Tne distribution of pcpuiation presents two diverse problems: 1) a high
concentration of the population in the two “centers” with many typical urban
health and social problems common to developing countries (crowding, lack of
Sanitation,
unemployment,
substance
abuse,
etc.),
and
2)
a
remote,
scattered, and yet quite sizeable portion of the population in rural areas,
the outer islands.
These people's access to health care is complicated by
long water distances between atolls as well as within them, long periods of
bad weather,
and
a scattered
settlement pattern.
Typically homes
are
located on each household's weto, or traditionally allocated segment of land
which cuts across an island from ocean to lagoon.
Families may furthermore
have wetos on different islets within an atoll] to which they move around to
periodically harvest copra.
severe
problem
complicating
Spatial mobility of the population is thus a
both
the
planning
and
delivery of
health
services.
3.
Morbidity and Mortality
Estimates
of morbidity and mortality come primarily from hospital
discharge and clinic "sick call" data.
is available.
This is not ideal but it is all that
Tables 4 and 5 show the 17 leading causes of death and rank
order of selected causes of death (0-4 years of age).
According
to the TIPI
Five-year Health Plan,
the Marshalls
lead
Micronesia in the notifiable diseases of: meningitis, tuberculosis (all
forms), fish poisoning (causes uncertain), rubeola, and shigella.
Other
serious communicable diseases of children and adults are still a problem,
j.e. mumps, polio (which has led to a high need for post-polio paralysis
rehabilitative services), a whole range of parasitic diseases, and upper
respiratory
diseases
(i.e.
pneumonia
and
influenza).
Malaria
and
schistosomiasis are not present.
Chronic diseases are also very serious, particularly among the adult
population.
Many of the Pacific People, such as the Marshallese, have very
high rates of diabetes (estimates run up to 40% of the adult population).
The adult onset type of diabetes is most common, though its epidemiological
characteristics are not well understood in this population.
The treatment
of insulin-dependent diabetics (requiring insulin) is one of the major tasks
of Health Assistants in the Marshalls.
of insulin
is thus a real need.
The need for adequate "cold storage"
Health education and other preventive
services to reduce the incidence and complications of these diseases are yet
to be effectively instituted, particularly in the outer islands.
9