Pacific island health inequities forecast to grow unless profound changes are made to health systems in the region
Don Matheson A D , Kunhee Park B and Taniela Sunia Soakai CA Griffith University School of Medicine, 170 Kessels Road, Nathan, Qld 4111, Australia.
B World Health Organization, Level 4, Provident Plaza One, Downtown Boulevard, 33 Ellery Street, Suva, Fiji. Email: parkku@who.int
C Pacific Community BP D5, 98848, Noumea, New Caledonia. Email: sunia@spc
D Corresponding author. Email: donmathes@gmail.com
Australian Health Review 41(5) 590-598 https://doi.org/10.1071/AH16065
Submitted: 9 May 2016 Accepted: 23 August 2016 Published: 20 February 2017
Journal Compilation © AHHA/World Health Organization 2017 Open Access CC BY-NC-ND
Abstract
Objective Twenty years ago the Pacific’s health ministers developed a ‘Healthy Islands’ vision to lead health development in the subregion. This paper reports on a review of health development over this period and discusses the implications for the attainment of the health related Sustainable Development Goals.
Methods The review used qualitative and quantitative methods. The qualitative review included conducting semi-structured interviews with Pacific Island Government Ministers and officials, regional agencies, health workers and community members. A document review was also conducted. The quantitative review consisted of examining secondary data from regional and global data collections.
Results The review found improvement in health indicators, but increasing health inequality between the Pacific and the rest of the world. Many of the larger island populations were unable to reach the health Millennium Development Goals. The ‘Healthy Islands’ vision remained an inspiration to health ministers and senior officials in the region. However, implementation of the ‘Healthy Islands’ approach was patchy, under-resourced and un-sustained. Communicable and Maternal and Child Health challenges persist alongside unprecedented levels of non-communicable diseases, inadequate levels of health finance and few skilled health workers as the major impediments to health development for many of the Pacific’s countries.
Conclusions The current trajectory for health in the Pacific will lead to increasing health inequity with the rest of the world. The challenges to health in the region include persisting communicable disease and maternal and child health threats, unprecedented levels of NCDs, climate change and instability, as well as low economic growth. In order to change the fortunes of this region in the age of the SDGs, a substantial investment in health is required, including in the health workforce, by countries and donors alike. That investment requires a nuanced response that takes into account the contextual differences between and within Pacific islands, adherence to aid effectiveness principles and interventions designed to strengthen local health systems.
What is known about the topic? It is well established that the Pacific island countries are experiencing the double disease burden, and that the non-communicable disease epidemic is more advanced.
What does this paper add? This paper discusses the review of 20 years of health development in the Pacific. It reveals that although progress is being made, health development in the region is falling behind that of the rest of the world. It also describes the progress made by the Pacific countries in pursuit of the ‘Healthy Islands’ concept.
What are the implications for practitioners? This paper has significant implications for Pacific countries, donor partners and development partners operating across and within Pacific countries. It calls for a substantial increase in health resourcing and the way development assistance is organised to arrest the increasing inequities in health outcomes between Pacific people and those of the rest of the world.
Additional keywords: health promotion, health system evaluation, health system strengthening, Healthy Islands, Pacific island health development, settings approach, sustainable development goals.
References
[1] Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 384 766–81.[2] United Nations. The millennium development goals report 2015. 2015 Available at: http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20%28July%201%29.pdf [verified June 2016].
[3] World Health Organization, Regional Office for the Western Pacific. Sanitation, drinking-water and health in Pacific island countries: 2015 update and future outlook. Manila: WHO Regional Office for the Western Pacific; 2016.
[4] World Health Organization (WHO), Regional Office for the Western Pacific. Yanuca Island declaration: March 1995. WHO; 1995. Available at: http://www.pihoa.org/fullsite/newsroom/wp-content/uploads/downloads/2012/09/WPR_RC46_INF_DOC1.pdf [verified 14 October 2016].
[5] World Health Organization, Regional Office for the Western Pacific. Recommendations of the meeting of the Ministers of Health of the Pacific islands Koror, Republic of Palau, 18–19 March 1999. Available at: http://iris.wpro.who.int/bitstream/handle/10665.1/5565/WPR_HRH_DHI_99.1_eng.pdf [verified 14 October 2016]
[6] Pacific Health Ministers. 2015 Yanuca Island Declaration on health in Pacific island countries and territories 15–17 April 2015. In Eleventh Pacific Health Ministers Meeting, 2015. Available at: http://www.wpro.who.int/southpacific/pic_meeting/2015/phmmdeclaration2015_english_final_nov3.pdf. [verified 13 October 2016].
[7] United Nations. Transforming our world by 2030: a new agenda for global action. 2015. Available at: https://sustainabledevelopment.un.org/post2015/transformingourworld [verified 14 October 2016].
[8] World Health Organization (WHO), Western Pacific Region. The first 20 years of the journey towards the vision of Healthy Islands in the Pacific. Manila: WHO; 2015. Available at: http://iris.wpro.who.int/bitstream/10665.1/10928/3/9789290617150_eng.pdf [verified 14 October 2016]
[9] Anderson I. The economic costs of non-communicable diseases in the Pacific Islands. A rapid stocktake of the situation in Samoa, Tonga and Vanuatu. Final report, November 2012. 2012. Available at: http://www.worldbank.org/content/dam/Worldbank/document/the-economic-costs-of-noncommunicable-diseases-in-the-pacific-islands.pdf [verified 14 October 2016].
[10] Asian Development Bank (ADB). Estimates based on data from World Bank’s world development indicators online. Extracted from ADB, Key Indicators for Asia and the Pacific. 2014. Available at: www.adb.org/statistics [verified 15 February 2016].
[11] World Health Organization. Achieving the health-related MDGs. It takes a workforce! 2010 Available at: http://www.who.int/hrh/workforce_mdgs/en/ [15 Oct 2016].
[12] Mills D. Mending the road behind and building the road ahead. In: National Rural Health Alliance. Proceedings of the 13th National Rural Health Conference, Port Moresby, 2–3 Sept 2015. Available at: http://www.ruralhealth.org.au/13nrhc/images/paper_Mills%2C David.pdf [verified 15 February 2016].
[13] Morris IP, Somanathan A. Papua New Guinea (PNG) health workforce crisis: a call to action. Washington, DC: The Worldbank; 2012. Available at: http://documents.worldbank.org/curated/en/216511468332461651/Papua-New-Guinea-PNG-health-workforce-crisis-a-call-to-action World Bank [verified 31 October 2016].
[14] Sheridan S, Brolan CE, Fitzgerald L, Tasserei J, Maleb M-F, Rory J-J, Hill PS. Facilitating health and wellbeing is ‘everybody’s role’: youth perspectives from Vanuatu on health and the post-2015 sustainable development goal agenda. Int J Equity Health 2014; 13 80
| Facilitating health and wellbeing is ‘everybody’s role’: youth perspectives from Vanuatu on health and the post-2015 sustainable development goal agenda.Crossref | GoogleScholarGoogle Scholar |
[15] Joint forum economic and Pacific health ministers meeting outcomes statement, Honiara, Solomon Islands, 11 July 2014. 2014. Available at: http://www.forumsec.org/resources/uploads/attachments/documents/2014_Joint_FEMM_PHMM_%20Meeting_Outcomes_Statement_July14_approvedbyMinisters.pdf [verified 31 October 2016].
[16] World Health Organization. Pacific tobacco taxation project. 2015. Available at: http://www.wpro.who.int/tobacco/pacifictobaccotaxationproject/en/ [verified 15 February 2016].
[17] Haque T. Economic transitions in Solomon Islands. 2013 Available at: http://bellschool.anu.edu.au/sites/default/files/publications/attachments/2016-04/ssgm_ib_2013_16.pdf [15 February 2016].
[18] United Nations. The millennium development goals report. 2015. Available at: http://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20%28July%201%29.pdf [verified Oct 2016].
[19] World Health Organization. Towards a food secure Pacific. 2010. Available at: https://pacenet.eu/system/files/documents/Food Secure Pacific Framework for Action.pdf [verified 15 Feb 2016].
[20] Friel S, Hattersley L, Townsend R. Trade policy and public health. Annu Rev Public Health 2015; 36 325–44.
| Trade policy and public health.Crossref | GoogleScholarGoogle Scholar |
[21] Organization for Economic Cooperation and Development (OECD). Official development assistance 2014. 2015. Available at: http://www.compareyourcountry.org/oda?cr=oecd&lg=en [verified 28 January 2016].
[22] United Nations General Assembly. Resolution adopted by the General Assembly on 14 November 2014. 69/15. SIDS Accelerated Modalities of Action (SAMOA) Pathway 2014. Available at: http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/69/15&Lang=E [verified 31 December 2016].
[23] United Nations. (2015). Third international conference on financing for development outcome document of the Third International Conference on Financing for Development: Addis Ababa Action Agenda Annex Addis Ababa Action Agenda of the Third International Conference on Financing (Vol. 1, pp. 1–39). Available at: http://www.un.org/esa/ffd/ffd3/documents.html [verified 15 February 2016].
[24] SciDevNet. Island states slam climate fund red tape. 2015. Available at: http://www.scidev.net/global/funding/news/pacific-island-states-climate-fund-red-tape.html [verified 15 February 2016].
[25] Organization for Economic Cooperation and Development. The Busan partnership for effective development co-operation. 2011. Available at: http://www.oecd.org/dac/effectiveness/49650173.pdf [verified 12 December 2015].
[26] National Health Strategic Plan 2016–2020. (2016). Honiara. Available at: http://daisi.com.au/wp-content/uploads/2016/09/Strategic-Plan-for-Solomon-Islands-2016-2010.pdf. [verified 13 October 2016].
[27] Snowdon W, Thow AM. Trade policy and obesity prevention: challenges and innovation in the Pacific Islands. Obes Rev 2013; 14 150–8.
| Trade policy and obesity prevention: challenges and innovation in the Pacific Islands.Crossref | GoogleScholarGoogle Scholar |
