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Lifestyle disease rate explodes among Pacific Islanders


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POSTED: Thursday, May 27, 2010

Diabetes, heart disease, strokes, cancer and other diseases—many lifestyle- related—have reached “;epidemic”; proportions in the U.S.-affiliated Pacific islands, a crisis that grips Hawaii because many islanders choose to live here under the Compact of Free Association.

The diseases are lumped into the category “;noncommunicable”; to differentiate them from epidemics such as influenza and tuberculosis, which spread from person to person.

“;Some of the Pacific Islands have the highest rates of noncommunicable diseases in the world,”; said Michael Epp, executive director of the Pacific Island Health Officers Association. “;In 20 to 25 years, if things continue as they are, it will be a social catastrophe.”;

The association took a dramatic step as a result, declaring a health emergency for the region, which includes Palau, the Marshall Islands and Federated States of Micronesia.

Epp cited a combination of factors, including a lack of adequate health care, poverty, poor eating habits and a sedentary lifestyle, with high rates of smoking and binge drinking.

“;The data requires the same urgency as H1N1 (swine flu) or bioterrorism,”; he said in an interview.

There is no precedent for such a declaration, Epp said, but the association deemed it necessary to focus on the high prevalence of diseases with “;an urgent call to all of society for immediate action.”;

As a policy tool, the declaration “;is unique and very creative actually,”; said Dr. Neal Palafox, chairman of the Department of Family Practice and Community Health at the University of Hawaii John A. Burns School of Medicine.

An authority on health in the Pacific region, he added, “;The government oftentimes quickly reacts to what they consider are emergencies and looks snazzy to put money into because it's a new thing.”;

But afflictions like type 2 diabetes, cancer and cardiovascular disease can be as deadly as communicable epidemics, he said.

“;Over time they become worse than any other epidemic, and they have already gone so far,”; he said.

Hawaii has had to deal with the issues because residents of Palau, the Marshalls and the Micronesian states of Yap, Chuuk, Pohnpei and Kosrae are allowed to travel freely to the U.S. About 12,215 people were living in Hawaii from the compact states in 2008.

Many qualify for free health care under the state's QUEST and Quest-like programs. State officials said shelter, medical, financial and other services for the compact migrants amount to about $120 million a year, with only about $11 million provided in federal funds.

The high state costs for medical care for people from the compact states led to a limited coverage plan for about 7,500 noncitizens (excluding pregnant women and children) that was challenged legally.

The Department of Human Services has drafted administrative rules and sent letters to clients telling them the Quest-like “;Basic Health Hawaii”; Plan will be implemented July 1.

Immigrants here less than five years originally weren't getting any medical benefits, but if they are receiving financial assistance they will be covered by the basic health plan, a human services spokeswoman said. She said the major concerns of advocacy groups have been addressed with coverage provided for kidney dialysis and chemotherapy.

Officials are working on recommendations for a coordinated policy to address the problem, which Epp said must include education, trade and agriculture.

“;We've got to look at the whole economy, and make it more attractive to have fruits and vegetables than go down and get a can of Spam,”; said Epp. “;It's a combination of education and changing the environment.”;