Winning battle against NCDs tops Public Health agenda in Tonga

Jun 20, 2016

Nuku'alofa, Tonga: Feliti Hoeft, 54, comes from the village Tofoa in Tongatapu. Before getting diagnosed with diabetes, he was a hard working man, gainfully employed operating heavy earth moving machines. Today, both of his feet are amputated. The first amputation took place in 2000, the same year his diabetes was diagnosed. He admits he never imagined the disease would progress this far and so he never took the doctor’s advice seriously. In those initial days after the disease was diagnosed, he continued to be casual about both his eating habits, nor would he take the medicine seriously. “I did not really know what to avoid eating. Whatever was offered I would not refuse. That meant not cutting back on a carbs-heavy diet of root crops such as the cassava, tapioca and the dalo. “Now, I am on greens and only a very limited proportion of the carbs. But it is already too late” he says with a half-resigned look.  

Feliti concedes eating right is a major part of the battle won. “Wrong diet was my enemy number one. I was one of those who thought I could go on eating almost everything because I was taking medicine regularly but clearly this was a wrong approach. And I paid dearly for my wrong approach”.

“Everything is at a stop now. Once I am out of the hospital, I will reassess if I can work but with both my legs affected, I wonder if I can work in the way I used to before”, Feliti says with a tone of wistfulness. He adds, “I do educate my children about their vulnerability to the disease and the importance of sound eating habits. They seem to listen to me while t home but I am not sure if my lessons are adhered to in school as well”.

Prevalence of diabetes, a non-communicable disease (NCD) characterized by high blood glucose (blood sugar) levels, is extremely high in Tonga. In 2012, it was estimated at 34 per cent, more than double the 2004 estimate of 16 per cent. Although some of the increase can be attributed to higher case detection, in general low levels of physical activity combined with high consumption of starch-heavy imported junk food, carbonated drinks and fat-rich animal meats have caused close to 70 per cent obesity among the Tongan population. Surveys show more than 50 per cent of Tongan household expenditures are on imported foods, a majority of which are high in sugar, salt and fatty contents, which also points to low consumption of nutrient-dense foods, such as fruits and vegetables.  

NCDs, including diabetes, heart and lung diseases and cancer account for nearly 75 per cent of deaths in the Western Pacific. Over 50 per cent of these deaths are premature and preventable. They pose significant risks to public health in the Kingdom and impose a significant socio-economic burden on Tongan citizens as well as the Tongan economy. The Tonga National Strategy to Prevent and Control Non Communicable Diseases (NCD Strategy) is evidence-based, visceral and frank in citing some of the serious NCD and public health challenges the country faces. 

An estimated 99.9 per cent of Tongan adults between the age of 25 and 64 are at moderate-to-high risk of developing a NCD.  In 2012, Tonga was ranked the third most overweight country in the world. Obesity is commonly occurring at younger ages. The percentage of the population susceptible to Diabetes with impaired fasting glycaemia rose by around 7 per cent between 2004 and 2012. High cholesterol affects almost half the adult population. Almost one in two men are smoking, and smoking appears to be increasing amongst young women. The number of cases of lung and tracheal cancer has rapidly increased over the last 30 years and admissions for chronic obstructive pulmonary disease are growing.

The country has now placed the oversight of the NCD Strategy in the hands of the National NCD Committee (NNCDC), a multi-disciplinary empowered body comprising chief executives from key government ministries as well as church and civil society representatives. 

For dealing effectively with the scourge of tobacco use, the Kingdom of Tonga has put in place a much strengthened legislative and enforcement mechanism that ensures compliance and results in measurable improvements in dealing with tobacco abuse. Smoking in all public places, including work places, kava parties, schools and other educational institutions and even bars, night clubs and restaurants has been banned by law. The police are authorized to levy spot-fines for any observed infringement of the law. 

The health promotion interventions designed as part of the NCD Strategy implementation by the Ministry of Health (MoH) focus on four distinct programme interventions: healthy setting; healthy eating; tobacco control; reduction of alcohol abuse. Health promoting schools, the church health promotion forum and health promoting work spaces carry forward those messages.

It is now known that 46 per cent of males and 13 per cent of females are smokers in Tonga.  As part of the NCD strategy implementation, a nation-wide multi- media anti-tobacco campaign was launched on 31 May 2016. The campaign will run for six weeks. Aside from running public service advertisements on broadcast and social media and having posters and billboards put up at busy and strategic locations all over the country, an innovative feature of the campaign is a phone-in based ‘Quickline’ that enables the general public to call and speak to a Quickline counsellor. The role of monitoring the implementation of the NCD Strategy has been assigned to Tonga Health, an autonomous body appointed by the Minister of Health. Tonga Health is composed of two representatives from the field of health and illness prevention, one with expertise in business, management or law, one representing the interests of the churches or community groups, and one member of the Legislative Assembly.

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