St. Helena, one of the world’s most remote inhabited islands, is best known as the place where Napoleon was exiled. Perhaps less widely known is the fact that noncommunicable diseases (NCDs) account for a large share of ill-health and mortality on this tiny island in the South Atlantic Ocean, with data from 2017 suggesting that one fifth of the population were diabetic, and potentially half of adults were hypertensive. Obesity and tobacco use were prevalent, with findings suggesting that almost 7 in 10 patients were overweight or obese and 48% of young adults in their twenties smoked. In addition, island policymakers began to perceive the compelling economic and sustainable development case for reducing NCDs. The island receives overseas development funding and it was evident that NCDs were straining the island’s capacity to address its health and wider needs.
Despite a small and developing public health infrastructure compared to many countries, St. Helena has made considerable progress against NCDs over the past three years, and recently received an award from the United Nations Inter-Agency Taskforce on Noncommunicable Diseases (UNIATF) for its success in implementing a government-wide strategic approach to reduce NCDs and their risk factors. This is an outstanding achievement for St. Helena, which is competing in a category dominated by much larger national governments.
Strategic Framework Helps St. Helena Reduce NCDs
Prior to joining RTI, I was drawn to this small island nation to answer the government’s request for help to address the high prevalence of NCDs by designing tailored solutions based on international evidence. I was attracted by the challenge of addressing the extremely high NCD prevalence and limited public health infrastructure, combined with my belief that the issues were solvable. The starting point in developing the first Health Promotion Strategic Framework 2018-2019 was to understand the issues and context by assessing available national data and identifying gaps, conducting formative research and engaging with a wide range of stakeholders, and reviewing the international evidence. This helped us identify key issues, potentially effective strategies, and perhaps most importantly, how to tailor those strategies to be effective in St. Helena. Delivery was truly collaborative, with all developments undertaken in partnership with different parts of the government, community, and private sector. Health service reorientation developments were led by staff across a range of different disciplines.