The current health status of many people in Vanuatu is critical.
About Vanuatu
Vanuatu is a lower-middle income country and archipelago of 80 small islands located in the South Pacific in the region of Melanesia. Its population of approximately 265,000 is dispersed over six main provinces with two main urban centres: Port Vila, the capital city, and also Luganville.
About one quarter of the population reside in these urban areas, while the majority of the population live in rural areas. There has been an influx of people relocating from rural areas to urban areas, particularly Port Vila, which is difficult for the country’s capital to manage the spike in urban population density.
Of the people with the highest economic status in Vanuatu, 57% of them live in urban areas. Only about one fifth of the population have a secondary-level education, the majority of which live in urban areas. Government funding for education is limited to primary school only, so secondary education is a privilege to the children of families who can afford it. The population is growing at a fast rate; 40% of people in Vanuatu are younger than 15, which emphasises the significant burden on the government to provide a free primary-level education.
An additional consideration to highlight is the disconnectedness of the dispersed islands-based population as well as the lack of electricity in more than 60% of households. This limits communication within the population and their accessibility to schools and health care centres.
This is all clear evidence of social polarisation in Vanuatu.
The Health of People in Vanuatu
In 2009, 25% of the population smoked cigarettes and 10% drank alcohol, most of which were males predominately aged 20-39. There was also a significant increase of imported processed foods into Vanuatu, introducing poor nutritional diets to the people of Vanuatu. The Torba Tourism Council is rallying to ban junk food imports, which may take up to two years for the national government to make the final decision on which products to ban. Those in urban areas are more likely to be exposed to imported processed junk foods, higher levels of air pollution and increased accessibility to tobacco, drugs and alcohol.
Between 1990 and 2013, Vanuatu’s prevalence of cardiovascular diseases increased to 24%. Though, it was surpassed by a rise to 75% in self harm, 71% diabetes, 50% cancer and 44% muscular-skeletal disorders. Ischeamic heart disease and stroke are the leading causes of deaths caused by cardiovascular diseases in Vanuatu and are likely related to an increase in malnutrition and household air pollution from solid fuels. Evidently, males in Vanuatu had the highest levels of exposure of modifiable proximal determinants with highest exposures being high systolic blood pressure and dietary risks.
Vanuatu’s economy relies on subsistence agriculture, though the tropical climate is a significant disadvantage for Vanuatu due to the frequency of high-intensity storms. After recovering from the damage caused by an earthquake in 2002, Vanuatu was flattened and destroyed by Cyclone Pam, a category 5 cyclone, in March 2015. Lives were lost and it threatened survivors with famine after destroying nearly all of their farmed crops. This is a tremendous blow to the community, thus, a lack of food security is a causal factor of adopting poor diets and declining mental health.
It’s important to address the high prevalence of self harm in relation to cardiovascular diseases in Vanuatu. With a high population growth rate and marriage rate, most women in Vanuatu are wives and mothers. In a country where 60% of women are exposed to gender-based violence, this stress is inherently passed onto their children. Additionally, due to the frequent famines caused by natural disasters, “mental health problems in mothers and children are more common when mothers are food insecure, a stressor that can potentially be addressed by social policy” (Whitaker, R. et. al., 2006). These psychosocial factors are risk factors for cardiovascular diseases and it emphasises the high prevalence of non-modifiable determinants for children in Vanuatu.
What is the Government Doing?
The census schedule for Vanuatu is every ten years, with the last held in 2009. This is not frequent enough for policy makers to adequately respond to demographic issues, particularly for health. Thus, Vanuatu is disadvantaged by a lack of responsiveness to real-time issues. To address this shortfall, a partnership between the Vanuatu Ministry of Health, Vanuatu Statistics Office and Secretariat of the Pacific Community (SPC) was formed to conduct the first Demographic Health Survey (DHS) in 2013 to provide information on health to policy makers and planners to coordinate effective health programmes. Financial assistance for the DHS was provided by the Asian Development Bank, the UN Population Fund, the UN Children’s Fund and Australia’s Department of Foreign Affairs and Trade (DFAT).
The government funds roughly two thirds of the country’s health expenditure, relying on financial support from external donor organisations for the rest. Due to the low income for majority of households in Vanuatu, the out-of-pocket costs are just 5%, which emphasises the population’s dependence on the government to fund health care. From 2008 to 2012, the government allocation to the health care system decreased by 4% as well as a 3% decrease in funding support from the Ministry of Health and AusAID.
Is the Health Care System Coping?
The rise of non-communicable diseases in Vanuatu places a significant burden on its four-tier primary health care system as patients outnumber health care workers. The health care system is split between two directorates, the northern (Luganville) and the southern (Port Vila) with only two referral hospitals that can provide allied health services such as nutrition in these two cities. There are a number of provincial hospitals, but they are limited in capacity. Most people in Vanuatu will only have access to aid posts, which aren’t staffed with qualified nurses and can only provide basic primary health care. The second tier is dispensaries which are staffed by one to two nurses and are restricted by less than five inpatient beds.
The suite of Vanuatu’s health legislation is outdated, thus inadequate to address the influx of non-communicable diseases, which is why a degree of caution is needed when acknowledging the release of the Health Sector Strategy 2010-2016 because the health care system’s capacity to achieve the stated objectives and aims is very limited. Furthermore, the government cannot afford the full amount of medication required that patients with non-communicable diseases need and it is likely that health care workers don’t fully understand its burden, particularly when the current priority of the health care system is provision of family planning and communicable diseases. Vanuatu’s health care system is inadequate in comparison to developed, high-income countries who can afford the medications to lower blood pressure and cholesterol and whose health care workforce has sufficient awareness of and training for treating and preventing non-communicable diseases.
References:
Adams, R. & Foster, S. (2017) Vanuatu
Carter, et. al., (2016) Causes of death in Vanuatu, Population Health Metrics
Chow, C., et. al. (2009) Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review. International Journal of Epidemiology, 38(6), 1580–1594. doi:10.1093/ije/dyn258
Flicker (2017) A Midwife at Norsup Hospital on Malekula Island.
[Health Grove (2017) Cardiovascular Diseases in Vanuatu]
(http://global-disease-burden.healthgrove.com/l/41479/Cardiovascular-Diseases-in-Vanuatu)
Health Grove (2017) Ischemic Heart Disease in Vanuatu
Linhart, et. al. (2015) Mortality Trends in Pacific Island States
The Guardian (2017) As Obesity Rises, Remote Pacific Islands Plan to Abandon Junk Food
The World Bank (2017) World Bank Country and Lending Groups
VNSO (2009) 2009 National Population Housing Census
VNSO (2015) About Vanuatu Demographic and Health Survey
VNSO (2017) Vanuatu DHS: Population Characteristics
Whitaker, R. et. al. (2006) Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in their Preschool-Aged Children, American Academy of Pediatrics
WHO (2015) The Impact of Chronic Disease in Vanuatu
WHO WPRO & Ministry of Health (2012) Vanuatu, Vanuatu Health Service Delivery Profile
World Atlas (2017) Vanuatu
WorldVision Aus (2015) Communities in Vanuatu say thank you to Australians
Image Source:
All the non cited images are available for Reuse under Creative Commons Licenses from either Pixabay, Pexels, or Wikipedia Commons or created by me.
