Alcohol Control Policy was launched as part of the commemoration of the World Health Day 2016. The successful passage of these key legislation has been largely enabled through years of proactive multimedia health promotion programs which link the 4 risk factors of NCDs, unhealthy diets, tobacco and alcohol use and lack of physical activity to the many NCDsnow affecting a majority of Samoans.
  • Policies on reducing consumption of food and drink products directly linked to obesity, heart disease and diabetes in the Pacific, especially salt and sugary drinks. Within the Pacific, taxes on Sugary Sweetened Beverages are or have been applied in Cook Islands, Fiji, Nauru, Samoa, and Tonga. We are also exploring taxes on processed foods and food high in salt content.
  • Improved efficiency and impact from the existing health dollar by reallocating resources to targeted primary and secondary prevention of NCDs including scaling up of Package of Essential Non-communicable (PEN) Disease Interventions for primary health care and better drug prices;
  • The aptly named PEN Fa’a Samoa, literally meaning ‘PEN the Samoan way’, applies a village-based model for NCD prevention and control that emphasizes community participation and ownership. A significantly higher numbers of people are being screened for NCD risk factors and those who show symptoms are being given timely referrals for management of their condition.
  • Strengthening the evidence base for better investment planning and program effectiveness, including estimating productivity losses to the economy from premature NCD disability and death.

This NCD Roadmap Report for the Pacific is intended to help ‘operationalise’ – in ways that are affordable and cost-effective – the already agreed frameworks and strategies for responding to NCDs. Because of their applicability and feasibility to all countries in the Pacific, the four strategies

– if adopted – would then also become a coherent regional strategy. Each country can then also choose other interventions from a menu of other options to suit their own country circumstances.
Finally a multi-sectoral approach is essential as multiple factors inside

– and beyond the health sector are driving the rise in NCDs. The social determinants of health need to be addressed. But relying on the health sector alone to reduce the NCD crisis is ineffectual.

Thank you for your attention.