Diabetes ‘tsunami’ overwhelms Pacific

Diabetes has been called “a tsunami” that is overwhelming healthcare systems in the Pacific Islands.

Seven of the 10 countries with the highest rates of the disease are in the Pacific. The highest is the Marshall Islands, where 33 per cent of people aged 20 to 79 have diabetes.

In October, the Herald spent a week with the Fred Hollows Foundation in Vanuatu where 21 per cent of the population have been diagnosed with the disease.

The rates in other Pacific countries in which the charity works are Kiribati, 28 per cent; Samoa, 24 per cent; Tonga, 19 per cent; Fiji, 16 per cent; Papua New Guinea, 14 per cent; Solomon Islands, 13 per cent.

It is part of the broader problem of non-communicable diseases — heart disease, stroke, diabetes, cancer and chronic respiratory diseases — that cause about 70 per cent of all deaths, says public health specialist Robert Beaglehole.

Diabetes increases the risk of deadly heart disease, stroke or kidney failure. In New Zealand, more than 240,000 people have been diagnosed with it, while the Ministry of Health estimates 100,000 others have it too. Taken together, that is about 7 per cent of the population.

Olympic shot put champion Valerie Adams recently revealed her late mother, a Tongan, had type 2 diabetes, as did half of the family from her mother’s generation.

The rate in the Ma¯ ori and Pasifika communities is about three times higher than for other New Zealanders but much lower than in Pacific Island countries.

Beaglehole, an Auckland University emeritus professor, puts that down to greater focus in New Zealand on healthier foods.

“It’s diet but that suggests an individual responsibility and it is much more than that.”

The opportunity, particularly in the Pacific, of a healthy diet was low.

“If the local supermarket is bringing in cheap stuff — mutton flaps, turkey tails, chicken wings — then of course you go for that,” he says. “In Samoa, a fresh coconut is more expensive than a can of coke.”

There were still isolated atolls in the Pacific that had low rates of obesity and diabetes because the traditional diet had not changed.

“Apart from the costs [to healthcare], the most tragic aspect for me is the fact that diabetes is preventable. We didn’t used to have these high rates of diabetes . . .

“I hate to use this word but it is [driven by] the modernisation of access to poor quality food in the context of a tradition in which eating large amounts of food is important.”

Dr Malakai Ofanoa, a Tongan who lectures in Pacific health at Auckland University, adds cultural factors to the mix.

“Have you been to a Tongan feast?” he asks. “Fifty suckling pigs! Food is a big part of the culture. If you explore that further, you will see the issues around that.”

He makes a list: types of food, inactivity, poverty, poor knowledge, lifestyle as well as cultural aspects.

“In some of the islands, half of the people are affected by diabetesrelated blindness.”

Diabetes’ rise has opened a new frontier for the foundation set up by Dunedin-born eye surgeon Fred Hollows. Hollows began by treating trachoma in Australia’s indigenous population and moved on to other preventable and treatable diseases, particularly cataract. While cataract is still the leading cause of blindness worldwide, diabetic retinopathy is close behind.

“There is a big and growing need to fill the gaps in healthcare systems in these countries,” said Komal Ram, manager of the foundation’s Pacific diabetic eye disease programme.

The foundation’s goal is for each country it works in to have its own national eye-care system headed by an opthamologist.

“The diabetes problem in the Pacific has been referred to as a time bomb that has gone off. People are presenting too late, with chronic conditions . . . the job becomes trying to prevent them getting the complications; amputations, going blind, renal failure.”

Another charity seeking to reduce preventable blindness is the Queen Elizabeth Diamond Jubilee Trust.

Its director of programmes, Andrew Cooper, visiting Vanuatu, told the Herald education was needed on diabetes, diet and exercise: “To see the number of people who have diabetes, the numbers having amputations and the numbers who might go blind has been quite shocking.”

The goal was to help each country provide annual eye checks and laser operations where needed.

“We know that with the right screening and treatment we can reduce 95 per cent of the worst sightthreatening diabetic retinopathy.”

● The Herald visited Vanuatu courtesy of the Fred Hollows Foundation NZ.