Pacific island health inequities forecast to grow unless profound changes are made to health systems in the region

Abstract

Objective. Twenty years ago the Pacific's health ministers developed a 'Healthy Islands' vision to lead health development in the subregion. This paper reports on a review of health development over this period and discusses the implications for the attainmentof the health related Sustainable Development Goals.Methods. The review used qualitative and quantitative methods. The qualitative review included conducting semistructured interviews with Pacific Island Government Ministers and officials, regional agencies, health workers and communitymembers. A documentreview was also conducted. The quantitativereview consisted of examining secondary data from regional and global data collections.Results. The review found improvementin health indicators, but increasing health inequality between the Pacific and the rest of the world. Many of the larger island populations were unable to reach the health Millennium Development Goals. The 'Healthy Islands' vision remainedan inspirationto health ministersand senior officials in the region. However, implementation of the 'Healthy Islands' approach was patchy, under-resourcedand un-sustained. Communicable and Maternal and Child Health challenges persist alongside unprecedentedlevels of non-communicablediseases, inadequate levels of health finance and few skilled health workers as the major impedimentsto health development for many of the Pacific's countries.Conclusions. The currenttrajectory for health in the Pacific will lead to increasing health inequity with the rest of the world. The challenges to health in the region include persisting communicable disease and maternal and child health threats, unprecedentedlevels of NCDs, climate change and instability, as well as low economic growth. In order to change the fortunes of this region in the age of the SDGs, a substantial investment in health is required, including in the health workforce, by countries and donors alike. That investment requires a nuanced response that takes into account the contextual differences between and within Pacific islands, adherence to aid effectiveness principles and interventions designed to strengthen local health systems.What is known about the topic? It is well established that the Pacific island countries are experiencing the double disease burden, and that the non-communicabledisease epidemic is more advanced. What does this paper add? This paper discusses the review of 20 years of health development in the Pacific. It reveals that although progress is being made, health development in the region is falling behind that of the rest of the world. It also describes the progress made by the Pacific countries in pursuit of the 'Healthy Islands' concept. What are the implications for practitioners? This paper has significant implications for Pacific countries, donor partners and development partners operating across and within Pacific countries. It calls for a substantial increase in health resourcing and the way development assistance is organised to arrest the increasing inequities in healt...

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