Pacific health ministers led the NCD global agenda, but slow off the block – why?
The global threat posed by Non-communicable diseases (NCDs) was first flagged by the Pacific region in 1995 according to World Health Organization representative Dr Rasul Baghirov.
Since then, NCDs have become the number one cause of deaths in the world. And expected to cost the global economy US$47 trillion over the next two decades, and push millions of people into poverty. Again, it will be the number one topic at the Pacific Health Ministers Meeting (PHMM) taking place in Rarotonga, Cook Islands starting today (28 to 30 August).
“This region, the Pacific islands, recognized the [NCD] problem earlier than the United Nations. They responded by putting together a program of action – the 1995 Yanuca Declaration,” Dr Baghirov who is based in the Samoan capital of Apia told Pacific Guardians.
“However, progress has been slow. And no, that is not due to any conflict between activities at the UN level and the regional level, it is simply an operational issue.”
Those responsible for managing the ‘how’ and ‘direction’ that the ‘operational’ issue takes are Pacific Health Ministers of State and their senior officials and advisors. They are at the coalface and must take responsibility for the ‘slow’ response to the NCD crisis.
The PHMM is where the region’s priority health issues are highlighted and progress checked. It also acts as an accountability mechanism where ministers come back and report what they have done and what they have achieved.
There is hope that the 2017 PHMM will be more robust, aggressive, innovative, and bold so the region can catch up with where the rest of the world is at.
For WHO and the intergovernmental agency Pacific Community (SPC) they are secretariats to the PHMM therefore are “support mechanisms”. They do not define the regional health directions, “that is very much in the hands of the ministers representing their governments.”
But having said that, Dr Baghirov felt the 2017 PHMM will focus on four key areas and set the direction for the region to address it in an integrated way.
“NCDs will dominate the landscape and agenda,” he said with confidence.
“That’s because it is not just a health issue, it is about the way people live their lives – it is about their lifestyles and the choices they make. So it goes well beyond the medical care type of service and that is why NCDs are such a big challenge.”
And heaven knows the region needs to take more aggressive actions as the NCD crisis has still to reach its summit.
“We are still in the middle of a crisis, we have not yet reached the stage where we have turned things around. There are a lot of effort so far on many fronts but the numbers show we have increased diabetes, hypertension is on the rise, obesity is still a big problem and it is getting worse, so despite all the measures that have been put together by many people, governments and WHO, the problem still persists and is a big challenge because this is not just a health problem.”
The second area of focus will be Universal Health Coverage (UHC). “In many countries, UHC is called by many different names but essentially it’s the availability of services or expanding the services available to people.”
Many countries in the Pacific region struggle to provide services he said.
“In bigger countries like Samoa, they do have some elements of ‘tertiary care’ available but there are a large number of people that are referred to New Zealand, Australia, even India for treatment. So Pacific countries cannot afford to have the full continuum of care.
“It means Primary Health Care should be a priority focus because that is where a lot of the prevention can take place which will avoid the complications that will happen later on.”
The third area should be ‘Convergence’ he continued, “If someone is trained in Tokelau or Tonga right now, to what extent is their qualification recognized by different countries? So it is an issue of staff mobility between countries.”
Convergence also includes medicines. “Is panadol in one country legally allowed to be used in another. Convergence is another focus item in terms of medicine and human resources that needs to be considered as we look to a more integrated Pacific.”
And the fourth area are the health impacts of ‘Climate Change and Natural Disasters’.
“Outbreaks like dengue recently happened here in Samoa, American Samoa and several other Pacific countries are due to the advent of climate change.
“So how do we collectively fight those, and other emerging diseases like Zika, and the uncertainty that we don’t fully know what else could be coming next. This part of the health landscape is to look at the ‘Security Agenda’ which is becoming an important global and region priority.
‘There are also other big issues like mental health that are important from a public health perspective. Those are a range of topics the PHMM could focus on over the next three days in my personal view, but what ministers will select as the immediate and most urgent priorities we will soon see. The final decision is up to them.”
As a fully qualified heart surgeon who felt helpless to stem the number of people with heart diseases at the operating table, Dr Baghirov left to go further up stream and try to prevent people from needing heart surgery said, “Declaration [Yanuca 1995] is one thing, but how you change the behavior of people as individuals, as families, as communities is where the biggest challenge is, but also the greatest reward.”