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Poor Health in the Pacific Has Hope
The World Health Organization has identified nine out of the top 10 most obese nations as being located in the Pacific. Within these nine nations, rates of obesity range from 35 percent all the way up to 50 percent.

Obesity measurements are calculated by looking at an individual’s BMI, or body mass index. Pacific islanders naturally have a larger build than people of other ethnicities. This is the case because, at one time, people from this region were forced to endure long and difficult journeys at sea. People able to store enough energy in the form of fat were more likely to survive, and evolution selected for these genes. However, this genetic component still does not explain all of the obesity rates.

What does help to explain this epidemic is the increasing number of foods that are being imported to the islands. Traditional tropical diets included an abundance of fresh produce and fish, but these foods are now replaced with more processed foods, which provide a cheaper alternative. One World Health Organization worker and Fijian native even noted that “it’s cheaper to buy a bottle of coke than a bottle of water.”

Additionally, urbanization and increasing numbers of office jobs contribute to poor health in the Pacific. Historically, many jobs such as fishing and farming included a great deal of physical activity. However, as more people begin to drive to work in offices, physical activity is greatly reduced.

This obesity academic is exhibited in children as well. Roughly one in five Pacific children are obese, and diabetes is a constant concern for children as well as health services who struggle to meet increasing demands.

Despite these unfortunate circumstances, there is still much hope for improving health in the Pacific. Members of the World Health Organization are confident that higher taxes on soft drinks, controlled marketing of products aimed at children and general promotions of a healthy lifestyle can help to turn things around.

Additionally, Australian researchers recently found an issue with the way that the rates of Type 2 diabetes were being measured in the Pacific. Essentially, blood glucose levels measured in the first phase of the survey were mistakenly compared to plasma levels in the follow-up portion of the survey. This caused rates to become inflated to nearly twice their actual value.

It was originally believed that Samoa experienced a 24.3 percent increase in diabetes from 2002 to 2013 when the actual increase was less than 3 percent. Tonga was thought to have experienced a 12 percent increase when diabetes rates actually decreased by three percent. Clearly, a recalculation may be required.

Although this inflation certainly does not mitigate the entire health crisis occurring in the Pacific islands, it does mean that at least rates of diabetes may be lower than was previously thought. Further steps to improve health in the Pacific will need to include conscious efforts on behalf of national governments, health organizations and citizens to strongly promote healthy living.

Nathaniel Siegel

Photo: Flickr

Top Diseases in KiribatiKiribati is stricken with a hefty mix of diseases that are communicable and non-communicable. The top diseases in Kiribati resulting in death are circulatory, parasitic, nutritional and metabolic disorders. The leading causes of health complications are fungal, respiratory and diarrheal infections.

Life expectancy in Kiribati is the second lowest in the Pacific, with females at 69 years and males at 64 years. Factors contributing to Kiribati’s increased burden of disease are overcrowding, poor hygiene, inadequate sanitation, insufficient immunization coverage, as well as a lack of care and supplies for maternal/neonatal health.

Water-borne illnesses are among the top diseases in Kiribati. The primary infections being diarrhea, dysentery, conjunctivitis, rotavirus, giardia and fungal. These diseases are most threatening to children, causing 60 deaths per 1,000 live births in children under five.

The prevalence of water-borne illness plagues Kiribati mostly due to sanitation issues. Unfortunately, unsafe water is only part of the problem, improper food handling and the continued sale and consumption of expired foods only adds to the cycle of parasitic diseases.

Once a contagious disease has planted itself on the island, it becomes hard to contain because of the high density living arrangements of most communities. For example, Kiribati is one of only four countries in the world that still has leprosy, the number of contractions reaching 180 last year in 2015.

Tuberculosis (TB) is another top disease in Kiribati. TB remains rampant in Kiribati because it is easily spread and can remain dormant for long periods of time. However, disease begets disease. A burdened immune system makes it harder to prevent and treat other diseases. Not surprisingly, the magnitude of diabetes in Kiribati contributes largely to the continued occurrence of TB.

Lifestyle choices, or ignorance of health, feeds the expansion of diabetes, making it one of the top diseases in Kiribati. The majority of I-Kiribati fit into a profile at high risk for diabetes: high blood pressure, obesity, lack of exercise, poor nutrition and smoking. Already, 25% of the adult population is receiving treatment for diabetes or pre-diabetes, with numbers growing each year.

Smoking and diabetes are a deadly combination progressing towards a failing circulatory system, resulting in limb amputation and other disabilities. The rate of amputation in Kiribati is increasing at an alarming rate. In 2014, there were 136 amputations, nearly doubling that of the previous year.

Tobacco consumption is a risk factor for diabetes, but smoking also carries its own army of diseases such as respiratory infections, stroke, cancers and circulatory problems. Kiribati’s tobacco consumption is the highest in the South Pacific as 61.5% of its population smoke.

Like with combating most diseases, the key to success in ending the cycle of disease in Kiribati is awareness and prevention. The government of Kiribati, along with support from the World Health Organization have implemented plans to heighten the awareness of communicable and non-communicable diseases.

The goals for these programs are to reinforce good hygiene, improve water sanitation services, increase standard immunizations, educate citizens on the harmful effects of smoking, as well as informing them on the benefits of exercise and good nutrition. As awareness spreads and prevention occurs, there will be a decline in top diseases in Kiribati.

Amy Whitman

Photo: Flickr

Public Health Challenge: Combating the Top Diseases in Estonia
A member of the European Union since 2004, Estonia is among the wealthiest nations in the Baltic region. Likewise, the country has a modern health system that can reasonably support its population of 1.3 million.

Almost all Estonians are covered by health insurance, and the greatest menaces to public health, like heart disease and cancer, are characteristic of a developed country.

Nonetheless, more than one in five Estonians live below the poverty line and are especially at risk for certain health problems that are prevalent in the country. Here are some of the top diseases in Estonia and what is being done to combat them.

HIV/AIDS

While the death toll from AIDS is dwarfed by that of heart disease and cancer in Estonia, the country has the highest prevalence of HIV in all of Europe. Around 1.3% of the population carries HIV, comparable to rates in Sierra Leone or Mali.

The first case of HIV was diagnosed in 1988, and the rate of incidence remained minuscule until the turn of the century. According to a report by the World Health Organization (WHO), the disease exploded in 2000, mostly among drug users.

Since then, the incidence rate has declined, but still more cases are reported each year. Epidemiologists have found that heterosexual transmission has increased in recent years, adding to the more than nine thousand Estonians who have been infected.

Estonia has seriously grappled with HIV/AIDS for decades. All treatment for HIV-positive patients is free, and education about the disease is standard in Estonian classrooms. Some trends have epidemiologists in the country hopeful: according to U.N. AIDS, both safe sex practices and HIV testing are on the rise among Estonians.

Tuberculosis

Like AIDS, tuberculosis is not one of the major killers in Estonia, but the disease poses complex challenges for the country’s health system. Estonia has one of the highest multi-drug resistant tuberculosis burdens in the world. In many ways, tuberculosis in the country is tied to the issue of HIV: the prevalence of TB/HIV co-infection in Estonia is one of the highest in Europe at 15%.

Beyond people who suffer from AIDS, tuberculosis also particularly threatens Estonians who use intravenous drugs or drink heavily — a population that reports from WHO suggest could be large.

The rate of tuberculosis incidence is decreasing, indicating that Estonia is winning its battle against the disease. But according to WHO, as the incidence decreases, new challenges will arise. As the issue shrinks in magnitude, political and financial commitment may also dwindle — something that Estonia’s government must avoid if the disease is to be defeated in the country.

Obesity

There is still controversy over whether obesity is actually a “disease,” but reports and data on public health in Estonia have outlined it as a clear issue. Sources disagree, but 2014 research from the University of Tartu found that as many as one in three Estonians are clinically obese (a body mass index of over 30).

Obesity can greatly increase the risk of a myriad of health issues, including diabetes, heart disease and stroke. Heart disease and stroke accounted for nearly half of all deaths in Estonia in 2012 (48%), so many physicians believe the issue should be taken seriously as one of the top diseases in Estonia.

The issue may be correlated to modernization. WHO estimates that nearly half of Estonian adults are insufficiently active, while salt intake is growing.

Obesity is not an easy issue to tackle, but growing scholarship and research on obesity has helped Estonia assess its magnitude and effects. In recent years the government has implemented some policies to promote consumer awareness and healthy eating habits in schools.

Estonia faces unique but surmountable public health challenges. The government likely has the means to solve such issues, and the nation, therefore, serves as a good example of how funding is not the only weapon fights like these; there must be political attention, commitment and patience. Coming years will tell the extent of Estonia’s diligence in the realm of health, and likely provide valuable lessons for nations facing similar issues.

Charlie Tomb

Photo: Flickr

Obesity and Malnutrition
In 2014, more than 1.9 billion adults were overweight, and more than 600 million of these adults were obese. While we may often associate the epidemic of obesity with the developed countries, it has spread to the developing world as well.

There is a “double burden” of obesity and malnutrition in developing countries. Food that lacks important nutrients but is high in carbohydrates and sugars has become widely available in the developing world for a very low cost. Families that may not have a lot of money often resort to these food options.

This burden of both obesity and malnutrition is particularly evident in urban areas of poverty-stricken countries. The subsidization of agriculture in combination with multinational companies has made the production of foods with refined fats, oils, and carbohydrates cheap and widely accessible. Furthermore, more than 50 percent of low-income countries lack recommendations for food and beverage consumption.

In March 2015, the World Health Organization (WHO) released a guideline for sugar intake. While this is a step in the right direction, there is still more work to be done.

Potential solutions include taxations of high sugar content products, restrictions in marketing these products, and food industry regulations.

It is essential that the developing world does not repeat our mistakes. More importantly, it is not acceptable for developed countries to supply cheap, low-quality food simply for profit. There is a global accountability and responsibility that accompanies the rise in globalization.

Iliana Lang

Sources: NIH, The Lancet, Oxford Journals, Food Navigator

Photo: Flickr

brazil
Brazil is the largest country in Latin America and has been on the rise for many years. Along with a rise in overall GDP and standard of living, experts have found a rise in obesity levels. This trend has come to be associated with countries that are rapidly developing as snack foods have become a symbol of wealth and locally grown produce is seen as cheap and unrefined. Bela Gil, daughter of one of Brazil’s most famous singers, Gilbert Gil, recently posted a photo of her daughters’ lunchbox, and this created an uproar.

The young girls’ lunchbox contained fresh food, yams, bananas and more, all locally grown and in proper portion size, her daughter was being fed well and with Brazil recently being named the nation with the best health reforms, it would usually be something worthy of praise. Instead, the internet reprimanded Gil, saying that she was not feeding her daughter enough and making jokes about how little food there was and how unrefined it was. The truth is that was a great meal because it was so unrefined, in the processed sense of the word.

This healthy farm to table style of eating has only recently gained popularity, and with more and more celebrities jumping on board to endorse healthy eating, it is a wonder it has not been more popular. By posting pictures of her daughters’ healthy meal and various other meals, Gil is using her position of influence to proposition the public to really watch what they are eating. While fast food and highly processed snacks with name brands may be a sign of wealth they are also the cause of Brazil‘s increased obesity rate which has nearly doubled in the past decade.

While we often associate poverty with a complete lack of food, we must also begin to connect it to an abundance of unhealthy food. Overall health can be an indicator of a country’s poverty levels and Brazil’s is on the steep decline. In order to remedy this, individuals of influence must begin to associate wealth with healthy eating and good health habits. By posting pictures of this and promoting healthy portion size and control we are promoting healthy living, saying that class can be found in the food choices we make. Essentially, in order to take away the stigma of wealth and junk food we must reassociate it to wealth and health food.

While many other celebrities are joining this bandwagon, some coming under similar scrutiny for their choices, it may take some time for this new idea of healthy living to really take hold in nations that are just reaching the peak of their development, such as Brazil. These healthy meals are grown in the farms of Brazil, supporting local business and people in the neighborhood, and these choices will not only make for a better person, but a better community as a whole.

Sumita Tellakat

Sources: NPR, CNN
Photo: NPR

Malnutrition-in-Taiwan
Since the end of the Second World War, the face of malnutrition in Taiwan has changed dramatically. Once among the ranks of third world nations, Taiwan has enjoyed meteoric economic growth over the past seventy years. This growth has raised living standards, reduced poverty and eliminated undernutrition as a development issue. But despite this newfound prosperity, Taiwan continues to face malnutrition in the form of obesity and poor diets.

Between 1895 and 1945, Japan ruled over Taiwan as an imperial master. Over these five decades, Japan structured the island as a satellite granary. Taiwan’s principal crops became sugar and rice, and by the 1930s, Taiwan exported more than half of its agricultural output to the Japanese home islands. In fact, according to researcher Samuel Ho, the amount of rice available for consumption in Taiwan had fallen 24 percent by the 1940s. Although Japanese administrators modernized Taiwanese agriculture and invested in transportation infrastructure, they did little to improve the lot of the poorest Taiwanese: real wages remained low and malnutrition prevalent.

Soon after the end of Japanese rule, Taiwan found itself in a position to tackle malnutrition. No longer Japan’s offshore breadbasket, Taiwanese farmers saw export markets for their crops collapse. They thus began putting significantly less of their rice crop on the market and retaining more for home consumption. In addition, the Taiwanese government implemented land reforms that broke up large agricultural estates and turned tenant farmers into landowners. Combined with other “pro-farmer” policies and a growing industrial export sector, Taiwan had effectively eliminated malnutrition by the early 1970s.

But with the development of an advanced economy in Taiwan, malnutrition has resurfaced as a public health concern. According to University of Washington sources, dietary risks are the second-greatest contributor to Taiwan’s disease burden. Whereas most Taiwanese were once unable to afford a varied, nutritious diet, many now eschew healthy eating electively. To add to this concern, contemporary Taiwanese suffer from increasing rates of obesity: 31 percent of females and 41 percent of males were overweight in 2013, and obesity in people under 20 has increased by more than 50 percent since 1980. This “double burden” of malnutrition — undernutrition paired with obesity — among Taiwan’s youth may foretell the resurgence of malnutrition in Taiwan as a public health issue.

Recent research also suggests that cultural norms may perpetuate patterns of malnutrition in Taiwan. Researchers Lin and Tsai find that girls born to “marital immigrant” parents (in which one spouse — usually the wife — hails from abroad, typically Southeast Asia in the case of Taiwan) are significantly shorter and lighter than Han Chinese girls. Lin and Tsai note that Taiwanese men who marry immigrant women are disproportionately disadvantaged economically and physically. These men face immense pressure to preserve the family line, leading them to spoil their sons at the expense of their daughters. Given such ongoing changes in Taiwanese society, malnutrition in Taiwan may prove more intractable than previously thought.

– Leo Zucker

Sources: Malnutrition in Taiwan, Nutrilite Economic History Institute for Health Metrics and Evaluation Nutritional Research
Photo: World Vision International

obesity
In 2010, the Global Burden of Disease published a study that pointed to obesity as a more widespread health problem than world hunger. The study stated that about 30 percent of the global population was overweight or obese and that the latter caused approximately 5 percent of all deaths.

The problem of transitioning from widespread hunger to widespread obesity tends to occur in island countries termed ‘banana republics’, or those known for their direct economical dependence on trade relations with developed nations. Said dependence leads to a massive overconsumption of processed foods imported from the West and soaring rates of obesity.

A poster child for this phenomenon is Nauru: a Pacific island whose people were starving until a U.K. company discovered the country’s potential for phosphate mining. What followed the invariable economic boom was a precipitous rise in average weights as fast food largely replaced the Nauruans’ fresh fish and tropical fruits. Today, approximately 94 percent of Nauru’s population is overweight.

Unfortunately, banning fast foods will not solve the problem. Companies such as Dunkin Donuts and McDonalds have such tremendous political and economic clout that illegalizing their products would mean eliminating thousands of (barely) paid jobs and “food” products that nonetheless quell starvation.

Powerful as they are though, their products make it possible for a person to be obese and undernourished simultaneously. No impoverished individual is going to look at the nutritional labels on food, however deceptive they may be, if she is holding her first meal in a week.

The saddest part is that so-called banana republics cannot afford to buy their own food. Between the menaces of deforestation, immoral trading practices, and perpetuated poverty, their people are increasingly dependent upon foreign aid for unhealthy imports and foodstuffs each year.

If the current rate holds, nearly half of the world’s adult population will weigh in above a healthy range by 2030. The number will rise most prominently in industrialized regions compared to rural; already that trend has taken ahold of India and China.

What lies at the heart of the epidemic is widespread addiction to a substance of which large swaths of peoples’ ancestors were once deprived. It takes several generations, if ever, for their descendants’ brains to catch up to the sudden abundance. Until then, they subconsciously perceive the unhealthy food as a rare, invaluable delicacy and gorge down as much of it as possible.

Education is not enough to stop the obesity epidemic because emotion will always trump logic. The first step to solving the problem does not lie with educators or the educated; it lies with policy-makers.

It is policy-makers who are capable of manipulating the market such that island nations’ exports fetch a higher price on the market so that their people do not have to resort exclusively to fast food. If they have no other feasible options given their budgets, education would be completely useless.

Because people choose which foods to consume based on emotion, educators need to employ compassion. Psychology studies have shown that people are less likely to make unhealthy food choices when their self-esteem is intact. Eating is a social activity, so it is important to also share meals with supportive individuals. Lastly, healthier foods also tend to have more natural ingredients. If there are three or more unpronounceable, unrecognizable ingredients on the nutrition label, don’t buy that product.

– Leah Zazofsky

Sources: ASAHI, Flagler Live, Psychology Today
Photo: Challenged Kids International

obesity and food insecurity
According to nutrition epidemiologist Barry Popkin, in roughly 15 years, obesity rates in Mexico among men and women went from a small proportion of each population to 65 and 71 percent, respectively. Mexico’s situation is part of a trend of increasing obesity on a global scale. Around 2.1 billion people in the world are now either obese or overweight.

Because more than half of all the world’s obese and overweight live in fewer than 20 countries—developed countries, mostly—the temptation exists to disregard obesity’s impact on many developing countries.

However, one study found that “obesity rates tripled in developing countries between 1980 and 2008,” whereas it only increased by about half that amount in developed ones.

Developing countries tend to struggle with high levels of food insecurity, though, which one might assume would lead to lower weights, not obesity. Researchers are perplexed as to how the two factors— obesity and food insecurity —can coexist and they have been searching for data that will establish correlation, causation or both.

The recently released Global Food Security Index, which just added a new obesity indicator to its model, studies the matter in detail. Its overall conclusion affirms that co-existence is possible. Despite the correlation, it remains that the relationship between obesity and food security/insecurity is still poorly understood on a global scale.

The index helps to explain the presence of obesity in highly food insecure countries by noting differences between classes. It is the wealthier classes in developing countries, which are more food secure, that have experienced the largest increases in obesity (often after switching to more Western lifestyles).

The study also points out that obesity is increasing among the poor, as well, and experts have proposed various explanations for this phenomenon.

Some maintain the poor have to rely on high-calorie, low-nutrient food, which leads to obesity. Others look to “feast-famine cycles” for answers: poor populations swing between binging and starving—a cycle that changes one’s metabolism. Still others say obesity among the poor is rising because obesity is a wealth-indicator for the poor.

Causality remains exceedingly difficult to prove, though, because many factors, such as diet, wealth and level of physical activity, can all help cause obesity. Moreover, even correlation has been hard to establish in every developing country. In fact, studies in Ghana, Trinidad and Tobago show food insecurity correlated with lower weights, but results from studies in Malaysia were more complex.

Thus, no conclusion can be drawn as to what single factor is causing obesity in developing countries. It may be that no such factor exists.

Nevertheless, researchers will continue to search for causes. Three million people die every year from health problems that obesity contributes to. Researchers know that if they can pin down the causes of obesity, it could help to save the lives of millions.

Ryan Yanke

Sources: Global Food Security Index, Scientific American, Huffington Post, Reuters
Photo: Today Online

global food security index
Last May, the Economist Intelligence Unit (EIU) published its annual DuPont-commissioned Global Food Security Index (GFSI). The index aims to “provide a robust and consistent analytical framework for measuring and deepening the understanding of food insecurity around the globe.”

The index showed that food security in 70 percent of countries increased from 2012 to 2013. In that time span, the number of people suffering from chronic hunger decreased from 868 million to 842 million, with a 17 percent decline over the past 24 years.

However, the index also highlighted numerous obstacles inhibiting the growth of food security that both poor and rich countries have yet to surmount.

One hundred nine countries were ranked. The top five, in order, were the United States, Austria, the Netherlands, Norway (tied with the Netherlands) and Singapore. The bottom five were Burundi, Togo, Madagascar, Chad and the Democratic Republic of the Congo. Of all 109 countries, Uganda saw the biggest increase and Myanmar saw the biggest decrease in food security.

To determine these rankings, the GFSI incorporates three categories: Affordability, Availability and Quality & Safety.

The Affordability category incorporates measures like food consumption as a percentage of household expenditure, the proportion of a country’s population living under the $2 dollar per day global poverty line and import tariffs on agricultural goods. This category, a combination of six indicators, seeks to determine the degree to which people can purchase nutritional food without depleting their financial resources. In the top performing countries (U.S. and Singapore), people spent less than 15 percent of their budget on food.

This all matters little if food is affordable, but unavailable, so the GFSI assesses how easily people can access food as well. Acquiring the food one needs can be difficult in countries plagued by corruption, a lack of infrastructure and unpredictable agricultural outputs. Low-income countries in Sub-Saharan Africa scored the lowest in Availability, though the region experienced a notable increase in overall food security.

Lastly, the GFSI analyzes the quality and safety of diets in different countries. It looks at the availability of micronutrients like vitamin A and vegetal iron, protein quality and diet diversification, among other indicators.

According to the index, the majority of countries made gains in Affordability, but many countries lost points in Availability and Quality & Safety. In many countries grouped in the “Asia & Pacific” region, food indeed became more affordable, but only because diet diversification had been markedly reduced.

Two new indicators were added this year: food loss as part of the Availability category and obesity as part of the Quality & Safety category. Both have been controversial in recent years. In India, for example, a lack of food-chain infrastructure results in tremendous food loss—as much as 25 percent of produce every year.

Furthermore, obesity has become a growing concern even in countries with high food insecurity, though experts are still at a loss to explain this phenomenon.

The upshot of the index seems positive, with food security increasing in most countries. Despite this progress, areas for improvement have been pointed out. For one, women farmers across the globe still lack the same access to education, land and machinery that men have. Moreover, governments in developing countries are still struggling to make food more affordable without sacrificing dietary quality.

– Ryan Yanke

Sources: Economist, Blouin News, Dupont, Global Food Security Index
Photo: BlouInNews blog

facts about global health
Global health issues are being addressed now more than ever, here is a list of 10 facts about global health that show how far the world has come and how much more progress needs to be made.

1.

Around the world, cardiovascular diseases are the leading cause of death. They account for approximately 30 percent of all deaths. At least 80 percent of these deaths that occur prematurely could be prevented by adhering to a healthy diet, getting regular physical activity and avoiding use of tobacco products.

2.

Improving sanitation, water supply, personal hygiene and management of water resources could prevent nearly 10 percent of diseases and 6.3 percent of all deaths around the world.

3.

Currently, approximately 6.6 million children under the age of 5 die annually. By the year 2025, it is estimated that there will still be five million deaths among this age group. Ninety-seven percent of these deaths will occur in developing countries, and most will be a result of infectious diseases like pneumonia and diarrhea or malnutrition.

4.

Sixty-five percent of people around the world live in a country where overweight and obesity kills more people than underweight.

5.

It is estimated that 39.5 million people worldwide are living with HIV or AIDS. Sub-Saharan Africa accounts for about 70 percent of the cases.

6.

There are about 200 million women around the world who do not have access to effective family planning methods, like reproductive information and care services, despite the desire to use these resources. If these resources can be more widely accessed, unplanned pregnancy rates would drop, unsafe abortions would become less frequent and maternal and infant deaths would be reduced significantly.

7.

Preterm birth, birth before 37 weeks of pregnancy, is the most common cause of infant mortality globally. Fifteen million babies are born preterm every year and more than one million of them will die.

8.

The global average life expectancy has increased significantly over the past 20 years. The overall average is now 70 years; in low-income countries it is 62 and in high-income countries it is 79.

9.

Eight hundred women die everyday due to complications related to pregnancy and childbirth.

10.

The global population today is made up of 613 million children under age five, 1.7 billion children and adolescents between the ages of 5 and 19, 3.1 billion adults between the ages of 20 and 64, and 390 million elderly over the age of 65.

— Hannah Cleveland

Sources: WHO 1, WHO 2, Facing the Future, Bill & Melinda Gates Foundation
Photo: WHOIAA