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

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 attainment of the health related Sustainable Development Goals. Methods The review used qualitative and quantitative methods. The qualitative review included conducting semi-structured interviews with Pacific Island Government Ministers and officials, regional agencies, health workers and community members. A document review was also conducted. The quantitative review consisted of examining secondary data from regional and global data collections. Results The review found improvement in 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 remained an inspiration to health ministers and senior officials in the region. However, implementation of the 'Healthy Islands' approach was patchy, under-resourced and un-sustained. Communicable and Maternal and Child Health challenges persist alongside unprecedented levels of non-communicable diseases, inadequate levels of health finance and few skilled health workers as the major impediments to health development for many of the Pacific's countries. Conclusions The current trajectory 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, unprecedented levels 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-communicable disease 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 health outcomes between Pacific people and those of the rest of the world.

Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders' Discussions, Challenges, Priorities and Solutions, 2015-2020.

In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as 'a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.' Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015-2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.

Achieving UHC in the Pacific, a Closer Look at Implementation: Summary of a Report for Pacific Health Ministers.

The principles of universal health coverage (UHC) are deeply embedded in health systems across the Pacific. UHC is also one of the stepping stones to achieving the Healthy Islands vision, adopted by Pacific health ministers in 1995, which envisages healthy islands as places where citizens grow, learn, play, and age with dignity. However, recent evidence suggests that though health systems across the Pacific largely remain affordable, there are growing challenges in ensuring access to good quality essential services. This article examines three common challenges to improving essential service delivery across the Pacific and reforms that are currently being put in place to address them. It is based on a report on the status of UHC, with a focus on primary health care (PHC), across 22 Pacific Island countries and territories that was submitted to the most recent meeting of Pacific health ministers in 2017. That report identified the challenges and reform efforts using data from a literature review, interviews with senior policy makers, as well as technical consultations. The three challenges-delivering integrated PHC services with appropriate delivery models; increasing the share of resources allocated to PHC; and improving managerial, administrative, and supervisory capacity to ensure that resources reach and are well used for PHC-are being addressed through country-specific reforms across the Pacific. However, concerted political effort is needed to ensure that these reforms are effective in improving access to good quality PHC for citizens across the Pacific.

A review of measles supplementary immunization activities and the implications for Pacific Island countries and territories.

INTRODUCTION: Standard measles control strategies include achieving high levels of measles vaccine coverage using routine delivery systems, supplemented by mass immunization campaigns as needed to close population immunity gaps. Areas covered: This review looks at how supplementary immunization activities (SIAs) have contributed to measles control globally, and asks whether such a strategy has a place in Pacific Islands today. Expert commentary: Very high coverage with two doses of measles vaccine seems to be the optimal strategy for controlling measles. By 2015, all but two Pacific Islands had introduced a second dose in the routine schedule; however, a number of countries have not yet reached high coverage with their second dose. The literature and the country reviews reported here suggest that a high coverage SIA combined with one dose of measles vaccine given in the routine system will also do the job. The arguments for and against the use of SIAs are complex, but it is clear that to be effective, SIAs need to be well designed to meet specific needs, must be carried out effectively and safely with very high coverage, and should, when possible, carry with them other public health interventions to make them even more cost-effective.

Mortality trends and the epidemiological transition in Nauru.

This article aims to examine the epidemiological transition in Nauru through analysis of available mortality data. Mortality data from death certificates and published material were used to construct life tables and calculate age-standardized mortality rates (from 1960) with 95% confidence intervals. Proportional mortality was calculated from 1947. Female life expectancy (LE) varied from 57 to 61 years with no significant trend. Age-standardized mortality for males (15-64 years) doubled from 1960-1970 to 1976-1981 and then decreased to 1986-1992, with LE fluctuating since then from 49 to 54 years. Proportional mortality from cardiovascular disease and diabetes increased substantially, reaching more than 30%. Nauru demonstrates a very long period of stagnation in life expectancy in both males and females as a consequence of the epidemiological transition, with major chronic disease mortality in adults showing no sustained downward trends over 40 years. Potential overinterpretation of trends from previous data due to lack of confidence intervals was highlighted.