small island states in crisis: the economic impact of...

SMALL ISLAND STATES IN CRISIS: THEECONOMIC IMPACT OF LIFESTYLE DISEASES

IN THE SOUTH PACIFICBy Philip Szmedra and K.L. Sharma*'

INTRODUCTION

Public health concems in the South Pacific region in recent years haveshifted from the prevention and control of infectious diseases to dealing withthe increasingly prevalent problem of non-communicable disease (NCD) orwhat has been termed lifestyle illnesses. Improved living standards haveresulted in increased consumption of high fat diets and increased use of alcoholand tobacco. Epidemiological research has firmly established a relationshipbetween these consequences of higher living standards and ill health.^

Foremost among these illnesses is diabetes which affects upwards of30 million people in the Westem Pacific region with predictions ofthis numberdoubling over the next twenty years.^ Diabetes has become much moreprevalent in the Pacific region with certain island nations reportingextraordinarily high population levels.

Nauru has one ofthe highest incidences of diabetes in the world withbetween 30 and 40 percent ofthe adult population suflfering from the disease.''Hypertension and other circulatory diseases are also on the rise as the result ofthe adoption of modem diets high in saturated fats and oils and processed sugarrather than reliance on traditional root crops and fish as sources ofcarbohydrates and protein.

In Fiji, mortality rates and complications related to diabetes havesignificantly increased over the past thirty years with mean rates doublingabout every five years.' In a comprehensive survey to measure the incidenceof diabetes in the population of Fiji, Hoskins, et al* surveyed 5000 adults andfound 24 percent of Fijian females and 15 percent of Fijian males to be diabeticwhile 34 percent of Indo-Fijian females and 25 percent of Indo-Fijian maleswere similarly identified.

The issue is both pertinent and topical. Pacific health ministersmeeting in March 2003 in Nuku'alofa, Tonga heard of the gravity of theproblem of lifestyle diseases from officials ofthe World Health Organization(WHO) and the Secretariat ofthe Pacific Community (SPC).^

'Philip Szmedra is Associate Processor of Economics, Georgia Southwestern StateUniversity, Americus, Georgia, 31709; and K. L. Sharma is Senior Lecturer, Department ofEconomics, University ofthe South Pacific, Suva, Fiii.

Journat of Third World Studies. Vol. XXIV. No. 2© 2007 by Association of Third World Studies, Inc.

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JOURNAL OF THIRD WORLD STUDIES. FALL 2007

ECONOMIC IMPACT

Disease incidence is occurring in younger population strata, whichrestricts the ability ofthe stricken individual to contribute to the economic wellbeing of his family. The impact on families that have lost a member topremature or sudden death from these types of illnesses is often severe.Community support structures rarely fully compensate for the loss of aneconomically active family member. These losses can and often do result in theimpoverishment of families, restricting the ability to support children'seducation, and ultimately resulting in a cycle of poverty that is difficult tobreak.* In a larger sense, earlier disease onset impedes the ability of adeveloping country to exploit the energies and talents of a segment of thepopulation that normally is the most dynamic contributor to economic growth.

PREVIOUS RESEARCH

Most of the research dealing with lifestyle disease in the Pacificregion has attempted to categorize the types of illnesses that afflict the regionand to quantify the number of individuals affected by the various maladies. TheUnited Nations Development Program has been active in determining thescope ofthe problem.'The WHO and the SPC have reported on the problemsof obesity in the Pacific, which arguably lies at the heart of the lifestylediseases problem.'" Dalton and Crowley attempted to estimate thecosts togovemment of freating NCDs relative to overall spending for healthcare in Fij i,Samoa, and Tonga. Their findings indicate that between 40 percent (Fiji) and60 percent (Tonga) of government spending directed toward healthcare andmaintenance go to the treatment of NCDs."

Beyond the estimation of explicit costs to govemments of treatingNCDs there has been no work done in the Pacific region that attempts toinclude an estimation ofthe economic impact of NCDs at the macroeconomiclevel. Specifically, how and to what extent this increase in NCD incidenceplaces a drag on the economic growth potential of many Pacific Island nations.

RESEARCH METHODS

A. Methodology

Our intention was to monetize the annual economic loss suffered inour target nations as a result of NCDs. High rates of NCDs are a heavy burdenon government finances, as many countries in the region will either partiallycover (Fiji), or more commonly, fully cover (Nauru) the expenses associatedwith treating NCDs. These explicit costs are budget items and though an

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Philip Szmedra and K.I. Sharma/Smali Island States in Crisis:Ihc Economic Impact of Lifestyle Diseases in the South Pacific

important factor iti the capital budgets of these nations, are not the subject ofour work.

More importantly for us is the effect these illnesses have on theproductive lives ofthe people affected and thereby the economic potential oftheir nations. As mentioned, many people affected by NCDs in the Pacific arerelatively young and in their prime productive years. Hours and days lost fromwork due to illness, either being too ill to work or the time taken in seekingtreatment for the effects of their disease or diseases diminishes their ability tocontribute to the financial support of their families and communities.

At a microeconomic level these impacts have serious consequenceson the ability ofthe family to support itself at some socially acceptable level.This is especially true if the illness results in permanent disability and thewithdrawal by the individual completely fi'om the labor force. For example,many diabetics are prone to circulatory and nervous system damage as aconsequence of their disease which may result in amputation of a foot or legrendering the individual incapable of carrying out physical labor. While a veryserious problem to the individuals and families affected, the problem iscompounded when a significant portion ofthe population is afflicted with thesame type of debi I ity. Our interest is in monetizing and aggregating these typesof individual debilities and costs through lost work time to provide a dollarestimate ofthe loss NCDs cause on the economies ofthe two nations we havechosen to study.

Economic development efforts in the developing world typically focuson building infrastructure, or institutional capacity, or promoting "goodgovernance". Sufficient regard to, and promotion of, healthy life-styles arenecessary antecedents for developing nations aspiring to maintain sustainablegrowth. Developing nations neglect effective preventative health programs atthe risk of more than debilitated and marginalized segments of theirpopulations; they risk retarding economic growth.

B. Research Approach

The survey portion of this project was conducted in two stages. Thefirst stage occurred on Nauru in June, 2003. The second stage took place in Fijiin June 2004 at five different survey locations including urban, peri-urban, andrural health center environments. Initially we obtained permission from theMinistry of Health of Nauru to conduct a survey during June, 2003 amongpeople being treated for NCDs at the central hospital serving the island nation.The survey targeted those individuals that suffered from diabetes,hypertension, cardiovascular disease, kidney disease, eye disease, and nervedamage. We chose Nauru and Fiji because ofthe high incidence of premature

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mortality for both men and women as a result of lifestyle disease.Approximately 20 percent of male Nauruans and 15 percent of females, die dueto non-communicable diseases before they reach the age of 40.'" Nauru has thedubious distinction of having one ofthe highest rates of adult-onset diabetesin the world. In Fiji, life expectancy at birth has been stagnant for the past twodecades even though infant mortality has been decreasing indicating higheradult mortality."

The following narratives describe the research process at each ofthesurvey locations.

Nauru - The Republic of Nauru (RON) Hospital's dialysis clinic treatsapproximately 10 patients per day in four-hour dialysis sessions three days perweek. We visited the clinic on four consecutive days to be assured of includingin our survey all individuals that visited the clinic during a normal week. Wechose this venue and these individuals because most of these patients continuedto be economically active (i.e. employed in the formal sector) in spite oftheseriousness of their health problems.

In addition, student enumerators contacted individuals in theircommunity districts that were known to have NCDs. These two sample sub-populations provided a total of 61 responses which represents 1.7 percent ofthe total population of interest.

Fiji - We initially visited the diabetic and hypertension clinics being conductedat the Colonial and War Memorial Hospital (CWM) in Suva, the largest andmost sophisticated medical facility in Fiji. Suva, Fiji's capital city, which islocated on the island of Viti Levu, the Fiji archipelago's largest land mass.Over a period of two days eighty-two outpatients were interviewed.

The following two days were spent at the Valelevu Medical Clinic,which is located approximately fifteen kilometers from the Suva city centrealong the densely populated principal arterial thoroughfare connecting theurban sprawl of Suva and the town of Nausori. The enumerators interviewed69 outpatients waiting for consultation and treatment. In addition, the surveyteam conducted interviews at the Raiwaqa medical and diabetic clinic inRaiwaqa, a relatively poor section in the metropolitan Suva area.

The final urban survey locale was the Lautoka Hospital in the city ofLautoka on the westem side of Viti Levu approximately 230 kilometers fromSuva. The Suva survey team spoke to fifty outpatients at the general medicaland diabetic clinics.

The rural population of Fiji was sampled on Vanua Levu, Fiji'ssecond largest island. We visited the Labasa Hospital in the town of Labasa.Our visits coincided with the weekly outpatient diabetic and hypertension

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Philip Szmedra and K.I. Sharma/Small Island States in Crisis:The Economic Impact of Lifestyle Diseases in the South Pacific

clinics. A total of 308 usable questionnaires were completed during the Fijiportion of our survey work.

There is no other way than the survey method to collect these type ofdata in the developing world short of invasive procedures requiring medicalteams engaging in complete physical assays including blood sampling,extensive medical history workups. and similar methods. This is a veryexpensive proposition better left to the individuals of the World HealthOrganization or research teams working with WHO funding. Our methods ofasking straightforward questions of chronically ill individuals elicited what wefeel were honest responses from people who were not told in advance of oursite visits. We acknowledge that their responses may contain a significantmargin of error but feel that the results are valuable as a first approximation ofthe magnitude ofthe problem in that region ofthe developing world.

RESULTS

1. Demographics

Table 1 provides demographic infonnation for the samplepopulations. The sample populations have been chosen expressly to reflect theimpact of illness on the economic prospects of each nation and do not reflectthe overall mean population demographics. The Body Mass Index (BMI) forthe sample populations reflect the higher incidence of overweight individualsseeking treatment for NCDs. Obesity is a contributing factor to many oftheNCDs experienced by peoples in the Pacific. Many Pacific Island nations haverecognized the serious public health problem that obesity poses and have begunto implement educational programs to address the issue. However, it is thoughtthat both a genetic predisposition to store fat and the movement away fromtraditional diets to modem manufactured foods heavy in fats and sugars aspopulations move from rural to urban areas are counteracting any positiveimpact that educational programs to modity diet and lifestyle may be having.

The sample populations are heavy relative to their short stature withthe Nauruan sample registering in the obese BMI classification. The Fijisample population less so though the BMI index for the Fiji sample is in theoverweight category. The Nauruan sample is relatively well educated for anation considered to be among the poorer in the Pacific. The samplepopulations in Fiji report fewer years in school.

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Table 1. Select demographics of the Fiji and Nauru sample populations

Demographics

Age (mean)

Weight (kg)

Height (cm)

BMI**

Number in family

Years in school

Married ((%)

Single (%)

Married years

Fihi*

54.1

74.2

167.7

26.6

4.4

. 7.0

90.0

5.2

30.8

Nauru

42.6

86.2

163.1

32.4

5.0

11.4

60.7

26.2

18.3

* weighted averages by number of respondents at each sampled site.

Body Mass Index - Below 18.5 = underweight18.5-24.9 = nonnal25.0-29.9 = overweight30.0 and above = obese

2. Health (Alcohol-Tobacco)

Table 2 demonstrates that many of the individuals included in thesample populations indulge in either the consumption of alcohol or tobacco, orin many instances both. However, significantly fewer people in the Fiji samplesmoked cigarettes which may be due to diligent anti-smoking campaigns thathave been promoted by the govemment of Fiji. Most respondents reportedbeing advised by a physician or other health care provider to quit or cut downon either alcohol or cigarette consumption or both. And most respondentsreported in unstructured sample responses that following this type of advicewas difficult considering the problems they faced in their daily lives and theneed have a physical and psychological outlet to help them cope.

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Philip Szmedra and K.I. Sharma/Small Island States in Crisis:The Kconomic Impact of Lifestyle Diseases in the South Pacific

Table 2. Health impacts (Alcohol-Tobacco) in sample populationsin Fiji and Nauru

Trait

Drink alcohol (%)

Smoke cigarettes (%)

Cigarettes per day (#)

Fiji

34.5

16.5

15.3

Nauru

47.5

40.0

30.7

3. Health (Diabetes)

We chose our sample populations carefully to include largepercentages of individuals afflicted with diabetes and other NCDs (Table 3).While the overall population of Nauru contains between 30 percent and 40percent diabetic individuals depending on gender (females being more proneto the disease than males) our sample population contains a much higherpercentage. Our Fij i data include fewer diabetics reflecting the greater numberof general medical clinics we visited which dealt with various medicalproblems.

The impact of diabetes is severe in Nauru. The govemment of Nauruprovides complete medical coverage for people being treated for the diseaseincluding medication, hemodialysis for those individuals suffering from kidneyfailure, and when financial conditions permit, the costs of kidney transplantwhich involves evacuation to and hospitalization in Australia. The ability ofthegovemment to continue this degree of beneficence is now limited due to thenear exhaustion ofthe phosphate deposits which were the only source of exportearnings for the island nation. A number of respondents mentioned that theyhad been waiting in some cases years for a transplant operation but thegovemment did not have the funds. It appears from these data that the problemwill not be solved anytime soon. More than 80 percent of Nauruan respondentsreported that other family members were also diabetic.

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Table 3. Health Impacts (Diabetes) in sample populationsin Fiji and Nauru

Trait

Diabetic (%)

Time since diagnosis (yrs)

Times to clinic (per month)

Treatment (%): Diet

Insulin

Drugs

Diabetics in your family (%)

Fiji

52.8

6.0

3.3

18.7

17.2

• 29.1

18.0

Nauru

73.3

12.0

5.5

40.9

15.9

43.2

81.7

4. Health - Heart, Kidney, and Eye Diseases

Significant portions of our sample population were afflicted with othertypes of NCDs in addition to or other than diabetes (table 4). The Nauru datareflect our visits to the dialysis clinic at the RON Hospital. One third of allrespondents suffered from kidney disease. Many ofthese people were in end-stage renal failure and undergoing dialysis treatments with the expectation ofreceiving a kidney transplant in the near future if govemment financespermitted. A smaller percentage ofthe Fiji respondents suffered from kidneydisease. There are no hemodialysis facilities in Fiji. The data describing kidneydisease in Fiji probably refiect a combination of two factors; 1) lower incidenceof diabetes, which is a strong contributing factor to renal disease; and, 2) a highmortality rate among people developing kidney disease and the inability toeffectively treat renal failure without access to hemodialysis equipment. Kidneydisease is a significant cause of lost work days due to illness. Those aflflictedwith kidney disease reported losing 48 days of work due to the debilitatingeffects of their disease. This includes the time spent in dialysis for thosesuffering from renal failure. Dialysis sessions require the individual to spenda minimum of four hours per session three days a week. More if problems arisein transport to the clinic or in hospital preparedness.

Diseases ofthe eye were the most common reported health problemby the sample populations. More than half of Naumans sampled reported eyeproblems. The figure was thirty percent in the Fiji sample . This result is notsurprising in the Nauru sample as diabetes also affects the delicate vascular

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systetn that nourishes the eye. Relatively high eye disease rates among Fijiresidents may have to do more with the hot and dry climate of the westem andnorthern regions of Fiji which contribute to the debilitating effects of diabeteson the eye. Arid climates dry the mucous membranes in the eye and provide anenvironment for opportunistic infections. However, in no nation was thissource of illness an important contributing factor to work absence.

Table 4. Health Impacts (Other NCDs) in sample populationsin Fiji and Nauru

Trait

Heart disease (5)

HD (days missed work)

Kidney disease (%)

KD (days missed work)

Eye Disease

ED (days missed work)

Fiji

26.7

26.5

7.7

16.2

28.7

11.3

Nauru

16.4

32.0

32.8

48.3

52.5

10.8

5. Health - Hypertension and Nerve Disorders

Table 5 (see next page) reports data on other NCDs that affected thesample populations. All groups reported significant levels of hypertension.Hypertension contributed to significant levels of lost productivity in all samplepopulations. In addition, nerve disorders were a relatively common complaintexpressed by all sample populations affecting more than a quarter of theindividuals in the Nauru sample.

6. The Macroeconomic Effects

Our objective was to monetize the dollar loss to each nation'seconomy from the acute and chronic effects of NCDs among the economicallyactive members of the population. Our approach and objective omits those notin the labor force. While the debilitating effects of these diseases are as severeon those not in some type of formal employment as it is to those working forwages, attempting to estimate the financial impact on those outside formal

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JOURNAL OF THIRD WORLD STUDIE.S. FALL 2007

employment with much confidence is a much more difficult and subjectivetask.

Table S. Health Impacts (Hypertension and Nerve Disorders)in sample populations in Fiji and Nauru

Trait

Hypertension (%)

HYP (days missed work)

Nerve disorders (%)

Nerve (days missed work)

Fiji

77.2

17.0

10.9

10.6

Nauru

77.8

21.5

26.2 '

13.0

6a. Estimation Procedure

Data describing the incidence of select NCDs in the populations ofNauru and Fiji are available fi-om SPC publications.''' When differentincidence rates were reported for males and females in each country we tooka weighted average with 50% being the weight assigned to each gender specificrate. For instance, according to Coyne, the incidence of diabetes in Nauruanfemales is approximately 33 percent according to the latest survey data. Thecorresponding incidence figure for males in the population is 28 percent.Therefore the weighted average of diabetes incidence in the overall populationis 30.5 percent. The average daily wage among those employed in the formalsector on Nauru is the equivalent of US$35.34. By knowing what percentageof the overall population suffers from a particular NCD and also whatpercentage of our sample population lost a given amount of work days to theirillness, we determined what part of the overall population lost a similar numberof days to the same illness.

Most individuals we interviewed suffered from multiple illnessesrelated to either their diabetic condition or some other chronic illness. Weasked respondents to attempt to ascribe to each illness that they were afflictedwith, a distinct number of work days lost. For instance, if someone sufferedfrom both heart and kidney disease, we asked the individual to estimate theunique number of work days lost because of the affects of his heart disease, andthe unique number of work days lost because of the effects of his heartcondition. In this way we attempted to avoid the possibility of double countingdays lost from work.

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We determined the percentage ofthe population that is active in thelabor force and the overall level of unemployment from U,S, CentralIntelligence Agency data,,'^ When the number of people in the labor force wasnot explicitly provided, we took as the labor force those between the ages of15 and 64 and factored out the reported level of unemployment. The numberof people in the labor force times the number of people in the total working agepopulation that lose the mean number of days to a particular illness gives thetotal number of people in the working population that lose the reported averagenumber of days to an illness. The number of days lost times the average formalwage per day times the average number of people experiencing this lossprovides the total loss in dollar terms to those employed in the formal sector,

A. Nauru

1, Diabetes - Because of the widespread incidence of adult onsetdiabetes on Nauru and the fact that diabetes is a precursor to many ofthe other NCD illnesses of interest, the survey instrument did notdirectly solicit estimates of lost work time and productivity due to thisillness. We wanted to avoid the risk of double counting productivityloss. Productivity loss is therefore measured as associated with theother NCDs, to which diabetes is a significant contributing factor, orresults from the progression ofthe disease,

2, Heart Disease - Ten of 61 respondents in our sample populationreported being diagnosed with heart disease. Six of those individualsreported losing an average of 32 days per year due to their conditionincluding time lost from work seeking treatment, time in hospital, andfeeling too ill to do their job,

3, Kidney Disease - Twenty of 61 respondents had kidney disease,many of those in end stage renal failure. Surprisingly, a majoritycontinued to work in spite of the seriousness of their medicalcondition. However, the productivity loss was particularly evidentamong these people as they spent an average of four hours per daythree days per week attached to a hemodialysis machine. Some werecompensated by their employers for the time spent during dialysis andsome were not. However, whether employees are compensated fortheir time away from work or not, the loss of their productivity is areal loss to the growth prospects and potential of Nauru, The averagedays lost during the past year resulting from kidney disease includingtreatment and debilitating effects ofthe illness was 48 days.

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JOURNAL OF THIRD WORLD STUDIE.S. FALL 2007

4. Eye Disease - Thirty two of 61 respondents had diseases ofthe eye.Eye disease is a common result ofthe progression of diabetes as thedisease attacks the vascular structures in the eye and gradually causesblindness. Fifteen of the sample respondents reported losing anaverage of 10.8 days in the previous year due to eye problems.

5. Hypertension - Fifty four of 61 persons in the sample populationreported having been diagnosed with hypertension. Thirty onerespondents reported losing an average of 21.5 days of work over thepast year because ofthe effects of hypertension.

6. Nerve Damage (neuropathy) - Sixteen individuals in the samplereported having been diagnosed with nerve damage, most generallyto the extremities, which is a common affliction among diabetics.Eight individuals reported losing an average of 13 days of work in theprevious year because of problems related to neuropathy.

7. Nauru IVIacroeconomic Impacts

Table 6 displays the projected estimates of overall dollar loss to the formaleconomy of Nauru fi-om the NCDs included in the study.

Table 6. NCD Economic Impacts to Nauru

NCD

Heart Disease

Kidney Disease

Hypertension

Eye Disease

Nerve Damage

Total

Estimated Dollar Loss (US$)

$ 312,198

2,523,148

200,147

133,620

172,744

$3,341,857

The GDP of Nauru in 2004 in current dollar terms was US$25.4million which includes US$24.4 million fi-om the government of Australia inthe form of payments to the govemment of Nauru to house refugees from the

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Philip Szmedra and K.I. Sharma/Small Island Stales in Crisis:The Economic Impact of Lifestyle Diseases in the South Pacific

Middle East and Southeast Asia that have attempted to enter Australiaillegally,'" The drag on the overall economy as a result of lost work time dueto the treatment, hospitalization and debilitating effects of NCDs amounted toapproximately 14 percent of 2004 GDP or a loss of L)S$581 per capita for eachmember ofthe workforce. No current projections exist for GDP growth onNauru, The tenuous state ofthe economy with its reliance on an essentiallydepleted stock of phosphate as its principal foreign exchange earner makesfuture economic viability dubious. But whatever future resource prospects, thedeteriorating state of public health among the island's population bodes ill forany revitalization of the Nauruan economy and for the social and physicalwelfare of its people,

B Fiji

1, Diabetes - The incidence of diabetes in our surveyed sample was52,8 percent ofthe 308 respondents. However, we assume an overallpopulation incidence of 15 percent aggregating the indigenous Fijianand Indo-Fijian segments into one group. Further, the five Fiji surveysites (CWM, Raiwaqa, Valelevu, Lautoka, and Labasa) were mergedinto one dataset with weighted averages used to determine overallincidence and disease impact, the weights based on the number ofobservations taken at each site,

2, Heart Disease - our results indicate that 79 of 308 individuals in oursurvey reported being diagnosed with heart disease. Sixty-eight ofthese respondents reported losing an average of 33,8 days of work theprevious year due to the effects of their illness including daysinvolving hospital or clinic visits and instances in which therespondents felt too ill to work,

3, Kidney Disease - approximately 5 percent ofthe population of Fijisuffers from sort of kidney ailment , Sixteen people in our surveysample reported losing 16,2 days of work during the previous yeardue to kidney disease. In spite of the relatively advanced state ofpublic health delivery in many areas of Fiji compared with othernations in the region, the effective management of kidney diseasevaries greatly according to geographic location and financial means.The Labasa Hospital on Vanua Levu has no kidney dialysis facility.Kidney disease patients in need of dialysis and without the means tosecure overseas treatment usually succumb to their illness.

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4. Eye Disease-weestimated that 5 percent ofthe population of Fiji isafflicted with diseases of the eye, many related to diabeticcomplications. In our survey 74 of 308 respondents reported losing11.3 days of work during the previous year due to these conditions.

5. Hypertension - A large majority of survey participants reportedbeing diagnosed with hypertension. Two hundred and thirty four of308 people reported suffering from the effects of elevated bloodpressure. Ofthese, 213 reported losing an average of 17 days of workin the previous year because ofthe effects ofthis condition.

6. Nerve damage -A total of 21 respondents reported this conditionwith 17 people indicating a mean loss of 10.8 work days during theprevious year from its effects.

7. Fiji Macroeconomic Effects

Table 7 provides the estimates of overall dollar loss to the formaleconomy of Fiji in the previous year due to lost work time and subsequent lostincome. The GDP of Fiji in 2005 was approximately US$1.9 billion." Ourestimates indicate a loss to the revenue generating capacity ofthe labor forceof US$26.9 million or approximately 1.4 percent of GDP. This figure shouldbe taken as a minimum value since the loss in national income would havenegative multiplier effects in the overall economy which we have not attemptedto quantify.

Table 7. NCD Economic Impacts to Fiji

NCD

Heart Disease

Kidney Disease

Hypertension

Eye Disease

Nerve Damage

Total

Estimated Dollar Loss (US$)

$ 15,570,000

2,313,964

5,524,233

1,856,171

1,581,209

S 26,845,577

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Philip Szmedra and K.I. Sharma/Small Island States in Crisis:Ihe Economic Impact of Litestjle Diseases in the South Pacific

DISCUSSION

The Pacific region has seen an increase in the incidence of NCDs asinfectious disease has become less common and as the relative wealth of mostofthe region has improved. The burden of these illnesses is both financial tothe individuals afflicted through lost productivity, and emotional, through thepain and suffering caused. The financial impacts are also severe and mountingfor the govemments involved due to the significant costs of disease treatment.The cost of managing lifestyle-related NCDs in the Pacific accounts for abouthalf of health care expenditures in some Pacific island countries. Our work hasassigned dollar values to the productivity and income losses experienced bythose in the overall population that are economically active in the formalsector. Our estimates are undervalued probably by a number of orders ofmagnitude. They are admittedly and necessarily so because ofthe difficultiesin accurately estimating physical debility due to disease in populations that areessentially rural where most economic activity occurs in the informal sector.However, our estimates provide a first approximation of the losses to theformal sector in these two nations as a result of NCDs, In that light they offerindividuals involved in health policy formulation, information and insight toguide the budgetary and policy process to more effectively target theseincreasingly menacing afflictions,

NOTES

1, The authors would like to thank the University ofthe South PacificUniversity Research Committee for their generous financial supportwhich allowed us to undertake the research. We also are indebted tothe Ministries of Health in Nauru and Fiji for their sanctioning of ourfield work allowing the research team access to rural and urban clinicsand hospitals. Our gratitude also goes to the physicians, nurses andother medical staff in each island nation that worked with us duringthe survey process. Finally, we dedicate this work to the noble peoplewho we met and spoke with that were being treated at the medicalfacilities we visited that carry on with their lives with exuberance andvitality in spite ofthe health problems and issues they face. We hopethat the policy impact of this work does in some way positively affecttheir lives,

2, D, Kromhout, A, Menotti and H, Blackbum, Prevention of CoronaryHeart Disease. Diet, Lifestyle, and Risk Factors in the SevenCountries Study. (New York: Kluwer Academic Publishers, 2002,)

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3. World Health Organization. Plan of Action for the Western PacificDeclaration on Diabetes 2002-2005, (Manila. WHO, Westem Pacificregional office. 2001.)

4. T. Coyne. Lifestyle Diseases in Pacific Communties. Secretariet ofthe Pacific Community. (Noumea, New Caledonia. 2000.)

5. Ibid6. P. Hoskins, D. Handelsman, and Hannelly, et al. 'Glycosylated

hemoglobin as an index ofthe prevalence and severity of diabetes inbi-ethnic Fiji." Diabetes Research and Clinical Practice, 1987,3:257-67.

7. Secretariat ofthe Pacific Community. Diet, Physical Activity, andHealth. Meeting of the Ministers of Health of the Pacific Islandcountries. Nuku'alofa, Tonga. Available from URL:http//www.fiji.gov.fj/press/ 2003_03_17-03.shtml). AccessedSeptember 2004.

8. United Nations Development Program (UNDP). Pacific HumanDevelopment Report 1999: Creating Opportunities^ Suva, Fiji.1999.)

9. Ibid10. World Health Organization/Secretariat ofthe Pacific Community.

Obesity in the Pacific; Too Big to Ignore. Report on a Workshop onObesity Prevention and Control Strategies in the Pacific,{ Samoa.2000.)

11. Andrew Dalton, and Steven Crowley. Economic "Impact of NCD inthe Pacific Islands" (with special reference to obesity). Paperpresented at the workshop on Obesity Prevention and ControlStrategies in the Pacific. Apia, Samoa, September, 2000.

12. Secretariat ofthe Pacific Community (SPC). Demographic Program.1999.

13. United Nations Development Program (UNDP). Pacific HumanDevelopment Report 1999: Creating Opportunities, (Suva, Fiji.1999.)

14. T. Coyne. Lifestyle Diseases in Pacific Communties. Secretariet ofthe Pacific Community.

15. Central Intelligence Agency (CIA) World Factbook, 2005. availablefrom URL: http://www.cia.gov/cia/publications/factbook/geos/html.Accessed May, 2005.

16. U.S. Department of State. Available from URL:http//www.state.gov/r/pa/ei/bgn/16447.htm#econ. Accessed May2005.

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17, Central Intelligence Agency (CIA) WorldFacthook, 2005. availablefrom URL: http//www,state,gov/cia/publications/factbook/geos/fj,html#Econ, Accessed September 2006,

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