Childhood Obesity: U.S Pacific

George CruzPacific Partners for Tobacco Free IslandsPat LucesPacific Chronic Disease CoalitionNia AitaotoAdvisor/Advocate

Pacific Islanders: Who we are?

Polynesians Hawaiians, Samoans, Tongans, Maori, Tahitians,

Cook Islanders, etc.

Micronesians Chamorros, Carolinians, Chuukese, Pohnpeians,

Yapese, Marshallese, Palauans, Kosraeans, etc.

Melanesians Papuans, Solomon Islanders, Fijians, Vanuatu

Islanders, etc.

U.S Pacific

Territories (Guam & A.S) Commonwealth (CNMI) Freely Associated States

(Republic of Belau, Republic of the Marshall Islands and the Federated States of Micronesia)

History

Rock IslandsRepublic of Palau

Early 1800’s: What the first Europeans saw…

Early 1800’s Carolinians on the Island of TinianSource: Micronesian Seminar

History & Colonization

Spanish German Japanese American

Early 1900’s: Germans & Japanese Era

Early 1900’s: Germans & Japanese Era

Palauan

Traditional

Healers

Source: MicSem

After World War II (mid 1940’s)

Change of Diet & Physical Activities

Marshall Islands Kwajalein Atoll

1944

Source: MicSem

Relationship with U.S

The Promise Health Education Protection

The Reality High Poverty Disparity in Health Spending Migration to the United States

Per Capita Health Budget

$4,700

$614 $510 $320 $151 $143 $128 $92$0

$500$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500$5,000

WHO Top 10 Obese Countries

1. Nauru 94.5%2. Micronesia 91.1%

*CNMI 91.1%3. Cook Islands 90.9%4. Tonga 90.8%5. Niue 81.7%6. Samoa 80.4%7. Palau 91.1%8. Kuwait 74.2%9. U.S.A 74.1%10. Kiribati 73.6%

CNMI Saipan

Chamorro 33.6% overweight47.3% obese 6.1% extremely obese 87% overweight obese

Carolinians 22.2% overweight50% obese16.7% extremely obese88.9% overweight obese

Other Pacific 42.9% overweight50.0% obese7.1% extremely obese100% overweight obese

Diabetes Rates

American Samoa 47.3%

CNMI 35.0%

FSM 24.4%

Guam 9.2%

Palau 38.9%

Marshall Islands 29.8%

Health Concerns Non-Communicable Disease

Heart Disease & StrokeDiabetesCancer (Tobacco Related)

Communicable DiseaseTuberculosisMeasles Sexually Transmitted Disease

Health Concerns

Hansen’s Disease Dengue Hepatitis B

That was not always the case…

1940’s U.S Navy health survey Found: intestinal parasites,

yaws, tuberculosis and skin diseases

Complete absence of malnutrition or obesity

No indication of diabetes Almost no hypertension

Globalization & Health Western Diet but lack Western Med and

Tech Traditional Healing

Model Spirit – Mind - Body Health Delivery

Western Medical Model

Obesity & Pacific Individual Level

Cultural beliefs Attitudes

Relationship Collectivistic Strong Family/Clan influence

Community Social Justice Poverty and Hardship Racism and Discrimination

Organization Lack of Data and Analysis Obesity NOT a priority

Societal Health Policies Access (health, housing, social

services, etc.)

Paddling to the Outer Islands

Chuuk – Lagoon Islands

Needs

Assessment (Information) Research (Unique Health

Issues) Culturally appropriate health

care system Culturally appropriate outreach More Pacific Islanders in

Health Care Field Pacific Islanders: learn how to

navigate in the new system.

Coalitions in the Pacific

Driftwoods

Laura, Marshall Islands

Pacific Partnership for Tobacco-Free Islands

Coalition Members

American Samoa Dottie Siavii Roseann Tuiasosopo

CNMI Rebecca Robles George Cruz

Guahan Gil Suguitan Roselie Zabalas

FSM Wahlberg Hadley Shra Alik

Marshall Islands Ione deBrum Donny Andrike

Palau Kambes Kesolei Roman Oseked Sr.

Partners Legacy Papa Ola Lokahi Tobacco Technical Assistance Consortium Queens Medical Center (Hawaii) American Cancer Society Kellogg Foundation Asian Pacific Partners for Empowerment,

Advocacy and Leadership Asian Pacific Island Health Forum Pacific Chronic Disease Coalition Cancer Council of the Pacific Islands

Mission Statement

To weave together our resources, appropriate practices and experiences; and drawing strength from our cultures and relationships for a Tobacco-Free Pacific

Five Year Action Plan 2008-2013

Share successes, struggles and experiences Guam Meeting March 2007 NCTOH - Minnesota, Oct. 2007 Hawaii Gathering April 2008 NCTOH - Arizona, June 2009

Improve tobacco programs in the region Brief tobacco intervention training in CNMI and FSM

(Trainers from Guam) Regional Intense tobacco intervention training in Guam

Advocacy International

World Tobacco Conference (India) WHO Philippines World Tobacco Framework

U.S Federal CDC Office of Smoking and Health Office of Minority Health NIH NCMHD HRSA

Pacific Regional WHO – Western Pacific Regional Office Pacific Islands Alliance of Non-government Organizations Pacific Islands Health Officers Association

Pacific Jurisdiction FSM – Tobacco Law Amendment Guam – Increase Tobacco Tax ($3.00 tax per pack) CNMI – Smoke-Free Air Act Palau – RJ Reynolds donation to Palau

Five Year Action Plan 2008-2013 continue Develop a monograph of successes and

resources

Establish and publish local best practices SOPHE Journal of Health Promotion and

Practice (in progress)

Regional Challenges

Legislation for Tobacco Control & Taxes Enforcement of Existing Laws Increase Tobacco Sponsorship of Events Little or No Implementation of the FCTC Betel Nut and Tobacco

American Samoa: (2) Loata Sipili TBA

Commonwealth of the Northern Mariana Islands: (2) Tayna Camacho TBA

Federates States of Micronesia: (5) Kipier Lippwe (National

Coordinator) – Vice Chairman

Robina Anson (Pohnpei) Moria Shomour (Chuuk) Frank Limfang (Yap) Maria Mongkeya (Kosrae)

Guam: (2) Patrick S Luces - Chairman Lawrence O. Alam

Republic of the Marshall Islands: (3) Ione deBrum (Majuro) –

Secretary/Treasurer Johannes Seremai (Ebye) Donny Andrike (Outer Islands)

Republic of Palau: (2) Yorah Demei TBA

Members

Pacific Chronic Disease Coalition’s Vision

Prosperous Pacific people living a healthy lifestyle in a healthy Pacific environment.

Pacific Chronic Disease Coalition’s Mission

Reduce the Chronic Disease Burden Bridge the Gap in Disparities Share & Mobilize Resources Advocate with Policy Makers and Recognize the Uniqueness of the Pacific Islands.

PCDC Activities Collaborated w/ Pacific Partners for Tobacco Free Islands

Hosted an integrated Diabetes, Tobacco, Cancer conference in Honolulu, May 2008

UH – Dept of Native Hawaiian Health Collaboration NIH Funded – Diabetes needs assessment in all PIJ.

FASC Recommendations for improving capacity and infrastructure for diabetes programs in the PIJ. Office of Global Health & CDC

Professional development training NACDD Academy PDEP

PCDC Collaboration

Pacific Chronic Disease Coalition & Pacific Partners for Tobacco Free Islands

PIHOA – Policies & Human Resources PCDC & PITCA collaboration

Association of Diabetes & TBSharing Resources Improving service for DM & TB patientsSharing of data and technology

Obesity Project

Technical Assistance: Planning, Implementation and Evaluation

Resources: Pacific Island Obesity Council Training

Kinnisow – Kommol – Kulo