Deputy Secretary General, Andie Fong’s remarks at the 2016 Non-Communicable Disease (NCD) Summit Addressing NCDs as a Region - Strength in Numbers

Nuku’alofa, Tonga

20 June 2016

Honourable Jone Usamate, Chair of the Pacific Health Ministers Meeting

Honourable Ministers and distinguished delegates from the region,

Director General of the Pacific Community,

Representatives of Technical Agencies and Development Partners,

Ladies and Gentlemen

May I firstly take this opportunity to convey the well wishes of the Secretary General of the Pacific Islands Forum, Dame Meg Taylor. Dame Meg is currently on her way to Palau for a special meeting of the Leaders of Smaller Island States that will take place later this week. Incidentally, Non-Communicable Diseases (NCDs) are amongst the issues that will be considered by the Leaders of the Smaller Island States.
I also take this opportunity to commend the Pacific Community and the World Health Organisation for their initiative in convening this important summit. And I thank the Kingdom of Tonga for hosting this event and for your wonderful hospitality.
Ladies and Gentlemen, it is a real honour to address you on the very significant issue of NCDs, an issue that unfortunately has become extremely critical in our Pacific Islands region.
The statistics are alarming. NCDs account for 70 to 75 per cent of all deaths in the Pacific region. Or to describe it in starker terms, NCDs claim approximately fifty thousand Pacific Islander lives every year. So we are seeing our region’s population – which is already small – being devastated by diseases which we know to be largely preventable. NCDs are not just a medical or public health issue, but also a political issue – and this will be the focus of my discussion today.
My presentation will look at how the issue of NCDs has been addressed at the political level through the Pacific Islands Forum. I will talk about the various policy measures that have been identified by Forum Economic and Trade Ministers, and the opportunities for pursuing strategies to address NCDs through national trade policies. I will also talk about how the Forum is addressing a particular form of NCD, being cervical cancer. And I will conclude with some observations about the importance of partnerships in supporting our regional ambition for a healthy and productive Pacific.

Role of the Pacific Islands Forum

For those of you who are not familiar with the region or its regional institutions, the Pacific Islands Forum is the political community of 16 independent and self-governing countries in the Pacific islands region. As stated in the Forum’s constituent treaty, its purpose is to ‘strengthen regional cooperation and integration ….. in order to further Members’ shared goals of economic growth, sustainable development, good governance and security’.
The pre-eminent decision-making body of the Forum is the annual meeting of Forum Leaders – and we are busy preparing for the 47^thmeeting of the Forum which will take place in the Federated States of Micronesia from 7 to 11 September. A range of ministerial and officials level meetings also contribute to the development of regional policies and initiatives to promote sustainable development, economic growth, governance and security.
At the Pacific Islands Forum Secretariat, we work closely with other regional and international organisations to ensure that the Forum’s political directives are translated into practical action. And we work to encourage the Forum’s various country partners to also support these directives, for example through the provision of development assistance or through political support in other fora for Forum policies and initiatives.

What do we mean by regional action/’strength in numbers’?

16 Members – 1 Forum

Before I talk about how the Forum has approached the issue of NCDs, I think it worthwhile to briefly reflect on what we mean when we talk about regional action. For many of you here today who are experts in public health issues, I am sure that there is tendency to think of NCDs as largely a national issue – the responsibility of national governments to address. But we are a region that places great stock in regional action to support issues which we all share in common, such as the prevalence of NCDs. Regional action might take different forms, such as through regional dialogue and sharing of information and best practices, or the harmonisation of policies and laws, or the pooling of resources to deliver a particular service.
There are good reasons for this commitment to regional action, not least being the ability to overcome the limited resources of most of our Member countries. In this way, regional action can be seen as an important supplement to national efforts, enabling our membership to overcome shared challenges and achieve common goals.

Framework for Pacific Regionalism

I will be making reference at various points to the Framework for Pacific Regionalism, which I am sure many of you are well acquainted with. But for those who are not, the Framework represents Leaders’ most recent and detailed statement about their expectations for the Pacific region, and how regional action can support these expectations.
One of the key innovations of the Framework is its emphasis on inclusivity in the identification of priorities for regional action. A new mechanism introduced by the Framework enables anyone in the Pacific to contribute their ideas and proposals for regional initiatives. As I will discuss a bit later on, this new process has led to the increased profile on the Forum’s political agenda of the incidence and impact of cervical cancer in the Pacific.

How the Forum has approached the issue of NCDs

At their annual meeting in 2011 in Auckland, Forum Leaders squarely placed the issue of NCDs on the regional political agenda.

NCDs: Political Statements and Discussions

In their statement on NCDs, Leaders expressed their deep concern that NCDs have ‘reached epidemic proportions in Pacific Island countries and territories’. Indeed, Leaders recognised the issues as a ‘human, social and economic crisis requiring an urgent and comprehensive response’.
Leaders particularly focused on the economic implications of NCDs, including the rapidly rising expenditure on NCDs, which in many island countries accounted for over 50 percent of the total health budget. Leaders also recognised the potential for NCDs to ‘undermine labour supply, productivity, investment and education’, and the devastating impacts this could have on island economies.
In light of these circumstances, Leaders called for ‘a whole of government and whole of society response’ to address the crisis of NCDs. They also committed themselves and their governments to expedite implementation of the five key intervention areas that have been proven to reduce NCDs, being tobacco control, improved diets, physical activity, reduced alcohol, and access to essential drugs and technologies.

Economic implications of NCDs

At this point I’d like to give some more detail on the economic implications of NCDs.
NCDs place a significant strain on the social welfare and health systems of government. For example, data provided to the 2013 meeting of Forum Economic Ministers indicated that government spending on NCD-related healthcare ranged from 40% [Fiji] to 60% [Tonga] of the healthcare budgets of our Member countries.
Part of this expenditure relates to the costs of treatment which is generally higher for patients with NCDs than of other patients. For example, data indicates that in Vanuatu it is

eight times more expensive to treat patients with NCDs than communicable diseases.

Joint Economic and Health Ministerial: Agreed Actions

NCDs present significant economic implications for our Members. But conversely, economic measures can play an important role in addressing the problem of NCDs.
In 2014, Forum Economic and Pacific Health Ministers met to discuss the NCD Roadmap and jointly agreed to a range of actions. These actions included:

(i) Strengthening tobacco control by an incremental increase in excise duties;

(ii) Considering an increase in taxation of alcohol products as a way of reducing harmful alcohol consumption;

(iii) Considering policies that reduce consumption of local and imported food and drink products that are high in sugar, salt and fat content through targeted preventative measures, taxes and better regulation;

(iv) Improving the efficiency and impact of the existing health budget by reallocating scarce health resources to targeted primary and secondary prevention of cardiovascular disease and diabetes, and

(v) Strengthening the evidence base for better investment planning and programme effectiveness to ensure interventions work as intended and provide value for money.

The taxation measures relating to alcohol, tobacco and unhealthy foods are gradually being adopted by Forum Island Countries. These reforms are being considered in a time when many Forum Islands Countries are needing to balance comprehensive tax reforms with the anticipated revenue loss due to broader trade liberalisation initiatives which are in train. At the same time, economic responses to NCDs must be supported through better outreach and information campaigns about healthy living practices to make these responses more effective.
At the country level, there are ongoing efforts to introduce food safety regulations requiring nutrient labelling on processed foods. Efforts have continued to increase the efficiency of spending on health services for NCDs, with continued implementation of the Package of Essential NCDs interventions (PEN) and “best buys” in primary health care, tailored to the specific health challenges, capacities, and resources of individual countries.
More detailed discussions on these matters are expected to take place in later sessions. And as noted earlier, the progress of the measures identified by Forum Economic and Pacific Health Ministers will also be discussed at this week’s special meeting of Leaders of Smaller Island States.

Linkages between trade and NCDs

Let me now briefly touch on the linkages between trade and NCDs.

Proliferation of trade agreements

In the past two decades, our region – like the rest of the world – has seen an accelerating trend in the negotiation of bilateral and regional trade agreements. These agreements aim to integrate Forum Island Countries into the world economy, liberalise economies, increase foreign investment and exports to foreign markets and reduce prices of imported goods. With this emerges two contrasting experiences:

The benefits of trade and its contribution to economic growth and government resources; and
Profound changes in lifestyles and consumption, due to increased access to different goods and services and structural changes to economies.

Main importing origins of processed food

As is well known, our island economies are characterised by very narrow resource bases and are therefore highly dependent on international trade. Imported foods constitute, on average, 20 – 30% of total imports into Pacific island countries. The increased consumption of imported foods is a well-recognised cause of the increase in NCDs in our region. Similarly, alcohol and tobacco products are largely imported into our countries, and also represent key causes of NCDs.
There is therefore a strong case for addressing NCDs through national trade policies and measures. Indeed Forum Trade Ministers have recognised the linkages between trade and health and the need for trade and health officials to work closely together in an effort to offer a balanced approach to NCDs
Encouraging the development of comprehensive national trade policies that also take into account the health sector needs, has been a key focus of work by the Pacific Islands Forum Secretariat in recent years. This work seeks to ensure a comprehensive and coherent approach to trade, which is also consistent with other national policy objectives, such as the prevention of NCDs.
The development of national trade policies typically involves the establishment of a functional consultative body such as the National Trade Development Committee that comprises representatives from key departments within government and other key stakeholders. This mechanism presents a valuable opportunity to build linkages between trade and health policies at the national level and consider measures such as ‘sin’ taxes on products such as alcohol, tobacco and food and drinks which are high in sugar and fat.
Let me also very briefly touch on the trade, health and regionalism nexus using the pooled or bulk procurement mechanism as an illustration. The Pacific region has not sufficiently explored all possible options for reducing costs and standardising possible solutions for the health sector, particularly for the NCDs. As small markets, the Pacific Islands need to aggregate their purchasing power to reduce unit costs for various pharmaceutical products and health solutions. For example, many Pacific islanders are unable to access medication and treatment for diabetes and related complications due to the high costs. We need to explore effective regional schemes.

Cervical cancer as a regional priority

While Leaders have generally addressed NCDs as a collective issue, it is worth noting the particular attention that Forum Leaders have given to the issue of one form of NCD, being cervical cancer.

Cervical Cancer

As I mentioned earlier, the Framework for Pacific Regionalism has introduced a new process enabling anyone in the Pacific to contribute ideas or proposals for regional action. One of the proposals made last year highlighted the incidence of cervical cancer in the Pacific, and argued that this warranted regional intervention. The issue was referred to Forum Leaders who collectively recognised ‘the substantial burden that cervical cancer places on women and girls in the Pacific region as well as the insufficient response to address it across the region.’ However,

Leaders sought further consultation on the issue with relevant technical organisations and national authorities.

I am pleased to advise that these consultations are currently being progressed by a multi-agency taskforce comprising the Pacific Community, the World Health Organisation, the UNFPA, the Asian Development Bank and the Forum Secretariat. The group will explore the full burden of cervical cancer in the region, and current responses and levels of investment by countries. This analysis will enable the group to provide detailed recommendations for addressing cervical cancer through regional measures. A situation and response analysis report on the burden of cervical cancer will be presented to Leaders in 2016.

Progressing regional priorities with our partners

Before I conclude I would like to briefly reflect on the importance of partnerships in progressing our region’s policy priorities.

Partnerships to progress regional priorities

Like many of the issues which Forum Leaders deal with, the issue of NCDs is multi-faceted and complex – it cannot be solved or delivered by any one single organisation, either at the national or regional level. As such, partnerships are essential to our collective endeavour in reducing the prevalence of NCDs in our region.
The Framework for Pacific Regionalism emphasises effective, honest and enduring relationships based on mutual accountability and respect. This expectation is not limited to the relationships between the Member countries of the Forum, but applies to the relationships the Forum has developed with a wide range of regional and international organisations, many of which are represented at this Summit. Each organisation has its own institutional mandate, but you all share a common purpose in supporting the public policy priorities of Pacific countries. With your technical expertise and skills, regional and international organisations are important actors in achieving the regional goals identified by the Leaders of the Pacific.
The Framework’s emphasis on accountable partnerships also relates to the relationships that the Forum has developed with other countries. Seventeen countries are currently recognised by the Forum as Post Forum Dialogue Partners which confers certain privileges of access to Forum Leaders.
The PFD mechanism provides an important platform by which the Forum membership can communicate its collective priorities, and seek the political and developmental support of our partner countries. For representatives of our Post Forum Dialogue Partners in attendance today, I would like to reiterate the call by Leaders that PFD Partners commit to more closely aligning their engagement in the Pacific with the priorities set by Forum Leaders.

Conclusion

Distinguished delegates, Forum Leaders have articulated a vision for the Pacific in which all Pacific people ‘lead free, healthy and productive lives’. This Summit represents an important opportunity for us to make this goal a reality.
Thank you very much for your attention.

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