Christopher Tufton | Declare NCDs in SIDS as public-health emergency

The recent SIDS Ministerial Conference on Non-communicable Diseases (NCDs) and Mental Health in Barbados yielded an important outcome document: the 2023 Bridgetown Declaration on NCDs and Mental Health.

However, while reflecting the concern of SIDS that progress to address NCDs “has been limited and not commensurate with the burden of these conditions”, it stopped short of calling for the declaration of NCDs in SIDS as a public-health emergency.

To my mind, this is a necessary next step in the effort to ensure that SIDS are able to rein in the NCDs epidemic and is justified by prevailing realities within SIDS.

• Even at the height of the COVID-19 pandemic, more persons were dying from hypertension than from COVID-19. Worldwide, raised blood pressure alone is estimated to cause 7.5 million deaths each year compared to global COVID deaths – 1.9, 3.5 and 1.2 million in 2020, 2021, and 2022, respectively. Yet COVID was declared a public- health emergency.

• SIDS are among the countries with the highest estimated risk of dying young from NCDs.

• They also have varied and profound vulnerabilities related to the triple planetary crisis of climate change, nature loss, and pollution.

• In SIDS, there is also the risk of NCDs becoming a polycrisis all on their own, impairing public health and challenging the capacity of health systems to guarantee continuity of care and access to those in need; compromising workplace productivity; and triggering challenges to the national economy even as sustainable development prospects are undermined.

PUBLIC HEALTH EMERGENCY

The time has come to declare NCDs in SIDS a public-health emergency and laying the foundation for a set of deliberate, scaled-up actions that meaningfully and sustainably support them in their NCDs response.

The SIDS dedication to turning the corner on NCDs, meanwhile, is not in question. It is in black and white in the Bridgetown Declaration, which affirms their commitment to “bold SIDS-specific action to accelerate progress in SIDS to, by 2030, reduce by one-third premature mortality from NCDs through prevention and treatment, and promote mental health and well-being”.

This follows on the 2007 Caribbean Community Port-of-Spain Declaration, which the Bridgetown Declaration reminds us “was crucial to catalyse the first High Level Meeting of the United Nations General Assembly on NCDs in 2011”; and is punctuated by the Pacific Islands NCD Roadmap, the SIDS Accelerated Modalities of Action (SAMOA Pathway), the Barbados Declaration on Achieving Sustainable Energy for All in SIDS, and the Bridgetown Initiative.

It makes sense to make this move to declare NCDs in SIDS a public-health emergency. Once recognised as such, NCDs in SIDS would be elevated to a level requiring the mobilisation of global economic and other resources. It would also support the creation of the necessary enabling environment for the implementation and sustainability of tailored interventions – and with human development prioritised in the response. This includes giving primacy to the reform of the food system.

FOOD SOVEREIGNTY

SIDS NCDs vulnerabilities and burdens are driven in part by the lack of food sovereignty. The World Trade Organization facilitates and encourages rather than discourages our acceptance of unhealthy food imports that fuel unhealthy diets, which is among the major risk factors for NCDs.

SIDS must have greater influence over the global commodity chain and what that means for their nutrition, including as it relates to front-of-package labelling and the elimination of trans-fats from the food system.

NCDs have also been shown to present a higher burden on people with fewer resources, thus worsening poverty and inequality, and compromising their productivity and quality of life. I, therefore, also challenge our multilateral stakeholders, including the World Bank, to give greater attention to the health imperative in economic modelling.

There needs to be a much more broad-based conversation around health and not just from a clinical perspective, but also from an economic modelling perspective and a quality-of-life perspective.

We have indeed advanced and celebrated progress as a world but appear, in some respects, to have left human quality of life in our rear view. We see the technological advances, but people are not necessarily having or enjoying a good quality of life because of ill-health. That is a problem we must fix.

HAVE FOUNDATION

Important to note is that we would not be starting from scratch. SIDS have a foundation – a fact also referenced in the Bridgetown Declaration. Both the WHO/PAHO and individual countries have developed innovative, evidence-informed actions and best practices to tackle NCDs and their risk factors in SIDS. However, there needs to be more mechanisms for countries to develop and sustain initiatives that specifically address their needs.

Ministers of health also have an important role to play. They are central to championing the NCDs response such that there is need for an institutional SIDS NCD driver. This could perhaps be a similar entity to CARICOM’s Council for Human and Social Development or PAHO/WHO supported, where ministers come together to discuss progress on this specific matter.

As I noted at the recent meeting of the PAHO Executive Committee in Washington, DC, this mechanism must continue the Barbados meeting framework, be driven by SIDS with support from WHO/PAHO and other development agencies; and should include civil society and persons living with NCDs. The private sector should also be engaged in the implementation phase, after priority policies have been determined by governments and their agencies.

The journey to healthier SIDS, free from the burden of NCDs cannot be taken alone and not without a robust enabling environment. Declaring NCDs in SIDS as a public- health emergency helps to get us there.

- Dr Christopher Tufton is Jamaica’s minister of health and wellness and member of parliament for St Catherine West Central. Send feedback to cctufton@gmail.com or columns@gleanerjm.com.