The Pacific’s response to non-communicable diseases: progress and the path forward

Introduction

Non-communicable diseases (NCDs) pose the most significant health and economic challenge globally. ¹ High rates of diabetes, cardiovascular disease, hypertension, obesity, and preventable cancers have placed a strain on healthcare systems, contributing to rising medical costs, reduced workforce productivity, and economic instability in the Pacific region.^2,3 These health burdens are driven by key risk factors such as unhealthy diets, physical inactivity, tobacco use, and harmful alcohol consumption. In addition, climate change and food insecurity exacerbate the crisis by increasing dependence on processed foods in the Pacific Island Countries and Territories (PICTs).

Recognising the urgency of this crisis, Pacific leaders endorsed the Pacific NCD Roadmap ⁴ in 2014, setting strategic actions to tackle the rising burden of NCDs. The roadmap emphasises taxation on unhealthy products, strengthening food and nutrition policies, integrating NCD prevention into primary healthcare, and enhancing regional monitoring and evaluation mechanisms. While notable progress has been made, implementation gaps, governance weaknesses, and competing priorities continue to hinder progress. This article highlights key milestones in NCD prevention and control, ongoing challenges, and strategic priorities needed to ensure sustained improvements in population health outcomes.

Achievement and Progress in NCD Prevention and Control

A major achievement in the Pacific’s NCD response has been the implementation of fiscal policies aimed at reducing the consumption of harmful products. In the past 10 years, of the 21 PICTs, 19 PICTs had increased tobacco taxation, with six countries surpassing the recommended threshold of 70%. ⁵ Alcohol taxation had also been strengthened in 14 PICTs, while 13 countries had introduced taxes on sugar-sweetened beverages. ⁵ Assessments conducted in some PICTs, including Tonga, have demonstrated that increased taxation on these products has resulted in higher retail prices, decreased import volumes, and reduced consumption. ⁶

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Progress in tobacco control has been significant, with declining smoking rates observed in several PICTs. The 2019 report highlights that between 2000 and 2020, smoking prevalence dropped from 70% to 41% in Kiribati, 33% to 26% in Fiji, 44% to 23% in the Cook Islands, 53% to 39% in Papua New Guinea, and 38% to 25% in Samoa. ⁷ While these figures indicate progress, tobacco use remains high in some PICTs. Sustaining these trends requires continued investment in tobacco control.

Encouragingly, physical activity levels have improved in some PICTs, including Federated States of Micronesia, Solomon Islands, Nauru, and Kiribati.^8,9 Community-led wellness initiatives, school-based physical education programmes, and workplace health interventions have contributed to this progress. Dietary habits in the Pacific continue to pose challenges, with many PICTs remaining limited in improvement.^8,9 The continued reliance on processed, high-calorie foods remains a major concern, driven by factors such as affordability, convenience, and changing food environments.

Trends in alcohol consumption show mixed results. While some countries, including Nauru, Solomon Islands, and Palau, have reported declines in alcohol use, other PICTs remained unchanged.^8,9 This variation suggests that while fiscal policies and regulatory measures have been effective in some contexts, broader socio-cultural influences and industry marketing continue to shape alcohol consumption patterns.

Governance structures for NCD prevention have also been strengthened in the Pacific region. The establishment of multisectoral NCD taskforces in several PICTs has enhanced coordination across ministries. ⁵ The Pacific Legislative Framework for NCDs, endorsed by the Pacific Health Leaders in 2022, has provided legal guidance on tobacco and alcohol control, food regulations, and public health protections to scale up the development and implementation of laws and regulations that address NCDs. ¹⁰ The MANA Dashboard, introduced as a regional accountability tool since 2018, has further enabled PICTs to systematically track progress in NCD-related policy implementation.^11,12 While these mechanisms have improved transparency and data-driven decision-making, challenges in implementation remain.

Issues and Challenges

Despite these achievements, major challenges remain in scaling up NCD prevention efforts. Inadequate enforcement of fiscal policies and resource constraints in many PICTs continue to limit the effectiveness of interventions. The availability of illicit tobacco and alcohol products reduces the impact of taxation measures, while industry interference complicates regulatory enforcement. The increasing use of e-cigarettes, particularly among young people, presents a new challenge, with weak regulations allowing their widespread availability and marketing. Trade policies remain misaligned with health objectives, with weak regulatory frameworks allowing an influx of ultra-processed, unhealthy food products.

Competing national priorities, including climate change adaptation, economic recovery from COVID-19, and disaster responses, often divert political and financial resources away from NCD prevention. ¹³ Data collection and reporting inconsistencies further hinder progress. Some countries face delays in updating their MANA dashboards, limiting their ability to assess the progress of interventions in real-time. Strengthening surveillance systems and providing additional technical support for policy evaluation will be crucial to ensuring that NCD strategies remain responsive and effective.

Key Priorities for the Next Decade

To achieve lasting reductions in NCD prevalence, PICTs must transition from incremental policy advancements to a transformative and system-wide approach. Strengthening governance structures, increasing sustainable financing, and integrating NCD prevention into national development strategies are key priorities. In line with NCD best buys, ¹⁴ fiscal policies should be expanded to increase excise taxes on unhealthy products while incentivising healthier alternatives. Strengthening primary healthcare systems, particularly in underserved areas, is critical to ensuring universal access to essential NCD medicines and screening services. In addition, leveraging digital health technologies for real-time data collection and impact evaluation will be crucial in enhancing policy responsiveness. More investment is needed in public awareness campaigns and school-based programmes to promote long-term behaviour change.

Conclusion

The Pacific faces a critical moment in its fight against NCDs. Without immediate and sustained action, the region risks reversing hard-won gains, with severe economic and social consequences. While demonstrated some achievements, the slow pace of implementation and weak enforcement mechanisms remain key threats to progress. To ensure a healthier future, PICTs must scale up NCD interventions, strengthen regulatory enforcement, and secure long-term financing mechanisms. Addressing NCDs is not merely a health sector issue – it is a fundamental pillar of sustainable development, economic stability, and social wellbeing in the Pacific. By committing to decisive action, Pacific governments can safeguard the well-being of future generations and build a healthier and more resilient region.