Keynote Address from UNDP Administrator Helen Clark on 'Non-communicable Diseases – a Sustainable Development Priority for Pacific Island Countries'

Jun 20, 2016

I am delighted to join you at this Pacific NCDs Summit on “Translating Global and Regional Commitments into Local Action”. Let me begin by thanking His Majesty King Tupou VI and the Government of Tonga for hosting this timely and important Summit in collaboration with the Pacific Community (SPC). I am pleased to see so many leaders and ministers here from across the region, along with officials from key supporters of this event from the Australia Department of Foreign Affairs and Trade, the New Zealand Ministry of Foreign Affairs and Trade, the World Bank, the World Health Organization, and the World Diabetes Foundation. UNDP is also proud to support this Summit. All of us have come together here in Tonga because we are committed to addressing the health and development challenges which NCDs are posing to the Pacific, and to redoubling our joint efforts to turn the tide on this epidemic of disease. 

As recently as the 1960s, diabetes was not a significant problem in the Pacific Islands. Today, every twelve hours a Fijian loses a part of his or her lower limbs to this debilitating condition.  The story, sadly, is similar elsewhere in the sub-region. Of the ten countries and territories with the highest diabetes prevalence in the world last year, eight were Pacific Island countries.  The year before that, seven Pacific Island countries were ranked amongst the ten most obese countries globally. 

Forty percent of Pacific Islanders have been diagnosed with an NCD according to WHO in 2010  — many before they have reached their fortieth birthday. In several countries, including Vanuatu and the Solomon Islands, over one-third of deaths from NCDs occur before the age of sixty – a much higher proportion than in many other low– and middle-income countries.  Cardiovascular disease, cancers, chronic respiratory disease, and diabetes are clearly no longer unique to wealthy countries and aging populations. 

I call attention to these trends, as did the honourable speakers before me, not to alarm you but as a sobering reminder of the immense NCD challenge faced by this unique region.

I am confident, however, that the Pacific has the determination to meet the challenge head on. Already it is showing strong leadership in the NCD response. In 2011, it recognized NCDs as a crisis, and two years later adopted the historic Tobacco Free Pacific by 2025 target. Most recently, a Regional NCD Roadmap has been agreed to operationalize global, regional, and national frameworks and strategies for responding to NCDs.

Yet we find ourselves here with good reason – progress has been insufficient and uneven in combating NCDs, both globally and in the region. This Summit is an opportunity for the Pacific to strengthen its commitment to take stronger, integrated, and more urgent action. It is also a time for working on how to ensure that NCD responses are well aligned with global health and development agendas more broadly, including with the SAMOA Pathway.

In my remarks today, I will highlight common bottlenecks holding back action on NCDs in the Pacific and around the world, and offer some potential pathways for collective action. 

NCDs in the 2030 Agenda for Sustainable Development

Last year was a watershed year for global development. Member States reached major new agreements which set the global development agenda for a generation. Framing the work ahead are the 2030 Agenda for Sustainable Development, the Paris Climate Agreement, the Sendai Disaster Risk Reduction Framework, and the Addis Ababa Action Agenda on financing for development. The SAMOA Pathway for Small Island Developing States also frames sustainable development action here in the Pacific.

Agenda 2030 is broader and more ambitious than the MDGs which preceded it. The new agenda has goals and targets aimed at achieving inclusive growth, decent work, infrastructure development, social policy objectives, and environmental sustainability. A core principle is reducing inequalities of all kinds significantly.

The Agenda was shaped by many voices, including from this region. Almost two years ago at the UN Conference on Small Island Developing States in Samoa, I commended UN Member States from this region on their unwavering efforts to ensure that NCDs and tobacco control were positioned firmly in what are now the Sustainable Development Goals. 

Thanks to your efforts and those of many others, we now have clear targets in these areas in the new global agenda. For example, by 2030 we must strive to reduce premature mortality from NCDs by one third.  And, thanks in large part to vocal supporters like Palau, the new agenda urges strengthening implementation of the WHO Framework Convention on Tobacco Control in all countries. 

For everyone in this room, both Agenda 2030 and the SAMOA Pathway are important foundations for action. The challenge now is implementation – to reach the objectives the international community has set.

NCDs as a development issue

In moving forward, it is critical that we see the health and development agendas as closely linked.

Whether we’re talking about the costs of insulin in Vanuatu  or of kidney dialysis in Samoa , the evidence is clear: the epidemic of NCDs is straining health systems and budgets, and diverting scarce resources away from other health and development priorities. 

NCDs hold back national and global economies and society. Diabetes alone costs Australia AUS$ 14.6 billion each year, with the costs expected to more than double to thirty billion by 2025.  The projection is for US$ 30 trillion to be lost in global economic output between 2010 and 2030 because of cancer, cardiovascular disease, diabetes, and chronic respiratory illness. 

The costs of NCDs to individuals, families, and communities are also high. NCDs often rob wage earners of the ability to provide for their families. Unpaid care work often rises for women and young girls, with the latter pulled out of school to care for bedridden or disabled relatives.  Where adequate social protection is unavailable, poverty, inequity, and vulnerability in Pacific communities worsen. 

Whole-of-government approaches to the epidemic are needed. The impact of NCDs is felt across all sectors. The conditions in which people are born, grow, live, work, and play - the social determinants of health - shape patterns of disease distribution. 

Action in the health sector alone will not produce the gains in health status and development we all want to see. As a young Health Minister almost a quarter of a century ago, I could see that I had been able to achieve as much, if not more, for public health in my previous role as Minister of Housing.  

Now, as Administrator of the UN Development Programme, my conviction is even stronger that just as health shapes development, so development also shapes health. NCDs are no exception to this rule. In the Pacific, the NCD crisis is strongly linked to patterns of trade, consumption, agricultural production, foreign direct investment, and unplanned urbanization. These have combined powerfully to promote the energy-dense and nutrient poor diets which are a key NCD risk factor.

Take trade for example. Imported goods and services as a share of GDP are nearly twice as high in Pacific Island countries as in the rest of the world – 59 per cent in the Pacific versus thirty per cent globally.  Exported mutton flaps, turkey tails, ultra-processed foods, and other products high in fat, sodium, and/or sugar have reached Pacific Islanders’ dinner plates. These products are marketed intensively by industry. Unfortunately, they are often more affordable, convenient, and available than are healthier local and traditional alternatives. 

This is the situation today. But it need not – and cannot – be the situation tomorrow. The obesity epidemic in the Pacific is not inevitable and it can be stopped. With the right policies, the right investments, and the right support from all partners, the tide can be turned on NCDs in this region and in the rest of the world. 

Win-wins across sectors for NCDs and sustainable development

Getting the policies, investments, and partnerships right depends critically on coherent action across government on the links between NCDs and the social, economic, and environmental strands of sustainable development. Achieving this coherence across different ministries and sectors – each with their own mandates, priorities, and budgets – has been one of the persistent bottlenecks for getting effective NCD responses in the Pacific and around the world.

It was encouraging to see Tonga apply the MDG Acceleration Framework to address the links between poverty, gender, and NCDs. UNDP and other partners have been delighted to support this, knowing that the experience can help shape regional action on NCDs. It is important that the Regional NCD Roadmap recognizes the importance of action across sectors for NCDs. 

The 2030 Agenda can be a springboard for the implementation of the Roadmap. The interconnected nature of the Agenda’s seventeen goals and 169 targets demands national responses which work across siloes. Win-wins are possible for health and development – take taxes on health-harming products like tobacco as a powerful example of that. Such taxes discourage people using products which harm their health. This enables people to be healthier and economies to be more productive, while also raising government revenue and reducing future health care costs. 

Tobacco taxation is specified in the Addis Ababa Action Agenda on financing for development as an important revenue stream. In the past year alone, most Pacific Island countries have increased tobacco tax rates. In Kiribati, the tobacco-specific excise tax is above seventy per cent of the retail tobacco price. In Tonga, I understand the total tax on tobacco, when excise and value-added taxes are combined, is also above seventy per cent of the retail tobacco price, as it is in my own country, New Zealand.  With these precedents, it could be possible for tobacco taxes to reach at least seventy per cent of the retail tobacco price across Pacific Island countries. 

Of course tobacco is not the only health-harming product of concern. A majority of Pacific Island countries have now raised taxes on sugar and sugar-sweetened beverages, while a number have decreased taxes on fresh produce. We need both incentives and disincentives to change behaviours and promote healthier consumption.

Let’s also focus on the harm to people of living or working in an unhealthy environment — in 2012, 12.6 million deaths were attributed to that. 8.2 million of those deaths were from NCDs caused by air pollution.  Removing fossil fuel subsidies in order to reduce greenhouse gas emissions, and then releasing the money for sustainable development, including for health, is a smart move. 

Indoor air pollution from open wood fires and charcoal cooking is affecting people in rural Papua New Guinea, the Solomon Islands, and Vanuatu — as it does in many countries worldwide. Initiatives like the Global Alliance for Clean Cookstoves can both increase energy efficiency and reduce deforestation, while also curbing indoor air pollution and the chronic illnesses it causes. Since women and young children are often exposed disproportionately to smoke from stoves, there are significant gender and health equity benefits.

Education is another area where we can link health and development. Schools are a ready-made environment in which to offer children and young people healthy food and beverages, and to promote healthy behaviour overall. We must empower youth to adopt healthier diets and increase their physical activity. In turn this will help their ability to learn. NCD prevention and control is a foundation for long, productive, and better lives.

Bold policies have been designed to address all the matters I am raising in a number of Pacific Island countries. Now is the time to implement them vigorously. 

Curbing the NCD epidemic will require new ways of working together.  We must commit to:

  • effective and transparent co-ordination across sectors, to improve knowledge sharing and help align different priorities and actions;
  • empowering affected communities and civil society to engage in policymaking, implementation, and monitoring progress; and
  • guarding against industry interference in policymaking. At this very moment, transnational tobacco, food, and beverage corporations, including those based in the Pacific, are actively lobbying governments against policy or regulatory interventions. I encourage you all to protect the right to health when determining trade, investment, and commerce policies. 

Financing challenges and options

Once priorities for action are identified, they have to be financed. Compared to the scale and depth of the misery which NCDs cause, responses to them are still chronically underfunded. 

There has been generous development assistance for global health over the years. Now it is important for development partners in this sub-region to align their support closely with the disease profile and epidemiological burden which Pacific Island countries face. A greater focus on NCD prevention is vital. 

Support from longstanding development partners in the Pacific continues to be needed to develop capacities and incentivize more effective and cross-sectoral approaches to NCDs. The UN Chief Executives Board has proposed the development of a Pacific Trust Fund for NCDs. With available resources, that would be a significant boost to the implementation of the Regional NCD Roadmap.

Existing funding flows could also be adapted. Last year, the Global Fund to Fight AIDS, TB, and Malaria approved a framework for financing co-morbidities, offering opportunities for countries experiencing HIV, TB, malaria, and NCD challenges. Evidence linking infectious diseases with NCDs continues to mount, underscoring the need for integrated responses. 

Support from partners can be catalytic, and can supplement the capacity of governments themselves to commit domestic resources to NCD prevention and control. Tonga, our host, legislated for a Health Promotion Foundation Act nearly a decade ago. Palau has just recently passed legislation creating a fund to combat NCDs — ten per cent of tobacco and alcohol taxes are allocated to this fund. I understand that there is a similar endeavour in New Caledonia.    

UN system support

While individual countries in the Pacific must lead their NCD responses, region-wide action in support of their efforts matters. The Pacific NCD Partnership bringing together Pacific leaders, ministers and officials with the SPC-Pacific Community, Pacific Islands Forum Secretariat, UN agencies, key development partners, and civil society – is an example of how regional support can come in behind national efforts on NCDs. Under the leadership of the WHO, the Pacific sub-region was the first in the world to set up a UN Theme Group on NCDs with extended membership beyond the UN. 

UN Development Assistance Frameworks are a critical entry point for integrating NCDs into development planning.

UNDP’s focus, like that of the SPC, is on convening and supporting stakeholders beyond the health sector to play a role in determining a country’s health and development outcomes. We are committed to working with key partners in the Pacific to strengthen national leadership on NCDs, building upon key initiatives already underway. For example:

  • With WHO, UNDP is supporting countries to make the economic case for investing in NCD prevention and control. It is using a country-specific return on investment analysis which weighs the costs of proven policy measures against the direct and indirect costs of inaction. An economic case has already been developed for Barbados, revealing that the country is losing 2.6 percent of its GDP to healthcare costs and productivity losses from diabetes and cardiovascular diseases alone.  This exercise is now underway in Fiji. UNDP and WHO are looking for partners to help us meet country demand for this support.
  • Backed by the Global Environment Facility (the GEF), UNDP and WHO are working to enhance the capacity of national and local health systems, institutions, personnel, and communities to manage and mitigate climate-related health risks, including NCDs. This work is being planned in Kiribati, Solomon Islands, Tuvalu, and Vanuatu, and supports greater co-ordination across ministries and departments on climate change and health issues. 
  • Finally, as a Principal Recipient of Global Fund Grants, UNDP is exploring avenues to support national health programmes to bridge the gap between NCD responses and HIV, TB, and malaria responses – while also better identifying and addressing overlapping social determinants of health. 

Conclusion

The Pacific is at a critical juncture in the NCD response.  Successes to date are still outstripped by illness, disability, human suffering, and premature deaths from NCDs. The region is very much on the frontlines of this global fight, just as it is on the frontlines of the fight against climate change. 

This Summit is an important opportunity for the Pacific to redouble commitments to addressing the NCD crisis without delay, and to be a pathfinder for how we can build the partnerships across governments, regional organizations, the UN, civil society, and the private sector to best respond to NCDs. 

The NCD crisis is surmountable and reversible. What we have to gain are not just longer lives and more sustainable economies. It is the enjoyment and pride we take in nurturing new generations to lead healthier lives and in celebrating unique cultures and environments.

As I have outlined today, the new global Agenda 2030 and the SAMOA Pathway can be catalysts for NCD action. A proactive NCD response will help the Pacific to make lasting progress on a wide range of other health and development priorities in turn, and support the achievement of the SAMOA Pathway’s aspirations and the Sustainable Development Goals.

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