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Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey.
The International Diabetes Federation (IDF) -- the umbrella organization for 200 diabetes associations in more than 160 countries -- just released its 2013 Diabetes Atlas. If you've been following the trend in diabetes, it will not surprise you to know diabetes continues to rise, unabated, around the world.
Type 2 diabetes, which many consider an epidemic currently, is increasing worldwide predominantly due to poor diet, sedentary lifestyle and the fact that we are living longer.
Leonor Guariguata, IDF biostatistician and coordinator for the Diabetes Atlas, told me via email something shocking. Already, diabetes extracts a high cost in health care dollars, economies' financial stability, lost productivity, and it destroys lives and families. Sir Michael Hirst, IDF President, told me via email that research shows one in 10 of the world's population will have diabetes by 2035.
Diabetes imposes unacceptably high human, social and economic costs on countries at all income levels (p. Why are we willing to further erode our nation's economic progress with a stunning "ignore now, pay overwhelmingly later" game? The refrain in public health is that, "People will make the healthy choice when the healthy choice is the easy choice." Guariguata agrees. If diabetes is in your family, make sure everyone gets a fasting blood sugar test and see whether you have diabetes or Stage 1, pre-diabetes. The proportion of people with diagnosed diabetes generally increases with age (Figure 1-1).
From 1997 to 2011, the age-adjusted percentage of people aged 35 years or older with diabetes who reported having coronary heart disease, stroke, or other heart disease showed little or no change. High incomes and a taste for fast food and sugary drinks have pushed nationals of the United Arab Emirates into the obesity club, the World Health Organisation has said. A multicultural field gathered at 07:00 for the start of the recent Abu Dhabi half marathon.
Chris Collier, from the Abu Dhabi Striders Club, which organizes the annual event, puts the absence of local entrants down to the lack of an exercise culture in the United Arab Emirates (UAE). The low levels of exercise, along with a taste for fast foods laden with carbohydrates, salt, fat and processed sugar is cause for increasing concern about the nation’s health.
Oil production, which started in the 1960s, has triggered massive population growth and urbanization and an attendant change in lifestyle. Dr Ayoub Al Jawaldeh, regional adviser on nutrition at WHO’s Office for the Eastern Mediterranean Region (EMRO), says people have become victims of their affluence. While he cites a lack of health awareness among the public, there are signs of urgency among government officials in tackling the problem.
The UAE draft strategy – which is being developed with support from WHO – will focus on health and nutrition education, improve food consumption patterns with more focus on vegetables and fruits, food fortification with micronutrients, food labelling and marketing and school feeding programmes. Al Jawaldeh believes it is not the lack of facilities that discourages people from exercising. The trade-off between exercising more and eating less has been studied by researchers in Australia, who last year reported that overeating rather than sedentary living was almost entirely to blame for the rise in obesity in the developed world. Al Jawaldeh says people in developing and transitional countries, especially younger people, are susceptible to marketing. His emphasis on educating young people is endorsed by Dr Kazem Behbehani, the director-general of Kuwait’s Dasman Institute for Research, Training and Prevention of Diabetes and Other Chronic Conditions.
Data snapshotIn the March 2010 quarter the unemployment rate for Pacific peoples was 14.4 percent, higher than for all ethnicities. Inadequate housing affects children more than adults, particularly children in low-income families, in larger families, rental dwellings, and more deprived neighbourhoods (Centre for Housing Research, 2010). Social cohesion means cohesive community relationships with levels of participation in communal activities and public affairs, and a high number of community groups. A healthy diet is a key determinant of health outcomes and is particularly important for the growth and development of children and young people.Food choices are influenced by affordability as well as personal, family, and cultural preferences. Data snapshotThe National Children’s Nutrition Survey conducted in 2002 found that Pacific children were the least likely to bring their food from home to school, and most likely to buy it from a canteen, shop, or takeaway.Pacific children had a lower mean energy intake than Maori children (but higher than European children), and derived a higher portion of their energy intake from fat. Physical activity is known to protect against obesity and cardiovascular disease, particularly in combination with a healthy diet (National Institute for Health and Clinical Excellence, 2010).
Life at Faith City‘Life-changing’ is how participants have described the Life 12 Week Weight Loss Challenge run by Manukau’s Faith City Church.The first Life challenge was held late in 2010.
New Zealand has one of the highest obesity rates among OECD countries (Ministry of Social Development, 2009). Smoking is the biggest single cause of preventable morbidity (the non-death impacts of disease) and mortality in OECD countries, including New Zealand, and is well recognised as the leading risk factor for many forms of cancer, respiratory disease, and cardiovascular disease in adults. More Maori and Pacific peoples smoke (45 percent and 31 percent, respectively) compared with the total New Zealand population (20.7 percent) (Ministry of Health, 2008k). Potentially hazardous drinking carries a high risk of damage to physical and mental health; including death and injury due to traffic accidents, drowning, suicide, and violence. Problem gambling can result in a range of negative effects for the gambler, their families, and the wider community. People’s beliefs and practices in relation to health and illness influence the ways they engage in health-promoting behaviours and access health services. Pacific peoples’ beliefs and practices may be different from mainstream understandings about health and illness.
Access to timely and effective health care is an important determinant of health outcomes, for both death rates and the impact that chronic conditions have on Pacific peoples.
Data snapshotImmunisation provides protection against a range of communicable diseases, and is considered to be one of the most cost-effective public health interventions. For the 12 months to October 2010, 89 percent of Pacific two-year-olds were fully immunised, compared with 87 percent of European two-year-olds. Screening identifies potential health problems at an early stage in people who do not show any symptoms. Breast and cervical cancer screening programmes have been effective in reducing mortality in the general population. The Primary Health Care Strategy (Ministry of Health, 2001b) established primary health organisations (PHOs) to provide structures for the local delivery of primary health-care services. The benefits of health care are dependent upon the quality of care received as well as accessibility of care.
The average time spent annually with GPs during visits is a key indicator of access and use of primary care. Secondary care includes services provided by specialists, as well as in-patient and out-patient care in public and private hospitals. Health is strongly influenced by a broad range of cultural, social, economic, and environmental factors. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. That despite being a non-communicable disease, where there are changes in risk factors and environments, diabetes will spread from one community to the other, essentially acting like a communicable disease. 14) of diabetes deaths are in people under 60 years old, handicapping Africa's ability for development. In every respect -- human, financial, societal -- the burden of diabetes is, and is becoming, crippling. Put pressure on your policy makers to vote for health, and create a healthier lifestyle for yourself and your family. Data computed by personnel in the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion. Now, in a report written, Michael Reid endeavours to reveal how the UAE government is tackling a problem that has caused cases of diabetes to skyrocket. Runners from Australia, Canada, France, India, South Africa and the United Kingdom, to name but a few of the countries represented, took their marks. In 2000 the World Health Organization (WHO) reported that over 50% of men and women in the UAE were overweight or obese. However, obesity and related illness in the UAE are not exclusive to the country’s nationals, who account for less than 20% of the population. In December last year Dr Al Jawaldeh’s team at EMRO released a draft regional nutrition strategy for 2010–2019. A study of the US obesity epidemic carried out by the WHO Collaborating Centre for Obesity Prevention at Deakin University, Victoria, Australia, suggested there had been no significant reduction in exercise levels in the past 30 years.
Students are assigned two hours of physical activity a week, an hour of theory, plus homework.
The quality of housing and household crowding are closely related to the risk of developing ARF, meningococcal disease, respiratory disease, and other infectious diseases.Due to their low income, many Pacific families live in less affluent communities.
Healthier food options are often more expensive than those with high concentrations of fat and sugar, and those that are nutritionally limited.
Thirty-three mostly Pacific women completed the three-month course, which is designed for those who are very overweight and are keen to eat more healthily and be more active.Life involves training four times a week, sessions with a nutritionist and three weekend retreats to help address the psychological reasons behind obesity and unhealthy lifestyles. Obesity is associated with many adult health conditions such as cardiovascular disease, type 2 diabetes, cancer, and psychological and social problems (Ministry of Health, 2008e). Exposure to cigarette smoke (during a mother’s pregnancy and in childhood) is recognised as a major risk factor for sudden unexplained death in infancy syndrome and respiratory illness (Ministry of Health, 2005).Smoking is an important contributor to inequalities in life expectancy between ethnic groups. Alcohol problems are also associated with high-risk sexual behaviour and consequent problems.Fewer Pacific peoples drink alcohol than the general population.
Pacific peoples’ understandings tend to be characterised by a holistic perspective, where healthy and strong families are the basis for the well-being of individuals and communities.
Suicide, for example, can be seen as the “ultimate rejection of one’s family” and a bereaved family can experience a “sense of failure to adequately care for and support the individual who is ill” (Beautrais et al, 2005). In 2006, just over 90 percent of New Zealand infants were enrolled with Plunket, which provides clinical assessment, health promotion and parent education services.
Screening improves health outcomes by offering effective interventions before diseases become advanced. An increase in the uptake of cervical screening and the introduction of the HPV vaccination programme in 2008 (which has reported high coverage among Pacific girls (Minister of Pacific Island Affairs, 2010) should contribute to lower incidence of, and deaths from, cervical cancer in the future.
The levels of coverage are below the target of 70 percent of all eligible women, but there has been a sustained increase in coverage for Pacific women. Each PHO has an enrolled population, and is responsible for providing services to this population.In October 2007, nearly 100 percent of Pacific peoples were enrolled with a PHO6.
The quality of health care is in part determined by interpersonal care; the interaction between health-care professionals and health-care users or their caregivers. The National Primary Medical Care Survey found that Pacific, Maori, and Asian people spent significantly less time with GPs, after controlling for a range of other variables.
Secondary care services are normally accessed by referral from primary care or hospital emergency departments. In general, people with fewer socio-economic resources tend to have poorer health outcomes due to a combination of reduced material resources, greater exposure to health risks and behaviours, greater psychosocial stress, and reduced access to health services.Many Pacific peoples have not experienced success in the education system, and therefore tend to have lower incomes and live in communities with the fewest economic resources.


The estimate of the socio -economic contribution is based on analysis undertaken in relation to the impact of socio-economic inequality on the difference between the Maori and the European or other ethnic group in the NZ Census-Mortality Study. That is, they were physically active for at least 30 minutes a day, for at least five days in the previous week.
The survey uses AUDIT, which is a ten-item questionnaire covering alcohol consumption, abnormal drinking behaviour, and alcohol-related problems.
This data is from the Enriched CBF Register produced by HealthPac at the Ministry of Health. Like the child and his brother in Africa who walk four hours in no shoes once a week to get insulin from the one clinic. Yet of the 306 runners who made it back to the Golf and Equestrian Club, not one was from the United Arab Emirates. In 2005 it estimated that 1.6 billion adults were overweight, of whom at least 400 million were obese.
The country’s development relies heavily on expatriate labour, mainly from Bangladesh, India, the Islamic Republic of Iran, Pakistan, the Philippines and Sri Lanka. It urges all countries in the Region to develop programmes to suit their situations and resources. It said too many calories were to blame, a result researchers expect to find when the research is repeated in other countries.
We need a worldwide convention to regulate the advertising of food on television when children are most likely to be watching.
Howard Reed, the college’s director, has been pushing for better health and fitness standards in schools since settling in the UAE from the United States almost two decades ago. For example, the proportion of Pacific households (with at least one Pacific adult) spending more than 30 percent of their income on housing was 33 percent in 2009, reflecting a steady increase from 23 percent in 2004 (Ministry of Social Development, 2010, p69).Students attending schools in communities with fewer economic resources tend to experience less education success than those in more affluent communities (Ministry of Social Development, 2009, p138). The prevalence of factors associated with lower levels of well-being, such as widespread smoking, obesity, hazardous drinking, and non-casino gaming machines, is greater in these communities.
Societies with diminished social cohesion have higher mortality rates and worse social outcomes than those with high levels of social cohesion (Stansfeld, 2006).Most Pacific communities have strong social connections, often centred on church and community activities. Affordability of food is a significant issue for Pacific households, who were the least likely to report that they could always eat properly. The training sessions include gym workouts, weights, running, boxing, aquarobics, and hill running. Obesity is primarily caused by poor nutrition and sedentary lifestyles (Ministry of Health, 2008e). Pacific peoples who drink alcohol are more likely to be New Zealand-born and young (Alcohol Advisory Council of New Zealand, 2009). Similarly, 7.6 percent of the Pacific population reported experiencing problems as the result of someone else’s gambling, double the number of adults in the total population who reported being affected by someone else’s gambling.
Suicide prevention, support, and other interventions must therefore be tailored to work with and within existing beliefs and attitudes.Similarly, culturally-based attitudes towards sex mean that Pacific youth often have reduced access to information regarding sexual health. It includes the provision of health education and prevention services, coordination and treatment of less serious illnesses, and referral to secondary care.Other than emergency departments, primary care services are the first step into the health system. Pacific infants (87.2 percent) were less likely than European, but more likely than Maori infants to be enrolled (Craig et al, 2007, p121). Effective screening is dependent on well-structured and organised processes and the monitoring of indicators of process quality. One of the providers, BreastScreen South, has reached the 70 percent target for both Maori women and Pacific women (National Screening Unit, nd, a). For the overall population, the target coverage is 75 percent (Massey University, Centre for Public Health Research, 2008).
Craig et al (2007) reported that Pacific children and young people had higher enrolment rates compared with non-Pacific people.
Underlying good interpersonal skill are communication skills, the building of trust, understanding and empathy, the discussion and explanation of the patients’ symptoms, and involvement in decisions regarding management or treatment of a patient’s condition (Campbell, Roland, & Buetow, 2000). Overall, Pacific patients spent an average of 18.8 minutes less time annually with GPs than European patients. Despite this, Pacific peoples are actively involved in their communities and have strong social and cultural resources with strong family ties, church affiliation, and community support.
Or the young wife in India who has sold all the family possessions to buy her husband medicine and nurse him. But it is the rapidity with which these problems have taken hold in the UAE where less than half a century ago the people – nomadic Bedouin desert farmers and coastal dwellers involved in pearling and sea trade – still subsisted on a diet of fish, rice, bread, dates, yogurt, homegrown vegetables and meat from sheep, goats and camels. In response, the UAE’s Ministry of Health and other government agencies have formed a National Nutrition Committee to draft a national strategy for reducing obesity, diabetes and other diet-related diseases. Pacific students tend to have poorer education outcomes than other students from the same communities.
An individual’s identity and well-being are traditionally dependent on family heritage, connections, roles, and responsibilities. They were also more likely (at nearly 50 percent) than Maori and Europeans to report sometimes running out of food due to lack of money (Ministry of Health, 2003). Social interaction is one of the factors that promote participation in physical activity (De Bourdeauhuiji, 1998), which in turn encourages social cohesion and social well-being.Pacific children have relatively high levels of incidental physical activity (such as walking to school), although they participate less than other groups in organised leisure and sport. Day one of the challenge requires participants to push four-wheel drive vehicles around a carpark.Faith City project manager Essendon Tuitupou says women in last year’s challenge called it “life-changing”.
Smoking accounted for 37 percent of this loss for men and 13 percent of the loss for women (Ministry of Health, 2001a).
However, the Youth 2007 Survey found that twice as many Pacific students are regular smokers compared with European students.Living in a house with a smoker influences children and young people to take up smoking, and contributes to respiratory and other childhood illnesses.
Overall, those aged 35–44 years had the highest prevalence of problem gambling (Ministry of Health, 2008a). Parents are less available to provide advice, as it is considered culturally inappropriate for children to discuss sexual health with their parents.
They are crucially important in identifying serious illnesses that are then managed in conjunction with secondary and tertiary services.
The results demonstrate that effective means are available to engage with Pacific peoples and deliver care services. BreastScreen South used a communications campaign where Maori and Pacific women were the priority audience, as it was apparent they were groups who were less familiar with the service (National Screening Unit, nd, b). From 2011, the coverage target will be 80 percent (National Screening Unit nd, e).Since 2007, National Cervical Screening Programme communications campaigns have been particularly focused on encouraging more Maori and Pacific women to have regular smears (National Screening Unit nd, c). Fifteen percent of Pacific peoples were enrolled with a Pacific PHO and the remainder with a mainstream PHO (Ministry of Health, 2010c).
Improvements in the annual consultation rate coincide with the implementation of the Primary Health Care Strategy (Ministry of Health, 2001b) and the reduction in fees to access primary care.To access services, people must first be aware that the services are available and that they are needed. Only 21.2 percent of Pacific adults compared with 31 percent of non-Pacific adults used medical specialists in the previous 12 months. These community ties provide protection from some of the worst consequences of illness, and health services can be promoted to Pacific peoples through community organisations.Lower incomes mean that many of the conditions or factors that support good health, such as good nutrition and quality housing, are less accessible. From this low base about 85 percent of Pacific peoples are sending remittances overseas (Money Pacific, 2010).
Or my neighbor's Type 2 diabetes that has caused her health to fail dramatically so for days she doesn't leave the apartment. This is a result of a combination of factors, including lower levels of participation in early childhood education and teaching and learning practices throughout schooling that are less effective for Pacific students(Statistics NZ and Ministry of Pacific Island Affairs, 2010).Poor education reduces peoples’ employment opportunities.
This reduces access to employment or education opportunities, community activities, and health care. Having a strong sense of belonging seems to reduce the likelihood that an individual will consider or attempt suicide (Beautrais et al, 2005).In the 2006 Census, 83 percent of Pacific peoples stated they had at least one religion, compared with 61 percent of New Zealand overall.
The 2002 National Children’s Nutrition Survey found that Pacific children were more likely than European children to be the most active, and the least likely to be the least active. In 2006, 48.1 percent of Pacific children under the age of 15 years lived in a household with a smoker (Craig et al, 2007, p165). Primary care services have historically been centred around GP and practice nurse services, but more recently these have been expanded to involve multi-disciplinary teams and a broader range of services.
It was considered that this may reflect the difficulties of working through caregivers during the consultation, or generational or cultural differences (Davis et al, 2005). These findings are concerning given the documented high health needs of Pacific peoples, particularly the prevalence of chronic health conditions.Cultural competence is the ability of individuals and systems to understand and appreciate the differences and similarities within and among groups. Pacific peoples were even less likely to visit medical specialists when the specialist was located at a private facility. Pacific peoples experience greater exposure to risk factors such as smoking, alcohol, and poor nutrition, with Pacific youth being particularly at risk. Now we have delivery services from any number of restaurants.” Al Jawaldeh says food portions have become too big.
4 percent).For the 12-month period to October 2010, 89 percent of Pacific 2-year-olds were fully immunised, compared with 87 percent of European 2-year-olds. The 2006 Census of Population and Dwellings showed that 35 percent of Pacific peoples had no qualifications, compared with 25 percent of all New Zealanders. Improvements in health can be achieved by improving educational performance and other social and economic circumstances. Pacific students express the importance of spiritual beliefs (57 percent) much more frequently than European students (20 percent) (Helu et al, 2009). The biggest thrill for me is when those ladies go away and continue with physical activity themselves.”Members of the group forged strong friendships and have continued to train together. Interestingly, the rate of parents ‘smoking at home’ was much lower than overall parental smoking rates, indicating that approximately half of Pacific families with smokers do not support smoking inside the house.Youth smoking rates are a key predictor of adult smoking behaviour, as taking up smoking early increases the risk of smoking-related diseases. Overall, Pacific adults experienced greater levels of harmful consequences subsequent to drinking and those who drank reported greater alcohol consumption (Huakau et al, 2005).According to the results of a 2003 Alcohol Advisory Council (ALAC) survey that looked at youth access to alcohol, Pacific young people are more likely to be non-drinkers compared with other ethnicities.
Pacific young people are less likely to access sexual health services as they are concerned that others may find out (Ministry of Health, 2008i).
Programmes with a strong community-support focus, including provision of transport to attend appointments, have also had a positive effect on cervical screening participation rates.Cost is recognised as a continued barrier and the Ministry of Health supports subsidised cervical screening for groups where the uptake of screening services is lower (H Lewis, personal communication, October 2010).
Similarly, medical insurance, which can allow more timely access to health care, is held by half as many Pacific (19 percent) as non-Pacific adults (38. Exposure to these risk factors contributes to a greater incidence of chronic diseases (such as diabetes, stroke, and ischaemic heart disease) among Pacific peoples. The unemployment rate is higher for Pacific peoples (14.4 percent in the March 2010 quarter) than for any other ethnic group (Statistics NZ, 2010).
This has been discussed in Education and Pacific peoples in New Zealand (Statistics NZ and Ministry of Pacific Island Affairs, 2010) and will be explored in a future report on economic development. Voluntary work underpins a wide range of groups and organisations whose activities contribute to social well-being. The survey found that about two-thirds of Pacific young people (compared with just under half of young people overall) are non-drinkers (McMillen, Kalafatelis & De Bonnaire, 2004).


Appropriate sexual and reproductive health information needs to be made available by alternative means.The relatively low success rate of smoking cessation programmes among Pacific peoples may be related to the belief, held by a relatively large number of Pacific smokers (24. Cultural competence training of professionals improves patient satisfaction and the number of patients continuing with agreed medical care plans. 6 percent) (Ministry of Health, 2008a).‘Did-not-attend’ rates for out-patient appointments appear to be consistently higher among Pacific peoples. Alcohol consumption is associated with a greater risk of injury through accidents and violence. Since the March 2008 quarter, the rise in Pacific unemployment has been greater than the total rise in unemployment. The General Social Survey 2008 showed that 42 percent of Pacific peoples had done voluntary work in the previous four weeks, significantly more than the mainly European ethnic group (Ministry of Social Development, 2010).The General Social Survey showed that 85 percent of Pacific peoples had at least weekly face to face contact with friends compared to 79 percent of the total population. This may be because Pacific children have higher rates of incidental activity, but lower rates of participation in organised leisure and sport, which is what SPARC measured.Research findings about adult levels of activity are mixed. However, among young people who do drink, Pacific youth consumed, on average, 6.9 standard drinks. Those Pacific people who used face-to-face counselling services were experiencing more severe harm5 than those from other ethnic groups (Francis Group, 2009). Pacific primary care providers deliver integrated services that include health promotion, primary care, secondary care, and social services. 4 percent), followed by lack of time, lack of availability of a suitable appointment, and not wanting to make a fuss. It impacts on the ability of an individual to communicate with health professionals, to discern what good advice is, and to translate this into action.
The New Zealand Health Practitioners Competence Assurance Act 2004 requires professional bodies to ensure that set levels of cultural competence are met by practitioners (Tiatia, 2008). Addressing these risk factors will improve Pacific peoples’ health outcomes.People’s beliefs and practices in relation to health and illness influence their behaviour and how they access health services. There is no control of the food in the school canteens where they sell fast food and soft drinks. Pacific peoples are over-represented in non-skilled and lower-skilled occupations (Ministry of Pacific Island Affairs, 2010). The Youth 2007 Survey found that 17 percent of Pacific youth had helped others in their community in the last 12 months, (Helu et al, 2009) compared with 14 percent of youth overall (Adolescent Health Research Group, 2008).
The New Zealand Health Survey (Ministry of Health, nd, f) found that only about half of New Zealand’s total population, and slightly fewer Pacific peoples (46.1 percent), were sufficiently active to gain any health benefits3. Fonua Mo’ui grants are designed to improve Pacific peoples’ health by supporting initiatives that promote healthy eating and physical activity. Since 1999, the number of smokers in the total New Zealand population has been trending down for all groups including Pacific boys and girls (Paynter, 2010). Pacific smokers are also most likely to believe that smokers should be able to quit without the assistance of a programme (Ministry of Health, 2009a). They aim to provide services that incorporate Pacific cultural care and language components to ensure the services are more appropriate for, and responsive to, Pacific peoples. Pacific peoples were significantly more likely than non-Pacific people to cite cost as a reason for an unmet GP need. Those with limited health literacy have worse health status than those with adequate health literacy. This applies to both nurses (Nursing Council of New Zealand, nd) and doctors (Medical Council of New Zealand, 2006).
The higher rate among Pacific peoples may reflect the barriers Pacific peoples face in accessing services, including getting time off work, transport difficulties, cultural beliefs, and a lack of cultural responsiveness (Ministry of Health, 2008f).Surgical admissions (which tend to be elective rather than emergency) are lower for Pacific peoples.
For example, attitudes to sexual health act as a barrier to Pacific peoples accessing sexual health services and protecting their sexual health. Of course, this is not something linked to the UAE alone, but in Europe and the United States of America, people realize they need to change their diet and lifestyle. Evidence from previous recessions also suggests that unskilled workers are hit hardest in times of recession, when unemployment rates for unskilled workers increase more than those for skilled workers (Department of Labour, 2009).Figure 1 shows that approximately half of all Pacific children and young people live in a crowded house, a higher proportion than other ethnic groups. Pacific peoples were the most sedentary group (undertaking less than 30 minutes of physical activity in the previous week) – 19. The Youth 2007 Survey found that Pacific students regularly smoked at twice the rate of European students, and that rates were highest among Samoan and Cook Island students (Helu et al, 2009).The 2006 Census showed that there are sub-group differences within the Pacific population.
The proportion of Pacific young people (32 percent) who reported ‘binge drinking’ at least once in the previous four weeks was slightly lower than European young people (Helu et al, 2009).Drinking alcohol at an early age is associated with greater adverse health outcomes (Odgers et al, 2008).
These findings show that beliefs regarding the nature of nicotine addiction and cessation options need to be changed in order to increase the number of Pacific people who give up smoking.
Access to care has been improved through lowering fees, providing local facilities, and giving nurses a greater role in primary care.
Cost is also a factor in the collection of prescribed medications (Jatrana, Crampton, & Norris, 2010).
Older people, those with more limited education, lower socio-economic groups, and those whose primary language is not local tend to have more limited levels of health literacy (Adams et al, 2009). Access to coronary artery bypass grafts (CABG) operations, angioplasties, and major joint-replacement operations has improved (Ministry of Health, 2006b).
Lack of knowledge of tobacco addiction and smoking cessation interventions may prevent Pacific peoples accessing cessation services and traditional respect for authority may prevent Pacific peoples demanding the best care within the health system. A child growing up in an over-crowded house will be more susceptible to communicable diseases (Hawker, 2005) and over-crowding can have a detrimental effect on successful learning. It is estimated that three-quarters of Pacific peoples in New Zealand send money to family members in the Pacific region (Money Pacific, 2010).As well as building resilient and supportive communities, social connections also provide useful foundations for community health interventions.
4 percent – and were 40 percent more likely to be sedentary than the total New Zealand population.
Drinking socially at an early age can cause increased short-term harm such as motor vehicle injuries and deaths, suicide, as well as longer-term harm from alcohol dependence, abuse, and related medical conditions (Alcohol Advisory Council of New Zealand, 2002). Nicotine replacement therapies are considered ineffective by a large number of Pacific peoples, and a relatively low proportion of Pacific peoples in south Auckland made claims for subsidised nicotine replacement therapies. Pacific providers have shown better results for the management of patients with long-term conditions than other providers (Ministry of Health, 2010c).
The Adult Literacy and Life Skills Survey 2006 showed that, overall, the literacy of Pacific peoples was lower than other ethnic groups (Statistics NZ and Ministry of Pacific Island Affairs, 2010). Ambulatory-sensitive hospitalisations (ASH) are admissions that are potentially avoidable through primary care interventions. While the number of admissions for coronary operations is low compared with the need experienced by Pacific peoples (Tukuitonga & Bindman, 2002), the inequalities in angioplasty operations are narrowing. Projects that “create and reinforce strong social connections across Pacific communities” (Tait, 2008) provide useful foundations for effective public health action. SPARC’s 2008 Active NZ Survey used the same criteria as the New Zealand Health Survey, and had similar findings.
Tokelauans are the most likely to be regular smokers, followed by Cook Islanders (38 percent), Niueans (33 percent), Tongans (29 percent), and Samoans (28 percent). Among young people, Cook Islanders are the heaviest drinkers with the most harmful drinking patterns, while Samoan men and women, and Tongan women are the least likely to drink (Ministry of Health, 2008i).
Although more Pacific people are likely to smoke, 60 percent fewer Pacific people used nicotine replacement therapies compared with Europeans (Thornley, Jackson, Mcrobbie, Sinclair, & Smith, 2010).
This may be due to a combination of factors, including poor communication of services by providers and difficulties managing the required application processes. Pacific peoples experience other factors that contribute to limited health literacy, such as lower socio-economic status and language difficulties. Between 1999 and 2005, there was a larger growth in the number of Pacific peoples receiving angioplasties than in the number of non-Maori, non-Pacific peoples receiving angioplasties (Ministry of Health, 2006b). For example, the success of initiatives such as the MeNZB and HPV vaccination campaigns in Pacific communities has been attributed to these strengths (F Tupu, personal communication, 2009; CBG Health Research Ltd, 2006). An ALAC study also found that Pacific young people, born and raised in New Zealand, consumed alcohol more frequently, pointing to the influence of acculturation factors (Alcohol Advisory Council of New Zealand, 2009). A Counties Manukau study of Pacific and Maori parents showed that these groups had a low awareness of other available cessation options (Glover & Cowie, 2010). For example, in education, difficulty with application processes was one of the main reasons identified for poor access to supplementary support (particularly when language is a barrier) (Clark et al, 2007; Rivers, 2005).
The incidence of ischaemic heart disease among Pacific peoples suggests that this group would have a greater need for angioplasties. Smoking is particularly common for young Samoans and Cook Islanders, older men, Pacific-born men – particularly Tongan men, and younger New Zealand-born women, particularly Tokelauan and Cook Island women.Traditionally, Pacific men were more likely to be smokers than Pacific women. This clearly indicates that these groups of smokers need to be better informed.The traditional respect for authority figures in Pacific communities can make it more difficult for Pacific people to question their health professionals and demand more effective services (Statistics NZ and Ministry of Pacific Island Affairs, 2010). This can lead to Pacific peoples being disempowered in the health system, not receiving services as needed, and therefore experiencing poorer outcomes.
However, rates did decline for Pacific children aged 0-4 years (Ministry of Health, 2008c).There is some evidence that the delivery of effective health care to Pacific peoples is improving.
Between 2001 and 2007, the proportion of people with diabetes receiving an annual check through the Get Checked Programme has increased, including for Pacific peoples, who have higher coverage than other ethnic groups. Prescription of statin medication also increased markedly for all ethnic groups, including Pacific peoples (Ministry of Health, 2008b). This may be due to the fact that smoking was traditionally a male activity in the Pacific Islands. In a study of people with both type 1 and type 2 diabetes in Counties Manukau, access to tests and appropriate medication was consistent across ethnic groups (Smith et al, 2010). It appears Pacific women born in New Zealand have been influenced by local smoking behaviour.
A study of patients with type 2 diabetes in south and west Auckland showed Pacific peoples, who visited a regular GP, had a higher average number of consultations, equivalent frequency of testing, but worse glucose control. They were less likely to be on a statin, despite higher serum lipids compared with the total population (Robinson et al, 2006).Overall, Pacific peoples receive less effective care. Access to care and the quality of care is improving but outcomes are not equivalent to other ethnic groups.
The reasons for this are complicated, and seem to include a combination of late presentation, receiving appropriate medication and treatment less often, and less effective ongoing management. This is influenced by the cultural attitudes and expectations of both Pacific peoples and those in the health system, and by levels of financial resources. Improved cultural competence of services will improve the quality of consultations and services, promote improved health-care delivery, and improve health outcomes.



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