19 - On the Strategy of Emergency Declarations: The 2010 Emergency Declaration on Non-Communicable Diseases as uplifting the voices of the US-Affiliated Pacific Island Region

Abstract Information: Emergencies are usually associated with imminent disasters, whether natural (i.e. hurricanes, earthquakes, etc.) or public health in nature (i.e. SARS, COVID-19, etc.). During such situations, emergency declarations become legal authority that is used to mobilize resources and policy to aid in the response. In recent years, the definition of “emergency” has been expanded to include more drawn out situations such as the opioid overdose epidemic or even climate change. However, in 2010, such a concept was still fairly novel, as when the Pacific Island Health Officers Association (PIHOA) declared a “Regional State of Health Emergency Due to the Epidemic of Non-Communicable Diseases (NCDs) in the United States Affiliated Pacific Islands (USAPI).”
The United States Affiliated Pacific Islands (USAPI) region is comprised of three US territories (American Samoa, Commonwealth of Northern Mariana Islands, and Guam) and three freely associated states (Federated States of Micronesia, Republic of Palau, and Republic of the Marshall Islands) that have special compact relations with the US which allow them to receive certain federal aid from the US but also make them subject to federal grant evaluation. Their health officials convene through PIHOA, a non-profit organization that provides a collective voice for Pacific health advocacy and regional policymaking, as well as supports partnership engagement and technical assistance to USAPI health departments and ministries. One of the biggest issues they are tackling are NCDs, which include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes (including kidney disease caused by diabetes), with NCDs continuing to be a significant cause of premature death in the region.
In 2022, the Stellar Group was contracted to do a retrospective evaluation of the impact of PIHOA’s 2010 Emergency Declaration, to find out to what degree PIHOA’s 2010 Emergency Declaration on NCDs 1) engaged health leadership, 2) coordinated with partners, 3) influenced NCD policy and advocacy, 4) helped improve NCD epidemiology and clinical measures, 5) helped improve NCD programs, 6) mobilized resources, and 7) strengthened systems capacity for the NCD response. Lastly, knowing all of this, the evaluation was also to make recommendations on what was needed for the next phase of the emergency response.
With the Emergency Declaration, PIHOA wanted to set the priorities and bring in additional funding and resources into the region. At the time, the 2010 Emergency Declaration was considered a novel approach and it generated considerable action and discussion. However, there were also questions as to its legal mandates, as these were health officers making emergency declarations on behalf of their own jurisdictions, and often still need considerable legislative and executive leadership buy-in to become truly effective. Moreover, the 2010 Emergency Declaration has also exhibited limited power over federal and international funding institutions. This presentation talks about findings of the evaluation of the Emergency Declaration in terms of government and public policy, exploring the strengths and opportunities of the approach, as well as the ways that the Emergency Declaration was able to uplift the collective voice of the USAPI region in the global arena.