Chronic diseases and health promotion

Part Four - Taking action: essential steps for success

Chapter One: Providing a unifying framework - the role of government

Success factors. Spotlight: Tonga

The following factors have been associated with success in policy formulation and adoption:

  • a high-level political mandate to develop a national policy framework
  • a committed group of advocates who may be involved with estimating need, advocating for action, and developing the national policy and plan
  • international collaboration providing political and technical support
  • wide consultation in the process of drafting, consulting, reviewing and redrafting the policy until endorsement is achieved
  • an awareness that the process of consultation is as important as the content in generating support and ownership;
  • development and implementation of a consistent communication strategy for all stages of the process
  • clarity of vision on a small set of outcome-oriented objectives.

Spotlight: Tonga’s intersectoral policy development

During the 1980s and 1990s, Tonga became increasingly aware of the rising number of people with cardiovascular diseases, diabetes and complications of diabetes such as gangrene, kidney failure and blindness. The prevalence of diabetes in the adult population doubled to over 15% in 25 years, although the majority remained undiagnosed and untreated. In 2003 clinicians, concerned public health staff and representatives of overseas development agencies met and conceived a national chronic disease strategy. Extensive consultations with stakeholders were held, and a survey was conducted to identify ongoing interventions.

The Government, churches, nongovernmental organizations and development agencies participated in a follow-up workshop. They produced the National Strategy to Prevent and Control Noncommunicable Diseases, based on the stepwise approach. A multisectoral committee was formed to coordinate the implementation of the strategy and advise the government, and four sub-committees on Physical Activity, Healthy Eating, Tobacco Control and Alcohol Misuse took responsibility for operational planning and implementation. The strategy was officially launched with national media coverage in March 2004 and later endorsed by cabinet. Important achievements include:

  • completion of a national survey on chronic diseases and risk factors, revision of the tobacco control act
  • development of a complete proposal to parliament for the establishment of a Health Promotion Unit funded by tobacco tax
  • inclusion of chronic disease control in the Millennium Development Goals for Tonga.

The strategy document has proved to be important in channeling external support and focusing resources on key interventions (Tonga Ministry of Health. A National Strategy to Prevent and Control Noncommunicable Diseases in Tonga. Nuku’ Alofa: Tonga MOH, 2003).