Some Health Issues in the South Pacific1
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Some health issues in the South Pacific1 Suliana Siwatibau he National Centre for Development than 10 per cent of Pacific islanders suffer TStudies at the Australian National from diabetes (excluding Nauru where one University organized a ‘Health Issues in the quarter of the population is diabeti~).~Yet, all South Pacific’ Workshop (funded by the the available mortality data, where diabetes Australian International Development should account for a higher percentage of Assistance Bureau) in Brisbane on 25-28 illness than its prevalence in the community September 1990. Twenty-one participants as a whole, never record diabetes as from eight Pacific countries, one accounting for more than 3 per cent of the representative of the World Health causes of death.5 Further, relatively few Organization, and eighteen individuals from diabetics die from diabetes. They die from Australian institutions attended. The other illnesses often aggravated by diabetes. background papers prepared for this workshop Yet, in Kiribati and Samoa, diabetes is are listed at the end of this paper. The Centre recorded as a higher percentage of total mortality than of morbidity.6 There are also expects to issue a study based on these papers some strange statistical practices. For and the discussions at this Workshop. example, in Vanuatu infant mortality This note is not a report on the Workshop. It estimates are derived from the incomplete is a review of some of the issues raised by the records of deaths and actuarial life tables.7 discussions in Brishane. It draws heavily Despite these difficulties an attempt can be (without specific attribution) on the papers made to observe some of the health problems prepared for the Workshop, as well as on other in the South Pacific, to suggest some of the writings. It is a cursory review rather than a causes for current conditions, and propose detailed discussion of some of the health some of the ways by which health could be problems in the South Pacific nations. Many improved. of the participants in the Brisbane meetings strongly disagree with many of the The state of health observations made here. Average life expectancy and infant mortality An examination of the available data for the are frequently used as indicators of community South Pacific indicates that they must be health. The first indicates the quantity of life treated with great caution. For example, that is enjoyed on average, but it is also likely Vanuatu has a detailed classification of the that someone who dies young will be less causes of death,2 but almost two-thirds of healthy and more uncomfortable than deaths are not reported to the authorities, and someone who lives to a ripe old age. The it is known that malaria is more prevalent in likelihood of an infant dying before it is one some of the areas where under-reporting is year old is partly determined by a mother’s more usual3. It is believed that somewhat less health and is also indicative of the health of all 1 This article has benefited from comments of the editors. 2 R. Taylor, Economics ofpublic health in the South Pacific, Islands/Australia Working Paper 9018, NCDS, ANU, Canberra. 3 David B. Evans, Public health in Vanuatu, IslanddAustralia Working Paper 9014, NCDS, ANU, Canberra. 4 Susan Sejeantson, Healthplanningand diabetes mellitus in the Western Pacific, IslanddAustralia Working Paper 9011, NCDS, ANU, Canberra. 5 Op. cit., supra n.2. 6 Op. cit., supra n.2. 7 Op. cit., supra n.3. 22 PACIE1C ECONOMIC UULLKITN infants and their health opportunities at the These generally poor health standards do start of life. On the basis of these proxies, the not arise from a lack of government effort. A health standards in the South Pacific large proportion of island gross national (excluding Papua New Guinea where the income is devoted to public health expenditure record is abysmal) are not impressive but not than in almost any other area of the world deplorable. In general, Pacific islanders except the wealthy countries (Table 2). The appear to be healthier than residents of focus on health expenditure of course belies sub-Saharan Africa and South Asia the fact that expenditure in other areas such (Bangladesh, India, Pakistan etc.), as healthy as water supply and sewerage, housing, as residents of Latin America and the infrastructure, food production and education Caribbean, but considerably less healthy than also contribute much to raising the standard of residents in most of East Asia (Table 1). As in health in a country. Percentage total budget the rest of the world, the standard of health in allocation, in addition, does not indicate a country appears to be correlated with its allocation per capita which may be a better average level of income (again excepting indicator for comparison of financial Papua New Guinea that is much wealthier commitments. However, the financial problem than the poor islands, but has the worst health in the Pacific mainly relates to the distribution record amongst them)8 of' resources rather than the amount. Impressive expenditures are often favoured Table 1 South Pacific countries: health over efficient ones. For example, in Vanuatu, indicators and comparisonsa, 98 per cent of the cases treated by the health various recent years services receive primary care (hospital out-patient, community health centre, and Average Infant Average life mortality other treatment), yet only a little more than per expectancy (deaths one-third of total expenditure is devoted to capita (years per '000 primary service^.^ In Micronesia, 2 per cent of GNP at live cases require tertiary care (specialist (US$) birth) births) treatment) but receive 50 per cent of health expenditure (frequently transport to and South Pacific islands treatment in Hawaii). Three per cent require LOW incomeb 420 59 52 Papua New Guinea 8 10 54 61 secondary care (general hospital in-patient Other low middle treatment) and receive 44 per cent of the income' 1250 62 26 expenditure, The remaining 95 per cent who High middle require no more than primary care receive only incomed 7100 68 I5 6 per cent of the expenditure. It has been World income groups estimated that a shift in resources from China and India 340 63 59 secondary to primary health care in Vanuatu Othcr low income 280 54 98 could achieve an increase of approximately Iaw middle income 1380 65 57 one-quarter in the provision of primary health High middle care with a small reduction in total health 3240 68 42 income expenditure." Areas Sub-Saharan Africa 330 51 108 Nor can a lack of foreign aid be blamed. The South Asia 320 57 99 islands are notorious recipients of aid East Asia 540 66 37 (Table 2). There is a widespread attitude of Latin America 1840 67 53 letting Australia do it' but protecting local ~~~ ~ ~~ ~ employment opportunities. Much of the aid is 'All averages weighted by population. %valu, Solomon Islands, Kiribati. misdirected. Donors are willing to provide 'Western Samoa, Tonga, Vanuatu, Cook Islands, Marshall expensive and useful equipment or buildings, Islands, Fiji, American Samoa. but do not provide adequate funds for dNorthern Marianas, Palua, New Caledonia, French I'olyncsia, Guam. operation and maintenance. There are too Sources: World Bank, World Deueloprnent Report 1990, many health service vehicles lying idle because Washington, D.C.; World Health Organization, Western they lack petrol or maintenance. It is Pacific Region Data Bank on Socioewnornic and Ilealth sometimes arguable whether the vehicles are Indicators, Manila, 1989. redundant or the petrol and maintenance is inadequate, 8 See AsiaPacific Profiles, National Centre for Development Studics, ANU, Canberra, 1990, p.llO. 9 Op. cit., supra n.3. 10 Garth Singleton, The health planning needs in small Pacific island states, and David B. Evans, Public health m Vanuatu, Islands/Australia Working Papers 90/3 and 90/4, NCDS, ANU, Canberra. HEALTHISSUES IN 1”E SOUlH I’ACIFlC 23 Table 2 South Pacific countries: related traffic accidents, sexually transmitted expenditure and aid receipts, diseases, hypertension, etc. largely because of various recent years the lifestyles that they have ‘chosen’ to live. Average Average Table 3 Selecteda South Pacific government per capita health official countries: causes of morbidity expenditure aid and mortality, individual (9% of CNP) (US$) recent years (per cent) South Pacific islands Causesbe Cause” Low income 2.3 100 of hospital Of Papua New Guinea 3.4 102 morbidity mortality Other low middle income 3.1 160 High middle income 2.6 300‘ Malnutrition 10 - Respiratory disease‘ 20 15 The world Infectious diseased 15 20 China and India 2 ‘Diseases of choice’ 30 35 Other low income 0.7 18 Other 25 30 Low middle income 0.9 16 High middle income 1.5a 3 ‘Countries and years for which data wen? presented to the workshop. ‘Approximate. bRounded to nearest 5 per cent. Sources: World Bank, World Deoelopment Report 1990, ‘Per cent of total cases, excluding maternity and Washington, D.C.; World Health Organization, Western unclassified. Pacific Region Data Bank on Socwemnomic and Health dChiefly tuberculosis. Indicators, Manila, 1989. Source: K. Taylor, Economics ofpublic health in the South Pacific, IslandslAustralia Working Paper 9018, NCDS, ANU, Overcoming poor health Canberra, 1990. The Pacific islands comprise a wide variety of Increases in income can help to overcome countries with differing health problems. In malnutrition, but people must be aware of the some of them, such as the Solomon Islands, best opportunities to spend their incomes. Vanuatu and parts of Papua New Guinea, Rapid growth in national income and the infectious and other communicable diseases distribution of the benefits of development to (particularly malaria and dengue fever), such people as subsistence farmers (for tuberculosis and other diseases associated example, encouraging the production of cash with unhygienic conditions are serious crops along with subsistence agriculture) problems.