The poor health of islanders moving in droves from United States-affiliated islands to America has sparked Hawaii and Arkansas state leaders to press Washington to reimburse the states for tens of millions of dollars spent to provide health care services, such as dialysis treatment, to islanders.
Last month, Hawaii Gov. Neil Abercrombie submitted to the U.S. federal government a report stating that Hawaii spent $115 million on migrants from the Federated States of Micronesia, Marshall Islands and Palau.
Abercrombie said more than $50 million of that total is medical care costs for sick islanders migrating to his state. “Simply put, the State of Hawaii cannot continue to absorb these costs which can only become greater on our taxpayers,” Abercrombie said.
But it’s not just Hawaii facing the financial onslaught of the rising incidence of non-communicable diseases. The increasing level of diabetes in the Marshall Islands “is the largest, most expensive crisis the Marshall Islands has ever faced,” said Denis Yates, who directs the Diabetes Wellness Center in Majuro. “And it’s just beginning. It is ‘gusts’ now. The typhoon is almost here.”
The urgency of these lifestyle health problems has prompted the Pacific Islands Health Officers Association to call on political leaders in U.S.-affiliated islands to convene a regional summit on non-communicable diseases. Regional agencies report that the world’s fattest countries are the Pacific islands, and within the region, the U.S.-affiliated islands rank the highest in obesity. Obesity is the highest risk factor for diabetes. The irony is that the “type 2” diabetes rampant in the islands is almost entirely preventable.
But for now, the growing diabetes epidemic is out of control, with huge cost implications for health departments in the islands and in the United States. Nine out of 10 patients in Majuro Hospital are there as a result of diabetes and its secondary effects, said Yates. His center is at the forefront of prevention work, and is showing success through promoting exercise and training people how to cook nutritious foods.
Majuro resident Caroline Lakabung had diabetic-level blood sugar levels before getting involved with the Diabetes Wellness Center program. “I felt sleepy all the time” and when she was at home she said “somebody had to help me by squeezing my hands and feet to keep them from going numb.” After six weeks of exercising regularly at the center’s exercise facility and eating vegetarian meals, Lakabung said she doesn’t just feel better, “I feel like I’m back to normal now.”
Lakabung is one of a few who have turned their health around. But thousands of the 56,000 people in the Marshall Islands have diabetes, and many don’t know it until their health deteriorates requiring amputation of a foot or leg, or other health complications.
The lifestyle problem has developed in the last two generations as islanders have moved from subsistence living on remote islands to working in office jobs in the urban centers. Children in the Marshall Islands eat a steady diet of junk food, colas, deep fried noodles known as “ramen,” white rice, and canned meat. “It’s like building a house with termite-infested wood,” Yates said of this diet lacking nutrients and fiber for children. “The first 20 years is when the body builds its organs.”
The Diabetes Wellness Center has its work cut out for it, not only because the Ministry of Health provides it a meager $94,000 out of a $21.5 million budget.
A report from a routine health screening of Marshall Islanders in June by the Ministry of Health showed that over half the women and more than 40 percent of the men screened were obese. Statistics like these are reducing life expectancy, not just in the Marshall Islands. Australian researchers said recently that for most Pacific countries, life expectancy has not been improving.
“Overestimation of life expectancy has ‘masked’ the problem of high adult mortality in the Pacific Islands,” said a paper presented to a World Health Organization-sponsored Non-Communicable Disease Forum in Tonga last month by Prof. Richard Taylor of the University of New South Wales, and University of Queensland’s Prof. Alan Lopez, Dr. Chalapati Rao, and Karen Carter.
Yates agrees. “We are fixing to double the Marshall Islands’ death rate,” he said.
But after focusing on diabetes prevention among adults for five years, Yates and the Wellness Center are shifting gears to a new strategy. With the start of the school year in the Marshall Islands two weeks ago, Wellness Center staff has launched an aggressive education and exercise program aimed at middle school students around the country. “Our hope for the future is with the schools,” said Yates. “We cannot let another generation go.”
The school campaign is combining exercise with teaching students how to be smarter about diet choices. Students will learn what causes diabetes, how to read labels on food products, and most importantly how to prevent diabetes, Yates said.
While Hawaii and Arkansas say their state budgets are struggling under the inflow of islanders with chronic illnesses needing expensive treatments, these small islands are no better off as they face spiraling hospital costs for treating the symptoms of preventable illnesses.
