“WHEN THE STATE FAILS TO REGULATE, DISEASE FILLS THE GAP: WHY PARLIAMENT MUST ACT ON NCDS”

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By Ake Poa, Solomon Islands Lawyer

When Prime Minister Jeremiah Manele addressed the United Nations General Assembly in September 2025, he issued a warning that speaks directly to the future of this nation:
“87% of all deaths in Solomon Islands are now caused by NCDs.”
“84% of adult hospital admissions are NCD-related, placing unsustainable pressure on our health system.”

These are not just numbers. They represent real people, parents dying too early, teenagers losing limbs, overcrowded hospital wards, and families pushed into poverty when the main income earner falls sick. And the trend is not slowing. NCD cases continue to increase, and they are rising in step with the growth of our population.

The Prime Minister has acknowledged the crisis at the global level. And only weeks later on 31 October 2025, all Permanent Secretaries were called to a high-level retreat chaired by the Secretary to Cabinet, where how to address NCDs among the issues discussed.

The question now is no longer whether there is a crisis. The question is whether Parliament will pass the laws needed to stop it.

The Government has already demonstrated its willingness to invest in treatment infrastructure. In January 2025, Solomon Islands Government formally received the SBD 90 million Comprehensive Medical Centre, funded by the People’s Republic of China, for the prevention, diagnosis and treatment of NCD patients.

But a hospital, no matter how modern, only helps after people are already sick. The Government has talked about NCDs in workshops, retreats, and media releases. But talk does not regulate markets, change diets, or save lives. Laws do. Solomon Islands now has a world-class treatment centre. What it still does not have is a law that stops people from needing it.

NCDs are often called “lifestyle diseases,” but that is only part of the truth. They are not simply the result of personal choice, they are the predictable outcome of the environment we regulate, or refuse to regulate. When sugary drinks are cheaper than water, when cigarettes are sold on every street corner, when unhealthy foods such as donuts, ice bula, ice blocks, and instant noodles are openly sold next to schools, when junk food carries no warning labels, when there is no sugar tax, and when highly-processed food imports enter the country without restriction, then illness is not an accident. It is authorised by omission. Silence can be as powerful as action, and legislative inaction in the face of a known public health threat is not neutral. It is a policy choice with foreseeable, preventable consequences.

Right now, the absence of legislation means commercial interests are protected, while public health is not. Profits are safeguarded. Families are not. Where Parliament fails to regulate harmful products, the legal effect is that corporations enjoy more rights than children. That is not public governance, it is regulatory surrender.

Other countries have already proven that strong laws, not just public awareness, can reverse NCD trends. Mexico, Fiji, Tonga, and the Philippines introduced sugar taxes and recorded consumption drops of 10–40%. Mexico alone saw a 37% decline in two years (Obesity Evidence Hub 2023). In Chile, front-of-pack warning labels forced companies to reformulate products; the proportion of supermarket foods exceeding “high in sugar/salt/fat” thresholds fell from 71% to 53% (Global Food Research Program 2022). London’s ban on junk-food advertising across its public transport network is estimated to have prevented 94,000 cases of obesity (LSHTM 2022). Tobacco control laws plain packaging plus high excise cut smoking by 30–40% in Australia, New Zealand, and Vanuatu. Workplace screening laws in Japan and Singapore helped detect disease early and reduced deaths from heart attack and stroke (JAMA 2020; RIETI 2022). These were not awareness campaigns. They were binding legal reforms, and they worked. The evidence is overwhelming: where the law intervenes, NCD rates fall. Where the law is absent, disease spreads.

What Solomon Islands needs to regulate is not vague or futuristic. It is specific, practical, and urgently achievable. Food import standards must restrict high-sugar, high-salt, and high-fat products. Excise laws must tax sugary drinks, alcohol, and tobacco, with revenue ring-fenced for health services. Food labelling laws must require clear, bold warnings, not fine print. Introduce national advertising laws which must ban junk-food and alcohol marketing to children. Schools must be free of sugary drinks and processed food. Government procurement rules should require healthy food in every State-funded institution. All workers aged 25 and above should receive mandatory annual NCD screening through their employer. Local licensing laws must control where fast-food, alcohol, and tobacco outlets are built. Consumer laws must penalise companies that sell harmful products disguised as “healthy.” If we do not regulate the causes, the country will keep paying for the consequences, through hospital care, dialysis, rehabilitations, amputations, prosthetics, medical evacuations, and unsustainable hospital budgets.

We already have rules for buildings, mining and logging. So we can definitely have rules for sugar, salt and trans-fat. The question is not “can we?”, it’s “why haven’t we?”

The cost of doing nothing is already visible. A national sugar tax could raise SBD 30–40 million annually, enough to fund rural screening, prosthetics, youth sports, and nutrition programs. Prevention is not only cheaper than treatment, it is the only financially realistic option for a small, aid-dependent economy. Economically, the choice is not “tax or no tax.” The real choice is whether we fund prevention through policy, or pay for health services through public debt.

For more than a decade, the national response has relied on awareness campaigns, posters, school talks and radio programs. These efforts matter, but the last 10 years have shown their limits. Awareness changes knowledge. Legislation changes behaviour, markets, and outcomes. We cannot treat NCDs as an “education problem.” We must treat them as a legal and policy problem.

As Sir Michael Marmot, a leading global authority on public health, has said: “Health is not a matter of charity, it is a matter of justice.” And justice, in any democracy, is not delivered by speeches, it is delivered by law.

The Ministry of Health and Medical Services must now do the right thing. It must go beyond talk and awareness, and prepare a clear national policy on NCDs that can quickly evolve into a draft NCD Prevention Bill with consequential implications for existing legislation, including tax, labour, and customs and excise laws. The Ministry already knows the scale of the crisis. Acknowledging it is no longer enough; it must act. When a danger is known and preventable, the government has a legal and moral duty to respond. Continued inaction turns a public health emergency into a failure of responsibility.

When the Ministry of Health and Medical Services fails to start the legislative process, the crisis is no longer unmanaged, it is being permitted. Parliament cannot debate a law that has never been drafted. The first failure is not in the House, but in the Ministry charged with safeguarding the nation’s health. Under constitutional principles, the State is the guardian of public welfare. A government that knowingly allows preventable death is not merely ineffective, it is complicit.

Every month of delay will now be counted in avoidable deaths, amputations, stroke cases, dialysis cost, funeral costs, and families pushed into poverty. NCDs are no longer just a health issue. They are a constitutional obligation, a moral question, and a test of leadership.

History will ask not whether our leaders understood the crisis, but whether they legislated to stop it.