August 22, 2011

By Bill Jaynes

The Kaselehlie Press

August 15, 2011-Health officials and development partners from 22 island nations arrived in the Kingdom of Tonga on August 8 with one common purpose-to develop strategies to eliminate or at least to curb the number one killer of Pacific Islanders-non-communicable diseases.

Speaking on the issue from a purely pragmatic point of view several presenters during the Pacific NCD Forum reminded participants that the cost of supplying medical care to patients with NCD's is a major source of monetary drain in Pacific Island nations. The economic cost affects the lives of every citizen and resident in the Pacifi c region.

"The health care costs related to these diseases is (are) formidable, with as much as 60% of the health care budgets in some Pacific Island countries and areas going toward expensive, overseas care. In addition, NCDs contribute to the burden of poverty and retard national development by impeding workforce development," background materials for the Forum said.

"Ironically, every one of the risk factors for these diseases, singly or in combination, is preventable. Yet, the prevalence of these risk factors in the Pacific remains unacceptably high," the materials continued.

The cost of expensive medical treatments for indigent immigrants to the United States from the FSM, Palau and the Marshall Islands (Freely Associated States, or FAS) has long been a source of frustration in the U.S. especially for state governments that get stuck with the majority of the bills. That frustration has escalated in light of the current U.S. economy and has recently driven high level members of Congress to push for controlled U.S. immigration policies and for dialysis treatment centers to be created within FAS countries.

But the issue of NCD's is much more personal than mere economics. In the Pacific region, loved ones, husbands, wives, moms, dads, aunties and uncles are dying or suffering from debilitating diseases far sooner than they might otherwise do had they lived healthier lifestyles.

"NCD's were responsible for 75% of the deaths in Pacific Island nations last year and were the cause of a similar percentage of chronic diseases," said Dr. Chen Ken on the first morning of the NCD Forum .

Dr. Chen is the WHO Representative in the South Pacific. He said that in the Pacific all current indicators show that NCD deaths and chronic diseases are on the rise and that something needs to be done and done quickly.

"Whatever has been done to combat the problem in the past is obviously not enough. The Pacific is in crisis," he said. He challenged the Pacific Island countries to move into crisis mode in their efforts to combat the personal and Pacific wide problem of NCD's. "Pacific in Crisis-Addressing NCD's to Appropriate Scale," was the theme of the NCD Forum jointly sponsored by the World Health Organization (WHO) and the Secretariat of the Pacific Community (SPC).

While speaking to a group of SPC sponsored journalists from eight Pacific nations participating in a pre-forum training on NCD's, Dr. Viliami Puloka, Team Leader of the Healthy Pacific Lifestyle Section of SPC simplistically defined non-communicable diseases as any disease that is not a communicable disease. He said that communicable diseases are caused by viruses, bacteria or by fungi. Communicable diseases can usually be cured by medication. NCD's on the other hand, once acquired are most often lifelong diseases whose symptoms can sometimes be treated by medicine, by dietary changes, or other lifestyle changes. They include heart disease, stroke, cancer, chronic respiratory diseases, diabetes, cirrhosis, and others.

Dr. Puloka used the acronym "SNAP" to help journalists to understand the principal behavioral risk factors that lead to non-communicable diseases: Smoking, Nutrition (unhealthy diet), Alcohol abuse, and insufficient Physical activity.

Health officials recommend that everyone participate in at least 30 minutes of moderate exercise fi ve days a week. They define "moderate" exercise as any exercise during which one can speak but cannot sing. They also say that everyone should have five servings of fruits and vegetables per day.

Most Pacific island nations report that high percentages of their populations are at risk of non-communicable diseases because of obesity, lack of physical exercise, smoking and alcohol abuse.

The problem is not an easy one to tackle because, strictly speaking the problem is not a treatment issue. There is no medicine a doctor can prescribe that would change unhealthy behaviors, lifestyle choices, or perceptions of what "life quality" means. There simply is no one stop solution to the problem of NCD's and forum participants expressed frustration that they most often spend their time "mopping up" after the problem rather than trying to solve it.

It's a hard message that is hard to hear, difficult to assimilate and tough for hearers to change even after they've heard the message. Education alone is not nearly enough.

Richard Thomson, SPC Communications and Media Officer for the Healthy Pacific Lifestyle section reminded journalists that we're all most likely going to die from an NCD someday. "Why should we die earlier, more slowly and much more painfully," he asked. Thomson was trying to convey the vital importance of media involvement in helping to stem the tide of NCDs in the Pacific. He said that members of the media have a responsibility to the people of the Pacific where NCDs are concerned. He said that it is common for media practitioners who live under constant deadlines to deal with the stress through unhealthy habits. He challenged the members of the media present at the forum to not only cover the issue of NCDs in their media outlets but also to personally model healthy lifestyles.

""I believe that no one can be an effective health officer without also being a Bible believing, spirit filled Christian," Dr. Josaia Samuela went so far as to say. Samuela is the Manager of the SPC's Health Advancement Unit. While his comment caused some mouths to drop open in bewilderment others shouted hearty "Amens!"

Other presenters discussed tax regimes and legislation as a method of controlling access to unhealthy products like cigarettes.

"We all know what we need to do but sometimes we need a bit of outside help to actually do it," Dr. Puloka said.

Health practitioners and policy advisors spent five days sharing their challenges and failures juxtaposed by encouraging success stories of which there were many.

For instance, Samoa completely banned the importation of turkey tails. A village in Tonga declared themselves to be smoke free. Marshall Islands banned the importation of betel nut. Workplace combined aerobic physical activity breaks are spreading like wildfire across the Pacific and SPC has produced a series of aerobic videos from throughout the islands to help with those daily exercise breaks. Some health ministries in the Pacific are leading by example by closing their offices and walking a set distance wearing t-shirts proclaiming the benefits of regular exercise. Some of the Health Ministers are coming out from behind their desks and actively participating in those exercise promotions. Of course, the Island Food Community of Pohnpei with their nutritional message of "Let's Go Local" was touted as a huge success.

The ideas and success stories were nearly endless.

The sharing of ideas amongst the 22 Pacific nations and the further ideas they might inspire to combat the problem of NCD's when they returned home was the principal purpose for the Forum.

We as Pacificans need to look to our own selves," said Dr. Puloka while addressing the entire assemblage of forum participants. "We need to go local. We need to be original."

"The saddest type of poverty is the poverty of ideas; the poverty of innovation…We (in the Pacific) may not have money. We may be poor in resources but we are not poor in our abilities."

The FSM was represented by Assistant Secretary for Health Marcus Samo, Program Manager of the NCD unit, Kipier Lippwe, and DPCP Coordinator for Chuuk State Moria Shomour. The Managing Editor of the Kaselehlie Press also attended the conference and committed to keeping the issue of NCDs in the public eye in the FSM.