The RMI NCD Program’s goal for this proposal is to prevent and reduce tobacco use and second-hand smoke exposure, improve the prevention and management of diabetes and diabetes related complications, high blood pressure, high blood cholesterol, and to prevent persons with diabetes from developing type 2 diabetes. In addition, it also aims to improve the capacity of the program to address oral health needs in the Marshall Islands.
The church and religion have played a significant role in shaping the attitude and behaviour of the people since the missionaries first arrived in the islands during the 1830s. Food habits among the residents of the Marshall Islands have undergone a change for the worse due to globalization, development of cash-based economy, and the availability of imported western food. The traditional nutritious diet consisting primarily of breadfruit, coconut, pandanus, taro, protein-rich fish, and chicken was overtaken by imported canned and processed food. Alcohol, smoking, substance abuse, and the crime rates are also on the rise. Lifestyle changes combined with changes in diet have led to the increasing incidence of diabetes and the secondary complications associated with diabetes. The health of the people is moving through a transition in morbidity and mortality, so that currently more people die from non-communicable lifestyle-diseases than from communicable diseases. Due to the rise of non-communicable diseases (NCDs) – the Marshall Islands officially declared a state of health emergency against NCDs on October 29, 2012.
In the short-term, the programs’ expected outcomes are: (1) routine collection, analysis, and use of NCD clinical and population-based data; (2) increased number of evidence-based strategies implemented that reduce access to tobacco; (3) increased awareness of the dangers of tobacco use, and the benefits of cessation; (4) Increased awareness about benefits of, and increased support for, smoke-free environments; (5) increased quality improvement practices in health systems to improve diabetes and cardiovascular disease (CVD) care; (6) increased use of health information technology to identify and manage patients with high blood pressure and high blood cholesterol; (7) increased implementation of team-based care in managing patients with high blood pressure and high blood cholesterol; (8) increased awareness and implementation of PHS guideline for treating tobacco use and dependence; (9) increased use of health extenders for the support of diabetes, high blood pressure, and high blood cholesterol; (10) increased availability of evidenced-based tobacco cessation services; (11) increased awareness and use of available cessation resources.
At the end of the project period, we expect the following outcomes: (1) decreased tobacco use prevalence; (2) decreased number and percent of adults with diabetes with an A1C>9; (3) increased control among adults with known high blood pressure and high blood cholesterol; (4) increased number of people with prediabetes enrolled in a CDC-recognized type 2 diabetes prevention program.