SITUA liON ANALYSIS FOR POLICY REPORT SAP/TRlWPROI001102

PACIFIC ISLAND MORTALITY EVALUATION Strengthening capability for collection, evaluation, analysis, project and reporting of mortality data from Pacific Island countries

Regional Office for the Western Pacific

Manila, Philippines June 2002 TABLE OF CONTENTS

1. INTRODUCTION AND BACKGROUND ...... 1

2. METHODS ...... 2

2.1 Survey of existing mortality data ...... 2 2.2 Evaluation of Validity of mortality data ...... 2

3. RESULTS 3.1 Problems with currently available Pacific Island mortality data ...... 3 3.2 Best estimates of current Pacific Island mortality ...... 4 3.3 Priority countries requiring assistance ...... 4 3.4 Summary table ...... 5 4. CONCLUSiONS ...... 7

ANNEXES:

ANNEX 1 - MELANESIA SUMMARY, GRAPHS AND TABLES ...... 9

ANNEX 2 - MICRONESIA SUMMARY, GRAPHS AND TABLES ...... 21

ANNEX 3 - POLYNESIA SUMMARY, GRAPHS AND TABLES ...... 39

ANNEX 4 - FORM FOR SURVEY OF PACIFIC ISLAND MORTALITY INFORMATION AND NOTE ON RESPONSE ...... 67

ANNEX 5 - INTERNET SEARCH ...... 73

ANNEX 6 - CANBERRA VISIT ...... 77

ANNEX 7 - SPC VISIT...... 79

REFERENCES ...... 81 1. INTRODUCTION

The Pacific Island countries are at different stages of the demographic transition, with some populations still experiencing relatively high mortality and fertility, while others manifest lower mortality and declining fertility. Many of these countries are also passing through the epidemiological transition, which is associated with complex changes in causes of mortality by age and sex over time and between countries.

The availability of accurate and current mortality data and trends is of vital importance for comparison purposes between countries to assist in the generation of the political will necessary to channel public and private resources into health-related activities. The consequences of inaccurate (low) mortality data are an under-estimate of the gravity and urgency of the health situation, and can result in under-investment in health development. Many international and aid agencies use infant and childhood mortality rates and life expectancy as part of the process of decision making for allocation of funds. Trends in mortality can also provide an overall assessment of the results of investment in social and economic development and health services.

In the mortality data from Pacific Island countries presently available, considerable contradictions are evident, especially with regard to implausible increases in life expectancy in several countries during the 1990's, and variation in data supposedly for the same period reported by different agencies.

The objectives of this project are to:

(1) identify and obtain recent empirically derived mortality data for Pacific Island countries, examine for validity, and report accurate mortality by sex;

(2) assist countries with assessment and analysis of their mortality data, including identification of important gaps; and

(3) assist countries with filling important gaps in mortality data and provide opportunities for group and individual training.

Phase 1 (2001) of the project involved: a detailed examination of material already obtained, searches of web sites and databases; telephone, email and fax contact with key informants in international agencies, universities and Pacific Island countries; visits to the Australian National University (ANU) in Canberra and the Secretariat for the Pacific Community (SPC) in Noumea; and a survey of mortality information held by Ministries/Departments of Health and Statistics in Pacific Island countries through the World Health Organization. Mortality data were evaluated from information on: source and methods, plausibility, and accuracy and consistency.

It is envisaged that Phase 2 (2002) would involve country visits to priority countries identified by the Phase 1 assessment. The purpose of the visits would be to obtain further mortality data and provide countries with assistance in evaluation and analysis of their own data, as well as identification of important gaps in mortality information collection and analysis. Phase 3 - 2 -

would involve: projects to rectify gaps in mortality information, detailed regional mortality analysis, and training activities including fellowships.

2. METHODS

2.1 Survey of existing mortality data

A systematic survey was undertaken of international and regional agencies, and universities and research institutes, known to be involved in the production and dissemination of mortality data in the Pacific Island region. The primary source of mortality data was traced through references in secondary material, and by interviews with authors of reports and key informants as far as possible. Relevant web sites were searched as well as electronic health and demographic databases. During Phase 1 information was gathered from institutions and a survey of countries with visits to ANU (Canberra) and SPC (Noumea).

A data collection instrument was sent to the Health and Statistics Ministries/Departments of the Pacific Island countries through WHO offices and representatives requesting published and un-published mortality data from 1990. Follow-up of this survey instrument by telephone and email was undertaken.

2.2 Evaluation of validity of mortality data

Mortality data was evaluated with respect to its: source and methods; plausibility; and accuracy and consistency.

Sources and methods: The source of mortality data was identified, and the methods used for computation and projections were ascertained as far as possible. These were evaluated with respect to known strengths and weakness of sources and methods. Some countries are known to have relatively good vital registration by the civil system or death recording by health departments. However, completeness of death recording is suspect in many Pacific Island countries. Use of model life tables for imputation of adult mortality from child mortality, or as part of indirect methods, were examined in relation to the appropriateness of the model life tables used. Projections were examined in relation to methodology and assumptions, when these were available.

Plausibility: Infant and childhood mortality and life expectancy figures were evaluated with respect to plausibility compared with other similar countries, the cause-structure of mortality, and reported changes in relation to previous estimates of greater validity.

Accuracy and consistency: If mortality estimates derived by independent methods requiring different assumptions provide approximately the same estimates, then confidence in such figures is enhanced. For example, concurrence of death recording corrected for under-enumeration and indirect methods from demographic analysis of censuses. - 3 -

3. RESULTS

3.1 Problems with currently available Pacific Island mortality data

The problems encountered with assessment of Pacific Island mortality data are set out below.

3.1.1 Death or vital registration data

There is considerable use of under-enumerated death recording or vital registration data, especially within countries, without any attempt to estimate and correct for under-enumeration using sample surveys or the Brass Growth Balance method. Both infant and adult mortality data are underestimated using these calculations.

(1) In some small island countries, especially with populations below 50 000, vital registration or death recording data are used to produce annual mortality estimates. The small number of deaths produces significant fluctuations from year to year with some estimates implausibly high and others implausibly low. Averages over three to five years, or in some cases seven to ten years, are required.

(2) Possibly inappropriate life tables are used in some countries to adjust and smooth empirical death recording or vital registration data. Depending on the locations of the countries in the demographic and health transitions, some model life tables may be inappropriate.

(3) In some small island countries with extensive connections with more developed metropolitan countries, out-migration of seriously ill persons for treatment may lead to under­ enumeration of deaths of these people (especially the French associates of New Zealand and the United States of America). Furthermore, sailors or expatriate workers may die overseas and not be registered although they were counted in the census. This usually causes greater under­ enumeration of male deaths than female deaths, and thus sex differences in adult mortality, which are implausibly small in some countries.

3.1.2 Imputation and indirect demographic methods

(1) In some countries, adult mortality is imputed from infant and under-five mortality using possibly inappropriate life tables. Such methods are very approximate, especially considering that the infant and childhood mortality from death registration or indirect methods may not be accurate.

(2) Some estimates of mortality from indirect demographic methods do not produce plausible results (compared with previous estimates and similar countries), and this may be due to uncorrected inaccuracies in the census or survey data, or problems in the analysis.

(3) Possibly inappropriate life tables are used for estimates, which rely on the combination of indirect measures of childhood and adult mortality. - 4 -

3.1.3 Projections

(1) Projection methodology for life expectancy and infant mortality estimates is rarely mentioned or described. However, there is indirect evidence that projections are frequently employed to produce 'current' estimates.

(2) There is indirect evidence that projections of life expectancy increases using a fixed fraction of a year of life expectancy per annum (such as one-half a year per annum) have been used in some countries. These projections are implausible for countries in the midst of the epidemiological (health) transition with an epidemic of non-communicable disease.

3.1.4 General comments

(1) There is very poor documentation of sources and methodology of mortality estimates in almost all published reports.

(2) There are significant differences between data published by different agencies for similar periods for many countries. It is usually not clear how such different estimates were derived.

(3) It may be the case that for some countries published mortality estimates are sourced from similar neighbouring countries or regional averages, or imputed from macro­ economic (e.g. GOP/capita) or social data.

(4) The age-specific mortality upon which life expectancies are based is frequently not provided.

3.2 Best estimates of current Pacific Island mortality

Table 1 presents he best recent mortality estimates in the opinion of the writer. The data given are not necessarily the most recent. For some countries, the best mortality estimates come from late 1980s or early 1990s data. Projections have not been made. Experience indicates that previous projections of Pacific Island mortality data have frequently been over-optimistic and not confirmed by subsequent empirical information. The data in the table are from published sources or data provided by countries or agencies.

3.3 Priority countries requiring assistance

A number of countries require assistance with analysis methods, development of vital registration systems, development and/or administration of census surveys (see Table 1). Countries singled out for assistance which could all benefit from detailed assessment of available vital registration data are: Fiji, Federated States of Micronesia, Marshall Islands, Nauru, Cook Islands, Samoa, Tonga and Tuvalu. - 5 -

3.4 Table 1: Summary table best recent mortality estimates. Pacific Islands

Country Best recent mortality estimates Method Comment (Popn '000) Year Life Year Infant expectancy at mortality rate birth (yrs) (/1000) both Male Female sexes MELANESIA Fiji 1996 65 69 1996 20 Demographic analysis Assistance with (810 in 1997) of 1996 census analysis of current vital registration data required New Caledonia 1999 70 76 1999 6.3 Accurate vital No assistance J197 in 1996L registration needed Papua New 1991 52 51 1995 76 Life expectancy based Results of analysis Guinea on 1991 census and of 2000 census (3 608 in 1990) IMR on inter-censual awaited No survey (1995) possibility of using death or vital registration data Solomon 1999 61 62 1999 66 Demographic analysis No possibility of Islands of 1999 census using death or vital (404 in 1999) reaistration data Vanuatu 1989 62 64 1989 45 Demographic analysis Analysis of 1999 (193 in 1999) of censuses census yielded life There may be expectancies of possibilities of using 66(M) 69 (F) and 27 death or vital (IMR) which are not registration data entirelv olausible MICRONESIA Federated 1990 64 67 1994 46 Life tables imputed Possibilities of using States of - from childhood death or vital Micronesia 1994 mortality derived from registration data (118 in 1997) indirect methods Assistance reauired Guam 1995 72 76 1995 9 Accurate vital No assistance (146 in 1997) reQistration needed Kiribati 1995 59 65 1995 62 Demographic analysis Unpublished data (81 in 1999) of 1995 census from 1999 census similar to 1995 census estimates Some possibilities of using death recordinQ data MELANESIA Marshall 1994 60 63 1994 63 Life tables imputed More recent Islands from childhood estimates (51 in 1999) mortality implausible Assistance required for analysis of death recording data Nauru 1991 54 61 1991- 13 Hospital death Assistance needed (10 in 1992) - 1993 registration data with periodic 1993 analysis of death registration data - 6 -

Country Best recent mortality estimates Method Comment (Popn '000) Year Life Year Infant expectancy at mortality rate birth (yrs) (/1000) both Male Female sexes Northern 1994 67 73 1992- 10 Vital registration data May benefil from Mariana - 1996 Probably accurate assessment of vital Islands 1996 registration data (59 in 1995) Palau 1995 64 70 1995 20 Vital registration data May benefit from (19 in 1998) Probably accurate assessment of vital registration data POLYNESIA American 1995 68 76 1991- 13 More information More information Samoa 1995 required required (63 in 1999) Cook Islands 1995 68 72 1991- 16 Vital registration data Requires assistance (17in 1999) - 1996 of with analysis of 1997 vital registration data French 1996 69 74 1996 10 Accurate vital No assistance Polynesia registration data required (220 in 1996) Niue 1991 70 1991- 18 Probably accurate May benefil from (2 in 1997) - 1996 vital registration data assessment of vital 1997 registration data Samoa 1998 65 72 1998 25 Vital statistics sample Requires assistance (175 survey with vital statistics in 1999) sample survey and development of death registration Tokelau 1996 68 70 1991- 32 Vital registration data May benefit from (1.5 1995 Probably accurate assessment of vital in 1996) registration data Tonga 1996 70 72 1996 19 Demographic analysis Assistance required (97 in 1999) of 1996 census to develop vital registration MELANESIA Tuvalu 1991 64 70 1990- 27 Life expectancy data Assistance required (11 in 1999) 1999 from demographic in assessment and analysis of 1991 analysis of vital census registration data May be too high Wallis and 1990 67 71 1990- 15 Probably accurate May benefil from Futuna - 1995 vital registration assessment of vital (14 in 1996) 1995 registration data - 7 -

4. CONCLUSIONS

The results of this initial survey represent published available information on Pacific Island mortality to the end of 2001. The 'best estimates' in the summary table above contain some information of questionable validity, but are the most accurate and plausible available in the opinion of the writer.

Apart from quoting infant mortality data directly from some of the few countries who provided detailed information to this project, no extensive assessment or analysis of vital registration data and its validity has been made. However, initial examination of these data suggested in some cases significant under-registration, and considerable annual fluctuations in countries with small populations. In other cases, death recording data suggested lower life expectancies than published sources.

Detailed assessment and analysis of mortality data from countries that would appear to be able to benefit from assistance would need to be undertaken in collaboration with the appropriate government departments in such countries. Publication of mortality estimates based on adjusted death or vital registration data that differed from present estimates would need to incorporate details of the methodology, and be conducted in collaboration with Pacific Island countries and concerned internat:..:...1 and regional agencies.

From this Phase I report it is possible to identify a selection of Pacific Island countries that would benefit from a more detailed assessment, particularly of un-analysed and un-published mortality information. This could lead to publication and dissemination of more reliable mortality and life expectancy information for these countries.

This report has also identified a number of problems in mortality assessment and analysis which could be addressed by workshops for relevant staff in Pacific Island countries. Some workshops could be sub-regional since the types of problems differ across the spectrum of Island countries.

There could also be opportunities created for fellowship attachments or post-graduate study for staff of Island countries who wish to gain further training and expertise in mortality assessment and analysis. - 9 -

ANNEX 1

MELANESIA SUMMARY, GRAPHS AND TABLES

Fiji Population in 1997: 809900

The most important observation conceming Fiji mortality data is the dramatic reported increase in life expectancy from around 61 years in males and 65 years in females in 1986 to over 70 years in males and over 75 years in females in the mid 1990s, only to be revised downwards to 65 years for males and 69 years for females by 2000. The data for the mid 1980s and the late 1990s, which are quite similar were derived from the demographic analysis of the 1986 and 1996 censuses using indirect techniques, supplemented by Department of Health data. These estimates are most likely correct. It is unclear how the earlier estimates of life expectancy of over 70 years were derived, but some may have come from analysis of under-enumerated vital registration data and other estimates may have been produced by over-optimistic projections from life expectancy from the 1986 census.

There is some possibility that selective out-migration since the late 1980s may have affected community mortality profiles, however, this would most likely have been persons with relatively low mortality, and would have affected the Indo-Fijian component only. It is unlikely that changes in health service provision would affect mortality in such a way as the recorded data indicate. The most likely reason for the recorded changes in Fiji life expectancy over the last 15 years is that the changes are largely artefactual.

Infant mortality of 15-20/1000 may be at the lower end of plausibility, although there are often significant problems with under-enumeration of early neo-natal deaths (mis-classified as stillbirths) in data derived from death recording.

If mortality has been mostly stationary in Fiji over the period in question this may be a consequence of a combination of: a continued rise in non-communicable disease mortality which could balance reduction in mortality from other causes; lack of improvement in health and social services and aspects of social and economic development related to health status and mortality; and/or an out-migration of segments of the population with low mortality which disguised mortality improvement in the remaining population. These suggestions would require more detailed investigation. However, data on change in life expectancy between the 1986 and 1996 censuses for Fijians and Indo-Fijians do not suggest a major difference between the races, which would not suggest differential out-migration as a cause.

Whereas the 1996 census gave life expectancy estimates of 65 years for males and 69 years for females, most recent data from the Fiji Ministry of Information (2000) gives life expectancies of 61 and 65 years respectively for males and females. It is unclear how the 2000 estimates were derived. - 10 -

Annex 1 (Fiji)

It is recognised that mortality data from the Department of Health is improving in quality and completeness. The most important task in Fiji is to develop Health Department capacity to devise methods for analysis of Department of Heath mortality data, which correct for under-enumeration and provide consistent and realistic estimates of Fiji mortality on a continuing basis.

Rjl Female Life Expectancy Fiji Male Life Expectancy

_ 80 80 E75 I ~ 75 ••• • .; 70 .; 70 ., . • r; 65 • ~ 65 • • • ~ 60 • • :ii 60 ~ 55 ~ 55 a. ll' 50 I 50 : 45 45 ~ 40 ...J 40 :s 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year) - 11 -

Annex 1 (Fiji) Table 1 RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date 11000 - -- nla 18 wwwunicef.om - 2001 113 Increase in life Fiji Ministry of expectancy to 72 and 2000 61.4 65.2 2000 16.3 81 Information, 2000 75 was projected, but nla nla nla 1997 20 UNICEF,1999 151 no difference in life www.sRc.org.nc - expectancy or infant 1996 64.5 68.7 1996 20 114 2001 mortality rate was Fiji Ministry of Health, detected between the nla nla nla 1997 16.8 82 1997 1986 and 1996 Fiji Ministry of Health, censuses using nla nla nla 1996 17.1 82 1997 indirect methods. Indirect methods 1996 64.5 68.7 1996 20 Rakaseta V, 1999 15 1996 census The estimate of IMR of Fiji Bureau of 711000 is very unlikely. 1996 64.5 68.7 1996 22 10 Statistics, 1998 PrGbably Y, a year The 2000 estimates South Pacific per year added to from the Fiji Ministry of 1995 72 75 1994 16 23 Commission, 1998 1986 census life Information show expectancy figures. lower life expectancy Secretariat Pacific estimates than 1995 72 75 1994 16 20 1986 census Community, 1998 previous data; methods not given 1990 United Nations, 2000 - 69.5 73.7 nla nla 30 Population Division 1995 Fiji Bureau of 1996 64.8 69.0 1986 22 Rakaseta V, 1999 15 Statistics 1996 1996 www.SRc.org.nc - 69.7 75.8 7 114 - - 2001 1998 1998 Fiji Co-ordinating 1993 M + F =71 1993 16.8 Committee on 84 Children, 1995 1992 nla I nla 1992 16.6 Fi'i Government, 1993 45 1990 M + F =71 1990 25 World Bank, 1995 47 Fiji Co-ordinating 1990 M + F =69 1990 22 Committee on 84 Children, 1995 65. Fiji Department for 1986 61.0 1986 46 2 - Women and Culture 65. Fiji Bureau of 1986 61.4 1986 20.9 43 1986 census 2 Statistics, 1986 1985 M + F =70 1985 29 World Bank, 1995 47 - 13 -

Annex 1

New Caledonia Population in 1996: 196 836

New Caledonia mortality and life expectancy data are based on vital registration of deaths, which is considered to be accurate. There are some deaths in New Caledonian residents who seek treatment abroad (Australia, France), which may not be included in the vital statistics data.

The increase in life expectancy and decline in infant mortality over the last decade might be partly influenced by in-migration of Europeans with relatively low mortality, but evidence available suggests that mortality decline is also affecting the Provinces outside of Noumea, which are overwhelmingly Melanesian.

The decline in mortality is probably partly a consequence of improved social and economic conditions and improved health services for the local population (of all ethnicities) consequent upon the accords agreed upon with France a decade ago.

There are no implications for changing the mortality recording system.

New Caledonia New Caledonia Male Life Expectancy Female Life Expectancy

I!! 75 80 _.. 80------'-1 ~ 75 .; 70 .",..~ .,; 70 t' 65 ~ 65 i 60 Ii 60 1l 55 1l 55 =- 50 i 50 5 ~~ j I ~ 45 ..... 40 +-~-~-_--l 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

New Caledonia Infant Mortality Rate

~ 70:~1--- -- I l 60 ~ 50 I ~o 3040 I =. 20 ~ 1~~j--__ --~~-.~~--~ 1970 1980 1990 2000 2010

Period (year) - 14 -

Annex 1 (New Caledonia)

Table 2

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 Age specific mortality 1999 69.8 75.8 1999 6.3 Nouvelle Caledonie 120 based on generally accurate civil vital Direction des Affaires registration. Problems Sanitaires et Sociales are: sparsity of deaths 1998 70.3 76.7 1998 6.9 93 de Nouvelle- in one year of data, Caledonie, 1998 and suspiciously low Secretariat Pacific IMR Plausible 1997 68.8 76.4 1997 5 21 Community. 1999 improvement in life Secretariat Pacific expectancy over 10 1995 68 76 1995 8 20 Community, 1998 years. South Pacific 1995 68 76 1995 8 23 Commission, 1998 SPC has different 1990 estimates for same - 69.7 74.7 nla nla United Nations, 2000 30 period -1996-1998. 1995 Nouvelle Caledonie, 1993 67.9 75.7 1993 7.6 119 1999 Nouvelle Caledonie, 1992 68.2 75.1 1992 8.6 119 1999 Nouvelle Caledonie, 1991 66.7 74.3 1991 8.2 119 1999 Nouvelle Caledonie, 1990 67.9 73.1 1990 10.7 119 1999 Nouvelle Caledonie, 1989 66.7 71.9 1989 11.2 119 1999

1987 1987 - 67.5 73.8 - 11.2 Rallu JL, 1991 18 1989 1989 - 15 -

Annex 1

Papua New Guinea Population in 1990: 3607954

There is no reliable vital registration of deaths in PNG either through statistics offices or the health department. All estimates of mortality are based on indirect demographic methods through censuses or surveys. The last empirical life expectancy estimates were from the 1990 census and suggested life expectancies of 52 years for males and 51 years for females. Estimates have been made for the mid-1990s of 55 and 54 years for males and females respectively, but these are probably projections.

Infant and child mortality is estimated from inter-censual surveys as well as censuses. The infant mortality appears to be around 70-80/1000 with no trends in the last decade.

The 2000 census is still being edited and entered, and the mortality analysis of this census is not due to commence until mid-2002, and results may not be available until 2003.

There is no alternative in PNG at present except to use indirect methods to estimate community mortality. While efforts to improve registration of deaths should continue the data are not expected to be sufficiently reliable for decades. Mortality estimates are infrequent because censuses occur only at 10-year intervals, although infant and childhood mortality estimates are also available from inter-censual surveys. A possibly to improve available mortality data would be to add techniques for calculation of adult mortality to inter-censual surveys, and/or to use sample vital registration areas.

Papua New Guinea Papua New Guinea Male Life Expectancy Female Life Expectancy

80 ~ 75 ------1 ~ 80,------, ! 70 :I,.. 75 ~ 65 ~ 70 c 60 :; 65 ~ 55 .... ¥ 60 ..e- 50 ~ 45 ~ 55 • ...J 40 +---_-_-_------l :5 50 ... 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) P. rlod (year)

Papua New Guinea Infant Mortality Rate

~ 80 ~-~.-.------­ :;; ~ 60 ~ 40 ~ "E 20

~ o +----__-~-__l 1970 1980 1990 2000 2010 Period (year) - 16 -

Annex 1 (Papua New Guinea)

Table 3

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 1991 ,1986 All data from censuses www.spc.org.nc- 54.6 53.5 77 114 and surveys. - - 2001 1996 1996 -- - nfa 79 www.unicef.org - 2001 113 PNG National nfa nfa nfa 1995 76 68 Statistical Office, 1996 1990 - 55.2 56.7 nfa nfa United Nations, 2000 30 1995 nfa 55 54 nfa 77 UNDP, 1999 29 South Pacific 1991 52 51 1991 82 23 Commission, 1998 Secretariat Pacific 1991 52 51 1991 82 20 Community, 1998 1991 52.2 51.4 1991 82 Hayes G, 1996 12 1986 1990 52.2 51.4 77 United Nations, 2000 30 -96 - 17 -

Annex 1

Solomon Islands Population in 1999: 404 000

Vital registration and health department death recording are variable and incomplete in Solomon Islands. All mortality data are derived from indirect demographic methods applied to censuses.

Life expectancy data given for the 1990s are implausibly high compared to the 1980s. There have been difficulties in calculating mortality levels from the last census (1999), but the most recent estimates of life expectancy of 61 years for males and 62 years for females are plausible; as is the IMR of 66/1000.

Solomon Islands Solomon Islands Male Life Expectancy Female Life Expectancy

80,------~ 80 "F 75 e 75 : 70 ~ 70 » • ;: 65 • ;: 65 u u li 60 • • • i 60 • • • ~ 55 55 Q, 1lQ, ~ 50 = 50 ~ 45 45 ~...J ...J 40 +--__~--~--~___" 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Solomon Islands Infant Mortality Rate

0 90 0 q 80 - 70 8. 60 • l!' 50 ~ 40 t: ... 0 30 • E 20 -..I: 10 -.5 0 1970 1980 1990 2000 2010 Period (year) - 18 -

Annex 1 (Solomon Islands)

Table 4

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date 11000 1999 60.6 61.6 1999 66 SPC 166 1999 census Mosl recent data n/a n/a nla 1999 38 UNICEF, 1999 158 plausible 1990 - 68.4 72.7 nla nfa United Nations, 2000 30 Reported data show 1995 an increase of 1 year 1990 per year from mid - 63.5 67.3 nla nfa United Nations, 2000 30 1980s to mid 1990s 1995 which is implausible. nJa 64 66 nJa 38 UNDP, 1999 29 South Pacific Large discrepancy in 1986 60 61 1986 38 23 Commission, 1998 IMR between Secretariat Pacific UNDP/UNICEF and 1986 60 61 1986 38 20 Community, 1998 those reported by 1980 1980 SPC. - 59.9 61.4 - 38.3 Bartleman et al., 1988. 1 Census 1985 1985 Methods for UN 1980 1980 projections need Secretariat Pacific 59.9 61.4 38 21 Indirect estimates investigation - - Community, 1999 1984 1984 1980 1980 www.sgc.org.nc - - 59.9 61.4 - 38 114 2001 1984 1984 - - - nla 37 wW'A'.un[GefoIQ - 2001 113 - 19 -

Annex 1

Vanuatu Population in 1999: 193219

Vanuatu mortality and life expectancy data are based on demographic analyses of censuses, however, the quality of some of these analyses may be questionable. This particularly applies to the available analysis of the 1999 census data. In this analysis the infant mortality rate was estimated at 26 and the life expectancy for males was 67 years and for females was 70 years. The Vanuatu mortality data from the 1999 census was re-analysed by SPC and results suggested life expectancies of 66 years and 69 years for males and females, with an IMR of 27/1000. However, these estimates may not be plausible and there may be problems with the census data itself.

The increase in life expectancy and decline in infant mortality over the last two decades might be partly influenced by improved environmental conditions and health services, but there are questions concerning validity of analyses.

Vanuatu Vanuatu Male Life Expectancy Female Life Expectancy

80 80 ---­ 'F 75 ~ 75 ! 70 ! 70 ,.. 65 ~ 65 • • u • • • i 60 • •• :i 60 ~ 55 55 • • i.. 50 ~ 50 ~ 45 ~ 45 ~ 40 +--_-_-_~ :::; 40 +---~_-~----" 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Vanuatu Infant Mortality Rate

c> 100 & • 80

,..~ 60 '" • ~ 40 • ~ • 1: 20 • .l!! B o+---_-_-_~ 1970 1980 1990 2000 2010 Period (year) - 20-

Annex 1 (Vanuatu

Table 5

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 1999 66 69 1999 27 SPC 166 1999 census Reported data show Vanuatu National an increase in life 1999 67 70 1999 26 79 1999 census Statistics Office, 2000 expectancy in the nfa nfa nfa 1999 39 UNICEF,1999 154 early 1990s of almost nfa 64 67 nfa 45 UNDP, 1999 29 1 year per year which Vanuatu Census Dala is implausible. nfa nfa nfa 1989 55-60 75 1989 census Office, 1991 www.sgc.org.nc- Decrease of IMR of 45 1989 61.5 64.2 1989 45 114 2001 to 26 deaths per 1000 South Pacific live births since 1989 1989 62 64 1989 45 23 Commission, 1998 may not be plausible. 1989 61.5 64.2 1989 45 Vanuatu & UN 76 1979 Methods for UN Secretariat Pacific - 61.5 64.2 1985 45 21 projections need Community, 1999 1989 investigation Vanuatu Census Data 1979 Nfa 56 1979 94 75 1979 census Office, 1991 1979 54 56 1979 94 Vanuatu & UN 76 - 21 -

ANNEX 2

MICRONESIA SUMMARY, GRAPHS AND TABLES

Federated States of Micronesia Population Estimate in 1997: 118000

FSM mortality and life expectancy data are derived from both censuses and vital registration. It is acknowledged that vital registration is under-reported, but considered to be slowly improving. There is a disclaimer in the 1999 FSM statistical yearbook indicating that the data is to be used for comparative purposes, and does not actually represent the number of deaths.

Direct measures of mortality could be calculated using deaths registered with the Department of Health, however ,these events are under-registered and inconsistently covered and at best the data provides a pattern of mortality. Small numbers of persons and deaths and inaccuracies in reporting make direct estimations difficult.

It appears that the most recent life expectancy estimates have been imputed from elltimates of childhood mortality.

For the census year 1994, IMR was calculated at 46/1000 using indirect methods from the census and 25/1000 using vital registration data. The level of infant mortality does not appear to have improved in the past decades.

Federated States of Micronesia Federated State. of Micronesia Infant Male Life Expectancy Morta IIty Rate

80 90 "F 75 § 80 ~ 70 .: 70 -z;: 65 i. 60 •• i:' 50 :i 60 • ~ 40 • •• i 55 • ~ 30 '"~ 50 - 20 ..... :S 45 i 10 o+---~-~-_------< 1970 1980 1990 2000 2010 1970 19S0 1990 2000 2010 Period (year) PeTiod (year)

Federated States of Micronesia Female Life Expectancy

80 'E" 75 ! 70 ~ 65 ... , Ii 60 • 1! 55 ~50 ~ 45 ...J 40 +--_~ ____------< 1970 1980 1990 2000 2010 Period (year) - 22-

Annex 2 (Federated States of Micronesia)

Table 6

RECENT ESTIMATES Ref, Reference Sources/Methods Comments E(X) IMR No, Date Male Female Date 11000 nla Nla nla 1999 28 UNICEF,1999 153 There is a FSM Government, considerable nla nla nla 1997 26.8 42 Registration data 1999 discrepancy in IMR FSM Government, between SPC/UNDP nla nla nla 1996 19.5 42 Registration data 1999 and UNICEF, and IMR FSM Government, from the FSM nla nla nla 1995 20.9 42 Registration data 1999 government is FSM Government, variable. nla nla nla 1994 24.9 42 Registration data 1999 - - - nla 20 www.unicef.org - 2001 113 FSM Government, 1994 nla 65.2 1994 47 41 1994 census 1996 Adult mortality and South Pacific 1994 64 67 1994 46 29 life table based on Commission, 1998 1 . CEBCS technique nla 64 67 nla 46 UNDP, 1999 29 FSM Government, Nla nla nla 1993 21.7 42 Registration data 1999 FSM Maternal and nla nla nla 1992 21 89 Child Health, 1991/92 FSM GovernmenU 1992 62.2 65.9 nla 52 90 UNICEF, 1996 1990 1990 www.sQc.org.nc - 64.6 66.8 45 114 - - 2001 1992 1992 1990 1990 - 64.6 66.8 - 45 Demmke e/ al., 1997 3 1994 census 1992 1992 1990 1990 Secretariat Pacific - 64.6 66.8 45 21 - Community, 1999 1992 1992 Vital registration 1979 1979 Adjusted death - 56.5 59.3 - 45.2 Taylor R, 1989 26 recording 1981 1981 - 23-

Annex 2

Guam Population in 1997: 146,328 Aproximately 129,000 Civilians and 16,000 Military Personnel (including families)

Infant mortality and life expectancy is generally determined from registered death data. In the period 1990-1995, the IMR was 9/1000.

Life expectancy for 1995 was estimated to be 73 years for males and 77 years for females.

While registration of births and deaths for Guam is likely to be complete, the influence of immigration and emigration is not documented. There are implications of migration of military personnel, including families, for life expectancy estimates. This may lead to assumptions of higher life expectancy for the indigenous Chamorro population, which comprises 43 percent of the population of Guam, than may be the case.

Guam Guam Male Life Expectancy Female Life Expectancy 80 .,------­ 80,------, ~ 75 •• ~ 75 • :I,., 70 ,.,: 70 ••• ;: 65 ~ 65 u ; 60 :; 60 55 ~ 55 i Q. :I 50 ; 50 :5" 45 ~ 45 40~ ____~-- __--~ 40~--~--______~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Guam Infant Mortality Rate

~ 80 ------.----.~ 1D Q. 60 ~ ~ 40 o E 20 C • J! 0 ~~--~----~ .E 1970 1980 1990 2000 2010 Period (year) - 24-

Annex 2 (Guam)

Table 7

RECENT ESTIMATES Ref. Reference SourceslMethods Comments E(X) IMR No. Date Male Female Date 11000 Secretarial Pacific Accurate vital 1995 72.5 76.6 1995 9 21 Community, 1999 registration data. Sou Ih Pacific Unnecessary to use 1995 73 77 1995 9 23 Commission, 1998 model life tables which 1990 yield higher life - 72,2 76,0 nla Nla United Nations, 2000 30 expectancies, 1995 Vital registration and census, 1990 1990 West Model life 71.5 75,6 - 9 Demmke et ai, 1997 4 - Table matching 1994 1995 registered deaths for 1990 -1994, 1990 www,sRc,org.nc- 1990 69,8 74.4 - 9 114 2001 1995 Vital registration. 1988 1990 West Model life - 69,8 74,43 - 9 Demmke et ai, 1997 4 Table matching 1992 1995 registered deaths for 1990 -1994, - 25-

Annex 2

Kiribati Population Estimate for 1999: 81 000

The vital registration system suffers from under-reporting and mortality estimates are produced from demographic analysis of censuses. The indigenous people comprise 99% of the population.

Infant mortality is indirectly estimated from census data. IMR declined from 82 to 62 per 1000 from 1978 to the 1990-1995 period, however, in the last decade it has remained stagnant at 62-67/1000.

Since the late 1970s life expectancy has been steadily increasing from 51 years for males and 56 years for females in the 1978-1985 period to 58 years for males and 63 years for females in the 1985-1990 period. For the period 1990-1995, life expectancy was 59 years for males and 65 years for females. Unpublished results from the analysis of the 1999 census suggest similar mortality figures.

Kiribati Kiribati Male life Expectancy Female Life Expectancy

80 -.---~--.------80 ------, F 75 .; 70 ~ 65 !:~ i U ...... :. I' c: 60 c: 60 ···4 55 • • ' -"i 55 ~ 50 • • ~ 50 ! ~ 45 ~ ...J ;:j 45 40~--~~--~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Pe riod (y •• r)

Kiribati Infant Mortality Rate

90 - .. .------_ .. __ .._-----, 8 80 • I ~ 70 .. .:: . I ~ 60 ~ 50 ~ 40 ~ 30 C 20 ~ 10 - O~--~ __--~--~ 1970 1980 1990 2000 2010 Period (year) - 26 -

Annex 2 (Kiribati)

Table 8

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 -- nfa 53 www.uniceLora - 2001 113 Sudden decrease in nfa nfa nfa 1999 67 UNICEF,1999 150 IMR from 67 to 53 Kiribati Ministry of deaths per 1000 live 1995 58.5 64.7 1995 62 86 Health, births in most recent South Pacific data provided by 1995 57 62 1995 67 23 Commission, 1998 UNICEF.

nfa 59 65 nfa I 67 UNDP, 1999 29 1990 1990 Kiribati Government, 57.15 62.3 67 162 - - 1997 1995 1995 CEBCS and 1990 1992 orphanhood method - 58.5 64.7 62 Demmke e/ al., 1998 6 applied to West 1995 1993 model life table 1990 1992 www.sQc.org.nc - 58.5 64.7 - 62 114 2001 1995 1993 1992 1992 Secretariat Pacific 58.5 64.7 62 21 - - Community, 1999 1993 1993 1990 M + F =60.2 1990 65 Tesfaghiorghis 55 62. Kiribati Government, 1990 57.7 1990 65 56 8 1993 1985 1985 62. Kiribati Government, - 57.7 - 65 162 8 1997 1990 1990 1981 1981 Census 55. 50.6 82 , Booth H, 1988 2 Indirect methods - 6 i 1985 1985 I 1978 1978 55. Kiribati Government, 50.6 - 82 162 - 6 1997 1985 1985 1973 1973 54. Kiribati Government, 50.3 87 162 - 5 - 1997 1978 1978 - 27 -

Annex 2

Marshall Islands Population in 1999: 50840

The Marshall Islands vital registration suffers from under-reporting, especially deaths. The Ministry of Health and Environment report in the Vital and Health Statistics Abstract 1989-1993 that the 1988 census determined that 57% of adult deaths were not reported.

Life expectancy estimates from 1980 to 1994 for both males and females remained stagnant at around 60 years for males and 63 years for females. For the period 1997-1999, the estimates jumped to 66 years for males and 69 years for females. It is unclear how these estimates were made, however, they seem to be imputed from infant or childhood mortality.

For the past two decades for infant mortality there is a large discrepancy in estimates for the same year or periods of time. Estimates are derived by direct recording and indirect methods. For example, for the 1989 census data put IMR at 55/1000 and vital registration data put it at 19/1000. This discrepancy would be partly due to the inadequacies of both census but especially vital registration data sets, as well as the small numbers in people and deaths. The average IMR for the period 1989-1994, according to vital registration is 28/1000, which is still much less than the IMR of 55/1000 according to census data (indirect estimates).

Marshall Islands Marshall Islands Male Life Expectancy Female Life Expectancy

80 ,------.------, F 75 80 ------75 Z 70 F ;:'" 65 1: 70 • • ~ 65 ":; 60 •••• :; 60 •••• i 55 il 55 ~ 50 ~ 50 GO :s 45 : 45 ...J 40 +-~_~_~~ 40+-~-~-~~ 1970 1960 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Marshall Islands Infant Morta Illy Rate ~ !~--- ~~-~------I

~ 50 • ~40 ~. I ~ 30 ••• I 20 1: • +. I' ~ 10 o +-~-~-~---' 1970 1980 1990 2000 2010 Period (year) - 28-

Annex 2 (Marshall Islands)

Table 9

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 . - - n/a 63 www,unicer.ora • 2001 113 Contradictions n/a n/a n/a 1998 27 UNICEF, 1999 149 between UNDP and 1997 SPC and other www,sRc,org,nc- . 65,7 69.4 1999 37 114 reported data on life 2001 1999 expectancy, n/a 63 67 n/a 63 UNDP, 1999 29 There are large Marshall Islands Vital registration discrepancies in SPC Planning and Vital n/a n/a n/a 1995 14,2 142 data for both life Statistics Department, expectancy and IMR 1995 from 1994 to 1999: Marshall Islands Vital registration increase in life Planning and Vital n/a n/a n/a 1994 20,9 142 expectancy of 5-7 Statistics Department. years over 5 years, 1995 decrease in IMR from Secretariat Pacific 1994 59,9 62,9 1994 63 21 63 to 37 per 1000 Community, 1999 deaths per live births, Marshall Islands Vital registration Planning and Vital n/a n/a n/a 1993 26.4 142 Statistics Department, 1995 Marshall Islands Vital registration Planning and Vital n/a n/a n/a 1992 31,8 142 Statistics Department, 1995 Marshall Islands Vital registration Planning and Vital n/a n/a n/a 1991 34,8 142 Statistics Department, 1995 Marshall Islands Vital registration Planning and Vital n/a n/a n/a 1990 27 142 Statistics Department, 1995 Marshall Islands Vital registration Planning and Vital n/a n/a n/a 1989 18.7 142 Statistics Department, 1995 29 -

Annex 2 (Marshall Islands)

(Table 9)

RECENT ESTIMATES Ref. f- Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 Marshal Islands 1989 census n/a N/a n/a 1989 55 59 Government Marshal Islands 1989 census n/a N/a nla 1989 55 59 Government Marshall Islands Census. 1988 1988 60 63 1988 63 81 - Government, 1990 Indirect methocls South Pacific 1988 60 63 1988 63 23 Commission, 1998 1983 1983 Census - 59.1 62.6 - 56.9 Raggers H, 1988 14 Indirect methods 1987 --. 1987 Marshallisiancls Census n/a n/a nla 1986 60 59 Government, 1992 1979 1979 - 58.4 61.9 - 44.8 Taylor R, 1989 26 Vital registration 1981 1981 --. - 31 -

Annex 2

Nauru Population in 1992: 9.919

The estimated life expectancy for Nauruan males and females from vital registration (assumed reasonably complete) for the 1991-1996 period is 58 years for both sexes (combined), one of the lowest compared to other countries in the Pacific Island region. This is due to the high death rate amongst adult males due to injury and non-communicable diseases such as cardiovascular disease, stroke, cancer, and diabetes. However, life expectancy for males improved in the decade from early 1980 to early 1990, from 48 to 54 years, while for females it remained almost the same at 61 years.

The estimated infant mortality rate, modelled on Life Tables of Coale and Demeny and the United Nations was approximately 13/1000 in the 1991-1993 period.

A consideration with data estimates is the small numbers of people and deaths. For this reason the estimates are calculated for a period of time such as 5 years which decreases the impact of annual fluctuations of deaths.

Nauru Nauru Male Life Expectancy Female Life Expectancy

80 80 ~ 75 75 ~ e. 70 .. 70 ~• ~ 65 65 ~ • :i 60 ..c 60 • • ~ 55 11 55 g, • • g, = 50 50 • J! 5 45 :::;= 45 40~~~~--~--~ 40 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Nauru Infant Mortality Rate

90~------. C> 80 ~ 70 !. 60 ~ 50 ~ 40 ~ 30 'E 20 .5J! 10 • • O+---__-- __--~~ 1970 1980 1990 2000 2010 Period (year) - 32-

Annex 2 (Nauru)

Table 10

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E/X) IMR No. Date Male Female Date /1000 - - - nla 25 www.unicef.org - 2001 113 There is a discrepancy between IMR data 1991 1991 Secretariat Pacific from SPC and 54.4 61.2 - 13 21 - Community, 1999 UNICEF. 1993 1993 Methodologies need to 1991 1991 www.spc.org.nc - be investigated. - 54.4 61.2 - 13 114 2001 1993 1993 1991 South Pacific 1988 55 64 - 11 20 Commission, 1998 1995 Registered births 1991 and deaths by age nla 54.4 61.2 12.5 Oemmke et a/., 1999 9 - and sex, applied to 1993 UN model life table nla 55 62 n/a 11 UNOP, 1999 29 1976 Vital registration - 48.4 60.5 nla nla Taylor et al., 1985. 24 1981 - 33-

Annex 2

Northern Mariana Islands Population in 1995: 58846

Estimates of life expectancy and infant mortality for CNMI is calculated using civil registration data. Civil registration is considered to have good death coverage. The last census was in 1995.

Using CNMI death registration data for 1994-1996, life expectancy was calculated at 67 years for males and 73 years for females. The six-year difference in life expectancy between males and females is explained by the higher death rate amongst males due to violence-related events such as accidents, homicides and suicides, and non-communicable diseases.

For the period 1992-1996, the estimate of IMR was 10/1000.

Northern Mariana Islands Northern Mariana Islands Male Life Expectancy Female Life Expectancy

80 80.------~ ~ 75 ~ 75 Z 70 := 70 • ... >- • ~ 65 • ;: 65 • u Ii 60 i 60 55 ¥Q. g 55 Q. III 50 ~ 50 ~ 45 ;,:;45o! ~~--~----~--~ 40+---______~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Northern Mariana Islands Infant Mortality Rate

90 -.-----.-~ --..... _- o 80 ! 70 i. 60 ~50 ~ 40 ~ 30 •• C 20 .+ • .5.:! 10 •...... O~--__~--~---, 1970 1980 1990 2000 2010 Period (year) - 34-

Annex 2 (Northern Mariana Islands)

Table 11

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E/X) IMR No. Date Male Female Date /1000 1994 1992 Primary sources and Secretariat Pacific - 66.6 72.6 10 21 methods unclear, but · Community, 1999 1996 1996 probably civil vital 1994 1992 registration. www.sRc.org.nc - 66.6 72.6 · 10 114 - 2001 1996 1996 Secretariat Pacific 1995 66.6 72.6 1995 9.9 60 Communities, 1998 1991 South Pacific 1995 67 73 · 9 20 Commission, 1998 1995 CNMI Government, nfa nfa nfa 1996 8.2 126 1997 CNMI Government, nfa nfa nfa 1995 7.2 126 1997 CNMI Government, nfa nfa nfa 1994 7.0 126 1997 CNMI Government, nfa nfa nfa 1992 9.9 126 1997 CNMI Government, nfa nfa nfa 1991 7.0 126 1997 CNMI Government, nfa nfa nfa 1990 9.3 126 1997 CNMI Government, nfa nfa nfa 1989 2.0 126 1997 CNMI Government, nfa nfa nfa 1988 17.9 126 1997 CNMI Government, nfa nfa nfa 1987 4.1 126 1997 CNMI Government, nfa nfa nfa 1986 10.0 126 1997 CNMI Government, nfa nfa nfa 1985 20.1 126 1997 CNMI Government, nfa nfa nfa 1984 23.8 126 1997 1980 CNMI Government, nfa nfa nfa · 16.9 100 1989 1986 1979 1979 - 62.5 71.1 · 26.4 Taylor et a/., 1989 26 Vital registration 1981 1981 - 35-

Annex 2

Palau Population Estimate in 1998: 18500

Palau is considered to have almost complete vital registration and mortality estimates are based on these data. Mortality levels have declined in the past two decades.

In the past two decades, life expectancy has increased slightly for males and females, from 63 years for 1979-1981 to 66 years in 1995 for males, and 70 years for 1979-1981 to 74 years for 1995 for females.

The infant morality rate has declined from 24/1000 in the 1980-1985 period to 20/1000 in the 1990-1995 period.

Palau Palau Male Life Expectancy Female Life Expectancy

80,------, 80,------. 'F 75 75 .. 70 ~ .. ~ ~ 70 ;: 65 • • • u i 65 60 • •• :Ii :Ii 60 ~ 55 ... 1: 55 .. 50 " =- 50 ~ 45 .... ~ 45 40~--,_--,_--~~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Palau Infant Mortality Rate

90 ,------, g 80 ~ 70 ~ 60 ~ 50 ~ 40 • ~ 30 ...... • 'E 20 . .. -.- ~ 10 • O~--~----__--~ 1970 1980 1990 2000 Period (year) - 36-

Annex 2 (Palau)

Table 12 Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 -- - nfa 28 www.unicef.ora 2001 113 Primary sources and method unclear for nfa nfa nfa 1998 22 UNICEF,1999 160 some data but 1994 Www.sRc.org.nc- probably mostly vital 1990 65.0 69.0 19 114 - 2001 registration. 1996 1992 Palau GovernmenV 1995 65.6 74.3 21 107 - UNICEF,1998 1996 Palau Government, Census, 1995 1995 63.9 70.2 1995 19.8 65 1999 Palau Government, Census, 1995 1995 63.9 70.2 1995 19.8 64 1998 Palau. 1994-1996 1995 64.2 74.2 nfa nfa 144 tables 1990 South Pacific 1995 64 74 - 20 20 Commission, 1998 1995 Palau, 1992-1996 1994 64.3 74.2 nfa nfa 145 tables 1994 Secretariat Pacific 1990 65 69 - 19 21 Community, 1999 1996 Palau Bureau Health nfa nfa nfa 1996 19.7 143 Services, 1997 Palau Bureau Health nfa nfa nfa 1995 15.1 143 Services, 1997 Palau Bureau Health nfa nfa nfa 1994 21.4 143 Services, 1997 Palau Bureau Health nfa nfa nfa 1993 22.5 143 Services, 1997 Palau Bureau Health nfa nfa nfa 1992 26.7 143 Services. 1997 Palau Bureau Health nfa nfa nfa 1991 8.6 143 Services, 1997 Palau Bureau Health nfa nfa nfa 1990 24.5 143 Services, 1997 Palau Bureau Health n/a nfa nfa 1989 16.2 143 Services, 1997 Palau Bureau Health nfa nfa nfa 1988 27.4 143 Services, 1997 - 37 -

Annex 2 (Palau)

Table 12

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date 11000 Palau Bureau Health n/a n/a nla 1987 19.3 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1986 25.9 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1985 26.7 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1984 32.6 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1983 22.9 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1982 22.2 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1981 14.2 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1980 27.0 143 Services, 1997 Palau Bureau Health n/a n/a n/a 1979 44.4 143 Services, 1997 Palau Government, n/a n/a n/a 1990 25 63 1993 1979 1979 Government of the - 62.7 70.4 - 27.6 Republic of Palau, 11 1981 1981 1983. - 39-

ANNEX3

POLYNESIA SUMMARY, GRAPHS AND TABLES

American Samoa Population in 1999: 63 300

The last census of population and housing was held in 1990. The civil registration system is reported to be complete in terms of births and deaths, however, these may be affected by migration since terminally ill persons may seek treatment outside of American Samoa (especially Hawaii). Life expectancy and IMR are produced using vital registration data. Estimates are produced as an average over a few years due to small numbers of people and deaths.

Life expectancies at birth for American Samoa for the 1987-1990 period were 68 years for males and 76 years for females and are based on age-specific death rates derived from the civil registration system. The project calculated life tables for males and females based on reported deaths for the period 1993-1997, and the population estimate for 1995. The life expectancies were 67 years for males and 71 years for females, both lower than earlier life estimates stated above.

The infant mortality rate for the period 1990-1994 was 11/1000, and for the period 1995- 1999 was 14/1000.

American Samoa American Samoa Male L.ife Expectancy Female L.lfe Expectancy

80 80 f 75 .. ~.. 75 • ! 70 .; 70 • >0 65 • • 1;' 65 ~ 60 c 60 8. 55 ~ 55 ~ 50 =- 50 :5 45 oS:! 45 40~--____-- __--~ ::::; 40 +-__-- __--~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

American Samoa Infant Mortality Rate

90 ------,-,------g_ 80 ~ 70 l 60 .?: 50 ~ 40 o 30 ! 20 • i 10 ...... ~# .... S O~--~-~'~__ -·-- __~ 1970 1980 1990 2000 2010 Period (year) - 40-

Annex 3 (American Samoa)

Table 13

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 1995 Sources and methods American nfa nfa nfa - 13.6 167 unclear but probably Samoa, 2000 1999 vital registration. American nfa nfa nfa 1999 12.7 167 Samoa, 2000 American nfa nfa nfa 1998 16 167 Samoa, 2000 American nfa nfa nfa 1997 10.4 167 Samoa, 2000 American nfa nfa nfa 1996 15.2 167 Samoa, 2000 1991 South Pacific 1995 68 76 - 13 Commission, 23 1995 1998 1995 66.9 710 nfa nfa Project team 162 1987 Rakaseta V, - 67.97 75.52 nfa nfa 17 1999 1993 1987 1990 WYI'NllPcorgcQ 68.0 75.5 - 11 114 - g - 2001 1993 1994 American nfa nfa nfa 1994 13.2 134 Samoa, 1995 Amencan nfa nfa nfa 1993 11.5 134 Samoa, 1995 f---- American nfa nfa nfa 1992 6.7 134 Samoa, 1995 American nfa nfa nfa 1991 11.0 134 Samoa, 1995 American nfa nfa nfa 1990 13.5 134 Samoa, 1995 f--- American nfa nfa nfa 1989 8.0 134 Samoa, 1995 American nfa nfa nfa 1988 10.5 134 Samoa, 1995 American nfa nfa nfa 1987 10.4 134 Samoa, 1995 Secretariat 1987 1990 Pacific - 68.0 75.5 - 11 21 Community, 1993 1994 1999 American nfa nfa nfa 1986 9.9 134 Samoa, 1995 American nfa nfa nfa 1985 11.1 134 Samoa, 1995 - 41 -

Annex 3 (American Samoa)

Table 13

RECENT ESTIMATES Ref. Reference SourceslMethods Comments E(X) IMR No. Date Male Female Date 11000 American n/a n/a n/a 1984 5.8 134 Samoa, 1995 American N/a nla nla 1983 6.8 134 Samoa, 1995 American N/a n/a n/a 1982 19.8 134 Samoa, 1995 American N/a n/a n/a 1981 14.7 134 Samoa, 1995 -- American N/a n/a n/a 1980 16.4 134 Samoa, 1995 American Nla nla nla 1979 15.8 134 Samoa, 1995 43 -

Annex 3

Cook Islands Population in 1999: 16500

The last census for the Cook Islands was in 1996. It is unclear which methods were used to estimate infant mortality rates and life expectancies, but they are probably based on vital registration. Since small numbers of people and deaths is a consideration with data estimates, multi-year averages provide more meaningful indicators. Migration of Cook Islanders between New Zealand, Australia and Cook Islands, means that not all births and deaths are registered in the Cook Islands as some permanent residents may seek delivery of their baby overseas, or die overseas. Thus births and deaths may suffer under-registration.

Life expectancies calculated by the Cook Islands Ministry of Health for the period 1991- 1996 were presumably based on vital registration and estimated at 69 years for males and 72 years for females. Estimation of life expectancies varies from year to year due to annual fluctuation of mortality rates. For males the estimates ranged from 67 years in 1991 to 51 years in 1995.

In the past two decades, the infant mortality rate overall declined steadily, though there have been annual fluctuations probably due to small numbers. For the period 1981-1986 IMR was 28/1000 and for the period 1991-1996 was 16/1000. However, an estimate for the 1997-1999 period was 25/1000, which is due to the particularly high IMR in 1997 of 36/1000.

The main problem with reporting of mortality data in the Cook Islands appears to be due to use of annual data which contains few events thus there are considerable fluctuations in IMR and life expectancy estimates. Five-year periods should be employed for calculation of mortality estimates. It is unclear whether mortality data are affected by out-migration of Cook Island residents for treatment overseas (especially NZ) who may then die there. This would result in lowering of the death rates. - 44-

Annex 3 (Cook Islands)

Cook Isla nds Cook Islands Male Life Expectancy Female Life Expectancy

80 ~.. 75 ~.. 75 ~ 70 ' : •••+: !t 70 . .. ~65 ~ 65 • :; 60 •• c: 60 55 55 ••• ~a. ~ II 50 ••• ~ 50 ~ 45 of 4S -' 40 ~ 40+----.---"----~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Cook Islands Infant Mortality Rate

90 ~ 80 ~ 70 Ii; 60 Q. I 50 I 7i'" '";;: 40 0 30 • • \ e .... . ! ~ 20 , ,. c: ...... J! 10 ,,~ .5 .. . 0 1970 1980 1990 2000 2010 Period (year) - 4-5 -

Annex 3 (Cook Islands)

Table 14

RECENT ESTIMATES Ref. Reference Sources/Methods Comments fIX) IMR No. Date Male Female Date /1000 www.unicef.or.g Source and methods - - nJa 26 113 - 2001 unclear nfa nfa nfa 1999 11 UNICEF,1999 152 A major problem is 1995 1997 www.spc.orgJl reporting of IMR and - 68.4 71.5 - 25 114 life expectancy based Q - 2001 1997 1999 on annual data or a 1995 1991 OemmkeA, few years only. This - 68.4 71.5 - 16 7 1999 results in considerable 1997 1996 fluctuations of Secretariat mortality indices. 1995 1991 Pacific - 68.5 71.5 16 21 - Community, 1997 1996 1999 1995 - 66.1 74.2 nfa nJa Project team 164 1997 Cook Islands, nJa nJa nJa 1997 36.3 127 1998 Cook Islands, nJa nJa nfa 1996 23.6 127 1998 Cook Islands, 1996 53 58 1996 21.6 128 1997 Cook Islands, nJa nJa nJa 1995 6.1 127 1998 Cook Islands, nJa nJa nJa 1995 6.1 127 199B

Cook Islands, 1995 51 63 1995 4.0 128 1997 Cook Islands, nJa nJa nJa 1994 5.5 127 1998 Cook Islands, 1994 60 72 1994 5.3 128 1997 Cook Islands, nla nfa nJa 1993 10.1 127 1998 Cook Islands, 1993 53 57 1993 11.8 128 1997 Cook Islands, nla nla nla 1992 5.9 127 1998 Cook Islands, 1992 58 59 1992 9.5 128 1997 Cook Islands, nla nla nla 1991 25.9 127 1998 Cook Islands, 1991 67 73 1991 31.3 128 1997 - 46 -

Annex 3 (Cook Islands)

Table 14

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 1991 South Pacific 1991 71 74 - 11 Commission, 20 1995 1998 Government of n/a n/a n/a 1991 31.6 the Cook 36 Islands, 1992 Government of n/a n/a n/a 1989 25.4 the Cook 37 Islands 1985 Cook Islands n/a n/a n/a - 24 Government, 108 1991 1998 1985 1984 Booth, - 66.9 72.7 - 21 UNDP/UNIFEM 38 1989 1988 IUNICEF,1989 Cook Islands, n/a n/a n/a 1990 24.9 127 1998 Cook Islands, n/a n/a n/a 1989 24.6 127 1998 Cook Islands, n/a n/a n/a 1988 11.5 127 1998 Cook Islands, n/a n/a n/a 1987 29.4 127 1998 Cook Islands, n/a n/a n/a 1986 27.9 127 1998 Cook Islands, n/a n/a n/a 1985 28.4 127 1998 Cook Islands, n/a n/a n/a 1984 11.9 127 1998 Cook Islands, n/a n/a n/a 1983 21.7 127 1998 Cook Islands, n/a n/a n/a 1982 29.6 127 1998 ._.. _-- Cook Islands, n/a n/a n/a 1981 19.5 127 1998 Cook Islands, n/a n/a n/a 1980 22.4 127 1998 Cook Islands, n/a n/a n/a 1979 38.5 127 1998 n/a 71 74 n/a 11 UNDP, 1999 29 -- - 47 -

Annex 3

French Polynesia Population in 1996: 219521

Mortality indices in French Polynesia are derived from vital registration data which is considered reliable. However, there may be some out-migration of residents of French Polynesia for treatment elsewhere (NZ, Australia, France) and some of these may die outside the country. This effect would lower recorded deaths.

In the period from the mid 1980s to mid 1990s, life expectancies for both males and females improved steadily from 65 years in the 1984-1986 period to 69 years in 1996.

Infant mortality rate decreased quite dramatically in the early 1980s, from 41/1000 in 1981 to 18/1000 in 1986, going on to continue to improve over the two decades to 1999 when IMR was estimated at 7/1000. The decline in mortality in French Polynesia over the past two decades is most likely due to improved health services (especially for infants and children).

French Polynesia French Polynesia Male Life Expectancy Female Life Expectancy

80 ------_ .. ----. -- 80 ~ 75 F 75 : 70 :1 70 .....••• ;:'" 65 ••• ;:'" 65 u •••• u :i 60 fi 60 i 55 i 55 ~ 50 = 50 ~ 45 5 45 ...J 40~--~~--~--~ 40~~~~--~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

French Polynesia Infant Mortality Rate

90 0 0 80 0 .: 70 8.60 ~50 • ~ 40 .. 0 E 30 • 1: 20 .l! 10 '¥'- .5 0 -.. 1970 1980 1990 2000 2010 Period (year) - 48 -

Annex 3 (French Polynesia)

Table 15

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 Polynesie Accurate civil vital Francaise registration. nfa nfa nfa 1999 6.8 87 Direction de la Sante. 1999 r----r----t-----~---i-----t~~~~--t_--_r------­ Secretariat Pacific 1996 69.1 74.2 1996 10 21 Community, 1999 r---~----t-----+----+----~ www.spc.orgn 1996 69.1 74.2 1996 10 114 C- 2001 1990 United Nations, 68.3 73.8 nfa nfa 2000 30 1995 South Pacific 1994 68 73 1995 10 Commission, 23 1998 Villedieu-Liou 1991 & Liou. 68.2 713 1992 12.7 Polynesie 133 1992 Francaise, 1994 r----~----t------~----+----~-~~~~__r-----.r_----.------­ Villedieu-Liou &Liou, 1991 12.4 Polynesie 133 Francaise, 1994 Villedieu-Liou 1989 &Liou, 66.3 71.7 1990 11.5 Polynesie 133 1990 Francaise, 1994 Villedieu-Liou & Liou, 1989 16.7 Polynesie 133 Francaise, 1994 Villedieu-Liou 1987 & Liou, 65.9 71.2 1988 15.9 Polynesie 133 1988 Francaise, 1994 r_--~----r_----+----+-----+~~~----r----r------Villedieu-Llou &Liou, --- 1987 20 5 Polynesle 133 I l__ --'-- ____L- ___ -'1____ -'-_____l~~~!a~:~ ______L ______~ ______49 -

Annex 3 (French Polynesia)

Table 15

RECENT ESTIMATES Ref. Reference Sources/Methods Comments E(X) IMR No. Date Male Female Date /1000 Villedieu-Liou 1985 & Liou, - 65.0 70.7 1986 18.3 Polynesie 133 1986 Francaise, 1994 Villedieu-Liou & Liou, - - - 1985 23.1 Polynesie 133 Francaise, 1994 Villedieu-Liou 1983 &Liou, - 65.2 70.6 1984 20.8 Polynesie 133 1984 Francaise, 1994 Villedieu-Liou & Liou, - - - 1983 23.6 Polynesie 133 Francaise, 1994 Villedieu-Liou & Liou, n/a n/a n/a 1982 34.7 Polynesie 133 Francaise, 1994 Villedieu-Liou &Liou, n/a n/a n/a 1981 40.9 Polynesie 133 Francaise, 1994 Villedieu-Liou & Liou, n/a n/a n/a 1980 40.7 Polynesie 133 Francaise, 1994 Villedieu-Liou &Liou, n/a n/a n/a 1979 48.9 Polynesie 133 Francaise, 1994 - 51 -

Annex 3

Niue Population in 1997: 2088

Since small numbers of people and deaths is a consideration with data estimates, multi-year averages provide the only meaningful indicators.

Life expectancy has been estimated in the 1990s for both sexes together and derived from indirect demographic estimates of childhood mortality only. Life expectancy based on childhood mortality from the children ever born/children surviving ratio for both males and females combined was estimated at 70 years for the period 1991-1997. Another estimation for life expectancies for the 1991-1997 period was 64 years for males and 70 years for females. It is expected that the difference in male and female life expectancy could be as much as 8 years, however, the very low numbers of deaths do not allow for a separate calculation of male and female life tables. In the period 1987-1997, there were 50% more recorded male deaths than female deaths. The published results are plausible.

The infant mortality rate for the 1991-1997 period was estimated at 18/1000, while for the 1979- 1981 period, IMR was lower at 11/1000, but this was only 3 years. The small numbers of people and deaths make it difficult for IMR to be a meaningful indicator for short periods.

Niue Niue Male Life Expectancy Female Life Expectancy

80 BO -,------, e 75 .. '575 .; 70 •• ! 70 •• ~ 65 •• • ~ 65 •• " 60 ~ 60 ~ 55 i 55 =- 50 = 50 ~ 45 ~ 45 ....I 40 -I--~~~ ___-I ....I 40 -I--_-~-_----4 1970 1980 1 990 2000 2010 1970 1980 1990 2000 2010 Period (year) Porlod (year)

Niue Infant Mortality Rate

90 80 ~ 70 -l 60 ~ 50 1ii 40 0 '"E 30 20 to J! 10 .5 • " 0 1970 1980 1990 2000 2010 Period (year) - 52 -

Annex 3 (Niue)

Table 16

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR -----_.------Date Male Female Date /1000 Requires further - -- n/a n/a '&'1/I1'!.uni~f 113 org - 2001 assessment. Vital UNICEF, registration based on n/a n/a n/a 1999 18 161 1999 very small numbers of 1991 1991 deaths Demmke et - M + F 69.5 - 17.5 8 al., 1999 1997 1996 1991 1991- M + F = 69.5 18 I/IW:W~~QQ[ 114 - 1997 g.l1<: - 2001 1997 1991 Project - 64.1 69.8 n/a n/a 165 team 1997 UNDP, n/a 74 74 n/a 18 29 1999 South 1991 Pacific 1994 60 65 - 22 20 Commissio 1995 n, 1998 South 1990 1991 Pacific - M + F 69.5 - 18 20 Commissio 1995 1997 n,1998 1978 1978- Taylor et M + F 66.5 10.64 25 - 1982 al., 1987 1982 - 53-

Annex 3

Samoa Population in 1999: 174800

Mortality in (Westem) Samoa has been traditionally measured by a post-census survey which records deaths in the sample over a retrospective period and compares household composition with the previous census. This method is used because of the unreliability of registered births and deaths.

Life expectancies at birth for Samoa, based on number of reported births and deaths in the 1998 demographic and health survey (using US-Census Bureau software package) for 1997-1998 was 65 years for males and 72 years for females. It is likely that deaths are under-reported, so the life expectancies may be over-estimated.

The infant mortality rate was produced by dividing the number of infant deaths reported in the 1998 interviewed population by the reported number of births in the same year, giving an IMR of 25/1000.

Western Samoa Western Samoa Male Life Expectancy Female Life Expectancy

so 80 e 75 e 75 • • .;.. 70 .. 70 ~ • ~ 65 • • ;: 65 • u ..c so ..c so 11 55 11 55 ~50 ~ 50 .. 45 .. '"....I 40 :s 45 1970 1980 1990 2000 2010 40 1970 1980 1990 2000 2010 Period (year) Period (year)

Western Samoa Infant Mortality Rate

90 g 80 ~ 70 ~ 60 .~ 50 ~ 40 ~ 30 C 20 ~ ~• ~ 10 O~--____-- •__ --~ 1970 1980 1990 2000 2010 Period (year) - 54-

Annex 3 (Samoa)

Table 17

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 www.unicef Contradictions - n/a 21 113 - - 0[9 - 2001 between SPC Governmen estimates for 1996 and 2000 17.8 t of Samoa, 139 1997 of 2-5 years in 2000 life expectancy, and UNICEF, between SPC and N/a n/a n/a 1999 23 159 1999 UNDP data of 4 years. Governmen Demographic and 1998 65.4 71.9 1998 24.9 t of Samoa, 69 health survey, 1998 1999

1997- www.~JlQOI 65.4 71.9 1998 25 114 1998 gnc - 2001 Secretariat 1997 Pacific - 65.4 71.9 1998 25 21 Community 1998 ,1999 UNDP, n/a 65 67 n/a 22 29 1999 -~ South 1991 Pacific 1996 70 74 - 22 20 Commissio 1994 n,1998 Western Samoan nfa n/a n/a 1995 10.5 106 Governmen

t, 1996 -- 1990 United - 65.9 69.2 n/a n/a Nations, 30 2000 1995 -- Western Samoan n/a n/a n/a 1992 25 106 Governmen t,1996 - 55-

Annex 3

Tokelau Population in 1996: 1 507

The last census in Tokelau was in 1996. The very small numbers of people and deaths in Tokelau is an important consideration in assessment of mortality with data estimates.

In the past decade 1990-2000, reported male and female life expectancies and infant mortality rates have remained at about the same level. Life expectancy was reported as 68 years for males and 70 years for females, and IMR was 38/1000. These are plausible estimates, however, it is unclear how these estimates were derived.

Tokelau Tokelau Male Life Expectancy Female Life Expectancy

80 . 80,------, 75 F 75 =>- 70 • • I :~ • • ~ 65 ~ 60 ~ 60 ~ 55 ~ 55 II'" 50 =-50 ~ 45 ~ 45 ..J ..J 40 +-____--~--~ 40~--__~--~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Tokelau Infant Mortality Rate

90 ~ ~~ i 60 ~ 50 ~ 40 • ~ 30 • C 20 10 .!!c: - O~--~_--__--~ 1970 1980 1990 2000 2010 Period (year) 56 -

Annex 3 (Tokelau)

Table 18

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 UNICEF, Very small populalion n/a nfa nfa 1999 38 157 1999 - 1,500 in 1999. South 1991 Pacific 1996 68 70 - 32 23 Commissio 1995 n, 1998 Secretariat Pacific 1990 67.8 70A 1990 38 70 Community ,1998 UNDP, nfa 68 70 nfa 38 29 1999 1990 67.8 70A 1990 38 '<'LW.V'L~pcQ[ 114 g~nc - 2001 Secretariat Pacific 1990 67.8 70A 1990 38 21 Community ,1999 - 57 -

Annex 3

Tonga Population Estimate in 1999 - 97 000

The last census for Tonga was in 1996.

Life expectancy at birth was calculated by demographic analysis of census data, since the registration system is considered incomplete. The estimates of life expectancies from the 1996 census data were 70 years for males and 72 years for females, which are only slightly higher than those for the 1986 census. It is thought that the slow decline in mortality rates may be associated with non-communicable diseases associated with risk behaviours including changing diet.

Estimates for infant mortality rate in 1986 vary, one being 26/1000 (16) and another being 10/1000 (146). It is unclear which methods were used to calculate these estimates but they are probably based on vital registration which may be under-enumerated. The IMR according to estimate from demographic analysis of 1996 census data was 19/1000 which is probably more realistic than estimates around 9-10/1000.

Tonga Tonga Male Life Expectancy Female Life Expectancy

80.------~ 80 T~~~~~~~~-~----~-~~~~~~~~··---~~-~~·, f 75 f 75 m 70 .. ,., ~ .; 70 • • ~ 65 • ~65 c .! 60 .. 80 i: 55 ~ 55 Q. )( ~ 50 " 50 :s" 45 :5 45 40~--~~--~--~ 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Tonga Infant Mortality Rate

90 g 80 _~ 70 !. 60 ~ 50 ~ 40 ~ 30 .. - 20 . j 10 ~...... so O~~-~-~__I 1970 1980 1990 2000 2010 Period (year) - 58 -

Annex 3 (Tonga)

Table 19

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 wwwunice! Methods require . . . nfa 18 113 org·2001 evaluation UNICEF, nfa nfa nfa 1999 19 156 1999 Tonga nfa nfa nfa 1998 15 Governmen 94 t,1998 Tonga 1996 68 71 1996 18.4 Governmen 94 t, 1998 Rakaseta 1996 census 1996 69.8 71.7 1996 19 16 V,1999 \'IV~V". §P.c. or 1996 69.8 71.7 1996 19 114 [)enc - 2001 South 1991 Pacific 1996 70 74 - 8 23 Commissio 1994 n, 1998 Tonga nfa nfa nfa 1994 12.1 Governmen 95 t,1996 UNFPA nfa nfa nfa 1993 138 71 1994 UNFPA, nfa nfa nfa 1992 10.9 71 1994 ----~~-~ UNFPA, nfa nfa nfa 1990 9.6 71 1994 Secretariat for Pacific nfa nfa nfa 1993 10.0 146 Communiti es, 1995

-~ Secretariat for Pacific nfa nfa nfa 1992 10.7 146 Communiti es, 1995 Secretariat for Pacific nfa nfa nfa 1991 9.1 146 Communiti es, 1995 - 59-

Annex 3 (Tonga)

Table 19

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 Secretariat for Pacific nfa nfa nfa 1990 10.1 146 Communiti es, 1995 Secretariat for Pacific Nfa nfa nfa 1989 9.0 146 Communiti es, 1995 Secretariat for Pacific nfa nfa nfa 1988 9.7 146 Communiti es, 1995 Secretariat for Pacific Nfa nfa nfa 1987 9.6 146 Communiti es, 1995 Secretariat for Pacific nfa nfa nfa 1986 9.9 146 Communiti es, 1995 Kingdom of 1986 67.6 70.7 1984 25.9 115 TonQa Rakaseta 1986 67.6 70.7 1986 26 16 1986 census V, 1999 Secretariat for Pacific nfa nfa nfa 1985 9.9 146 Communili es, 1995 Secretariat for Pacific nfa nfa nfa 1984 10.2 146 Communiti es, 1995 Secretariat for Pacific nfa nfa nfa 1983 14.4 146 Communiti es. 1995 Secretariat for Pacific nfa nfa nfa 1982 17.9 146 Communiti es, 1995 Secretarial for Pacific nfa nfa nfa 1981 24.6 146 Communiti es, 1995 - 60-

Annex 3 (Tonga)

Table 19

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 Secretariat for Pacific n/a n/a n/a 1980 25.7 146 Communiti es. 1995 UNDP, n/a 71 n/a 19 29 65 1999 - 61 -

Annex 3

Tuvalu Population in 1999: 11 000

Life expectancies estimated from demographic analysis of 1991 census data are 64 years for males and 70 years for females, but estimates provided just prior to this year imply much lower life expectancies. However, these may have been derived from a census a decade before. Even unadjusted vital registration data from the 1990s suggest lower life expectancies than this.

The infant mortality rate was reported as 56/1000 during the 1991-1996 period. According to unpublished excel files provided by the Tuvalu Government Statistics Office, the IMR for the 1991-1996 period was 36/1000 and for the 1997-2000 period was 25/1000. It is unlikely that infant deaths are over-enumerated. Annual estimates of IMR are characterised by significant fluctuation due to small numbers.

Tuvalu Tuvalu Male Life Expectancy Female Life Expectancy

80r---~------, 80..------, 75 F F 75 t 70 70 - 65 ,.,= • ~ ;:: 65 ; 60 • !" 60 • • I 55 • • II 55 := 50 a. GO = 50 :s 45 ....~ 45 40~--~~--~--~ 40 +--~-~-~---4 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Tuvalu Infant Mortality Rate

o :!t 80 ~ 8. 60 ~ I •• ~ 40· ~ •• .:o 20 ••" c • ~ 0 +-~--~--~----l 1970 1980 1990 2000 2010 Period (year) - 62-

Annex 3 (Tuvalu)

Table 20

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 www.unicef. Fluctuations in IMR - - nfa 40 113 - OlQ - 2001 are cause for concern, Tuvalu but may be due 10 1996 Governmenl, small numbers. Nfa Nfa nfa - 27 Statistics 118 2000 Office (Excelfile) Tuvalu Government, nfa nfa nfa 2000 13.1 Statistics 118 Office (Excelfile) Tuvalu Government, nfa nfa nfa 1999 34.6 Statistics 118 Office (Excelfile) UNICEF, n/a nfa nfa 1999 51 155 1999 Tuvalu Government, n/a n/a nfa 1998 21.5 Statistics 118 Office (Excelfile) Tuvalu Governmenl, n/a n/a n/a 1997 29.7 Statistics 118 Office (Excelfile) Tuvalu Government, n/a n/a n/a 1996 36.3 Statistics 118 Office (Excelfile) Tuvalu 1991 Government, n/a n/a n/a - 35.6 Statistics 118 1995 Office (Excelfile) Tuvalu Government, n/a nfa nfa 1995 49.8 Statistics 118 Office (excelfile) - 63-

Annex 3 (Tuvalu)

Table 20

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 Tuvalu Government, nla nla nla 1994 16 Statistics 118 Office (excelfile) Tuvalu Government, nla nla nla 1993 40.5 Statistics 118 Office (excelfile) Tuvalu Government, nla nla nla 1992 34.4 Statistics 118 Office (excelfile) Tuvalu Government, nla nla nla 1991 372 Statistics 118 Office (excelfile) Tuvalu nla nla nla 1995 49.8 GovernmenU 99 UNICEF, 1996 Tuvalu nla nla nla 1994 16 GovernmenU 99 UNICEF,1996 1996 wWw.sRc.org.n 1991 64.1 70.0 - 28 114 g - 2001 1998 1991 1991 census Oemmke et al., 1991 64.1 70.0 - 55.6 5 1998 1996 1991 South Pacific 1991 64 70 - 51 Commission, 23 1995 1998 nla 64 70 nla 51 UNOP, 1999 29 Tuvalu 1990 64.1 70 1990 41 Government, 98 1991 Government of 1989 57 60 1989 37.6 73 Tuvalu, 1989 1974 1974 Census Isaea et a/ .. - 56.9 60.1 - 43 13 1980 1978 1978 - 65-

Annex 3

Wallis and Futuna Population in 1996: 14166

The small population in Wallis and Futuna is an important consideration with data estimates.

Life expectancies are calculated using vital registration data. For the period 1986-1990 life expectancies were 67 years for males and 70 years for females, increasing to 70 years for males and 74 years for females for the 1991-1997 period. These data may be affected by out-migration for treatment elsewhere, especially in Noumea, New Caledonia.

There was a large decrease in IMR from 45/1000 in the 1986-1990 period to 15/1000 in the 1990-1995 period. Other estimates of IMR were 6/1000 in the 1991-1997 period, and 17/1000 for the 1994-1998 period. The high IMR in the 1986·1990 period is reported to have been associated with environmental health conditions such as overcrowding andlor inadequate health, water and sanitation services; these may have improved in the 1990s.

Wallis and Futuna Wallis and Futuna Male Life Expectancy Female Life Expectancy 80 "- """ """""--"----"-"----

F 75 _ 80 '"------"--~-"-----" -, ;. 70 • "fti 75 • ~ 65 ••• ~ 70 •• 1;' 65 • fi 60 Ii 60 ~ 55 1l 55 ~50 Q. : 50 ~ 45 : 45 40 +--~-~-~--: ... 40 +--~-~~-__I 1970 1980 1990 2000 2010 1970 1980 1990 2000 2010 Period (year) Period (year)

Wallis and Futuna Infanl Mortality Rate

Q 90,------8 80 .r 70 8. 60 ~ 50 ~ 40 • o 30 ~ 20 ~ 10 •• ~ o+--~-_·-_~ 1970 1980 1990 2000 2010 Period (year) - 66-

Annex 3 (Wallis and Futuna)

Table 21

Ref. RECENT ESTIMATES Reference Sources/Methods Comments No. E(X) IMR Date Male Female Date /1000 1994 Large decrease in IMR Project n/a n/a n/a - 17.4 163 from 1986 to 1997 team 1998 from 45 to 6 deaths 1991 1991 per live births but WWW8LC.9J some fluctuation may - 70.0 74.1 6 114 - 9Hc - 2001 1997 1997 be due to small numbers. Secretariat 1990 1990 Pacific - 667 70.8 - 15 21 Increase in life Community 1995 1995 expectancy of .1999 between 3-4 years South 1990 from 1990 to 1997. M +F Pacific 1990 - 15 23 68 Commissio 1995 n, 1998 1986 1986 Rallu JL, - 67.1 70.1 - 45 19 1991 1990 1990 - 67 -

ANNEX 4

The University of Sydney FACUL TV OF MEDICINE NSW 2006 AUSTRALIA Edward Ford Building (A27)

Telephone +61 29351 4375 • Facsimile +61 29351 7420 Email: [email protected]

DR RICHARD TAYLOR, ASSOCIATE PROFESSOR, DEPARTMENT OF PUBLIC HEALTH AND COMMUNITY MEDICINE

SURVEY OF PACIFIC ISLAND MORTALITY INFORMATION

WHO Regional Office for the Western Pacific would appreciate your co-operation with a survey of existing mortality information on Pacific Island populations from 1990.

The purpose of this survey is to provide a baseline for WHO assistance to Pacific Island countries with the collection, assessment, analysis, reporting and projection of mortality data on their populations. This survey will complement published information obtained from international and regional agencies, and elsewhere.

The survey will identify needs at country level which could be met by provision of advice and assistance with the collection, assessment, analysis and projection of reliable mortality data, and provision of individual and group training opportunities. Assistance to countries will be tailored to their requirements, and should benefit the entire range of Pacific Island countries at different stages of mortality information development. All country level mortality assessment, analysis, projection and interpretation will be undertaken in collaboration with Pacific Island states. The baseline mortality survey will be completed by end 2001 and country visits and training will occur in 2002-03.

As a first stage in this survey we would appreciate information on the existence of published reports and data collections: (a) published reports containing mortality data and analyses (published since 1990); and (b) existing mortality data held by countries. The source of these reports or data may be from the MinistrylDepartment of Health and/or the Government Statistics Office (vital statistics or census data). - 68-

Annex 4

Ministry/Department of Health

Published reports containing mortality data (published since 1990)

What is the main source of the data you use to report mortality?

Do you have any other sources of mortality data?

Do you have any other methods for collecting mortality data?

Methods for arriving at mortality data? Children, maternal, household.

[If here is not enough room here, please attach extra page/s.] - 69-

Annex 4

Existing recorded mortality data from death recording or registration Held as: Individual unit records Yes 0 No 0 Tabulations (counts) Yes 0 No 0 Variables or stratification: Age Yes 0 No 0 If Yes, which age groups Sex Yes 0 No 0 Year of death Yes 0 No 0 Residence at death Yes 0 Noo If Yes, which areas (e.g. Province, Island, etc.) Race, ethnicity, Yes 0 No 0 If Yes, which categories citizenship Cause of death Yes 0 No 0 If Yes, which categories (e.g. ICD codes) Other variables Yes 0 No 0 If Yes, which - 70-

Annex 4

Government Statistics Office (or similar body) Published reports containing mortality data (published since 1990)

What is the main source of the data you use to report mortality?

Do you have any other sources of mortality data?

Do you have any other methods for collecting mortality data?

Methods for arriving at mortality data? Children, maternal, household.

[If here is not enough room here, please attach extra pagels.] - 71 -

Annex 4

Existing recorded mortality data from death recording or registration Held as: Individual unit records Yes 0 No 0 Tabulations (counts) Yes 0 No 0 Variables or stratification: Age Yes 0 No 0 If Yes, which age groups Sex Yes 0 No 0 Year of death Yes 0 No 0 Residence at death Yes 0 No 0 If Yes, which areas (e.g. Province, Island, etc.) Race, ethnicity, Yes [1 No 0 If Yes, which categories citizenship Cause of death Yes 0 No 0 If Yes, which categories (e.g. ICD codes) Other variables Yes n No [J If Yes, which

Countr.ies which replied to the survey were: Kiribati, Fiji, Cook Islands, Samoa, American Samoa, Vanuatu, Niue, and Tokelau. Material obtained is included in the results presented. - 73-

ANNEX 5

INTERNET SEARCH

A research assistant conducted a search of the World Wide Web for resources and references published on the Internet to (1) age-specific mortality data and (2) life expectancy data. Below is a table of sites searched.

Institution Internet add ress Search strategy Data found (at June 2001)

United Nations Population !.111QJi~ww\llJfpQ,.Q[.9 Site search facility terms: No mortality data found. Fund (UNFPA) • Asia and the Pacific • Publications Searched: • Monitoring & Evaluation Resources United Nations bttJ):Jlw'!!w.undIHl.[9 Searched: No mortality data found. Development Fund (UNDP) • Country Office Websites: Samoa, Fiji. Papua New Guinea • Regional Bureau for Asia and the Pacific

United Nations Children's ~Jjll/Iwww.u ni~f org Searched: Country data sheets found. Fund (UNICEF) • Information Statistics Infant, under -five and maternal mortality data found. Sources: • For infant and under- five mortality: UNICEF, United Nations Population Division, United Nations Statistical Division, World Bank and US Bureau of the Census • For maternal mortality: World Health Organisation (WHO) and UNICEF - 74-

Annex 5

Institution Internet address Search strategy Data found (at June 2001) Secretarial for Pacific h!JQ;//www. s[lc.org.nc Searched: • Searched library Communities • Demography catalogue, search term (SPC) • Population "mortality' returned 104 records ranging Health sections • from statistical • In stare search facility, estimation, morality searched terms estimates, "mortality", "death/s", epidemiological and specific countries transition - - Fiji downloaded • SPC Library references bjtp~//www.~m.t!jJllrQl'J' In Demography Section: • The Micronesian • Data on Oceania Seminar Library Population: last Catalog census, population, ilttQ;i/21 61.02. 225.213/Se01 projected population, iDar/~Qrgl].QBJ crude death rate, 0 SPC Public Health infant mortality rate, Surveillance and life expectancy at birth Communicable • Suggests contacting Disease Section the Demography b.1l[//ww'!:!2!.c.QI]D~LQhs section [i1gjlto,temographg PpQJ to obtain information on sources and methods used. RT to advise on whether and mode of correspondence to do this. Post: Demography/Populatio n Program, Secretariat of the Pacific Community, BD 05, 98848 Noumea Cedex, New Caledonia • Site provides list of Pacific Island contacts - economic, statistics, development, and Directors of Health (though there is no reference to when the pages were last updated) - 75-

Annex 5

Institution Internet address Search strategy Data found (at June 2001)

Australian National http I /coom.p~iillu. edu. au! Searched: No mortality data found. University WVLW~L: • South Pacific (ANU) PacificStudi!l~htnJ! Information Network and • Pacific Studies WWW Virtual Library • Pacific Region Resources - Part 1 • Pacific Region Resources - Part 2

University of South Pacific tillp) /I','WI',',w~p,aj;"fiI Searched: No mortality data found. • Population Studies Program in the School of Social and Economic Development • Centre for Development Studies University of Hawaii bltill/www.h_awaii.edu/ Searched: No mortality data found. • School of Medicine • School of Public Health • International Pacific Research Center • Center for Pacific Islands Studies

Asian Developrnent Sank ottp.. i[wWw.aOQ. Qi$JI In site search facility search Policy for the health sector: (ADS) term "mortality" Regional (Asia and Pacific) • Health policy site health context >Changes in Health Status document (downloaded) - references to regional mortality rate changes - not sourced - specific country mortality rate changes - source: country census data of Papua New Guinea United Nations Economic http://www.unescap .. org No mortality data found. and Social Commission for Asia and the Pacific (UNESCAP) - 76-

Annex 5

Institution Internet address Search strategy Data found (at June 2001)

United Nations Statistics bltQ;1!wwW.UR.919LQepts/un~ Searched: Data found: Division Q • Global • life expectancy at birth Statistics>Social • infant mortality rate Indicators>lndicators • child mortality on health rate • Population and Vital Source: Population Division Statistics Report and Statistics Division of accessible to the United Nations subscribers only. Secretariat World Bank htt[):llwww.worldbank. Searched: Country at a Glance QI9 • Data & Statistics tables - life • Countries and expectancy and infant Regions: Social mortality rates Policy and provided in produced Governance in the in conjunction with East Asia and World Bank country Pacific Region staff various country • World sources Development Indicators database - could not access - 77-

ANNEX 6

CANBERRA VISIT

In June 2001 Dr Richard Taylor, and research assistant, Ms Michelle Tjhin, travelled to Canberra to visit the Department of Demography at the Australian National University (ANU), libraries at the ANU, and former employees of the Secretariat of the Pacific Community (SPC) to collect Pacific Island country data on mortality, life expectancy and population.

People visited were Dr Heather Booth and Dr Gerald Haberkorn, both former demographic staff with the SPC, and Dr David Lucas who has been researching demography in the Pacific for many years.

A total of fifty-five references across sixteen Pacific Island countries were collected from these sources. Much of the data is for the early-mid 1990s. - 79 -

ANNEX 7

SPC VISIT

In August 2001, Dr Richard Taylor visited the Secretariat of the Pacific Community (SPC) in Noumea, New Caledonia, and held detailed discussions with the staff of the Demography section, especially the SPC Demographer, Dr Chris McMurray, concerning the state of mortality data from each Pacific Island country within the jurisdiction of SPC.

Publicly available material related to Pacific Island mortality was extracted from the archives of the Demography section and also the SPC library, and copied. A significant number of references were acquired and the material has been integrated into this report. Important information on data analyses in progress and data quality were also obtained. Discussions were also held with the Health section at SPC, and other relevant personnel.

While in Noumea, the New Caledonian Health Department was also visited and the most recent reports of health status (including mortality) in New Caledonia were obtained. - 81 -

REFERENCES

1. Bartleman J, Eelens F, 1988. Report of the Solomon Islands 1986 Population Census. Report 2.8: Data analysis. Chapter VI: Mortality estimates.

2. Booth H, 1988. 1985 Population Census of Kiribati. Demographic analysis. South Pacific Commission. Noumea, New Caledonia. 3. Demmke A, HaberkornG, Rakaseta V, Lepers C, 1997. Federated States of Micronesia population profile: a guide for planners and policy makers. Secretariat of the Pacific Community. Noumea, New Caledonia.

4. Demmke A, HaberkornG, Rakaseta V, Lepers C, 1997. Guam population profile: a guide for planners and policy makers. Secretariat of the Pacific Community. Noumea, New Caledonia. 5. Rakaseta VL, Haberkorn G, Demmke A, Lepers C. 1998. Tuvalu population profile: a guide for planners and policy-makers. Secretariat of the Pacific Community. Noumea, New Caledonia.

6. Demmke A, HaberkornG, Rakaseta V, Lepers C, 1998. Kiribati population profile based on 1995 census: a guide for planners and policy makers. Secretariat of the Pacific Community. Noumea, New Caledonia.

1 7. Demmke A, 1999 • Cook Islands population profile based on 1996 census: a guide for planners and policy makers. Secretariat of the Pacific Community. Noumea, New Caledonia.

2 8. Demmke A, HaberkornG, 1999 . Niue population profile based on 1997 census: a guide for planners and policy makers. Secretariat of the Pacific Community. Noumea, New Caledonia.

3 9. Demmke A, HaberkornG, Rakaseta V, Lepers C, 1999 . Nauru population profile: a guide for planners and policy makers. Secretariat of the Pacific Community. Noumea, New Caledonia.

10. Fiji Bureau of Statistics, 1998. 1996 Fiji Census of Population and Housing: Analytical Report, Part 1 Demographic Characteristics. Parliament of Fiji Parliamentary Paper No. 49 of 1998.

11. Government of the Republic of Palau, 1983. Five year comprehensive health plan, 1983 - 87, as approved by the Olbul Era Kelelau. Koror, Government of Palau.

12. Hayes G, 1996. Estimates of mortality in Papua New Guinea based on the 1990 census and the 1991 demographic and health survey. UNFPAIILO Project PNG/94/P01 "Integration of Population factors into Development Planning" Port Moresby, Papua New Guinea. 13. Isoea S, Macrae S, 1980. A report on the results of the census of the population of Tuvalu, 1979. Funafuti, Government ofTuvalu. - 82 -

References 14. Raggers H, 1988. Census of Population and Housing 1988 Final Report. Republic of the Marshall Islands, Office of Planning and Statistics.

15. Rakaseta V, 1999. Fiji Islands population profile based on 1996 Census: a guide for planners and policy makers. Secretariat of the Pacific Community Noumea, New Caledonia.

16. Rakaseta V, 1999. Tonga population profile a guide for planners and policy makers. Secretariat of the Pacific Community Noumea, New Caledonia.

3 17. Rakaseta V, 1999 . American Samoa population profile based on 1996 census: a guide for planners and policy makers. Secretariat of the Pacific Community Noumea, New Caledonia. 18. Rallu JL, 1991. The population of the French overseas territories in the Pacific from 1945. (unpublished)

19. Rallu JL, 1991. Migration and development in Wallis and Futuna.lnstiut National D'Etudes Demographiques Paris. (unpublished)

20. Secretariat of the Pacific Community, 1998. SPESS: Selected Pacific Economies - A statistical summary. Number 14. Noumea, New Caledonia.

21. Secretariat of the Pacific Community, 1999. Pacific Island Populations Data Sheet. Compiled by the Population/Demography Programme, South Pacific Commission, Noumea, New Caledonia.

22. South Pacific Commission, 1994. Pacific Island Populations: Report prepared by the South Pacific Commission for the International Conference on Population and Development (1994: Cairo). SPC, Noumea, New Caledonia.

23. South Pacific Commission, 1998. Pacific Island Populations. - Revised edition. Report prepared by the South Pacific Commission for the International Conference on Population and Development 1994: Cairo, Egypt. SPC, Noumea, New Caledonia.

24. Taylor R, Thoma K. Mortality patterns in the modernised Pacific Island nation of Nauru. American Journal of Public Health 1985; 75:149-155

25. Taylor R, Nemaia H, Connell J, 1987. Mortality in Niue, 1978-82. New Zealand Medical Journal 1987;829:477-81

26. Taylor R, Davis Lewis N, Levy S. Societies in Transition: Mortality Patterns in Pacific Island Populations. International Journal of Epidemiology. 1989; 18:634-646

27. Taylor R, Davis Lewis N, Siadden T. Mortality in Pacific Island countries around 1980: geopolitical, socioeconomic, demographic and health service factors. Australian Journal of Public Health 1991; 15:207-221

28. UNDP, 1994. Pacific Human Development Report: Putting people first. United Nations Development Programme, Suva, Fiji - 83-

References

29. UNDP, 1999. Pacific Human Development Report 1999: Creating Opportunities. United Nations Development Programme, Suva, Fiji 30. United Nations, 2000. World Population Monitoring 1998 Health and Mortality: selected aspects. New York: United Nations 31. Taylor R, Lewis M, Powles J. Australian mortality decline: all-cause mortality 1788-1990. Australian and New Zealand Journal of Public Health 22(1):27-37. 1998

32. Taylor R, Lewis M, Powles J. Australian mortality decline: cause-specific mortality 1907- 1990. Australian and New Zealand Journal of Public Health 22(1):37-44. 1998. 33. Balkaran, S.; Taylor, R;, Naroba V. Mortality trends and differentials in Fiji (Chapter 5). In: Population of Fiji. Eds: Chandra, R; Bryant, J. South Pacific Commission, Country Monograph Series. SPC, Noumea, New Caledonia. 1990. 34. Ahlburg DA, 1996. Demographic and social change in the island nations of the Pacific. Asia-Pacific Population Research Reports, NO.7. East-West Center.

35. Booth H. 1999. Gender, power and social change: youth suicide among Fiji Indians and Western Samoans. The Journal of the Polynesian Society. Vol. 108, No.1.

36. Government of the Cook Islands, 1992. The situation analysis of Cook Island children.

37. Cook Islands Ministry of Health. Medical Record Section. 1986. Compiled by Ngari Munokoa Tini.

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