Pacific Endeavour

Group Seminar
Chronic Disease Trends In The
Pacific – An Overview

May 2009
Introduction
Chronic diseases has become a global
burden in recent times. As more people
live longer, indulge a sedentary life and
abuse harmful substances like tobacco,
chronic diseases prevalence increases
significantly.
WHO reported that chronic diseases
account for about 78% of deaths in the
Western Pacific region.[3] Obesity being
the main factor for common chronic
illnesses such as cardiovascular diseases,
hypertension, and type 2 diabetes.[4]
There is also an increase in mortality
Chronic diseases affects people for years
if not decades. Hence chronic diseases
poses immense impacts on the individual,
the community, and the nation with
threats of increase health costs and
decrease economical productivity.
Many costly and disabling chronic
diseases are associated with preventable
risk factors. Unfortunately health care
workers in general often failed to cease
patient interactions as opportunities to
inform patients about health promotion
and disease prevention strategies.[7]
Chronic Diseases on a
Global Scale
WHO reports and projections shows
chronic diseases greatly outweighs
communicable diseases and injuries in
terms of mortality in all member
countries except Africa.[6]
The causes of the main chronic disease
epidemics such as cardiovascular
diseases, cancers, and diabetes are well
established and well known. Their most
important modifiable risk factors are
unhealthy diet and excessive energy
Not so long ago, such chronic diseases
are said to be problems of rich
developed countries. WHO reports
indicates that globalization,
urbanisation, and population ageing
are the main causes for the
development of chronic diseases.[6]
Free global trading allows easy and
cheap access to unhealthy processed
food and tobacco as well as to
technology. As people move into an
urban lifestyle, physical inactivity and
consumption of fast foods became
common. Most simple exercises such
Chronic Diseases in the
Pacific
WHO reports on the Western Pacific
region indicates that Obesity is the
main intermediate risk factor that lead
to a lot of cardiovascular diseases and
diabetes.[4] Obesity being common is
believed to be due to cultural belief
that big is a symbol of health,
wellbeing, status, and beauty in the
Pacific Islands.
The report showed an increase shift in
pacific island diet in favour of
westernised high fat content food. The
Tobacco use has risen significantly in the Pacific
as well since World War II. This is due to the
increase importation of raw tobacco and later,
cigarettes.
There is a genuine fear that such changes in
Pacific Island lifestyle and preferences will
affect the younger generation. WHO indicated
extensive evidence that conditions before birth
and in early childhood greatly influence health
in adult life.[6] Children cannot choose the
environment in which they live, including their
diet, living situation, and exposure to tobacco
smoke. They also have a limited understanding
of the long-term consequences of their
behaviour. Yet it is precisely during this crucial
phase that many health behaviours are
Chronic Disease Health Trends
in the Pacific
The main chronic diseases in Pacific
Island Countries are related to non-
communicable diseases. These NCDs
are mainly as a result of obesity and
tobacco use.[4] Obesity (BMI figures 1-
3) and tobacco use (figures 4-6) in PICs
are ever increasing and has become a
major problem for health officials.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
 Impact of Chronic Diseases
• Social Impact – people with chronic diseases
needs a lot of attention and care. Some may
need long term palliative care and this
requires a lot of commitment from relatives
of the patient. In Fiji, some of these patients
are placed at homes or care facilities like St.
Giles for psychiatric problems or the Old
People’s Home, or at Tamavua Rehabilitation
Centre. In other Pacific islands such centres
are not available and so families still looks
after the affected individuals.
• Personal/Physical Impact – lots of affected
individuals who don’t have a caretaker and do
not have access to government facilities faces
a rapid deterioration of their quality of life.
Most will eventually unable to look after
themselves and this poses a lot of
humanitarian issues from members of society.
For developing countries like the small pacific
islands, relatives are the only caretakers
available as government cannot afford
assistant care facilities or shelters apart from
the hospital.
• Cost of illness Impact – there is no question
that there are costs associated with being ill.
Direct costs like the cost of treatment and
medications, cost of getting that treatment like
travelling to hospital, etc. Income foregone by
• Micro-Economical Impact – people with chronic
diseases demands a lot for the management of
their illness. Because most of them may not
fully able to get proper earnings as they tend to
be sickly, their finances will be a major
problem. This means that they will not be able
to finance for the management of their illness
especially with medicine and special nursing
care. Hence further deterioration of their ailing
illness.
• Macro-Economical Impact – chronic diseases
consumes a lot of human, material, and
financial resources. It takes up most of the
health budget annually and it can also
compromise the integrity of a healthy
workforce, decreasing productivity on a national
level. That is a lot of individuals of working age
are falling ill to chronic diseases and cannot
• National Development Impact – as more people
with chronic disease are of working age group,
this seriously affects the progress of
development as there will be more sick leaves
and early deaths of affected skilled personnel.
Such problems contribute to the slowness of
national progress in development and with it, a
slow economy.
• Poverty Alleviation Impact – with an increasing
number of the adult population in the pacific
being affected by chronic diseases, this not only
causes a burden to the economy and national
development but also hinders the progress for
poverty alleviation.
 With a lot of resources required from
government and society to manage chronic
diseases, and with an increasing ailing
workforce affected by chronic diseases
developing countries faces more obstacles to
resolving poverty in society. This can cause a
vicious cycle as increasing poverty can
contribute to a lot of chronic diseases and
hinders even further economic progress and
development.
• Cultural Impact – in a society with increasing
number of people affected with chronic disease,
it poses a major burden to families and the
community. It will drain the physical and mental
strength of supporting community members
and this will result in family members seeking
 This goes against island culture where we
look after our elderly or own family
members. Basically, chronic disease can
have an impact on cultural social values and
norms if not controlled soon. After all pacific
islanders now live in nuclear family
structures compared to extended family
structures in the past. Nuclear family
structures will not be able to handle the
impact of chronic disease without assistance.
For extended family structures, there may be
a more than one or two family members with
chronic disease and this may put stress on
the entire extended family financially and
socially.
Discussion Points
• WHO believes that health prevention
information sharing between patients and
their primary health doctor seldom
happens. In the Pacific medical training at
the Fiji School of Medicine has
incorporated public health learning into its
problem base learning teaching strategy.
This will allow new graduate doctors to
manage patients in a holistic manner that
involves advocacy for public health
prevention strategies.
• A number of national, regional, and global
strategies have been developed to address
these problems. WHO initiated a
• Whatever the strategy to tackle chronic
diseases, they have to be assessed by properly
interpreting surveillance data; develop policies
that needs to be SMART (Specific, Measurable,
Accessible, Realistic, Time-bound); and provide
assurances by creating a supportive
environment that help implement and maintain
such policies.
• SPC assessed that NCDs alone are too
overwhelming for developing countries to cope
with in terms of finance, technical assistance,
and infrastructure. That is why donor nations
and agencies as well as ongoing political
government commitment are too important for
the success of health prevention strategies.
• The impacts of chronic diseases are too great to
be ignored. Though communicable diseases are
just as important, health officials should
continue to be vigilant about chronic diseases.
After all, WHO publications showed that Chronic
diseases from NCDs has higher mortalities
almost ten-fold.[6]
• WHO responded with Innovative Care for
Chronic Conditions Framework.[7] It is centred
on the idea that optimal outcomes occur when
a health care triad is formed. This triad is a
partnership among patients and families, health
care teams, and community supporters that
functions at its best when each member is
informed, motivated, and prepared to manage
their health,
 The triad is influenced and supported by the
larger health care organization, the broader
community, and the policy environment.
When the integration of the components is
optimal, the patient and family become
active participants in their care, supported by
the community and the health care team.
• Though newer health promotion strategies
such as the WHO Ottawa Charter, or Pacific
Yasawa Declaration of Healthy Islands were
meant to handle the situation more
effectively, continuation of support and
commitment from governments, donor
agencies, health personnel, community
 References
1. Christopher Doran; “Pacific Health Project:
Economic Impact Assessment of NCD on
Hospital Resources in Kiribati, Tonga, and
Vanuatu”; National Drug and Alcohol Research
Centre; University of NSW; Australia 2003.
2. Jeanie McKenzie; “Tackling Non-Communicable
Diseases – The Pacific Framework for NCD
Prevention and Control”; Secretariat of the
Pacific Community Pub 2008; SPC – Noumea.
3. http://www.who.int/chp/chronic_disease_report/e
- Facing the Facts: The Impact of Chronic
Diseases in the Western Pacific (A WHO
Report).
4. SPC Compilation;“Obesity in the Pacific:
Too Big to Ignore”; Secretariat of the Pacific
Community Pub 2002; SPC – Noumea.
6. Suhrcke M, Nugent RA, Stuckler D, Rocco L;
“Chronic Disease: An Economic
Perspective;” London, Oxford Health
Alliance Publishers 2006
8. World Health Organisation; “Preventing
Chronic Diseases: A Vital Investment;”
WHO Publications; WHO Global Report
2005
7. WHO Fact Sheet No. 172; “Integrating
Prevention into Health Care”; Revised
October 2002.
9. WHO Fact Sheet No. 273; “Surveillance of
Non-Communicable Disease Risk
Factors”; Revised March 2003.