Turning the tide on non-communicable diseases in the Pacific region
Authors: Saia Piukala, Helen Clark, Colin Tukuitonga, Paula Vivili, Robert Beaglehole
Journal: The Lancet Global Health (2016)

Despite multiple global and regional commitments and action plans, progress in the prevention and management of non-communicable diseases (NCDs) is inadequate.1UN General AssemblyOutcome document of the high level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases.http://www.who.int/nmh/events/2014/outcome-document.pdfDate: July 7, 2014Google Scholar Maintaining the current state of affairs means that achievement of the Sustainable Development Goal (SDG) NCD target, a 30% reduction in premature mortality by 2030, is unlikely.2Kontis V Mathers CD Bonita R et al.Regional contributions of six preventable risk factors to achieving the 25 x 25 non-communicable disease mortality reduction target: a modelling study.Lancet Glob Health. 2015; 3: e746-e757Summary Full Text Full Text PDF PubMed Scopus (85) Google Scholar The Pacific region is at the centre of the global NCD crisis, which is straining health systems and budgets and diverting scarce resources away from other health and development priorities.3Tuitama LT Young-soo S Clark H et al.Acting on the Pacific crisis in non-communicable diseases.Lancet. 2014; 384: 1823-1824Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar A 2016 Pacific NCD Summit, instigated by the Secretariat of the Pacific Community and the Kingdom of Tonga to accelerate action on the crisis facing all 22 Pacific Island Countries and Territories, provided several lessons on how to accelerate progress.4Pacific CommunityPacific Non-communicable Diseases Summit.http://www.spc.int/en/ncd-summit.htmlGoogle Scholar Here we present four recommendations that emerged from the Summit, to offer a blueprint for countries in moving forward. First, act with much greater urgency in response to the NCD crisis, under the leadership of the Head of State or Government. Declarations are no longer sufficient; results require concerted and prioritised actions by a national coalition, involving all relevant government sectors, with civil society organisations as active partners. Achieving this coherence across different ministries and sectors—each with their own mandates, priorities, and budgets—has been one of the persistent bottlenecks in getting effective NCD responses around the world. In the Pacific, as elsewhere, finance and health ministers must continue to take the lead. Their collaboration has been crucial in ensuring that policies requiring fiscal responses, such as tax increases, are agreed and acted on. Affected communities and civil society must now be empowered to engage in policy making, implementation, and monitoring of progress. Second, set time-bound national NCD response targets that are specific, measurable, achievable, and relevant, and strengthen accountability mechanisms to regularly measure and report progress. Although the Pacific NCD Roadmap has been a positive force in encouraging implementation in countries, new national targets, in line with the SDGs, will need to be introduced. The Pacific Monitoring Alliance for NCD Action, endorsed by ministers of health and supported by the Secretariat of the Pacific Community, is one useful mechanism to build greater accountability in this region. Third, prioritise the implementation of a selected number of WHO's very cost-effective interventions, which have a great effect on health and require limited financial investment. In view of multiple commitments and hundreds of possible interventions to reduce the burden of NCDs, ministers of health and finance from all Pacific countries in 2014 endorsed the Pacific NCD Roadmap with four core NCD intervention priorities5The World BankNon-communicable disease (NCD) roadmap report. The World Bank Group, Washington, DC2014http://documents.worldbank.org/curated/en/534551468332387599/Non-Communicable-Disease-NCD-Roadmap-ReportGoogle Scholar based on the globally agreed risk factor and health system targets.6WHOGlobal action plan for the prevention and control of NCDs 2013–2020.http://www.who.int/nmh/events/ncd_action_plan/en/Google Scholar These priorities are to: •Strengthen tobacco control by an incremental increase each year in excise duties up to at least 70% of the retail price of cigarettes;•Increase taxation of alcohol products to reduce harmful consumption;•Increase taxes on unhealthy food and drinks, especially sugar-sweetened drinks; and•Scale up priority interventions in primary health care to make better use of the existing health budget. Fourth, act regionally to better coordinate and fund responses, and guard against industry interference in policymaking. Several Pacific countries have taken aspects of tobacco control seriously—for example, by introducing major tax increases and expanded packet health warnings. Some issues, such as trade in health-harming products, affect many Pacific countries, and these urgently require a regional response. With the support of the Secretariat of the Pacific Community, there is the potential to act together regionally to challenge vested interests. If all Pacific countries simultaneously introduced plain packaging of tobacco products, for example, this would represent a major success against the tobacco industry that prefers to tackle countries one by one. A Pacific NCD legal instrument, perhaps a treaty, would strengthen regional action. At the same time, the UN Chief Executive Board and the Pacific NCD Summit have proposed a Pacific NCD Trust Fund as being essential for enhanced and sustained country-led action, since current investments, including external aid, are insufficient to respond to the growing burden. The NCD crisis is surmountable and reversible. Individual countries in the Pacific must lead their own NCD responses; the Secretariat of the Pacific Community, WHO and other UN agencies, academia, key development partners, and civil society must join forces behind these national efforts to achieve the changes we so urgently need. We declare no competing interests.