Saving the Pacific islands from extinction

Abstract

Listen

Translate article

Small island developing states are a distinct group of 58 low-lying island nations and territories across three geographical areas—Caribbean, Pacific, and Indian Ocean and African regions. For many, thoughts of the Pacific island countries conjure images of tropical beaches and pristine blue waters. But like all small island developing states, those in the Pacific region face threats to viability and survival due to their small landmass, geographical remoteness, and vulnerability to climate change and natural disasters. This collection of countries, often forgotten by the medical and public health community, deserves closer attention. The Pacific island countries are a diverse population of 11 million people living in 22 nations and territories that span more than 25 000 islands and islets in an ocean that covers a third of the Earth's surface. Life expectancy ranges from 58 years for a man in Papua New Guinea to 72 years in Tonga. In the face of poverty and growing inequality, countries face a triple burden of challenges: the unfinished communicable disease agenda combined with maternal and child health problems, rising non-communicable disease (NCD) epidemic, and the health impacts of climate change. Mental health issues and disability also remain a substantial burden as does violence and injury, particularly violence against women and road traffic injuries. In 2017, up to 80% of deaths in the region were attributed to NCDs. Pacific islanders have among the highest rates of obesity and diabetes globally. There has been good progress to implement the Pacific NCD roadmap, and its four key actions: strengthen tobacco control, reduce consumption of unhealthy food and drink, improve efficiency and impact of the health sector for prevention and early treatment, and strengthen the evidence base for better investment planning and programme effectiveness. Samoa, Tonga, and Palau have been the best implementers, probably due to strong political leadership and governance. Although no country is on track to achieve the Pacific Tobacco Free goal by 2025, the recent regional focus on child obesity and the ongoing development of a Pacific legal framework for NCDs hold more promise. The climate crisis requires an urgent global response. The region is responsible for only 0·03% of the total greenhouse gas emissions, yet it is on the front-line of increased severe weather events, such as droughts, cyclones, and rising sea levels, which lead to food and water insecurity and displacement of communities. That said, the Pacific islands are leading the charge on mitigation efforts and have set ambitious targets. There is little research on small islands states but it is crucial to study these places since they often act as a magnified sentinel of what the future holds. Recognising these challenges, health ministers of Pacific countries in conjunction with UN agencies and development partners have reaffirmed their commitment to the Healthy Islands vision set in 1995—a health in all policies approach, linking health with ecological balance. To date, monitoring and implementation of the vision has fallen short of expectations. Inadequate finances, huge human resource deficit, and poor local infrastructure and capacity are a few of the immense challenges countries face. Coordinated action supported by external agencies and partnerships with key countries, for example New Zealand, France, and the USA, but implemented directly through the local people who understand small island politics and specificities is necessary. Crucially, small countries equipped with the right political leadership and supported through appropriate resource capacity can implement wholesale change comprehensively and rapidly and yield substantial benefits quickly using relatively modest resources. These initiatives can also serve as a valuable source of experience in implementing innovation to design future health systems in the digital age capable of mounting an effective and sustainable response to changing ecoepidemiology. The biannual Pacific Health Ministers Meeting (Aug 5–8) in French Polynesia is an important opportunity to assess progress of the Healthy Islands journey and decide on recommendations going forward. Agenda items include universal health coverage, health and climate change, health security, NCDs, water and sanitation, and immunisation. On Aug 5, a Series of articles on cancer control in small island developing states in The Lancet Oncology will be launched there. With next month's UN climate action summit and the High-Level Mid-Term Review of SAMOA—the overarching framework for guiding global, regional, and national development efforts to achieve the SDG aspirations of small island developing states—the world must turn its attention to protect the livelihood, security, and wellbeing of the peoples of this special archipelago.