—‘
The distribution of pcpuiation presents two diverse problems: 1) a high
concentration of the population in the two “centers” with many tbpical urban
health and social problems common to developing countries (crowdfing, lack of
Sanitation,
unemployment,
substance
abuse,
etc.),
and
2)f
scattered, and yet quite sizeabie portion of the population in
the outer islands.
a
remote,
fural areas,
These people's access to health care is complicated by
Tong water distances between atolls as well as within them, long
periods of
bad weather,
homes
and a scattered settlement pattern.
Typically
are
located on each household's weto, or traditionally allocated seghent 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 mo¥e around to
periodically harvest copra.
severe
Spatial mobility of the populati
problem complicating
both
the
planning
and
deliver
is thus a
of
health
services.
3.
Morbidity and Mortality
Estimates of morbidity and mortality come primarily fr bm hospital
discharge and clinic “sick call" data.
This is not ideal but it is all that
Tables 4 and 5 show the 17 leading causes of deé th and rank
is available.
order of selected causes of death (0-4 years of age).
According
to
the
TIPI
Five-year
Health
Plan,
the Mar halls
lead
Micronesia in the notifiable diseases of: meningitis, tuberchlosis (all
forms), fish poisoning (causes uncertain), rubeola, and shige Ta.
Other
serious communicable diseases of children and adults are still a problem,
i.e. mumps, polio (which has led to a high need for post-poli Db paralysis
rehabilitative services),
respiratory
diseases
a whole range of parasitic diseases and upper
(i.e.
pneumonia
and
influenza).
laria
and
schistosomiasis are not present.
Chronic diseases are also very serious, particularly among
population.
the adult
Many of the Pacific People, such as the Marshallesd, have very
high rates of diabetes (estimates run up to 40% of the adult
pulation).
The adult onset type of diabetes is most common, though its epi
miological
characteristics are not wel! understood in this population.
T
treatment
of insulin-dependent diabetics (requiring insulin) is one of thelmajor tasks
of Health Assistants in the Marshalls.
of insulin is thus a real need.
The need for adequate "c ld storage"
Health education and other preventive
services to reduce the incidence and complications of these dise ises are yet
to be effectively instituted, particularly in the outer islands
9