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Health care in the Marshall Islands: Tackling Obesity

Health care in the Marshall IslandsThe Marshall Islands is a set of beautiful islands and atolls, but this dispersed nature can make it difficult for residents to receive health care. As pictured above, Health Fairs are a way for the population to receive equitable health care.

The Marshall Islands houses just two hospitals and 56 smaller health care centers scattered around its array of islands. This dispersed health care system limits the Islands’ ability to provide quality health care, and its .46 doctors for every 1,000 people — below the worldwide standard of 1.5 — worsens that. This disunion in the health care system and high poverty rates make it extremely difficult to treat non-communicable diseases such as diabetes and obesity.

The Problem

People commonly view obesity as a disease plaguing wealthy people and often associate it with developed countries. However, there is a strong link between poverty and nutritional health care challenges. A lack of adequate nutrition because of poverty in developing countries leads to a prolonged unhealthy diet, driving up obesity rates. One example is the nutritional concerns in the Marshall Islands: 60% of adult women and 50% of adult men suffer from obesity. Additionally, 30% of the Islands’ urban population — double that in rural atolls — living below the national poverty line displays a stinging link between obesity and poverty.

The primary cause of obesity in the Marshall Islands is poverty. A lack of resources infringes on the population’s ability to sustain a healthy diet. Because of this, residents have replaced their traditional diets with cheap imports and canned goods, high in salt content, which increases the risk of obesity. Even worse is obesity’s alarming comorbidities, like heart and diabetes-related issues. Fortunately, the Marshall Islands has implemented efforts to fight obesity.

World Bank Helps Future Generations

Developing poor eating habits early in life is a gateway to obesity as an adult. The Marshall Islands government found that most children’s diets consisted of heavily processed sugar and junk, because of financial hurdles to access nutritious food. To combat this issue, the World Bank donated $12 million to incorporate more fruits and vegetables into Marshallese diets in 2019. The government approved plans for further funding to reduce unhealthy eating habits, but it has been backlogged due to border closings amidst the COVID-19 pandemic. Nonetheless, health care in the Marshall Islands is fully aware of its obesity crisis and is doing its best to stop it from spreading to future generations.

Blue Foods

Blue foods are food from an aquatic source. Unfortunately, nuclear radiation from nuclear testing during the WWII era has damaged some of the Marshall Islands’ blue food sources. In an effort to make a profit while simultaneously conserving the Islands’ rich sea resources, they drew up the Vessel Day Scheme at the UN Food Summit. To promote a sustainable food system by 2030, The Marshall Islands set limits on when people can fish, generating up to $30 Million and preserving their tuna populations for future use.

While the economic stride may seem unrelated to health care in the Marshall Islands, this conscious effort to grow blue foods provides healthy alternatives to the sugar-filled canned imports people rely on that cause obesity. Additionally, the solution directly addresses poverty in the Marshall Islands by aiming to improve the economy. A key pillar to reducing the Marshall Islands’ obesity and poverty rates lies within a strong and sustainable fishing scene.

A Community Effort

A successful method to prevent any disease is education, and obesity is no exception to that. To achieve educated citizenship, the World Diabetes Foundation created the Majuro Youth Lifetime Program, with a mission to reduce diabetes and obesity through a community-based approach. They approached the issue by surveying primary schools and pinpointing issues. As a result, they were able to educate 216 teachers across eight schools on healthy eating habits and lifestyle choices. They were also able to plant gardens at each of the schools, providing nutritious food for malnourished students impacted by poverty. The project ran from 2017 to 2020 and is a powerful example of how people work towards better health education and health care in the Marshall Islands.

One cannot understate the impact poverty has on developing countries. The efforts of the Marshall Islands provide hope for a future where everyone living there has access to healthy and nutritious food. As the efforts to reduce poverty and improve nutrition continue, the resilience and health of the Marshall Islands and its people, no doubt, grow stronger.

– Aditya Arora
Photo: Wikimedia Commons

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Facts About Poverty in the Marshall Islands

Facts About Poverty in the Marshall Islands
Poverty in the Marshall Islands is a major issue, with 30% of the population in the island’s two cities living below the basic-needs poverty line. With the threat of rising sea levels and the lack of quality health care, education and jobs, a third of the nation has migrated to the west in search of a better life. Here are some facts about poverty in the Marshall Islands.

Unemployment

Unemployment is rampant with a rate of 40%. There is a scarcity of younger workers (20-45 years old) due to this demographic leaving the islands for higher-paying jobs in the United States. The primary job sectors are fishing and agriculture, which made up three-fourths of the labor force in 1958. This has changed drastically to 21% in recent years. This reliance on overseas imports is one of the main factors of poverty in the Marshall Islands.

The 1986 Compact of Free Association Law Treaty

The United States and the Marshall Islands have close ties due to the 1986 Compact of Free Association Law (COFA). This treaty grants citizens of Micronesia, Palau and the Marshall Islands to live in the U.S. without visas or work permits. Marshallese citizens have permanent non-immigrant status, distinguishing them from refugees who only receive temporary asylum.

COFA emerged in response to nuclear weapons tests during the post-World War II period from 1946 to 1958, testing 67 nuclear bombs on these Pacific Islands and atolls. The treaty serves as reparations for the loss of lives, resources, forced migration and land destroyed during the times of the nuclear testing. As a result of these tests, a number of islands–like the famous Bikini Atoll of the Marshall Islands–are uninhabitable due to the high levels of radiation still prevalent to this day.

Inefficient Health Care and Malnourishment

The insufficiency in health care is another pervasive issue on the islands, specifically in the outer islands where poverty in the Marshall Islands is high. Many citizens have to leave the Marshall Islands to receive treatment due to the limited health care facilities and programs in place. These off-island referrals are costly, further depleting government finances.

PBS interviewed Isaac Marty–a Marshallese journalist who shared how his wife was not able to get proper treatment for her chronic anxiety and depression. Marty claimed that there is a shortage of qualified medical professionals living on the Marshall Islands, and oftentimes citizens receive medication that is inadequate for their ailments.

Additionally, many Marshallese children are malnourished due to reliance on highly processed imported foods. This has led to a high percentage of diseases such as diabetes, high blood pressure, obesity and gout. With a lack of exports and locally grown food, the country continues to rely on unhealthy and cheap imported foods–widening the deficit and increasing poverty in the Marshall Islands.

Environmental Challenges

In recent years, environmental changes have permeated the globe, but the Marshall Islands specifically has had to bear the brunt of these adverse weather changes. Many have found that small island states, specifically in the Pacific, are the most prone to the variability in sea-level rises. The incremental increase could gradually rise by one to four feet–to the potential cessation of some island states by 2050.

Droughts are a persisting issue with 92% of households indicating that one had affected them. During droughts, household members become dehydrated and sick because their only source of water is salty well water. When water reserves are down, those who cannot afford to buy clean water have to beg.

The Ebeye Water Supply and Sanitation Project

The ADB has worked together with Australia and the Marshall Islands to form the Ebeye Water Supply and Sanitation Project. This project sets out to improve freshwater systems and has done so with success. A new desalination plant implemented in 2017 has increased people’s access to safe, reliable water. The incidence of waterborne disease, particularly gastroenteritis, has decreased, and water supply and sewerage networks have expanded to an additional 300 households.

These facts about poverty in the Marshall Islands indicate that in its fight against poverty, the Marshall Islands has to first tackle the issue of improving various internal sectors, lessening its dependency on others, while increasing the country’s GDP. By working with natural resources abundant in the country, as well as implementing governmental programs, there can be significant changes in health care, quality of education and the economy, as well as improved climate provisions. This would further pull the population out of poverty in the Marshall Islands and increase the island’s viability.

– Mina Kim
Photo: Flickr

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Top 10 Facts About Living Conditions in the Marshall Islands

Living Conditions in the Marshall Islands

In the Central Pacific, a series of 29 atolls and five islands compose the independent republic of the Marshall Islands. The Marshall Islands used to be under United States trusteeship but now exists as a freely associated state with the U.S. As of 2018, the Islands had a population of 75,684 people. Additionally, life expectancy ranges from around 71 years for men and 76 years for women. Despite these promising life expectancy rates, there is room for improving current living conditions in the Marshall Islands. Below are the top ten facts about living conditions in the Marshall Islands.

Top 10 Facts about Living Conditions in the Marshall Islands

  1. Most of the nation’s economy comes from the United States’ lease payments for the utilization of Kwajalein Atoll as a U.S. military base. Between 1986 and 2001, approximately $1 billion in aid to the Marshall Islands was from the U.S. This was under the Compact of Free Association. The Compact has since been renegotiated, extending from 2004 to 2024; a 20-year period in which the Islands will receive an estimated $1.5 billion from direct U.S. assistance.
  2. The Marshall Islands are relatively safe, as the U.S. Department of State Travel Advisory classifies the republic at a Level 1 security threat. This means that tourists can exercise normal precautions when visiting. Although generally secure, theft of personal items from cars, hotels and homes are common.
  3. Both major cities of the Marshall Islands, Majuro and Ebeye have the equipment to handle routine medical issues. However, there are few to no hospitals elsewhere on the Islands. Serious accidents and injuries most likely require medical evacuation to the United States.
  4. There is a limit on the supply of natural freshwater in the Marshall Islands. The main source of freshwater is rain, and the capital city’s 36.5 million gallon reservoir cannot meet the growing demand. Desalination plants are likely going to become a new necessity and priority for the republic.
  5. As of 2014, almost one-third of the population of the Marshall Islands has relocated to the United States—particularly to Hawaii and the island of Guam. The most reason likely is a severe lack of economic and employment opportunities on the Islands. Access to equitable education and health care also represent a key reason many Marshallese people are leaving their homeland.
  6. Infrastructure in the Marshall Islands needs some improvement which the U.S. acknowledges. As a result, the U.S. provided $6.5 million worth of infrastructure grants to the small republic in 2017 to repair schools, hospitals, docks, recreational facilities and water distribution systems.
  7. As of 2012, more than 30,000 Marshallese citizens were living without electricity. Approximately 59 percent of the population has access to electricity, mostly found in urban areas. Electricity production has been increasing, as, in 2016, the Islands’ electricity output was 650 million kWh.
  8. Since 2009, Marshallese people have been able to access internet service through a super-speed international underwater fiber optic cable. Although this provides a relatively fast internet connection, no sufficient backup is available if there is damage to the cable. When the cable went out for repairs in 2017, the nation used a backup satellite with frustrating results. The satellite did not provide the speed or the breadth the republic was used to.
  9. Primary education (the first eight years of school) in the Marshall Islands is mandatory. Most students complete this compulsory education around the age of 14. Though foreign nations fund many of the schools, some have begun to fall into neglect and are in need of repairs.
  10. Due to the location of the Marshall Islands, living conditions in the Marshall Islands is mainly in seclusion. Most speak their own native language (although English is a popular second language), and citizenship is not a birthright. In fact, naturalization takes five years. With only around 5,000 tourists a year, the Marshall Islands is one of the world’s least-visited countries.

Although the interventions and aid of the United States are prominent in the islands, there is still work to be done that will hopefully improve living conditions in the Marshall Islands.

– Haley Hiday
Photo: Flickr

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Credit Access in the Marshall Islands

Credit access in the Marshall Islands
The Marshall Islands are not a dominant country in the international sphere. Home to only 70,000 people and largely separated as tiny islands that string across the Pacific, the Marshall Islands, and with them their people and businesses, are disconnected from much of the world. Although they lack economic significance in most regards, the Marshall Islands are valuable assets that should be protected and considered when discussing credit access and other business-related activities.

Credit Access Relating to Natural Disasters

Credit access in the Marshall Islands, while small when compared to more developed countries, is an important aspect when considering the looming threat of climate change and the impacts it may have on business development and activity. According to many reports regarding the financial aspects of the Marshall Islands, related relief related to natural disasters is a large component of the credit conversation in the country.

One of the main issues with credit access in the Marshall Islands, whether relating to natural disasters or not, is the limited amount of individuals who are able to oversee and initiate credit activity. As the Pacific Catastrophe Risk Assessment and Financing Initiative reports, “authority lies with a few key individuals who are also responsible for many other portfolios of work.” Already constrained by their regular duties, these authority figures are further stretched when natural disasters take place and require immediate attention. The impact of climate change is growing in this area of the world with rising sea levels, acidification of crops and infrastructural damage, and credit access in the Marshall Islands seems to be entering a time of greater complexity, with few people able to navigate the system.

U.S. Foreign Aid

The Marshall Islands are currently receiving significant levels of aid from the United States. Since 1986, the U.S. has committed roughly $46 million per year to the Marshall Islands, focusing on boosting economic standing within the country. While international aid is a positive aspect as a whole, the fact that a significant portion of the economy and its associated activity rely on outside help is a point of concern, especially because the U.S.-Marshall Island aid agreement is ending in 2023. Foreign aid fluctuations or, in the extreme case, suspension of all aid, could result in disaster for the Marshall Islands and their people.

The Marshallese face not only the prospect of being unable to create and establish new business ventures with a lack of adequate credit, but the possibility that credit already in place could be severely undercut. Credit access in the Marshall Islands is already limited, and international aid is essentially the only aspect keeping the nation afloat.

Difficulties With Microcredit

Microcredit activity is another financial aspect being considered in the Marshall Islands; however, complexities with this activity are also concerning. As the Enterprise Research Institute (ERI) explains, microcredit activity requires “substantial expertise” and diligent follow up, which often prove costly. The ERI finds another issue with microcredit initiatives in the fact that, “usury laws impose a ceiling on lending charges at an effective nominal interest rate of 24 percent per year. This amount is below the minimum sustainable level of successful microcredit institutions in other countries.”

Individual Credit Access

When taking a closer look at individual access to credit, the situation is not much better. While legal rights are widely acknowledged throughout the country, the depth of credit information is severely lacking; the Marshall Islands scored a 0 out of 8 in the category for depth in credit information index. Not only is credit access misunderstood throughout the country, but basic information regarding this area of concern is either limited or held from view. Additionally, the Marshall Islands placed 90 out of 190 countries in the category of “getting credit.” While not at the bottom of the list, there is still substantial room for improvement.

While the Marshall Islands are home to a small population and an economy that predominantly relies on agricultural activity, access to credit remains an important aspect within their economy, especially when considering the looming impacts of climate change on economic activity. Not only is Marshallese credit access reliant on foreign aid from countries like the United States, but it is becoming increasingly tied to the topic of disaster relief. Credit information is limited nationwide, microcredit activity is seemingly non-applicable and authority figures who can properly handle the allotment of credit are already few and far between. As of now, credit access in the Marshall Islands resembles the physical layout of the country: underdeveloped, propped up by international aid and under the constant threat of natural disasters.

– Ryan Montbleau
Photo: Flickr