Case Studies, Pacific

Tonga prioritises NCDs

HPF’s Senior Health Promotion Strategist in charge of the Pacific portfolio, Dr Viliami Puloka, reports that non-communicable diseases (NCDs) – many of which are preventable – are the overwhelming cause of death in Tonga.  The good news is that Tonga recognises the problem and is prioritising it at a government level.  Dr Puloka believes the situation there is reflected across the Pacific and that we should keep a close eye on the results of the work being done in Tonga to address the problem. Babies in Tonga have an excellent survival rate, with just 15 out of 1,000 dying before they reach the age of five – a mortality rate of 1.5%.  However this picture changes dramatically once Tongans reach 15, where 25.6 % of males and 35.1% of females die before they reach 60 years of age. [i]  Much of this dramatic increase in mortality is accounted-for by NCDs, of which diabetes and cardiovascular disease are the main culprits. Tonga top of the obesity league table According to an article in British newspaper The Guardian in August 2006, more than 90% of Tongans are overweight; making it the world’s fattest nation .[ii]  In 2012 a league table from the London School of Hygiene and Tropical Medicine, supported this figure; putting Micronesia and Tonga at the top of the obesity league table, just ahead of the United States.[iii] Non-communicable diseases account for approximately 74% of all deaths in the Pacific nation.  Of these the vast majority are preventable diseases such as diabetes and cardiovascular disease. [iv] It’s not hard to see why NCDs are so prevalent here.  Two research papers, summarised in Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004) found that overall 60.7% of the Tongan population was at high risk of NCDs, with three to five risk factors from the following list:

  • Smoking (46.2% of males  and 16.3% of females aged 15-64 years)
  • Alcohol consumption (22.2% of males and 4.8% of females aged 15-64 years)
  • Low fruit and vegetable intake (approximately 92.8% of Tongans aged 15-64 reported they eat less than the require five servings of fruit and vegetables a day)
  • Low physical activity (54.8% of females and 32.4% of males aged 15-64)
  • Obesity (76.3% of females and 60.7% of males aged 25-64)
  • High blood sugar (16.4% of Tongans aged 25-64 had elevated blood glucose levels)
  • High blood cholesterol (66.1% of men and 34.2% of women aged 25-64 had blood cholesterol levels of more than 5.00 mmol/L)
At an obesity workshop for health workers held in Tonga in May 2013, delegates heard that one in 10 people admitted to hospital –  in Tonga, Vanuatu and Kiribati – were there because of an NCD.  However the money spent on NCDs is disproportionately high, with one in every five dollars spent on treatment being for those with an NCD [v]   Tonga is leading the way in tackling NCDs at a policy level The good news is that Tonga is one of the few countries in the world to be prioritising NCDs.  It is just one of a handful of nations to consider NCDs as a development issue.  They have been identified a key result area in the Tonga National Development Strategy.  Tonga has a multi-sectoral National NCD cabinet committee and sub-committes for NCD prevention and control. The National Health Promotion Foundation – TongaHealth was set up in 2007 to respond to the nation’s NCD crisis and 20 National NCD nurses have been employed to address NCD prevention. Dr Puloka advises us to watch the progress in Tonga closely.  “If there can be a favourable result from a regional approach to NCDs it will be in the Kingdom of Tonga,” he says.  

[i] S. Hufanga et al Mortality Trend in Tonga . Population Health Metric 2012
[ii] The Guardian, Thursday 3 August 2006
[iv] WHO  Risk Factors: Results of the Kingdom of Tonga NCD Risk Factors STEPS report (2004)  
[v] Doran C.  Pacific Action for Health Project: Economic impact assessmentof noncommunicable diseases on hospital resources in Tonga, Vanuatu and Kiribati. 2003