By: Marinna Okawa
Seven years ago, the Pacific Island Health Officers Association (PIHOA) declared a Regional State of Health Emergency for the US Affiliated Pacific Islands. Guam was included in these islands, part of an area that had alarmingly high rates of non-communicable diseases (NCDs), including diabetes, cancer, and cardiovascular disease.
Fast forward to today, Guam has demonstrated significant decreases in the prevalence of several risk factors that contribute to the development of such NCDs through multilateral public health efforts. In 2011, the Guam Non-Communicable Disease Consortium was formed, spearheaded by Guam’s Department of Public Health and Social Services. The Consortium, which involves members from a variety of backgrounds, including business, government, agriculture, and healthcare, has developed two strategic plans, one in 2011 and one in 2014, to reduce the presence of NCDs on the island. Through policy, advocacy, data surveillance, and outreach, the island brings hope for a healthier, brighter future in the westernmost territory of the United States, “Where America’s Day Begins.”
To really understand population health, a few of the factors that must be analyzed fall under the categories of macro-level conditions and proximate health determinants. Macro-level conditions focus on social, economic, cultural, and environmental elements while proximate health determinants involve behavioral or biological variables (Institute of Medicine, 2002). What makes the efforts of Guam’s Non-Communicable Disease Consortium effective is their focus on macro-level conditions to influence proximate determinants. These proximate determinants are referred to as NCD Risk Factors, and fall under four categories: Tobacco Use, Nutrition, Alcohol Consumption, and Physical Activity. Each of these categories has its own Action Plan within the overall Strategic Plan, and the objectives and activities listed within these action plans acknowledge various macro-level conditions, including affordability of fruits and vegetables, limited time for physical activity due to work schedule, or social norms of tobacco use. The beauty of this is the acknowledgement that macro-level conditions must be addressed to produce any proximate determinant progress.
The thought process behind the Strategic Plan may lay the foundation for Guam’s successful public health efforts, but the careful planning ensures future efficiency. There are four categories of risk factors as previously listed and five different areas of work: Administration and Coordination, Data and Surveillance, Policy and Advocacy, Communications, and Evaluation. Each risk factor and each area of work has its own action plan. The action plans have overarching objectives with a specific audience, measurable impact, and target date. For example, one of the objectives for the Nutrition and Obesity Prevention Action Plan is “By 2018, decrease the number of Guam residents reporting adding salt in cooking and at the table by 10%.” Within each objective, there are a number of activities needed to obtain this goal, and for each activity there are designated organizations, resources, target audiences, expected outcomes, and completion timeframes. This kind of planning allows for members of the consortium to not only know exactly what is expected of them, but to also have something specific enough to work toward that can produce several different feelings of accomplishment on the path to reach a larger goal.
The work of the Data and Surveillance team of the NCD Consortium ensures accountability and provides further encouragement. In August of 2017, the Data and Surveillance Team published their second NCD Consortium Dashboard. This dashboard included NCD Risk Factors and Adult NCD Diagnoses tables. Using data collected from the Youth Behavioral Risk Surveillance System and Behavioral Risk Factor Surveillance System, the tables measured prevalence of both risk factors and diagnoses in 2011 and 2015. From this data, members of the Consortium were able to see how close their work was to the targeted prevalence rates in 2018, and whether they might meet these goals based on progress within those measured four years. Less than a year before the end of the Strategic Plan, members had the opportunity to see the tangible effects that their efforts had allowed.
The planning, coordinating, and evaluating surely made the public health efforts of Guam more successful, but what really put these efforts special is the community. Small teams met consistently based on the area of work and the entire consortium met on a regular monthly basis. The Strategic Plan and the Data cannot capture the kind and compassionate relationships between members, but they certainly ensured the continuation and quality of the work done. The NCD Consortium brought together people from different departments, careers, and generations into one unified family dedicated to making Guam a healthier place to live.
Faced with a bleak state of health, Guam embraced this challenge with positivity, courage, and determination and created an involved, detailed course of action to effect tangible change. The island may be where America’s day begins, but perhaps it also offers the beginnings of a health movement that the rest of the country should look towards as well.
Marinna is a sophomore and a HGHI Summer 2017 Fellow. She spent the summer working for the Government of Guam's Department of Public Health and Social Services in the Community Health Bureau, which focuses on non-communicable disease prevention.