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UNCLAS SECTION 01 OF 03 SUVA 000157 
 
SIPDIS 
 
BANGKOK FOR REO AND AID/RDMA 
 
JAKARTA FOR RMO 
 
INTERIOR FOR OIA 
 
E.O 12958: N/A 
TAGS: SOCI TBIO FJ XV
SUBJECT: Non-communicable Disease: the Number One Killer in the 
Pacific 
 
Refs: A) State 002172   B) 08 Suva 450 
¶1.  Summary: Non-communicable diseases (NCDs) account for 
approximately 75 percent of annual deaths in the Pacific islands 
sub-region.  The World Health Organization (WHO) and the Secretariat 
of the Pacific Community (SPC) have recently joined forces to 
develop and implement "the Pacific Framework for the Prevention and 
Control of NCDs" in order to fight this epidemic.  The new WHO/SPC 
alliance may offer increased opportunities for U.S. collaboration 
with regional partners to address the growing problem of NCDs in the 
Pacific.  End Summary. 
Neglected Epidemic 
¶2.  In response to Reftel A, post prepared the following report to 
provide a regional overview of NCD policy developments involving 
Pacific island countries and territories (PICTs) with particular 
attention to Fiji as an indicative example.  Labeled "the neglected 
epidemic" by WHO, NCDs are the leading cause of mortality and 
morbidity in PICTs, accounting for approximately 75 percent of 
deaths annually, according to the SPC/WHO "Reducing Non-Communicable 
Disease Project Brief," which was published in June 2008.  Fiji's 
National NCD Coordinator, Lusiana Vodonaivalu, told us recently that 
in Fiji an astonishing 80 percent of deaths are attributable to 
lifestyle or non-communicable disease with 70 percent of these due 
to cardiovascular diseases.  More than half of these deaths occur in 
the age group 45 - 59 years.  Treating NCDs imposes enormous direct 
costs on PICTs.  Again using Fiji as an example, according to a 2002 
World Bank/SPC study, 38.8 percent of all medical treatment costs in 
Fiji could be attributed to NCDs as compared to 18.45 percent to 
communicable diseases.  Excessive alcohol use, smoking, poor 
nutrition (including increased consumption of processed food, 
especially among members of recently urbanized populations), and 
declining levels of physical activity, are reported by countries 
across the Pacific as the leading causes of NCD-related deaths. 
¶3.  Results from the WHO STEPwise approach to surveillance (STEPS) 
surveys carried out in several Pacific island countries and 
territories between 2002 and 2006 show very high incidence of NCDs. 
For example, the prevalence of diabetes in adults is three to four 
times higher than in the United States.  In Fiji, approximately 16 
percent of the population between 25 and 64 suffer from this 
disease.  The rate is even higher in American Samoa (approximately 
47 percent), the Marshall Islands (approximately 30%) and 
Independent Samoa (approximately 22 percent).  According to Fiji's 
Vodonaivalu, an average of 500 new cases of diabetes is registered 
each year in public hospitals here.  According to the Fijian Health 
officials, the figure for Fiji is lower than the actual incidence 
rate, since it is based on data that the Ministry of Health receives 
from public health clinics and does not take into account cases 
registered by private practitioners. 
Pacific Framework for the Prevention and Control of NCDs (2008-2011) 
- WHO/SPC join forces 
¶4.  In March 2008, WHO and SPC entered into a partnership to 
maximize the effectiveness of their efforts to fight NCDs in the 
Pacific.  The two organizations are working together to develop and 
implement a Pacific framework for the prevention and control of NCDs 
under a new initiative called the "2-1-22 Pacific NCD Programme" (2 
organizations, 1 team to serve 22 jurisdictions--all SPC member 
PICTs, including the U.S. Pacific territories and the Freely 
Associated States).  The 2-1-22 Programme aims to strengthen the 
development of comprehensive, multi-sectoral, national NCD 
strategies; support countries to implement their NCD strategies; 
develop sustainable funding mechanisms to deliver the strategies, 
strengthen national health systems and capacity to address and 
prevent NCDs; and strengthen regional and country level monitoring, 
evaluation and surveillance systems.  The program's focus is on 
reducing preventable NCD risk factors.  According to the SPC/WHO 
project brief, high priority will be given to developing national 
strategies and supporting their implementation with capacity 
building and funding mechanisms.  WHO/SPC also intend to provide 
support for the promotion of healthy lifestyles, the provision of 
clinical interventions and for capacity assessment. 
 
SUVA 00000157  002 OF 003 
 
 
¶5.  WHO and SPC have developed a joint work program that Ministers 
of Health endorsed in Manila in September 2008, and that will soon 
be made available on the WHO website.  Under the joint program, 
initial country consultations and talks on possible collaboration 
and partnerships have begun. 
National level actions and other initiatives underway in the Pacific 
 
¶6.  Fifteen out of the 22 PICs have already developed basic national 
NCD policies.  According to WHO NCD Officer for the Pacific, Dr. 
Temo Waqanivalu, the existence of these policies shows that there is 
some level of political awareness and commitment to prevent and 
control NCDs, but many of these plans need to be strengthened to 
make them more holistic and multi-sectoral in nature.  Dr. Temo 
emphasized the need to allocate more resources to monitoring and 
evaluation to better gauge the effectiveness of the implementation 
of national plans and strategies.  He further added that many 
countries were implementing some healthy living programs, but the 
effectiveness of these programs is unknown. 
Resources - always lacking 
¶7.  At the October 2008 Meeting of the Committee of Representatives 
of Governments and Administrations of the Pacific Community (Reftel 
B), one of the concerns participants raised was the lack of 
resources available to enable a comprehensive response to the 
"triple burden of disease" (the high level of communicable disease, 
the increasingly severe burden of NCDs, and the emerging risks from 
new diseases and changes in the social and physical environment). 
While most PIC Governments agree in principle that they need to 
increase their investments in public health, they remain dependent 
on regional/international organizations to provide leadership, 
financial resources, and technical assistance.  In Fiji, for 
example, the former government recognized that NCDs are the "number 
one killer" and developed a "National NCDs Strategic Plan 2004-2008" 
but allocated only minimal financial and human resources to 
implementing it.  The interim government has been even less 
supportive.  The NCD Unit has only one full-time National Project 
Coordinator, and the budget has also declined from FJD 500,000 in 
2004 to FJD 400,000 (around USD 200,000) in 2008 and 2009. 
According to WHO, this lack of government funding is typical of most 
PICTs. 
¶8.  Apart from having inadequate financial resources, Fiji is facing 
serious problems with national capacity for health care delivery. 
There is a high rate of staff turnover, and qualified doctors and 
nurses are leaving for greener pastures.  According to SPC, 
emigration of skilled workers is also high in Micronesian and 
Polynesian countries.  Dr. Temo Waqanivalu of WHO's Suva Office 
confirmed the SPC view on this issue and told us that, under the new 
program, WHO will help build in-country capacity.  (Comment: 
Increasing the supply of trained professionals is unlikely to solve 
the shortfall, however, if the underlying factors behind the exodus 
of health care providers are not addressed.  End comment.) 
¶9.  Response to the NCD epidemic at the regional level is largely 
funded through Australian and New Zealand government assistance. 
The Australian Government recently made a commitment to provide AUD 
20 million over the next four years to support the SPC/WHO work 
program, and NZAID has made a commitment of an additional NZD 8 
million.  Nevertheless, the needs greatly exceed the available 
resources, particularly given the low levels of national funding. 
Although the United States is not funding regional efforts, Dr. Temo 
was quick to acknowledge the work that U.S. agencies have been doing 
in the Northern Pacific.  One issue he noted, however, was the 
different guidelines used by U.S. agencies and WHO.  The existence 
of two sets of guidelines, he said, has posed some challenges for 
WHO in its work in the Freely Associated States.  Dr. Temo said 
that, while the guidelines contain the same information, they are 
presented somewhat differently, and these differences have caused 
some confusion.  He told us that he would seek out opportunities to 
discuss areas of mutual interest with U.S. agencies, and added that 
collaboration between SPC/WHO and the USG could greatly assist 
efforts to address NCDs at both sub-regional and bilateral levels. 
 
SUVA 00000157  003 OF 003 
 
 
On April 15, shortly after our discussion with Dr. Temo, WHO and SPC 
held an introductory teleconference with the University of Hawaii 
and Hawaii-based CDC representatives to discuss the Pacific 
Framework for the Prevention and Control of NCDs (2008-2011) and 
possible future collaboration.  A WHO/SPC-convened regional NCD 
meeting is scheduled in Nadi in August.  Participants from 
U.S.-affiliated jurisdictions and from U.S. agencies working in the 
Pacific will be invited to attend. 
¶10.  Comment: Ministers agreed at the Pacific Health Ministers 
Meeting in Vanuatu in March 2007 that a "whole-of-society" rather 
than a "whole-of government" approach is needed to prevent and 
control NCDs.  Consequently, efforts to reduce the prevalence of 
"lifestyle diseases" will focus on prevention.  Nevertheless, 
providing adequate care for those who are already ill will also 
require efforts to address serious human, financial, and technical 
capacity limitations.  Support from development partners for 
enabling and capacity-building activities such as the WHO/SPC 2-1-22 
Programme can play a valuable role in catalyzing action and 
promoting the sustainability of national efforts.  Continued 
exploration of possibilities for greater USG collaboration with WHO 
and SPC on this and other initiatives may offer opportunities to 
improve public health and expand U.S. engagement both in 
U.S.-affiliated jurisdictions and throughout the region. 
Pruett