RMI Preventative and Control Chronic Disease Associated Risk Factors - In the Republic of the Marshall Islands (RMI), non-communicable diseases (NCDs) such as diabetes, cardiovascular diseases, and cancer are the leading causes of death. Overall, NCDs account for around 76% of all deaths in the RMI. It is estimated that the premature mortality rate from NCDs was 804 deaths (per 100,000) in 2022 and rose to 888 in 2023. Left unchecked, NCDs could account for more than 85% of premature deaths in the RMI by 2040. The purpose of this project is to decrease the prevalence of modifiable risk factors that cause or contribute to chronic diseases, thereby reducing rates of disability and death associated with chronic diseases affecting the population of the RMI. To accomplish this, the Ministry of Health and Human Services (MOHHS) of the RMI will implement the five strategies of the CDC’s Advancing Public Health Actions to Prevent and Control Chronic Disease in the U.S. Territories and Freely Associated States. The MOHHS will collaborate with partners, including the Marshall Islands Epidemiology and Prevention Initiatives (MIEPI); the RMI NCD Coalition in Majuro; the Kwajalein Diak Coalition, which serves as the NCD coalition on Kwajalein; and the Center for Pacific Islander Health at the University of Arkansas for Medical Sciences (UAMS) to conduct implement these strategies throughout the RMI, with particular focus on the outer atolls, which experience exacerbated health disparities due to access issues (some atolls can only be reached by boat). Activities to implement Strategy1 include planning and conducting another NCD Hybrid Survey, Global Youth Tobacco Survey, and Youth NCD Survey and disseminating data to stakeholders. Activities for Strategy 2 include working with partners to conduct a media campaign to educate decision-makers and the public on the scientific evidence base for raising the minimum age of tobacco sales to at least 21and increasing the price of tobacco products, including e-cigarettes. The NCD Policy and Grant Project Director will work with decisionmakers on enacting evidence-based strategies such as taxes, prohibiting discounts and redemption coupons, and minimum price laws. For Strategy 3, we will develop curricula and educational materials on prediabetes, the effects of emerging tobacco products on youth and the benefits of physical activity conduct educational events at schools, health care facilities, and community events, as well as using media to disseminate at least three messages per month on these topics. Under Strategy 4, we will work with the Center for Pacific Islander Health at UAMS to expand a culturally tailored family model of diabetes self-management education and support (DSMES) to the outer atolls. This model is delivered by community health workers (CHWs) supported by a physician, and part of our approach under Strategy 5 will involve training CHWs to provide the DSMES program which includes family members. We will also promote physical activity at community events and work with clinics to provide a refresher course on tobacco cessation and tobacco screening and trainings on Brief Tobacco Intervention (BTI). These strategies will produce the outcomes of increased evidence-based interventions to reduce disparities from NCDs and risk factors; decreased tobacco use among adults and youth; broad public awareness of risk for smoking and diabetes; improved health outcomes among people with diabetes; improved self-management among people with diabetes; and reduced risk of T2D among adults in prevention programs.
