Thought leader Colin Tukuitonga
Without a doubt, a stand out figure from the health promotion, public health and global health sectors is Colin Tukuitonga. Speaking from Noumea, Colin shared some thoughts with us on his current work, public health issues for Pacific Nations and changes in health promotion over the years. Thank you for your time this afternoon Colin, firstly, what proportion of The Pacific Community (SPC) work would you identify as health promotion? Given the broad scope of my organisation’s mandate in food security, fisheries management & education, agriculture, public health, human rights and geoscience, this is difficult to answer however all of these things at one level or another are health promoting in their outcomes. We have a separate public health programme that has a large health promotion component and we work in 26 countries. What are the biggest public health issues in the Pacific nations? Most definitely non-communicable diseases (NCDs). Obesity affects three out of every four adults. We also have the increasing issue of obesity in childhood. All islands were part of developing the Pacific NCD roadmap with specific recommended actions. One of these was to introduce a tax on sugary drinks. Another was an increase in tax on tobacco. The Pacific NCD roadmap is essentially a blueprint for the islands to follow. Some are active on this. Others less so. However, we expect all islands to implement a sugary drink tax. Communicable diseases can affect some islands for example tuberculosis in Papua New Guinea. How do you see the role of health promotion in addressing these issues? Without a doubt this is where we need to be overall but resourcing places constraints on this. Many islands are doing their best to help but again, more often than not, hospital and treatment services take up the lion’s share of funding. We do what we can at SPC to encourage island nations to invest in core public health functions but it is challenging. You have signalled SPC’s strong support for the 2019 World IUHPE conference to be held in NZ. What do you see as SPC’s role at the conference? We have three roles. Firstly, general support for the hui. It is just fantastic that we get to have this event in this part of the world. Secondly, we are planning to provide some financial support. Thirdly, and most importantly, our role is to facilitate an opportunity at this global event for small islands to share concerns and then work together, to take strength and to think about a way forward as an organisation of small islands. That is what we would hope to achieve. Climate change is a major issue facing the peoples of the Pacific. What actions do you think are necessary to address this global environmental issue? We made significant gains with the Paris Agreement, the UN Framework Convention on Climate Change. Now with US withdrawing from that, it may take us back to before the agreement so trying to maintain momentum is really difficult. We need political support from many to honour the Paris Agreement. Without this we will be going backwards. Pacific nations have put a lot of energy into the agreement particularly the recommendations to limit emissions and enable funds for good work. Right now we are at risk of inertia with the US not agreeing to continue. How do you see public health and health promotion developing over the years? Well when I started people talked about more traditional quarantine measures, or the role of legislation to regulate behaviours or control diseases. We’ve come a long way since then. The watershed moment for me was the emergence of the Ottawa Charter. This changed things from a conventional public health approach to one of empowerment of communities and of developing healthy public policy. For me it is about continuing this Ottawa Charter type approach and supporting nations to invest more in health promotion practices. To undertake things like health impact assessment and environmental impact assessment when large development projects are on the table. We have a range of tools to choose from but in general these are not always applied consistently. Having worked in both New Zealand and the Pacific, how would you characterise the relationship between the two? In some areas it is going well however I would say there seems to be a general lack of awareness in New Zealand about what is happening in the Pacific regions. I do note though that there is more and more interaction taking place. We could learn a lot from the health promotion models and ideas in New Zealand. Smoking continues to be a significant problem in the islands. We are impressed with New Zealand’s smoke free work. Are there any other pointers from your recent work we could learn from? Recently I was part of the World Health Organisation Global Commission on Ending Childhood Obesity as a commissioner. From that we produced a final report with a set of recommendations and cost-effective measures for ending childhood obesity. New Zealand and Pacific nations have been slow to pick these up. One would hope governments provide leadership and look seriously at the recommendations of this report.