By Si Thu Win Tin, Elisiva Na’ati, Ilisapeci Kubuabola, Solene Bertrand, Maiwenn Moreau, Amerita Ravuvu
Globally, emerging and re-emerging diseases continue to threaten human health and hinder socio-economic development (WHO, 2014; UN, 2018). In the Pacific region, non-communicable diseases (NCD) such as diabetes, cardiovascular diseases, chronic respiratory diseases, and cancers are the leading cause of death, accounting for approximately 75% of mortalities (WB, 2014). This creates a major threat to health, social and economic development in the Pacific island countries and territories (PICTs). With the complex backdrop of globalisation creating unhealthy environments and accelerating the pace of change in people’s lifestyle behaviours, the burden of NCD is highly likely to increase. The Pacific will only be able to cope with the growing burden of NCD —and its challenges on development— if the countries and regional technical support agencies such as the Pacific Community (SPC), broaden their future perspectives and adapt strategies to meet the rapid pace of change in the region.
Recognising this, we – NCD technical support team under the Public Health Division of SPC –conducted a series of informal discussion sessions in 2021 and continuously scout the horizon with the aim of developing future strategies to better support PICTs to combat NCD. We adapted the futures thinking six pillars approach using in particular – mapping for the future, anticipating the future through emerging issues analysis, creating alternatives with scenarios and transforming the future through visioning and backcasting (Inayatullah, 2021; Inayatullah, 2020).
Assessing and mapping for the future
First, to inform the design of new strategies, we reviewed the existing global and regional NCD strategies including the global NCD best-buys (WHO, 2017), Pacific NCD Roadmap (WB, 2014), tobacco free Pacific strategies (WHO, 2013) and Pacific ending childhood obesity priorities (Ravuvu, 2020). To understand the progress made in PICTs, we reviewed key reports such as SPC’s 2016-2018 and 2019-2020 NCD result framework (SPC, 2018; SPC 2020), the Pacific Monitoring Alliance for NCD actions (MANA) Dashboard (Win Tin, 2020), and NCD impact assessment (WHO, 2019). This formed a key part of our shared history. To broaden our perspective, we discussed the progress and challenges associated with NCD prevention and control with the Pacific development partners and PICTs’ national NCD focal persons and mapped out technical support needs.
Through this process, we found that there are several gaps that we need to address to effectively halt or reverse the existing Pacific NCD crisis. For example – leadership, governance, and financing are still weak; policy and legislation measures are not strong enough; engagement from non-health sectors and civil society is very limited; and the health systems for NCD management services are fragile. The Global NCD progress monitor 2020 reported that most PICTs are not progressing fast enough and are off-track to meet their global NCD targets and commitments to reduce premature mortality from NCD (WHO, 2020).
Anticipating the future through emerging issues analysis
It is highly likely that high rates of premature death will continue to be associated with high rates of NCD. We identified and analysed the possible key emerging issues or potential drivers of change in the Pacific context, and their likely flow on effects in addressing NCD in the future. We also took a strategic outlook on the evolving NCD landscape and its implications on SPC’s work in this space.
Social, economic and environmental factors: A continued complex backdrop of globalization, unplanned urbanization, climate change and food insecurity (PIFS, 2019), PICTs will continue to experience changes in the way people acquire and practice unhealthy behaviours. The production and availability of local healthy foods will potentially continue to decline, and importation and consumption of unhealthy food will likely continue to increase due to social, environmental, economic and commercial factors influencing the Pacific. The likelihood of industries’ (tobacco, alcohol, and unhealthy diet) interference through advertising, promotion, sponsorship, and trade would hinder the efforts in combating NCD. It is highly likely that government ministries will need to strengthen and enforce NCD related policies and legislation in collaboration with non-health sectors, the private sector, and civil society through the establishment of strong political leadership and effective governance.
Co-morbidity and cross-cutting factors: With the COVID-19 pandemic and increasing comorbidities with NCD, the Pacific represents a region that is significantly vulnerable to the health crisis in the future (Win Tin, 2020). These comorbidities will intensify premature death, disability, and reduced productivity. Continued diverted attention and shifting resources to prepare for and respond to the COVID-19 pandemic and natural disasters will continue to hamper progress on all aspects of NCD prevention and control. The double burden of NCD and infectious diseases is likely to increase further. There will be a need to focus on addressing these cross-cutting issues otherwise PICTs will remain off track and this will continue to threaten economic development.
Technology, digital transformation, and communication factors: With advancements in technology and changing lifestyle behaviours, traditional ways of educating people to practice healthy lifestyle will no longer be sufficient to address NCD in the future. Instead, there will be a need to invest in innovative health promotion interventions using advanced technology and creative ways of communication to enhance behaviour change.
Other factors: In the recent literature, mental disorder has been added as an NCD (O’Neil, 2015) and air pollution has been included as one of the risk factors causing NCD (Linou, 2018). Compounded by the increasing burden of mental health conditions due to the impact of COVID-19 pandemic, it is likely that PICTs will need to strengthen their efforts in addressing mental health issues. NCDs are linked to other health conditions such as maternal and child health and sexual and reproductive health, and this interconnectedness emphasises the critical need for integrated interventions through a life course approach.
Creating and analysing alternatives with scenarios and identifying a preferred approach
The trends and emerging issues generally shape transformative scenarios and their potential for future strategic response. This also helped us to consider assumptions and scenarios for alternative futures. With the understanding of the evolving NCD landscape due to the existing and emerging issues at the global and regional level; the knowledge on the perspectives of key stakeholders in the Pacific through our mapping process; and the anticipation of ‘Pacific health as investment’ to maximise a sustainable socioeconomic development by combating NCD that cause premature mortalities and lost productivity, we explored multiple possible futures using scenario building method. Based on the scope and nature of our work, we considered three possible scenarios of change (i.e. no change, radical change and adaptive change) to identify possible future strategies to support PICTs.
No change: Unadventurous strategic actions
We reviewed our existing strategies that we have been supporting PICTs to strengthen NCD actions in the past five years. Most strategies continue to be relevant in the future, given that our current strategies are the essential pillars in addressing NCD. However, in our existing strategies, there are no concrete actions that will effectively address the potential emerging issues and trends such as those concerning trade and commercial factors, co-morbidities and cross-cutting issues, digital transformation, mental health, and air pollution. If we are to continue with limited additional investment and business as usual approach through traditional strategic actions despite the trends at the global and regional level, like ‘an island with no electricity’, we may not be able to shape the future we want to live in.
Radical change: Brand-new strategic actions
We considered if there is a need to make a total transformation of our existing strategic actions under each strategy given the existing circumstances and potential emerging issues and trends. We also considered if there is a need to have additional substantial investment to make a total transformation, considering limited resources in the region. Even though the ‘no change’ traditional approach may not completely and effectively address the growing burden of NCD, our existing NCD strategies and most actions will remain relevant. Like ‘strangers on a remote island’, total transformative change to an entirely new level may not be able to shape the future we want and could even deviate from the path towards our preferred future. Therefore, a total transformation or a substantial redesign to a brand-new strategic focus may not be required as there will be no guarantee of value for money.
Adaptive change: Sculptured strategic actions
In this scenario, we considered if there is a need to make adaptation in our current strategies and actions to cope with the changing environment. While we believe that our existing strategies remain relevant to address NCD, there is significant potential to expand our actions under each strategy and improve our support for PICTs to address some of the key emerging issues to fast track to achieving our preferred future. For example, given SPC is a multi-disciplinary organisation working in a broad range of fields, there is an opportunity for a greater emphasis on trade and commercial factors that support healthy living; engagement with non-health sectors and civil society to improve the whole of government and society approach; protection of people with NCD from emerging infectious diseases through building better health care systems and services; and utilizing technology-based innovative interventions to promote behaviour change, and assess health impact to generate more scientific Pacific evidence for future policies and planning. Taking into consideration our existing capacity on human and financial resources for a long-term sustainability; understanding of the Pacific context and the context in which SPC works; as well as the comparative advantages that already exist within SPC, we considered that an incremental improvement through building on investment and sculpturing strategic actions to cope with the changing environment, could be ideal, like ‘landing to the islands of wellbeing: healthy people, nature and animals’, to shape and achieve the future we want to live in.
Three scenarios of change to combat noncommunicable diseases: The Pacific island perspective (Illustration by Si Thu Win Tin)
Transforming the future through visioning and backcasting
We have reached a crossroad with options to choose, and we will take on adapting futures through an incremental approach to strengthen our support to PICTs. In light of the opportunities and challenges we face now and more so in the future; we anticipate our preferred vision as ‘Pacific people live long, healthy and productive lives’ through our goal of ‘PICTs improved multisectoral response to NCD and reduced premature mortality from NCD by a third by 2030 and by 50% by 2050[1]’. This is in line with the region’s existing commitments to the Healthy Islands Vision (WHO, 2015) and Sustainable Development Goals (UN, 2015), as well as its future potential commitment to the Blue Pacific Vision 2050[2].
Using the backcasting methodology, we reframed our existing NCD strategies to be implemented concurrently through prioritised expanded actions that we can take today, pave the path (as per the timeframe of SPC’s next business plan cycle by 2025, SDG by 2030, and Blue Pacific Vision by 2050), and make the future we want. These are:
- PICTs strengthened leadership, governance, and multi-sectoral engagement – 25% by 2025, 50% by 2030, and 90% by 2050.[3] Key actions include to:
- Ensure NCD has a high profile at regional and national ministerial meetings for stronger leadership;
- Develop multi-sectoral national NCD plans and establish committees to enhance governance; and
- Engage non-health and non-state actors to improve multisectoral engagement.
- PICTs enhanced policies and legislation in all relevant sectors that address NCD – 25% by 2025, 50% by 2030, and 90% by 2050. Key actions include to:
- Develop policies and legislations that address environmental, trade, and commercial factors;
- Develop regional goods including guidelines that address NCD and risk factors; and
- Review and assess unhealthy product imports and trade for policy recommendations.
- PICTs improved NCD prevention and management services – 25% by 2025, 50% by 2030, and 90% by 2050. Key actions include to:
- Develop training packages and tools, and conduct training and professional placement;
- Create resources using advanced technology and innovative ways for behaviour change; and
- Build better systems for NCD services through integrated and cross-cutting approaches.
- PICTs strengthened accountability mechanism and research to generate scientific Pacific evidence, 25% by 2025, 50% by 2030, and 90% by 2050. Key actions include to:
- Develop monitoring and evaluation frameworks and mechanisms to track progress; and
- Support NCD operational research priorities for future planning, policies and programs.
Conclusion
Recent years have been a time of unprecedented change on a global scale. However, the Pacific region has experienced much of this change very directly with countries facing climate change impacts and natural disasters, sea level rises and displacement, and fragile economic development due to health crises. A systematic and holistic approach is required to address emerging issues and determinants of health particularly NCD, during time of disruptions. We need to go beyond the usual activities that promise to be achievable and create our desired future. However, we also need to consider our resources and context in which our organisation operates to determine what we can do now and, in the future, when more opportunities arise. Overall, the six pillars approach, that we adapted, helped explore different possible futures alongside the opportunities and challenges, and makes our future foresight a practical exercise. The next step is to develop a detailed action plan with timeframes and specific indicators, explore additional resources and new opportunities, and anticipate actions to make our preferred future and vision real. Additionally, we must continuously explore potential drivers of change to challenge our preferred approach, adapt our strategies to meet the changing emerging issues, and prepare for a better future.
References
WHO (2014). Global Status Report on Non-Communicable Diseases, World Health Organization, Geneva, Switzerland.
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WB (2014). Non-Communicable Disease (NCD) Roadmap Report, World Bank Group: Washington, D.C. Retrieved June 1, 2021 from: http://documents.worldbank.org/curated/en/534551468332387599/Non-Communicable-Disease-NCD-Roadmap-Report.
Inayatullah, S. (2021). Become a Futurist – Futures 101 with Sohail Inayatullah. The Center for Futures Intelligence and Research (CFAR): Retrieved March 10, 2021 from https://www.metafutureschool.org/p/become-a-futurist.
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WHO (2017). ‘Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases, Department for Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland. Retrieved June 1, 2021 from http://apps.who.int/iris/bitstream/10665/259232/1/WHO-NMH-NVI-17.9-eng.pdf.
WHO (2013). Tobacco Free Pacific 2025. Retrieved June 1, 2021 from Tobacco free for a healthy Pacific (who.int).
Ravuvu, A. (2020). Childhood Obesity in the Pacific: Challenges and Opportunities. Curr Obes Rep, 2020. 9(4): p. 462-469.
SPC (2018). NCD prevention and control program progress report against SPC’s 2016-2018 business plan, in Internal Divisional Level Report, Pacific Community (SPC), Suva, Fiji.
SPC (2020). NCD prevention and control program progress report against SPC’s 2019-2020 business plan result framework, in Internal Divisional Level Report, Pacific Community (SPC), Suva, Fiji.
Win Tin, S. (2020). Baseline status of policy and legislation actions to address non communicable diseases crisis in the Pacific. BMC Public Health, 2020. 20(1): p. 660.
WHO (2019). Taxation impact studies in the Pacific: A focus on tobacco, alcohol, sugar-sweetened beverages, discretionary and other foods, in Thirteenth Pacific Health Ministers meeting, World Health Organisation, French Polynesia. Retrieved June 3, 2021 from https://www.who.int/westernpacific/about/how-we-work/pacific-support/pacific-health-ministers-meetings.
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PIFS (2019). Pacific Islands Forum Secretariat, Fiftieth Pacific Islands Forum Leaders’ Communique, Pacific Islands Forum Secretariat (PIFS): Retrieved June 3, 2021 from https://www.forumsec.org/wp-content/uploads/2019/08/50th-Pacific-Islands-Forum-Communique.pdf.
Win Tin, S. (2020). Insights in Public Health: COVID-19 Special Column: The Crisis of Non-Communicable Diseases in the Pacific and the Coronavirus Disease 2019 Pandemic. Hawai’i journal of health & social welfare, 2020. 79(5): p. 147-148.
O’Neil, A. (2015). A shared framework for the common mental disorders and Non-Communicable Disease: key considerations for disease prevention and control. BMC Psychiatry, 2015. 15(1): p. 15.
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UN (2015). United Nations Sustainable Development Goals. Retrieved June 3, 2021 from https://www.un.org/sustainabledevelopment/sustainable-development-goals/
Notes
- Progress and achievement will be monitored using the global NCD monitoring framework that measures the progress against the SDGs’ NCD target on premature mortality due to NCD. ↑
- With the recognition that the region’s vulnerability is seriously threatened by the escalating impacts of climate change and the intensification of geostrategic competition, Pacific leaders called for the development of the 2050 strategy for the Blue Pacific Continent which is still underway. ↑
- Progress and achieving targets (%, relative improvement) will be monitored using the PICTs’ 2020 MANA Dashboard as a baseline throughout the path i.e., by 2025, 2030 and 2050. ‘Strengthened/enhanced/improved’ means progress towards the implementation of strategies reached to the level of ‘green with 3 stars, i.e., high strength of implementation’, as per MANA Dashboard traffic light scoring and assessment criteria. ↑
Author’s Affiliations
- Si Thu Win Tin (Dr), Team Leader – NCD Prevention and Control Programme, Public Health Division, The Pacific Community (SPC), Suva, Fiji, sithuw@spc.int; sithuwintin@gmail.com
- Elisiva Na’ati (Ms), NCD Adviser – Public Health Nutrition, NCD Prevention and Control Programme, Public Health Division, The Pacific Community (SPC), Suva, Fiji, elisivan@spc.int
- Ilisapeci Kubuabola (Dr), NCD Adviser – Monitoring, Evaluation and Surveillance, NCD Prevention and Control Programme, Public Health Division, The Pacific Community (SPC), Suva, Fiji, ilisapecik@spc.int
- Solene Bertrand (Ms), NCD Adviser – Francophone Countries, NCD Prevention and Control Programme, Public Health Division, The Pacific Community (SPC), Noumea, New Caledonia, ameritar@spc.int
- Maiwenn Moreau (Ms), NCD Officer – NCD Prevention and Control Programme, Public Health Division, The Pacific Community (SPC), Noumea, New Caledonia, maiwennm@spc.int
- Amerita Ravuvu (Dr), NCD Adviser – Policy and Planning, NCD Prevention and Control Programme, Public Health Division, The Pacific Community (SPC), Suva, Fiji, ameritar@spc.int
