NCD Summit: Tokelau faces up to the challenge of non-communicable diseases

Tokelau’s Non-Communicable Disease (NCD) Summit has come to a close.
Opening of Tokelau's NCD Summit on the atoll of Nukunonu.
The main objective was to “bring all our leaders to share with them and to try and empower them with the information we have so they can make healthy decisions,” said Dr Silivia Tavite, Director of Health.

NCDs is a pandemic and it is well on its way to cause great damage to most Pacific countries where the majority have young growing populations.

One of the main concerns is that as these populations age, NCDs can be expected to increase. This is especially so given the existing level of all the main risk factors of smoking, nutrition, alcohol and Physical inactivity (SNAP) for NCDs will be laid down in younger life and grow to significant human and financial burdens in the future.
Recent data, which were made available for the first time to Tokelau leaders, confirmed that NCDs are increasing in remote Tokelau.

The summit, held in Nukunonu, saw more than 230 people attending the opening day. It included political and religious leaders, Taupulega delegates, elders, public servants, school children, general public and international partners the Pacific Community (SPC), WHO, and New Zealand Foreign Affairs.

In an atoll with a population of 499 (2016 Census), the attendance was an indication of the country’s high-level awareness about NCDs and its impacts, but not so much in understanding the why, where and how it can be resolved – because the NCD problem is solvable with the right actions founded on science and appropriate public health policies.

Therefore, this summit could be the paradigm shift needed as it is the first time that all levels of Tokelau society have been brought together in one place to discuss the issue. The hope is that a more integrated approach will be committed to as the way forward to resolve it.
Latest data from the World Health Organization Stepwise survey were made public for the first time. It highlighted what was already known to the health department – that the rate of NCDs in Tokelau is high – as it is in other Pacific countries.

In 2013, NDCs were the leading cause of death in 12 Pacific Island Countries accounting for 70 per cent of all deaths. Cardiovascular diseases were the leading cause of death, often twice the rate of more traditional communicable diseases.

But comparisons with other countries aside, the more relevant indicator for NCDs is the comparison to a similar survey conducted in 2005 for Tokelau. The comparison highlighted there has been an increase.

“It shows that what we have been doing from 2005 to 2014 is not enough to reverse this,” said Dr Silivia.

“And that is why we wanted to host this summit, to share with them [leaders], and hopefully gain their support. And key to the summit taking place has been the very strong support and priority accorded to the summit from the Minister of Health, Hon. Siopili Perez.”
Dr Silivia Tavite, Director of Health
Hon. Siopili Perez, Minister of Health and Ulu o Tokelau.
There is life and death urgency in her voice that is calling for “action must happen now”.

“For many years we have come up with so many plans, so many roadmaps but the reality is that Tokelau needs to act now. We have been trying to make a change but we can’t do it by ourselves.

“The two key messages of this summit: (i) for a healthy Tokelau, she needs an integrated approach; (ii) urgency – we need to act now.”

And that is where the leaders support and understanding are critical. That the majority of NCD causes are from outside the health sector she said.

“For example alcohol. All we can do is report and provide the information and try to encourage people to make a change. But to actually stop alcohol, we don’t have that mandate to tell government to stop or increase taxation.”

She points to the PEN program that staff use to screen patients for diabetes, hypertension in order to provide relevant advice.
Advice that’s rendered irrelevant and useless “when the patient comes out to a community that give out free alcohol,” she said.

“In that situation, the department just can’t effect the required change. And that is why we are hosting this summit, to show and ask our leaders and public why we need each and everyone of them to help because the department is struggling to provide for the need of Tokelau.

“We firmly believe that with their support we will be able to reduce the number of people coming to the hospital with diabetes, or cardiac problems.”

Dr Silivia and her team are aiming for an action-laden list of outcomes from the summit. That from Tokelau’s leaders, government departments, and partners SPC, WHO and New Zealand they will get their commitments to build a roadmap of ‘integrated’ NCD activities for the next three years.

“The expected outcome for us on the last day, is for them to come up with a list of activities that they would commit to implement in the next three years.

“After that, we as a department will compile their lists together into a Tokelau roadmap with an indication that this is what our villages of Atafu, Fakaofo, Nukunonu; and that government departments of Education; Health; Economic Development, Natural Resources Environment (EDNRE); Transport; and Power will do to contribute to the target.”

Added to that roadmap will be the commitments from regional partners SPC, WHO and New Zealand.

The final NCD roadmap will then go through Tokelau’s approval process that starts with the roadmap taken back and tabled to each respective Taupulega on its way to the General Fono.

“Every thing going well, we are hopeful that the roadmap will be endorsed by the last General Fono at the end of this year.

“Hopefully, when it reaches the General Fono, our leaders who were at the Summit this week would then endorse it.

So that’s the other goal of this summit, empowering our leaders with information so when the issue comes up for decision-making, they will be able to make well informed and healthy decisions.”

By By Lealaiauloto Aigaletaule’ale’a F. Tauafiafi