Ngaki’anga Kapiti Ora’anga Meitaki: The Cook Islands Strategic Action Plan to Prevent and Control Non-communicable Diseases 2021-2025

Objectives

The Cook Islands National Strategy and Action Plan for Non-communicable Diseases 2021–2025 seeks to prevent, control and mitigate non-communicable diseases (NCDs), particularly cardiovascular disease, diabetes, cancer and chronic respiratory disease, and to reduce associated morbidity, premature mortality and disability.[1]It supports the national vision of healthier lives and aspirations for all people in the Cook Islands.[1]The strategy treats NCDs as one of five national health priorities, alongside health security, workforce development, digital health and mental health.[2][1]

• Address behavioural, social, cultural, economic and environmental determinants of NCDs, including tobacco use, harmful alcohol use, unhealthy diets, physical inactivity, obesity, poverty, unequal access to care, low health literacy, harmful marketing and obesogenic environments.[3][4][5]
• Apply a life-course and settings-based approach that enables healthier choices at home, in schools, workplaces, recreational settings, communities and churches.[3]
• Advance four strategic action areas: whole-of-country leadership and governance; health promotion, prevention, health literacy and community empowerment; legislation and policy for safer and healthier environments; and equitable access to quality health services.[6]
• Promote partnership, participation, cross-sectoral action, accountability, universal health coverage, equity, the right to health, evidence-based practice and protection from conflicts of interest.[1]
• Align with Sustainable Development Goal 3.4, which aims to reduce premature NCD mortality by one third by 2030, and with World Health Organization global NCD targets.[7][8]

The strategic goals include reducing premature NCD mortality, harmful alcohol use, insufficient physical activity, salt or sodium intake, tobacco use and hypertension; halting increases in diabetes and obesity; expanding preventive cardiovascular care; and maintaining access to affordable essential NCD technologies and medicines.[9]The plan emphasises health promotion and prevention, community education and empowerment, healthier food and physical-activity environments, tobacco and alcohol control, childhood-obesity prevention, cancer control and vaccination, and timely patient-centred services for people with NCDs or elevated risk.[4][10][11]

Implementation

Implementation uses a multi-pronged, whole-of-government, whole-of-society and multi-sectoral model, led and coordinated by Te Marae Ora Ministry of Health Cook Islands.[3][12][6]It combines prevention-oriented policy and environmental action with strengthened primary care, integrated clinical services, surveillance and accountability.[5][13]The strategy calls for interventions that are evidence-based, cost-effective and adapted to the Cook Islands context.[8][4]

• Steer national action through a multisectoral NCD Taskforce reporting to the Minister of Health or delegated authority, supported by the Health Promotion and Prevention team as secretariat.[14]Include representation spanning health-related interests and government sectors such as law, agriculture, finance, education, internal affairs, island councils and police.[14]
• Convene the Taskforce regularly, establish Vaka NCD committees in Rarotonga, improve participation by community leaders and non-health stakeholders, and integrate NCD indicators and targets into national health and development planning.[5][15]
• Manage actual, perceived and potential conflicts of interest, including tobacco, alcohol and food-industry interference, through governance measures and conflict-of-interest registers.[5][16]
• Strengthen legislation, regulation and enforcement for tobacco control, alcohol control, food marketing, healthier food environments and public health.[4][10][16]Modernise the Cook Islands Public Health Act 2004 to embed health promotion, human rights, clearer governmental responsibilities and accountability for prevention and control.[10]
• Develop dietary guidelines and food and nutrition policy, increase physical activity in schools, workplaces, vakas and the Pa Enua, support Baby Friendly Hospital accreditation, and work with Customs on excise-tax proposals for tobacco, alcohol and sweetened sugar beverages.[16][17]
• Train frontline health workers on the Package of Essential Non-communicable Disease interventions guidelines, implement an NCD communications strategy, and improve awareness of modifiable risks among school students.[18]
• Deliver primary-care services for early detection, diagnosis, risk-factor modification and treatment of cardiovascular disease, hypertension, stroke, diabetes, cancer and asthma-related conditions.[13]Ensure access to screening, counselling, rehabilitation, palliative care, essential medicines and basic health technology, supported by referral pathways, patient information systems and links with public-health and community services.[13][11]
• Provide secondary and tertiary care through hospitals, visiting specialists in Rarotonga and the Pa Enua, and referrals to the New Zealand health system.[5]Develop home-based palliative care and strengthen cancer surveillance, screening, diagnosis, treatment and palliative care capacity.[10][11]

Monitoring combines the national framework of 129 high-level health indicators with five-yearly NCD surveys, school health assessments, cardiovascular risk assessment for adults, the World Health Organization NCD Global Monitoring Framework and the Pacific Monitoring Alliance for NCD Action dashboard.[12][19]Indicators span health status, risk factors, service coverage and health-system performance, including premature NCD mortality, tobacco and alcohol use, physical activity, raised blood pressure and glucose, screening, treatment, workforce and access to care.[19][20]Te Marae Ora is expected to improve MedTech documentation and disease classification, conduct data-quality audits, analyse and systematically report data, and use information systems to assess outcomes and intervention cost-effectiveness.[13]The Taskforce must report urgent implementation matters to the Secretary of Health and present annual progress reports to the Minister of Health.[14]

The plan includes indicative annual costs for selected actions, including 83,000 in the source table’s unspecified currency for Te Marae Ora leadership and coordination, alongside smaller allocations for Taskforce meetings, community committees and national planning.[15]It also includes costed activities for workforce training, communications, legislation, tobacco and alcohol control, healthy food, physical activity, primary-care access, palliative care, diabetes-register review and surveillance.[18][16][17][11][21]The source does not specify an overall budget, confirmed currency, funding sources, resource-mobilisation arrangements or financing gap.[15][21]

Monitoring & Evaluation

The monitoring framework combines national health indicators, non-communicable disease (NCD) surveys, routine clinical information, implementation reporting and regional dashboards. It seeks to improve data quality, classification, analysis, surveillance and accountability, while recognising that health gains from prevention may take many years to emerge.[7][4][13][12]

• Monitor population health through 129 national indicators endorsed by the Te Marae Ora Executive in 2020, covering health status, risk factors, service coverage and health-system performance.[12][19]
• Classify measures by expected intervention effect: short term, under 12 months; medium term, one to five years; and long term, over 10 years.[12][19]
• Track premature NCD mortality among people aged 30 to 69 years, reported at 24% in 2016, 22% in 2017, 20% in 2018 and 26% in 2019.[7][3]
• Undertake five-yearly NCD surveys, annual and biennial public health nurse assessments of school-aged children, and cardiovascular risk assessment for residents aged 18 years or over.[12]
• Align national monitoring with the World Health Organization Global Reference List of 100 Core Health Indicators, the NCD Global Monitoring Framework and the Pacific Monitoring Alliance for NCD Action dashboard, which supports annual regional reporting and traffic-light assessments.[8][12]
• Use global NCD benchmarks including reductions in premature mortality, tobacco use, harmful alcohol use, physical inactivity, salt intake and hypertension; halting increases in diabetes and obesity; expanding preventive cardiovascular treatment; and ensuring access to affordable essential technologies and medicines.[1][8][9]
• Improve MedTech documentation and disease classification, conduct regular data-quality audits, strengthen staff capability, and use fit-for-purpose information systems to assess health outcomes and intervention cost-effectiveness.[13]
• Establish or strengthen mortality and premature-mortality, hypertension and cholesterol sub-registers; review the diabetes register; enhance cancer surveillance; and support two NCD research projects annually.[10][11][21]
• Track implementation through taskforce operation, committee meetings, inclusion of NCD priorities and targets in national plans, and production of four strategy progress reports.[15]
• Measure workforce training and student awareness against staged milestones of 50% in 2021-2022, 60% in 2022-2023, 70% in 2023-2024 and 80% by 2024-2025.[18]
• Report urgent implementation matters in writing to the Secretary of Health and submit annual progress reports to the Minister of Health through the multi-sectoral NCD task force.[14]

Accountability is assigned through Te Marae Ora managers, the National NCD Taskforce, Vaka committees and the Health Promotion and Prevention secretariat. The task force is expected to meet four times yearly, while the action plan also specifies twice-yearly taskforce meetings as a funded governance activity.[15][14]The strategy was authorised on 1 January 2021 and is generally shown with a review date of 31 December 2023, although action-table extracts also contain a review date of 1 March 2021.[1][12][16][17]

The supplied material does not provide a fully consolidated national reporting schedule, evaluation methodology or surveillance ownership arrangement beyond the listed indicators, reports, information-system activities and assigned implementation responsibilities.[13][18][19][9]

Costing & Financing

Costing information consists mainly of indicative annual action-plan allocations and estimates of the economic burden of the four leading NCDs. The source promotes World Health Organization ‘best buys’ and other context-appropriate cost-effective interventions, but does not present a complete funded implementation budget, financing plan, resource-mobilisation strategy or quantified funding gap.[7][4][21][22]

• Allocate indicative annual amounts totalling 91,000 in the source table’s unspecified dollar currency for governance and coordination: 1,000 for twice-yearly taskforce meetings, 5,000 for community committees, 2,000 for integrating NCD priorities into planning, and 83,000 for Te Marae Ora programme leadership and coordination.[15]
• Provide indicative annual costs for training, communications, school awareness, legislative reform, industry-interference management, tobacco and alcohol control, healthy nutrition, Baby Friendly Hospital accreditation, physical-activity campaigns and fiscal-policy work.[18][16][17]
• Provide indicative annual costs for primary-care access, a home-based palliative-care model, diabetes-register review, and an NCD surveillance, monitoring and evaluation framework.[11][21]
• Estimate the 2017 direct health-system, indirect productivity and intangible financial costs of the four leading NCDs at 5 million to 8 million dollars, with premature deaths valued at 75 thousand to 3 million dollars.[7]
• Estimate non-financial costs measured through years of life lost at up to 11.7 million dollars, with at least half attributed to cardiovascular disease, 27% to diabetes and 22% to cancer.[7]
• Propose a 70% increase in tobacco excise tax and consider tax measures affecting alcohol and sweetened sugar beverages; the extract does not quantify expected revenues or expenditure effects.[17]

The dollar currency used in action-plan cost tables is not identified. The material records substantial but unquantified Te Marae Ora investment in health information systems, information and communications technology and human resources, and identifies health expenditure indicators without supplying values, financing sources or economic assumptions.[13][9]