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 aims to prevent, control and mitigate non-communicable diseases (NCDs), reducing related morbidity, premature mortality and disability while supporting healthier lives across the Cook Islands. It addresses cardiovascular disease, diabetes, cancer and chronic respiratory disease, alongside associated disabilities and modifiable risk factors.[1][2]The strategy responds to NCDs as a leading source of premature illness, death, disability, health-system pressure and escalating healthcare costs, particularly in the context of population ageing.[3]

• Align national action with the World Health Organization target of a 25% relative reduction in premature mortality from the four principal NCDs by 2025 and Sustainable Development Goal 3.4, which seeks a one-third reduction in premature NCD mortality by 2030.[1][4]
• Apply 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 access to quality, equitable health services.[4]
• Address behavioural and structural determinants of ill health, including tobacco use, harmful alcohol use, unhealthy diets, physical inactivity, obesity, poverty, education, gender, low health literacy and unhealthy food environments.[5][6][7]
• Promote a life-course approach that enables individuals, families and communities to make healthier choices, including through community empowerment, social marketing and targeted action on childhood obesity.[5][6][7]
• Strengthen prevention and control of tobacco use, harmful alcohol consumption, hypertension, diabetes, obesity and diet-related risks, while improving care for diabetes, cardiovascular disease, cancer and chronic respiratory disease.[8][9][10]
• Improve timely access to primary care, screening, diagnosis, counselling, treatment, rehabilitation, palliative care, essential medicines and affordable basic technologies, with attention to vulnerable groups, including older people, disabled people and people requiring long-term care.[11][12]
• Support safer and healthier settings through modernised public health legislation, tobacco and alcohol controls, healthy food and nutrition policy, physical-activity promotion, restrictions on unhealthy food marketing and measures to protect children.[13][14][15]
• Use global NCD goals to pursue reductions in harmful alcohol use, insufficient physical activity, salt or sodium intake, tobacco use and hypertension; halt increases in diabetes and obesity; expand preventive medicine or counselling; and sustain access to essential technologies and medicines.[16]

Implementation

Implementation is based on a whole-of-country, whole-of-government and whole-of-society model led by Te Marae Ora Ministry of Health, combining multisectoral governance, community participation, prevention, primary health care and equitable clinical services.[5][1][7]NCDs are one of Te Marae Ora’s five priorities, alongside health security, workforce development, digital health and mental health.[17]The strategy applies principles of partnership, participation, accountability, universal health coverage, equity, the right to health, evidence-based practice and management of conflicts of interest.[1]

• Coordinate national implementation through the Cook Islands National NCD Taskforce, which monitors progress, establishes subcommittees, contributes to relevant policy and guidance, reports annually to the Minister of Health, and receives secretariat support from the Health Promotion and Prevention team.[2]
• Engage health and non-health institutions, including Te Marae Ora, agriculture, finance, statistics, education, internal affairs, island councils, Crown Law and police, alongside community leaders and Vaka NCD committees.[7][2]
• Strengthen taskforce representation, community participation and conflict-of-interest safeguards, particularly regarding potential tobacco, alcohol and food-industry interference in policy development and implementation.[7][14]
• Integrate NCD prevention and care across public health, community-based services and primary care, while maintaining hospital, specialist and New Zealand referral services for secondary and tertiary treatment.[7][11]
• Deliver evidence-based and contextually appropriate interventions, including World Health Organization Best Buys, taxation and regulation of tobacco, alcohol and sugar-sweetened beverages, food reformulation and labelling, physical-activity initiatives, cessation support, screening and clinical care.[6][9][10]
• Implement targeted prevention through healthier school food policies, water-only provision in schools, physical-activity programmes, restrictions on designated-product marketing within 200 metres of places where children gather, and health promotion in workplaces, vakas and the Pa Enua.[6][13][15]
• Strengthen tobacco control through the Tobacco Control Plan 2021–2025, excise-duty measures, smoke-free and alcohol-free government events, cessation text messaging and nicotine replacement therapy where available.[8][6][14]
• Develop collaborative cancer-control arrangements spanning surveillance, screening, diagnosis, treatment and palliative care, including extension of human papillomavirus vaccination from girls to boys.[13]
• Modernise the Public Health Act 2004 to embed health promotion, human-rights considerations, clearer government responsibilities and stronger accountability.[13][14]
• Assign operational responsibilities across designated Te Marae Ora leaders, including the Secretary of Health, managers for Health Promotion and Policy and Planning, directors of primary care, public health and hospital health services, the Health Information Systems supervisor and the Chief Pharmacist.[14][12]
• Monitor implementation through national health indicators, five-yearly NCD surveys including the World Health Organization Stepwise Approach to Surveillance, annual or biennial child health assessments, cardiovascular risk assessments for residents aged 18 years and over, NCD registers, data-quality audits and the Pacific Monitoring Alliance for NCD Action dashboard.[11][4][12]
• Use 129 national indicators covering health status, risk factors, service coverage and health systems, while classifying expected impact as short term, under 12 months; medium term, one to five years; or long term, more than 10 years.[11][18]
• Produce four progress reports on the strategy and action plan, supported by surveillance, monitoring and evaluation arrangements and two NCD research projects annually.[19][20]

Monitoring & Evaluation

Monitoring and accountability combine global and Pacific non-communicable disease (NCD) frameworks with national health indicators, surveillance, taskforce reporting and activity-level implementation measures. The strategy uses the World Health Organization Global Action Plan’s nine global NCD targets and 25 indicators, including a 25% relative reduction in premature mortality from the four main NCD groups by 2025, while also supporting Sustainable Development Goal target 3.4.[1][4]National monitoring is intended to address an established but incompletely quantified NCD and obesity burden.[5][17]

• Track reductions in premature NCD mortality, harmful alcohol use, insufficient physical activity, salt or sodium intake, tobacco use and hypertension; halt increases in diabetes and obesity; and improve preventive medicine, counselling, basic technology and essential-medicine access.[1][8][16]
• Monitor 129 national health indicators endorsed by the Te Marae Ora Executive in 2020, organised across health status, risk factors, service coverage and health systems.[11][18]Classify expected impact as short term, under 12 months; medium term, one to five years; and long term, more than 10 years.[11][18]
• Measure NCD mortality, morbidity and prevalence; cancer incidence; diabetes-related outcomes; physical activity; alcohol and tobacco use; blood pressure and glucose; diet; overweight and obesity; cancer screening; diabetes eye care; mental-health treatment; and availability of technologies and medicines.[21][16]
• Conduct five-yearly NCD surveys, including the World Health Organization Stepwise Approach to Surveillance, and annual or biennial public-health-nurse assessments of school-aged children.[4]Conduct cardiovascular risk assessments for residents aged 18 years and over.[4]
• Improve MedTech documentation, disease classification and data quality through regular audits, upgraded information and communications technology, health-information systems and a planned patient information system.[11]Establish or review registers for NCDs, premature mortality, hypertension, cholesterol and diabetes, and strengthen cancer surveillance.[13][12]
• Use the Pacific Monitoring Alliance for NCD Action dashboard, also referred to as the MANA dashboard, to support Pacific monitoring and annual reporting; the dashboard uses 31 action-oriented indicators and traffic-light ratings across leadership, prevention policy, health-system response and monitoring.[8][4][20]
• Require the NCD Taskforce to monitor implementation, meet four times annually, provide an annual progress report to the Minister of Health, and submit written reports to the Secretary of Health on urgent matters.[2]Produce four strategy and action-plan progress reports, coordinated by Te Marae Ora.[19]
• Monitor implementation through taskforce and committee operations, workforce training coverage, communications implementation, school-student awareness, legislative and policy milestones, conflict-of-interest registers, service access and programme reviews.[19][22][14][15][12]

Reported baseline measures include premature NCD mortality of 24% in 2016, 22% in 2017, 20% in 2018 and 26% in 2019; childhood overweight and obesity of 31% in 2017 and 46% in 2019; and, within the global-goal framework, 10% diabetes prevalence, 80% obesity prevalence and 100% availability of essential technologies and medicines.[3][6][16]The supplied material does not consistently specify indicator baselines, annual targets, reporting responsibilities, evaluation methods or accountability sanctions; although an annex covers 2021 to 2026, its annual target columns are not populated in the extract.[7][21][16]

Costing & Financing

Costing information consists mainly of indicative annual activity costs and burden estimates, rather than a consolidated financed budget. The strategy prioritises contextualised, innovative and cost-effective interventions because healthcare costs are rising and resources are constrained.[3][5][8]No overall programme budget, financing source, funding gap, resource-mobilisation plan or economic assumptions are specified in the supplied material.[1][14][20]

• Estimate the 2017 direct health-system and indirect lost-productivity or intangible costs of the four leading NCDs at 5 million to 8 million dollars.[3]Estimate costs associated with premature deaths at 75 thousand to 3 million dollars.[3]
• Estimate non-financial costs, measured through years of life lost, at up to 11.7 million dollars; cardiovascular disease accounts for at least half of this burden, diabetes 27% and cancer 22%.[3]
• Provide indicative annual costs for NCD governance, taskforce coordination, community committees, workforce training, communications, school-based risk-factor action, legislative reform, tobacco and alcohol controls, nutrition, physical activity, primary care, palliative care and diabetes-register review.[19][22][14][15][12]
• Assign 15,000 dollars to establishing a surveillance, monitoring and evaluation framework, led by the Manager of Research, Policy and Planning and the Te Marae Ora Research Committee.[20]
• Identify tobacco excise increases, possible alcohol taxation, sugar taxation and fiscal measures affecting sugar-sweetened beverages as policy options, but provide no revenue forecasts, expenditure effects or Cook Islands-specific fiscal assumptions.[8][6][14][15]
• Recognise that cancer control is poorly resourced across the Pacific, particularly in human and technological resources.[13]

Most action-table amounts are displayed with a dollar sign but without a stated currency, so currency cannot be confirmed.[14][15][12]Benefits from preventive policy and legislation may take time to materialise, requiring sustained public and political support.[8][6]