Lessons from the Field: Interventions to Improve Health and Quality of Life to Address the NCD Crisis in Palau - Fostering Collaboration Across Sectors within the Government and Civil Society.

The Republic of Palau is a small island nation in the North Pacific with a population of 17,501. The islands of Palau are geographically isolated, considered rural, and medically underserved. The prevalence of non-communicable diseases (NCDs) and risk factors are very high and account for more than 75% of all deaths and disabilities. Recognizing that the high rates of NCDs are undermining health and sustainable development of the nation, Palau declared a state of health emergency due to the epidemic of NCDs. It was recognized during the development of the NCD Prevention and Control Strategic Plan of Action 2015-2020 (Palau NCD Plan) that improved collaboration between government agencies, civil society, and the private sector was needed to address this epidemic. A multi-sectoral solution was needed to address a multi-sectoral problem. Through Presidential Executive Order, the National Coordinating Mechanism for Non-Communicable Diseases (CM) was established to mobilize sufficient resources and coordinate actions to prevent and control NCDs, ensure successful implementation of the Palau NCD Plan, the World Health Organization Framework Convention on Tobacco Control, and other related plans and commitments, align such plans to national policies, ensure a health-in-all-policy approach to address health inequities, and bridge the gap between health and quality of life. Though the CM is young, improved coordination between agencies and accelerated action has taken place. Legislation was enacted that mandates 10% of alcohol and tobacco taxes be directed to NCD prevention through the Coordinating Mechanism, thus ensuring sustainability.