Dunya Tomic, Chief of Editorials and Publications PMSA
The effects of a global ageing population have been thoroughly researched and the impacts in numerous domains including employment, housing and health are well documented. The Pacific Islands have a unique set of challenges in this regard as many countries in this region are undergoing significant sociological and epidemiological transitions (1). Furthermore, the financial issues of an ageing population are accentuated for many of these countries due to their small and remote economies (2), which historically have had low per capita growth (3). The area is also particularly vulnerable to the consequences of climate change (4), which will be an increasing problem in the years to come.
Due to the burden of maternal mortality and communicable diseases, Pacific health systems are primarily designed to address these issues, which will increase the difficulty in dealing with an ageing population. However, systems are adapting to tackle the epidemic of diabetes and other non-communicable diseases (NCDs) that are becoming major issues in the region (5). The rising prevalence of these diseases will place further strain on health systems as they greatly increase the need for health resources, so it will be essential for the Pacific to invest in preventive strategies to minimise the consequences. Although data suggests that NCDs slow the ageing process, this is because of the associated reduced life expectancy from complications of these diseases.
It will be difficult for Pacific countries to manage the ongoing issues of communicable diseases and maternal and child health, whilst planning for the repercussions of an ageing society. The Pacific has largely failed to meet the Millennium Development Goals in the areas its health systems target. Only seven Pacific countries have achieved the goal of reducing maternal mortality, and only six have succeeded in reducing communicable diseases. Astonishingly, Papua New Guinea, the most resource-laden country in the area, failed to reach all Millennium Development Goals (6); this indicates that increasing health expenditure is not translating to better health outcomes.
In addition, the aged still constitute a relatively small minority of the Pacific population, making it difficult to justify investing additional resources when these other issues still remain ripe and unsolved. Most countries have limited space for further investment in health systems due to their poor economic growth. The World Bank lists six Pacific countries – Solomon Islands, Tuvalu, Papua New Guinea, the Marshall Islands and the Federated States of Micronesia – amongst the most economically fragile across the globe (7). Given this situation the most important thing for the Pacific to address, in order to deal with its current health issues as well as those that loom in the future, will be organising and distributing funding in health systems to promote healthy ageing. Especially in smaller, less economically developed countries, it will be fundamental to ensure maximum health outcome and economic value from health expenditure. This can be achieved through improving efficiency, better evaluation, directed training, and better purchasing of pharmaceuticals. Both primary and secondary preventive strategies will be imperative to give the Pacific its best chance for healthier, happier ageing in the future.
Hayes G. Population ageing in the Pacific Islands: emerging trends and future challenges. Asia Pac Popul J 2009; 24(2):79-111.
The World Bank. Pacific possible: long-term economic opportunities and challenges for Pacific Island countries. Washington, DC: The World Bank; 2017.
Adelman M, Ivaschenko O. Hardship and vulnerability in the Pacific Island countries. Washington, DC: World Bank Publications; 2014.
The World Bank. Pacific Islands: disaster risk reduction and financing in the Pacific. 2012. Available at http://www.worldbank.org/en/results/2012/04/01/pacific-islands-disaster-risk-reduction-and-financing-in-the-pacific (accessed 17 July 2018).
Tukuitonga C. Diabetes remains major health challenge in the Pacific. 2016. Available at http://devpolicy.org/diabetes-remains-major-health-challenge-pacific-20161026/?utm_source=Devpolicy&utm_campaign=b2efb0c490-RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_082b498f84-b2efb0c490-312068301 (accessed 17 July 2018).
Howes S, Mako AA, Swan A, Walton G, Webster T, Wiltshire C. A lost decade?: Service delivery and reforms in Papua New Guinea 2002–2012. Canberra, Australia: The National Research Institute of Papua New Guinea and the Development Policy Centre; 2014.
The World Bank. Harmonized list of fragile situations in financial year 2017. Washington, DC: The World Bank; 2016.