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