1. The Pacific Island Health Officers Association 51 st PIHOA Meeting Status Report November 14, 2011

2. Mission Improve the health and well- being of USAPI communities by providing, through consensus, a unified credible voice on health issues of regional significance.

3. Governance - Directors & Associates Board of Directors VOTING Chief Health Ministers, Secretaries, Directors ► ROPPresident ► FSMVP ► RMISec ► Treasurer ► CNMI ► FSM ► Guam Associate Members NON-VOTING Advisory, provides continuity, active ► Four state Health Departments in FSM ► Heads of hospitals in Guam and AS ► Senior health deputies in RMI, Palau and Guam

4. Governance -- Affiliates Affiliate Members Professional associations for: ► Medicine ► Dentistry ► Nursing ► Behavioral Health ► Cancer Control ► Primary Care ► Education ► Health Care PIHOA commitment to Pacific Governance Must be: ► Pacific-Governed ► Charitable ► Impact on health policy Where a lot of work happens. PIHOA... ►... advocates for ►... builds capacity of ►... contracts with members for  Professional licensing  Continuing education  Program planning  More

5. Governance – Regional Associations Health Professions ► Pacific Basin Medical Association ► Pacific Basin Dental Association ► American Pacific Nursing Leaders Council ► Pacific Behavioral Health Collaborating Council ► Northern Pacific Environmental Health Association ► Association of USAPI Laboratories ► Association of USAPI Pharmacies

6. Governance – Regional Associations Disease Specific ► Cancer Council of the Pacific Islands ► Pacific Chronic Disease Coalition ► Pacific Partners for Tobacco Free Islands Policy / Leadership ► Pacific Resources for Education and Learning ► Pacific Post-Secondary Education Council ► Pacific Island Health Officers Association ► Association of Pacific Island Legislatures ► Micronesian Chief Executives Summit

7. Governance – Regional Associations Health Systems Specific ► Pacific Islands Primary Care Association Other Groups – Less Formal ► Quality Assurance Officers/Performance Improvement Managers ► Health Information Systems Swat Team ► Human Resources for Health Managers ► Public Health, Nursing and Nutrition Educators

8. Vasiti Uluiviti Human Resources for Health (HRH) Coordinator Greg Dever,MD Regional Laboratory Coordinator Alicia Sitan Fiscal Officer Michael Epp Executive Director Mark Durand, MD QA/QI and Health Information Systems Specialist Regie Tolentino Administrative Officer Current PIHOA Secretariat Angie Techur-Pedro Data Specialist

9. New Strategic Period Policy

10. PIHOA Resolution 48-01 passed May 2010 “Declaring a Regional State of Health Emergency to the Epidemic of Non- Communicable Diseases in the United States-Affiliated Pacific Islands” “Declaring a Regional State of Health Emergency to the Epidemic of Non- Communicable Diseases in the United States-Affiliated Pacific Islands”

11. The NCD Burden ► Biggest health problem in USAPI ► Among worst NCD disease and risk factor statistics in the world ► Current disease burden unsustainable  Endangering small, fragile cultures ► Current economic burden unsustainable  Largest part of health budgets  Worker health/productivity

12. Earthquake has hit, Waiting for the Tsunami ► Future burden will be catastrophic  High % of youth in USAPI  Alarming increase in risk factors among youth ► Impact on all sectors of society, especially health, labor, trade.

13. Current approach not adequate ► Heroic efforts underway, not nearly enough ► Fragmentation and lack of coordination at local, regional, donor levels ► Too health sector focused. Whole of society mobilization needed  Agriculture, Trade, Education, Fisheries, etc… ► Lack of Urgency

14. What’s happened since the declaration?

15. Phase 1: Evangelism May 2010 to Oct 2011 “Do you know there’s a problem? Do you know a problem? Do you know how big it is?” SocializationAlignment Political Will Why? So leaders will listen to you.

16. Resolutions & Endorsements Resolutions & Endorsements http://pihoa.org/initiatives/ncds/policy.php http://pihoa.org/initiatives/ncds/policy.php ► NCD Emergency Communique, 10th Micronesian Presidents' Summit Communique, July 2010 ► ► NCD Emergency Declaration by the 5th Micronesian Traditional Leaders Conference, November 2010, Koror, Palau; ► ► Resolution endorsing the NCD Emergency Declaration by the 14th Micronesian Chief Executives' Summit, December, 2010; ► ► NCD Emergency Declaration by the Association of Pacific Island Legislatures (APIL), December 2010. ► ► Adoption of Pacific-wide declaration of NCD crisis, modeled after PIHOA resolution 48-1, by the 9th Pacific Health Ministers Meeting, Honiara, June, 2011. ► ► Back again: NCD “Policy” Communique, 15 th MCES, Pohnpei, July 2011 ► ► Back again: Request by Association of Pacific Island Legislatures, 30 th General Assembly, for PIHOA to serve as NCD Policy Advisor, Palau, August 2011 (PIHOA given two hours on the APIL agenda)

17. Resolutions & Endorsements Resolutions & Endorsements http://pihoa.org/initiatives/ncds/policy.php http://pihoa.org/initiatives/ncds/policy.php ► ► Pacific Steering Group on Revitalizing Healthy Islands (Focusing on NCDs), Organzied by the World Health Organization in Nadi, Fiji, February, 2011, ► ► Western Pacific Regional Ministerial Conference, Seoul, Korea, March, 2011, ► ► First Global Ministerial Conference on Healthy Lifestyles and Non- communicable Disease Control, Organized by WHO, Moscow, 28-29 April 2011, ► ► 64 th World Health Assembly, May, 2011 (via representation through WHO Western Pacific Region), ► ► Endorsement of 9 th PMM Communique, Pacific Island Forums Meeting, Fiji, September 2011 ► ► High-level Meeting on the Prevention and Control of Non- communicable Diseases at the United Nations, New York, NY, September 2011.

18. Formal Emergency Declarations ! ! ! Palau ! ! ! ! ! ! Chuuk State ! ! !

19. Socialization Among Affiliates Evangelizing at the following MEETINGS: ► ► American Pacific Nursing Leaders Council (twice) ► ► Pacific Basin Medical Association ► ► Cancer Council of the Pacific Islands (twice) ► ► Pacific Behavioral Health Collaborating Council ► ► Pacific Resources for Education and Learning ► ► Pacific Islands Primary Care Association ► ► Guam NCD Coalition Meeting ► ► SPC/WHO meeting on Nutrition Diet and Lifestyle (Guam) ► ► 2-1-22 NCD Forum, Tonga (WHO/SPC) ► ► Association of USAPI Laboratories ► ► Association of USAPI Pharmacies ► ► QA/QI/Performance Improvement Managers ► ► Human Resource Managers Meeting

20. Socialization Among Affiliates Underwrote / Helped Coordinate the following CONFERENCE CALLS: ► ► Affiliate “Council” – 3 calls ► ► Pacific Basin Dental Association ► ► American Pacific Nursing Leaders Council ► ► Pacific Behavioral Health Collaborating Council ► ► Pacific Basin Medical Association ► ► Association of USAPI Laboratories (2 calls) ► ► Association of USAPI Pharmacists ► ► Education Committee

21. 50 th PIHOA Meeting: Emerging Consensus Policy ► ► Create healthy public policies throughout all sectors, in keeping with the Healthy Island Vision. ► ► NCD prevalence constitutes an emergency throughout the region, requiring urgent and coordinated response. NCDs are an emergency, and should be treated as such. ► ► Advocate for NCDs to be placed on the US national emergency management agenda. Prioritization / Resource Allocation ► ► Direct resources and activities to protect children and future generations, empowering them to live healthy lifestyles by addressing the priority risk factors, including diet, physical activity, tobacco, and alcohol. ► ► Transform our health systems to protect and empower the current generation by addressing the “Big Four” NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease.

22. 50 th PIHOA Meeting: Emerging Consensus Systems Strengthening ► ► Engage the government leadership to address the NCD crisis, using a whole-of-society response. ► ► Build the capacity of the health system to address the NCD crisis. ► ► Strengthen NCD-related information systems. ► ► Develop human resources to prevent and control the NCD emergency. Mobilization ► ► Mobilize sufficient resources to address the NCD emergency, and ensure sustainable resources to prevent its recurrence. ► ► Increase engagement of the full community – all of society, involving all sectors and jurisdictions, from local to regional. ► ► Build & strengthen mechanisms for regional sharing and collaboration across all groups involved regionally with addressing NCDs.

23. 51 st PIHOA Meeting: Emerging Consensus Strategic Objectives for Affiliate Organizations ► ► Association of Pacific Island Legislatures (Senators Scaliem & Won Pat) ► ► American Pacific Nursing Leaders Council ► ► Pacific Basin Medical Association ► ► Pacific Behavioral Health Collaborating Council ► ► Association of USAPI Laboratories ► ► Pacific Chronic Disease Coalition ► ► Cancer Council of the Pacific Islands ► ► Pacific Partners for Tobacco Free Islands ► ► Pacific Islands Primary Care Association ► ► Northern Pacific Environmental Health Association ► ► Pacific Resources for Education and Learning ► ► Pacific Post-Secondary Education Council

24. 50 th PIHOA Meeting: Emerging Consensus Strategic Objectives for Education Partners ► ► Chuuk State Government, Ministry of Education ► ► The Fiji School of Medicine ► ► The University of Guam, School of Nursing and Health Sciences ► ► College of the Marshall Islands, Administration and School of Nursing ► ► Guam Community College, School of Nursing ► ► Palau Community College, Public Health Program and School of Nursing ► ► College of Micronesia-FSM, School of Nursing ► ► The University of Hawaii John A. Burns School of Medicine ► ► The University of Hawaii School of Agriculture ► ► The University of Hawaii Department of Nursing of ► ► Island Food Community of Pohnpei ► ► Pacific Partners In Nursing

25. 50 th PIHOA Meeting: Emerging Consensus Strategic Objectives for Development Partners ► ► The World Health Organization ► ► The Secretariat of the Pacific Community ► ► US Health Resources and Services Administration ► ► US Centers for Disease Control and Prevention, Office of State, Tribal, Local, and Territorial Support ► ► US Health and Human Services, Region IX ► ► US Department of Interior ► ► Framework Convention Alliance ► ► Association of State and Territorial Health Officials ► ► National Association of Chronic Disease Directors ► ► Asian Pacific Islander American Health Forum

26. Phase 2: Regional Mobilization Nov 2011 to... “From Consensus to Action” Operationalizing the NCD Crisis Response

27. Sample Mobilization Activities at PIHOA ► Captured five year $1.7/year CDC National Public Health Improvement Initiative with significant NCD component:  Supporting NCD Policy/Law development ► “NCD Leadership Summit” early 2012  Development of NCD profiles  Development of standards ► All health systems strengthening priorities to include NCD focus (QA/QI, HRH, lab, planning, HIMS, planning, etc..)

28. Sample Mobilization Activities at PIHOA ► Recruited Presidential Management Fellow for six month rotation beginning Jan 2012. Primary focus: NCD Policy and Law ► Variety of health systems strengthening activities (see PIHOA Annual Report)

29. Thank you very much! Michael Epp Pacific Island Health Officers Association michaele@pihoa.org (808) 382-1231