According to reports from the Kiribati Ministry of Health, non-communicable diseases (NCDs) accounted for an estimated 68 per cent of all mortality in 2008.The most prevalent NCDs in Kiribati are cardiovascular diseases, which accounted for 23 per cent of total deaths across all age groups in 2008. Non-communicable variants of respiratory diseases, cancers and diabetes contributed four per cent, five per cent and eight per cent to total mortality respectively (2008).
A World Bank study also states the Pacific Islands are in top 10 countries with the highest rates of obesity — as well as diabetes. The NCD Roadmap was created at the request of the Pacific Finance and Economic Ministers. It was jointly prepared by the Secretariat of the Pacific Community, Australia’s Department of Foreign Affairs and Trade, New Zealand Aid Programme, the World Bank and the World Health Organization.
The report on the study was intended to help officials implement agreed strategies to respond to non-communicable diseases (NCDs) in ways that are affordable for Pacific Island governments. It provides the latest evidence about the economic and financial implications of responding to the NCD crisis in the region. This roadmap is not a plea for extra resources; rather it is an argument for using existing resources to better effect.
The report found that:
• NCDs account for around 70-75% of all deaths in the Pacific Islands. Many of these NCD-related deaths are premature (before age 60 years) and are preventable. Most of the trends and risk factors point to a worsening of the situation: the top 10 countries with the highest rates of diabetes in the world are in the Pacific Islands; 52.45% of adult males in Tonga are estimated to be obese; in Kiribati, Federated State of Micronesia, Tonga and Samoa adult female obesity is estimated to be 50% or more.
• NCDs impose large but often preventable financial costs on already overstretched government health budgets. Several NCD-related programs in the Pacific Islands are already unsustainable financially. However, there are proven, affordable, and cost-effective interventions. Some cost-saving interventions can pay for themselves over the longer term.
• Multiple factors inside and beyond the health sector are driving the rise in NCDs, so a multi-sectoral approach is essential. Health challenges that involve factors beyond the health sector include: availability of water and sanitation, the level and quality of girls’ education, policing of traffic violations, and domestic violence.
• Given risk factors in the Pacific and available use of cost effective actions (often referred to as ‘best buys’ for the available funding), each country should now finalize its own short country-specific NCD Roadmap that would include these four key strategies common to all countries in the Pacific:
1. Strengthening tobacco control, including raising the excise duty to 70% of the retail price of cigarettes.
2.Reducing consumption of food and drink directly linked to obesity, heart disease and diabetes such as sugar-sweetened drinks, salty and fatty food.
4.Improving the efficiency and impact of the health sector for prevention and early treatment.
5.Strengthening monitoring and evaluation around activities.
6. Effective implementation of the recommendations in this roadmap is the most likely way of ‘bending’ the cost curve for NCD treatments. The strategies put forward in the Roadmap are achievable and affordable
It is not at all surprising why the Pacific islanders who were known 100 years ago to be almost free from NCDs have made a complete reversal. Simply put they have made a complete change not only in their diet (from fresh natural foods to packed scientifically manipulated and chemicaliszed foods) but also in their patterns of life (from subsistence economy centered on hard manual labour to a cash economy based on a press-button easy way of life). A century or so ago, almost every I-Kiribati people preferred local foods over western foods but over the decades, given the smart advertising strategies from foreign suppliers of rice, four, sugar, canned and packed foods more and more switched their preferences to foreign goods over locally produced alternatives. The smoking of tobacco was among the foreign goods that first found roots in Kiribati and this went back to the early trading days when the traders first taught the locals how to use tobacco and provided them with free supplies at the initial stages. Later the locals became addicted smokers and during times tobacco supplies ran short or dry they would pay any amount in exchange for even a small piece of tobacco. Employment of thousands of I-Kiribati in the phosphate mining on Ocean Island managed by the British Phosphate Commission owned by the governments of Britain, Australia and New Zealand, over a period of about 80 years (1900 to 1979) also helped to promote a taste for western foods as the workers were rationed daily on rice, corned beef and biscuits for their entire two year contracts. As they returned to their home islands they had difficulty in going back to a daily diet of coconut, fish, breadfruit, “babai” (a ‘taro’ like tuber), pandanus and other home grown foods as they would rather eat nothing but rice, corned beef and biscuits every day. Nowadays it is getting more and more difficult to find Kiribati people eating their local foods as almost everyone from young to old is stuck on rice, flour, sugar, corned beef and other tinned or packed foods. And, if money is available, they would spend it on such goods, even if it is expensive. This is further compounded by the mindset that western foods are more prestigious than local foods and should be served to special guests of the family, village or community. As a result of these drastic changes in the attitudes and viewpoints, the quality and standard of health has deteriorated in the past few decades especially in the area of NCD’s. There are now serious talks not only in Kiribati but also in the Pacific region on ways and means of tackling the root causes of NCDs. The road map developed by a World Bank study referred to earlier is among the various approaches proposed to be adopted both nationally and regionally to bring about a reversal to the current NCD crisis.
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