Pacific Islanders, Micronesians, M... Health Article

THE PUBLIC HEALTH SYSTEMS

Throughout the colonial eras of the Spanish, the Germans, and the Japanese, the systems of public health in both Micronesia and the Melanesia were designed to assure a healthy workforce. Early records describe the "primitive" ways in which the people practiced even the most basic hygiene with water supplies contaminated by feces from animals as well as humans. Minimal available food made malnutrition a given among the population, and traditional healers practicing their trade as bone setters, herbalists, masseuses, and spiritualists, as in most indigenous populations. The establishment of the early German trading posts meant the need for local labor capable of loading and unloading ships. Thus, plantation-type medical care was made available, often from ship doctors and others with minimal training. With the movement of the Japanese into the area following World War I, the colonization of the region became more ordered, with settlers coming from Japan and local people receiving some basic education to improve the productivity of the copra (a coconut by-product) and other crops. The Japanese had physicians in all colonial outposts to address the immediate needs of the workers. Water and sewerage systems were established in the larger villages, and, in general, the public health of the population, while not excellent, was at least able to reduce the death rates from the many diseases brought to the islands over the preceding thirty years.

With World War II and the military mobilization of the Japanese colonists, the plantations became less important and the need to maintain a viable workforce was reduced. The public health system remained, as did the dispensaries and hospitals; however, as the war in the Pacific expanded, the infrastructure was destroyed.

At the end of World War II, there was no health or public health system throughout the Japanese-occupied areas. The American, Australian, and New Zealand troops dispatched to secure the various outposts brought their own medicines and providers with them and, as part of their efforts to win over the people, provided medicines

Figure 1

and care to those in need. In the U.S. Pacific, an assessment of the needs of the islanders in their protection (by international mandate) was made by the USS Whidbey in the early 1950s. The findings were shocking, in that the people suffered from many diseases that were thought to no longer be a problem to the world. Recommendations to the U.S. government at the end of the military era established the Trust Territory of the Pacific Islands (TTPI), with headquarters in Saipan and responsibility for all aspects of life in the "American Pacific" which, with the exception of Kiribati and Nauru, encompassed all of Micronesia.

Farther south, the abundance of the U.S. treasury was not available. The Australian and New Zealand governments assisted the Melanesians (including the people from Kiribati and Nauru) in their sphere of influence and brought public health and medical care to the southern Pacific, with the exception of New Caledonia, which remained a protectorate of France.

The modern public health and medical care systems of these two distinct regions of the Pacific have their basis in the postwar era. In the north, the U.S. government, through the TTPI, established a system of hospitals as the central points of care in all of the ten jurisdictions for which the TTPI had responsibility. In 1985 (1999 for Palau) the three areas now known as the Republic of the Marshall Islands, the Federated States of Micronesia, and Palau established a formal relationship with the U.S. government known as the Compact of Free Association. Under that compact the newly

Table 2

created nations were to be systematically transformed from dependencies to independent nations over a fifteen-year period. The responsibility for health services transferred to the island governments, and with it the determination of health priorities and expenditures. The period since 1985 has been spent revitalizing the public health and general health care systems. Newly trained indigenous health providers have staffed the health departments of these three nations, and reorganization of the strategies for health has come through much consultation with the World Health Organization (WHO) and the Asian Development Bank (ADB). These systems are attempting to establish primary health care centers throughout each nation, with the intent to reduce the dependence on expensive hospital-based care. However, budgets are small, needs are great, and the systems are weak.

In the southern Pacific, the transition from the post-war military care system to one operated by the national governments accompanied the independence of the various nations. The systems of care that the national governments inherited were already targeted on primary health care, and they already had a considerable investment in the use of dispensaries as a major source of care. However, the budgets have been very small in these nations as well, and the retention of trained local practitioners has been a major problem. Facilities have been built through bilateral arrangements sponsored by several foreign governments, and the basic public health infrastructure has begun to take shape through various ADB loans and other arrangements. The WHO has been very active in the southern Pacific, as has been the South Pacific Commission (now Secretariat for Pacific Communities) which has been instrumental in developing the health education focus of the region as well as the improvement of health data and general health department capacity.

In a short fifty years, the people of Micronesia and Melanesia re-created their public health systems. The water supplies are nearly all safe and sewerage is mostly disposed of in an appropriate manner. The food supply is inspected and safer, as is the supply of medicines used by the dispensaries and the hospitals. The prevalence of parasitic disease among children is remarkably reduced, as is the number of deaths from malnutrition and other nutritional deficiencies (see Table 2). However, the epidemiological transition is not over for the people of the Pacific. The future is dotted with many diseases of modernization—diabetes, substance abuse, severe mental illness, cancers, heart disease, and environmental diseases. The systems of care are not yet mature, and the need for continued support from major developed nations is obvious to any who have traveled the area.

D. WILLIAM WOOD

(SEE ALSO: Acculturation; Cultural Anthropology; Cultural Norms; Ethnicity and Health; Geography of Disease; Indigenous Populations)