Cover Story
Eating Themselves to Death
Behavior Patterns are Behind Today's Pacific Health Care.
Just how healthy are people living on Pacific Islands? When a comparison is made with some of the nations in Africa and Asia, the health status of Pacific populations seems not so bad. But when compared to other countries, such as Australia, or some of the more developed, but less isolated island nations, the less developed islands do not measure up well.
For example, life expectancy for women in Kiribati is 65.3 years, Nauru 69.2, Fiji 69.5, Micronesia 70.6, Tonga 72.5, and Samoa 72.7. Those figures compare extremely favorably with Uganda’s 44.5 years, but lag well behind Australian women, whose average life span is 83.5 years.
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But do such statistics really describe the health of the person in the street? And how does one measure health? The World Health Organization (WHO) defines “health” as a “complete state of physical, mental, and social well-being and not just the absence of disease or infirmity.” If this “physically well and happy” yardstick is used, then many — but not necessarily most — people in the region are not healthy.
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Prior to contact with outsiders, islanders enjoyed relatively good health. The whalers, missionaries, pirates, and other visitors brought new items, new ways of thinking, and new diseases. The 1900s brought war, work-saving devices, convenience foods, and more diseases. The new millennium has begun with AIDS arriving in the most isolated villages, and lifestyle related health problems spreading like wildfire.
Today, Pacific populations suffer from the worst of two worlds. Throughout the region, many tropical and developing world infectious diseases and under-nutrition problems burden the population, particularly children. At the same time, diseases associated with more developed nations — over-nutrition, inactivity, injury, and substance abuse — are affecting all ages.
The long-term challenge lies with diseases and conditions related to the westernization of the Pacific. Poor diet and lack of exercise are causing non-communicable diseases, such as heart disease, stroke, and diabetes. Cancer, liver conditions, and injuries caused by violence are related to the abuse of tobacco, alcohol, and other drugs.
Populations that used to engage in physical labor to obtain the daily bread are now largely sedentary. They take the car to work, sit most of the day at a desk or machine, eat convenience and junk foods, and then spend evenings watching TV. They smoke cigarettes, chew betel nut, and drink alcohol and/or kava to excess. First white rice, and now more recently instant noodles, have replaced nutritional local foods like breadfruit, bananas, yams, and taro. Following World War II, a health survey conducted by the U.S. Navy documented zero cases of diabetes in Micronesia.
Now it is difficult to find a family that has not been affected. Rates of many non-communicable diseases are double and triple those of the U.S. population and are responsible for more than 50 percent of the surgeries performed in many Pacific Island hospitals. In the Marshall Islands, for example, over 50 percent of hospital admissions are for treatment of diabetes-related ailments.
Beliefs that made sense three generations ago are now short-circuiting preventive health efforts. Unfortunately, many cultures traditionally viewed a large (or obese) body as a sign of high status. Now obesity, a major risk factor for many non-communicable diseases, among adults in some islands is as high as 75 percent. People are literally eating themselves to death, or as one physician put it, “You are digging your grave with your own teeth!”
Conversely, infants and young children are often borderline to severely malnourished, subsisting on a diet mostly of white rice, bread, instant noodles and occasional canned meats. Nauru, one of the Pacific’s richest countries, has the highest rates of obesity and diabetes. Kiribati, one of the region’s poorest countries, has some of the lowest rates of non-communicable diseases.
So what is to be done about the situation? How can the governments, the schools, the churches, and the health care systems affect changes? You can protect a child from diphtheria and polio with a shot. You can relieve a headache with a pill, and cure a rash or infection with an ointment.
Repairing the damage caused by the harmful habits and behaviors of many people in today’s Pacific Islands is much more complex. Changing behaviors and attitudes is not easy. In response to a discussion about preventative health measures, a man at a community meeting said: “Exercise is pointless work!”
The picture is bleak, but not hopeless. There are some programs that are making a positive impact. The “Get Up And Move – Guam” is an innovative health intervention set up by the Guam territorial government that acknowledges the fact that healthy workers are more productive and encourages participating government employees to exercise. Employees can take up to three work hours per week for exercise, gardening, and sports. Kosrae, in the Federated States of Micronesia, also permits paid time off for employees to exercise.
The U.S. Centers for Disease Control and Prevention (CDC) in Atlanta is providing much assistance to the U.S.-affiliated islands. One of its projects is the Pacific Diabetes Today Resource Center and aims to develop community-based programs to address the economic burden and decreased quality of life caused by diabetes. Several Pacific nations, with UNICEF support, have instituted Vitamin A programs in schools to combat a deficiency that is one of the most serious symptoms of malnutrition.
One of the benefits of the proliferation of TV’s in the islands is the interest in sports that has been generated. If the governments can take advantage of this by providing the needed facilities, many youths and adults will have the opportunity to have fun and exercise at the same time.
So there is some hope. Progress and development need not mean poor health. But the challenge of reducing the incidence of non-communicable — lifestyle — diseases is that it requires behavior change not only at a personal level, but also from governments and businesses.
In the American-affiliated Pacific Islands, nearly all preventive health programs are funded by outside donors, with little local money being committed to these essential activities. That, and people’s attitudes, will need to change before most islands will be able to get a grip on these escalating problems.
Photo: Karen Earnshaw
