—‘ 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