1. 18 th MCES – Regional Health Council Report Pacific Islands Health Officers Association (PIHOA) The Secretariat for the MCES Health Council

2. Oct 29, 2012: RMI Declares National Emergency due to NCDs

3. April 11 – Oct 12 – Chief Executives in Palau, Chuuk, Kosrae, RMI issue formal declarations

4. Health policy is the biggest bang for the buck BY FAR Appropriate regulations on sale, use and/or importation of tobacco, alcohol, salt, sugar, saturated fats Fostering built environments that encourage exercise, good diet, healthy lifestyle Key strategy for cost containment; much cheaper than even primary care (pennies on the dollar on a per capita basis) Much, much cheaper than dialysis: Up to $600 per tx (3x per week x 52 weeks=$93,600/year per pt) Cant happen without alignment of executive, legislative, and traditional leadership.

5. MCES Resolution 17-01: Calling for a Health Care, Non- Communicable Disease Law and Policy Summit

6. MCES 17-01 Resolved 1.Endorses significant increase in effort to pass NCD- related laws & policies (Directs RHC to find TA resources to assist) 2.Directs PIHOA to convene a joint MCES/APIL/T&FB Leaders law and policy summit within reasonable timeframe (Directs RHC to seek resources for summit) 3.Directs RHC to develop packet of recommended law & policy interventions; best and promising practices prior to summit 4.Requests development partners (WHO, HHS, etc) to assist with economic analysis of NCD impact 5.Directs MCE members to mobilize cross-sectorial response through cabinet and community leadership.

7. June 12 – APIL responds to MCES by formally endorsing joint law and policy summit

8. Sample activities since MCES 17-01 $45,000 for Summit secured so far; staffing to support Summit planners. To be hired Dec 15 NCD surveillance framework developed by USAPI reps; TA for developing local NCD surveillance initiated (FSM completed) Indicator #1 of 14: When % of students grades 9 through 12 who are overweight or obese decline three years in a row. Law and policy recommendations: The Commitment drafted and in review by health sector coalition (12/15 deadline)

9. Impact of NCDs on: GDP All sector budgets Worker productivity Household Income & spending Health & other sector budgets Current & Projected (e.g. dialysis) indirect costs such as missed school days Sample activities since MCES 17-01 EconAid request being prepared; Palau and Yap first pilot sites. Assessing NCD economic impact as well as economic impact of interventions (e.g., law & policy)

10. (Draft) Goal of Summit Goal: Increase capacity and consensus among executive, legislative, traditional and faith-based leaders, to select, enact and enforce NCD-related policy interventions that reverse the NCD epidemic in their territory or nation.

11. (Draft) Objectives of Summit 1.Increase leadership understanding of the context and urgency of the NCD crisis, socially, culturally, economically. 2.Identify strengths, weaknesses, and challenges of (and evidence for) particular policy interventions, to facilitate decision-making among leaders. 3.Encourage alignment among executive, legislative, faith- based, and traditional leaders in each jurisdiction for particular policy interventions of their choosing. 4.Link leaders to technical and financial resources that can assist them with enacting and enforcing policy interventions of their choosing; provide communications tools for forging adequate consensus for enacting policy at the local level.

12. RHC Recommendations for 18th 1.Endorse convening a planning group, 1 to 2 reps each from MCES, APIL, T/F-B Leaders, PIHOA. 2.Endorse having group meet at 53 rd PIHOA Meeting in, by phone thereafter after (PIHOA has travel resources) 3.Set deadline by when Summit will occur (August 2013?)

13. RHC Recommendations for 18th 4.Commit MCES to review, comment on, and as feasible endorse The Commitment (Recommended NCD policy and law package) prior to Summit 5.Instruct RHC to developed companion toolkit: model laws, experts, promising practices in implementation, & enforcement of The Commitment

14. REMINDER: Whos problem is this anyway? Health is a Shared Responsibility (RMI MOH Theme) Only 25% depends on Health Sector. The rest: Agriculture: Food security; accessible and affordable nutrition Trade: Appropriate import controls; privileging local produce Transportation: Pedestrian / exercise friendly environments Labor: Healthy workplace policies Education: Health education for students; health professional education (Etc…).

15. The NCD Earthquake has hit. Without your leadership, the next generation will bring the Tsunami.

16. THANK YOU The MCES Regional Health Council & Secretariat – PIHOA