SMALL ISLAND STATES IN CRISIS: THE
ECONOMIC IMPACT OF LIFESTYLE DISEASES
IN THE SOUTH PACIFIC
By Philip Szmedra and K.L. Sharma*'
INTRODUCTION
Public health concems in the South Pacific region in recent years have
shifted from the prevention and control of infectious diseases to dealing with
the increasingly prevalent problem of non-communicable disease (NCD) or
what has been termed lifestyle illnesses. Improved living standards have
resulted in increased consumption of high fat diets and increased use of alcohol
and tobacco. Epidemiological research has firmly established a relationship
between these consequences of higher living standards and ill health.^
Foremost among these illnesses is diabetes which affects upwards of
30 million people in the Westem Pacific region with predictions ofthis number
doubling over the next twenty years.^ Diabetes has become much more
prevalent in the Pacific region with certain island nations reporting
extraordinarily high population levels.
Nauru has one ofthe highest incidences of diabetes in the world with
between 30 and 40 percent ofthe adult population suflfering from the disease.''
Hypertension and other circulatory diseases are also on the rise as the result of
the adoption of modem diets high in saturated fats and oils and processed sugar
rather than reliance on traditional root crops and fish as sources of
carbohydrates and protein.
In Fiji, mortality rates and complications related to diabetes have
significantly increased over the past thirty years with mean rates doubling
about every five years.' In a comprehensive survey to measure the incidence
of diabetes in the population of Fiji, Hoskins, et al* surveyed 5000 adults and
found 24 percent of Fijian females and 15 percent of Fijian males to be diabetic
while 34 percent of Indo-Fijian females and 25 percent of Indo-Fijian males
were similarly identified.
The issue is both pertinent and topical. Pacific health ministers
meeting in March 2003 in Nuku'alofa, Tonga heard of the gravity of the
problem of lifestyle diseases from officials ofthe World Health Organization
(WHO) and the Secretariat ofthe Pacific Community (SPC).^
'Philip Szmedra is Associate Processor of Economics, Georgia Southwestern State
University, Americus, Georgia, 31709; and K. L. Sharma is Senior Lecturer, Department of
Economics, University ofthe South Pacific, Suva, Fiii.
Journat of Third World Studies. Vol. XXIV. No. 2
© 2007 by Association of Third World Studies, Inc.
45
JOURNAL OF THIRD WORLD STUDIES. FALL 2007
ECONOMIC IMPACT
Disease incidence is occurring in younger population strata, which
restricts the ability ofthe stricken individual to contribute to the economic well
being of his family. The impact on families that have lost a member to
premature or sudden death from these types of illnesses is often severe.
Community support structures rarely fully compensate for the loss of an
economically active family member. These losses can and often do result in the
impoverishment of families, restricting the ability to support children's
education, and ultimately resulting in a cycle of poverty that is difficult to
break.* In a larger sense, earlier disease onset impedes the ability of a
developing country to exploit the energies and talents of a segment of the
population that normally is the most dynamic contributor to economic growth.
PREVIOUS RESEARCH
Most of the research dealing with lifestyle disease in the Pacific
region has attempted to categorize the types of illnesses that afflict the region
and to quantify the number of individuals affected by the various maladies. The
United Nations Development Program has been active in determining the
scope ofthe problem.'The WHO and the SPC have reported on the problems
of obesity in the Pacific, which arguably lies at the heart of the lifestyle
diseases problem.'" Dalton and Crowley attempted to estimate thecosts to
govemment offreatingNCDs relative to overall spending for healthcare in Fij i,
Samoa, and Tonga. Their findings indicate that between 40 percent (Fiji) and
60 percent (Tonga) of government spending directed toward healthcare and
maintenance go to the treatment of NCDs."
Beyond the estimation of explicit costs to govemments of treating
NCDs there has been no work done in the Pacific region that attempts to
include an estimation ofthe economic impact of NCDs at the macroeconomic
level. Specifically, how and to what extent this increase in NCD incidence
places a drag on the economic growth potential of many Pacific Island nations.
RESEARCH METHODS
A.
Methodology
Our intention was to monetize the annual economic loss suffered in
our target nations as a result of NCDs. High rates of NCDs are a heavy burden
on government finances, as many countries in the region will either partially
cover (Fiji), or more commonly, fully cover (Nauru) the expenses associated
with treating NCDs. These explicit costs are budget items and though an
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Philip Szmedra and K.I. Sharma/Smali Island States in Crisis:
Ihc Economic Impact of Lifestyle Diseases in the South Pacific
important factor iti the capital budgets of these nations, are not the subject of
our work.
More importantly for us is the effect these illnesses have on the
productive lives ofthe people affected and thereby the economic potential of
their nations. As mentioned, many people affected by NCDs in the Pacific are
relatively young and in their prime productive years. Hours and days lost from
work due to illness, either being too ill to work or the time taken in seeking
treatment for the effects of their disease or diseases diminishes their ability to
contribute to the financial support of their families and communities.
At a microeconomic level these impacts have serious consequences
on the ability ofthe family to support itself at some socially acceptable level.
This is especially true if the illness results in permanent disability and the
withdrawal by the individual completely fi'om the labor force. For example,
many diabetics are prone to circulatory and nervous system damage as a
consequence of their disease which may result in amputation of a foot or leg
rendering the individual incapable of carrying out physical labor. While a very
serious problem to the individuals and families affected, the problem is
compounded when a significant portion ofthe population is afflicted with the
same type of debi I ity. Our interest is in monetizing and aggregating these types
of individual debilities and costs through lost work time to provide a dollar
estimate ofthe loss NCDs cause on the economies ofthe two nations we have
chosen to study.
Economic development efforts in the developing world typically focus
on building infrastructure, or institutional capacity, or promoting "good
governance". Sufficient regard to, and promotion of, healthy life-styles are
necessary antecedents for developing nations aspiring to maintain sustainable
growth. Developing nations neglect effective preventative health programs at
the risk of more than debilitated and marginalized segments of their
populations; they risk retarding economic growth.
B. Research Approach
The survey portion of this project was conducted in two stages. The
first stage occurred on Nauru in June, 2003. The second stage took place in Fiji
in June 2004 at five different survey locations including urban, peri-urban, and
rural health center environments. Initially we obtained permission from the
Ministry of Health of Nauru to conduct a survey during June, 2003 among
people being treated for NCDs at the central hospital serving the island nation.
The survey targeted those individuals that suffered from diabetes,
hypertension, cardiovascular disease, kidney disease, eye disease, and nerve
damage. We chose Nauru and Fiji because ofthe high incidence of premature
47
JOURNAL OF THIRD WORLD STUDIES. FALL 2007
mortality for both men and women as a result of lifestyle disease.
Approximately 20 percent of male Nauruans and 15 percent of females, die due
to non-communicable diseases before they reach the age of 40.'" Nauru has the
dubious distinction of having one ofthe highest rates of adult-onset diabetes
in the world. In Fiji, life expectancy at birth has been stagnant for the past two
decades even though infant mortality has been decreasing indicating higher
adult mortality."
The following narratives describe the research process at each ofthe
survey locations.
Nauru - The Republic of Nauru (RON) Hospital's dialysis clinic treats
approximately 10 patients per day in four-hour dialysis sessions three days per
week. We visited the clinic on four consecutive days to be assured of including
in our survey all individuals that visited the clinic during a normal week. We
chose this venue and these individuals because most of these patients continued
to be economically active (i.e. employed in the formal sector) in spite ofthe
seriousness of their health problems.
In addition, student enumerators contacted individuals in their
community districts that were known to have NCDs. These two sample subpopulations provided a total of 61 responses which represents 1.7 percent of
the total population of interest.
Fiji - We initially visited the diabetic and hypertension clinics being conducted
at the Colonial and War Memorial Hospital (CWM) in Suva, the largest and
most sophisticated medical facility in Fiji. Suva, Fiji's capital city, which is
located on the island of Viti Levu, the Fiji archipelago's largest land mass.
Over a period of two days eighty-two outpatients were interviewed.
The following two days were spent at the Valelevu Medical Clinic,
which is located approximately fifteen kilometers from the Suva city centre
along the densely populated principal arterial thoroughfare connecting the
urban sprawl of Suva and the town of Nausori. The enumerators interviewed
69 outpatients waiting for consultation and treatment. In addition, the survey
team conducted interviews at the Raiwaqa medical and diabetic clinic in
Raiwaqa, a relatively poor section in the metropolitan Suva area.
The final urban survey locale was the Lautoka Hospital in the city of
Lautoka on the westem side of Viti Levu approximately 230 kilometers from
Suva. The Suva survey team spoke to fifty outpatients at the general medical
and diabetic clinics.
The rural population of Fiji was sampled on Vanua Levu, Fiji's
second largest island. We visited the Labasa Hospital in the town of Labasa.
Our visits coincided with the weekly outpatient diabetic and hypertension
48
Philip Szmedra and K.I. Sharma/Small Island States in Crisis:
The Economic Impact of Lifestyle Diseases in the South Pacific
clinics. A total of 308 usable questionnaires were completed during the Fiji
portion of our survey work.
There is no other way than the survey method to collect these type of
data in the developing world short of invasive procedures requiring medical
teams engaging in complete physical assays including blood sampling,
extensive medical history workups. and similar methods. This is a very
expensive proposition better left to the individuals of the World Health
Organization or research teams working with WHO funding. Our methods of
asking straightforward questions of chronically ill individuals elicited what we
feel were honest responses from people who were not told in advance of our
site visits. We acknowledge that their responses may contain a significant
margin of error but feel that the results are valuable as a first approximation of
the magnitude ofthe problem in that region ofthe developing world.
RESULTS
1.
Demographics
Table 1 provides demographic infonnation for the sample
populations. The sample populations have been chosen expressly to reflect the
impact of illness on the economic prospects of each nation and do not reflect
the overall mean population demographics. The Body Mass Index (BMI) for
the sample populations reflect the higher incidence of overweight individuals
seeking treatment for NCDs. Obesity is a contributing factor to many ofthe
NCDs experienced by peoples in the Pacific. Many Pacific Island nations have
recognized the serious public health problem that obesity poses and have begun
to implement educational programs to address the issue. However, it is thought
that both a genetic predisposition to store fat and the movement away from
traditional diets to modem manufactured foods heavy in fats and sugars as
populations move from rural to urban areas are counteracting any positive
impact that educational programs to modity diet and lifestyle may be having.
The sample populations are heavy relative to their short stature with
the Nauruan sample registering in the obese BMI classification. The Fiji
sample population less so though the BMI index for the Fiji sample is in the
overweight category. The Nauruan sample is relatively well educated for a
nation considered to be among the poorer in the Pacific. The sample
populations in Fiji report fewer years in school.
49
JOURNAL OF THIRD WORLD STUDIES. FALL 2007
Table 1. Select demographics of the Fiji and Nauru sample populations
Fihi*
Nauru
Age (mean)
54.1
42.6
Weight (kg)
74.2
86.2
Height (cm)
167.7
163.1
BMI**
26.6
32.4
Number in family
4.4
5.0
Demographics
. 7.0
11.4
Married ((%)
90.0
60.7
Single (%)
5.2
26.2
Years in school
18.3
30.8
Married years
* weighted averages by number of respondents at each sampled site.
Body Mass Index -
2.
Below 18.5 = underweight
18.5-24.9 = nonnal
25.0-29.9 = overweight
30.0 and above = obese
Health (Alcohol-Tobacco)
Table 2 demonstrates that many of the individuals included in the
sample populations indulge in either the consumption of alcohol or tobacco, or
in many instances both. However, significantly fewer people in the Fiji sample
smoked cigarettes which may be due to diligent anti-smoking campaigns that
have been promoted by the govemment of Fiji. Most respondents reported
being advised by a physician or other health care provider to quit or cut down
on either alcohol or cigarette consumption or both. And most respondents
reported in unstructured sample responses that following this type of advice
was difficult considering the problems they faced in their daily lives and the
need have a physical and psychological outlet to help them cope.
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Philip Szmedra and K.I. Sharma/Small Island States in Crisis:
The Kconomic Impact of Lifestyle Diseases in the South Pacific
Table 2. Health impacts (Alcohol-Tobacco) in sample populations
in Fiji and Nauru
Trait
Fiji
Nauru
Drink alcohol (%)
34.5
47.5
Smoke cigarettes (%)
16.5
40.0
Cigarettes per day (#)
15.3
30.7
3.
Health (Diabetes)
We chose our sample populations carefully to include large
percentages of individuals afflicted with diabetes and other NCDs (Table 3).
While the overall population of Nauru contains between 30 percent and 40
percent diabetic individuals depending on gender (females being more prone
to the disease than males) our sample population contains a much higher
percentage. Our Fij i data include fewer diabetics reflecting the greater number
of general medical clinics we visited which dealt with various medical
problems.
The impact of diabetes is severe in Nauru. The govemment of Nauru
provides complete medical coverage for people being treated for the disease
including medication, hemodialysis for those individuals suffering from kidney
failure, and when financial conditions permit, the costs of kidney transplant
which involves evacuation to and hospitalization in Australia. The ability ofthe
govemment to continue this degree of beneficence is now limited due to the
near exhaustion ofthe phosphate deposits which were the only source of export
earnings for the island nation. A number of respondents mentioned that they
had been waiting in some cases years for a transplant operation but the
govemment did not have the funds. It appears from these data that the problem
will not be solved anytime soon. More than 80 percent of Nauruan respondents
reported that other family members were also diabetic.
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JOURNAL OF THIRD WORLD STUDIES. FALL 2007
Table 3. Health Impacts (Diabetes) in sample populations
in Fiji and Nauru
Fiji
Nauru
Diabetic (%)
52.8
73.3
Time since diagnosis (yrs)
6.0
12.0
Times to clinic (per month)
3.3
5.5
Treatment (%): Diet
18.7
40.9
17.2
15.9
29.1
43.2
18.0
81.7
Trait
Insulin
Drugs
•
Diabetics in your family (%)
4.
Health - Heart, Kidney, and Eye Diseases
Significant portions of our sample population were afflicted with other
types of NCDs in addition to or other than diabetes (table 4). The Nauru data
reflect our visits to the dialysis clinic at the RON Hospital. One third of all
respondents suffered from kidney disease. Many ofthese people were in endstage renal failure and undergoing dialysis treatments with the expectation of
receiving a kidney transplant in the near future if govemment finances
permitted. A smaller percentage ofthe Fiji respondents suffered from kidney
disease. There are no hemodialysis facilities in Fiji. The data describing kidney
disease in Fiji probably refiect a combination of two factors; 1) lower incidence
of diabetes, which is a strong contributing factor to renal disease; and, 2) a high
mortality rate among people developing kidney disease and the inability to
effectively treat renal failure without access to hemodialysis equipment. Kidney
disease is a significant cause of lost work days due to illness. Those aflflicted
with kidney disease reported losing 48 days of work due to the debilitating
effects of their disease. This includes the time spent in dialysis for those
suffering from renal failure. Dialysis sessions require the individual to spend
a minimum of four hours per session three days a week. More if problems arise
in transport to the clinic or in hospital preparedness.
Diseases ofthe eye were the most common reported health problem
by the sample populations. More than half of Naumans sampled reported eye
problems. The figure was thirty percent in the Fiji sample . This result is not
surprising in the Nauru sample as diabetes also affects the delicate vascular
52
Philip Szmedra and K.I. Sharma/Small Island States in Crisis:
The Economic Impact of Lifestyle Diseases in the South Pacific
systetn that nourishes the eye. Relatively high eye disease rates among Fiji
residents may have to do more with the hot and dry climate of the westem and
northern regions of Fiji which contribute to the debilitating effects of diabetes
on the eye. Arid climates dry the mucous membranes in the eye and provide an
environment for opportunistic infections. However, in no nation was this
source of illness an important contributing factor to work absence.
Table 4. Health Impacts (Other NCDs) in sample populations
in Fiji and Nauru
Trait
Heart disease (5)
HD (days missed work)
Kidney disease (%)
KD (days missed work)
Eye Disease
ED (days missed work)
5.
Fiji
Nauru
26.7
16.4
26.5
32.0
7.7
32.8
16.2
48.3
28.7
52.5
11.3
10.8
Health - Hypertension and Nerve Disorders
Table 5 (see next page) reports data on other NCDs that affected the
sample populations. All groups reported significant levels of hypertension.
Hypertension contributed to significant levels of lost productivity in all sample
populations. In addition, nerve disorders were a relatively common complaint
expressed by all sample populations affecting more than a quarter of the
individuals in the Nauru sample.
6.
The Macroeconomic Effects
Our objective was to monetize the dollar loss to each nation's
economy from the acute and chronic effects of NCDs among the economically
active members of the population. Our approach and objective omits those not
in the labor force. While the debilitating effects of these diseases are as severe
on those not in some type of formal employment as it is to those working for
wages, attempting to estimate the financial impact on those outside formal
53
JOURNAL OF THIRD WORLD STUDIE.S. FALL 2007
employment with much confidence is a much more difficult and subjective
task.
Table S. Health Impacts (Hypertension and Nerve Disorders)
in sample populations in Fiji and Nauru
Trait
Hypertension (%)
HYP (days missed work)
Nerve disorders (%)
Nerve (days missed work)
6a.
Fiji
Nauru
77.2
77.8
17.0
21.5
10.9
26.2
10.6
13.0
'
Estimation Procedure
Data describing the incidence of select NCDs in the populations of
Nauru and Fiji are available fi-om SPC publications.''' When different
incidence rates were reported for males and females in each country we took
a weighted average with 50% being the weight assigned to each gender specific
rate. For instance, according to Coyne, the incidence of diabetes in Nauruan
females is approximately 33 percent according to the latest survey data. The
corresponding incidence figure for males in the population is 28 percent.
Therefore the weighted average of diabetes incidence in the overall population
is 30.5 percent. The average daily wage among those employed in the formal
sector on Nauru is the equivalent of US$35.34. By knowing what percentage
of the overall population suffers from a particular NCD and also what
percentage of our sample population lost a given amount of work days to their
illness, we determined what part of the overall population lost a similar number
of days to the same illness.
Most individuals we interviewed suffered from multiple illnesses
related to either their diabetic condition or some other chronic illness. We
asked respondents to attempt to ascribe to each illness that they were afflicted
with, a distinct number of work days lost. For instance, if someone suffered
from both heart and kidney disease, we asked the individual to estimate the
unique number of work days lost because of the affects of his heart disease, and
the unique number of work days lost because of the effects of his heart
condition. In this way we attempted to avoid the possibility of double counting
days lost from work.
54
Philip Szmedra and K.I. Sharma/Small Island States in Crisis:
The Economic Impact of Lifestyle Diseases in the South Pacific
We determined the percentage ofthe population that is active in the
labor force and the overall level of unemployment from U,S, Central
Intelligence Agency data,,'^ When the number of people in the labor force was
not explicitly provided, we took as the labor force those between the ages of
15 and 64 and factored out the reported level of unemployment. The number
of people in the labor force times the number of people in the total working age
population that lose the mean number of days to a particular illness gives the
total number of people in the working population that lose the reported average
number of days to an illness. The number of days lost times the average formal
wage per day times the average number of people experiencing this loss
provides the total loss in dollar terms to those employed in the formal sector,
A. Nauru
1,
Diabetes - Because of the widespread incidence of adult onset
diabetes on Nauru and the fact that diabetes is a precursor to many of
the other NCD illnesses of interest, the survey instrument did not
directly solicit estimates of lost work time and productivity due to this
illness. We wanted to avoid the risk of double counting productivity
loss. Productivity loss is therefore measured as associated with the
other NCDs, to which diabetes is a significant contributing factor, or
results from the progression ofthe disease,
2,
Heart Disease - Ten of 61 respondents in our sample population
reported being diagnosed with heart disease. Six of those individuals
reported losing an average of 32 days per year due to their condition
including time lost from work seeking treatment, time in hospital, and
feeling too ill to do their job,
3,
Kidney Disease - Twenty of 61 respondents had kidney disease,
many of those in end stage renal failure. Surprisingly, a majority
continued to work in spite of the seriousness of their medical
condition. However, the productivity loss was particularly evident
among these people as they spent an average of four hours per day
three days per week attached to a hemodialysis machine. Some were
compensated by their employers for the time spent during dialysis and
some were not. However, whether employees are compensated for
their time away from work or not, the loss of their productivity is a
real loss to the growth prospects and potential of Nauru, The average
days lost during the past year resulting from kidney disease including
treatment and debilitating effects ofthe illness was 48 days.
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JOURNAL OF THIRD WORLD STUDIE.S. FALL 2007
4.
Eye Disease - Thirty two of 61 respondents had diseases ofthe eye.
Eye disease is a common result ofthe progression of diabetes as the
disease attacks the vascular structures in the eye and gradually causes
blindness. Fifteen of the sample respondents reported losing an
average of 10.8 days in the previous year due to eye problems.
5.
Hypertension - Fifty four of 61 persons in the sample population
reported having been diagnosed with hypertension. Thirty one
respondents reported losing an average of 21.5 days of work over the
past year because ofthe effects of hypertension.
6.
Nerve Damage (neuropathy) - Sixteen individuals in the sample
reported having been diagnosed with nerve damage, most generally
to the extremities, which is a common affliction among diabetics.
Eight individuals reported losing an average of 13 days of work in the
previous year because of problems related to neuropathy.
7.
Nauru IVIacroeconomic Impacts
Table 6 displays the projected estimates of overall dollar loss to the formal
economy of Nauru fi-om the NCDs included in the study.
Table 6. NCD Economic Impacts to Nauru
NCD
Estimated Dollar Loss (US$)
Heart Disease
$ 312,198
Kidney Disease
2,523,148
Hypertension
200,147
Eye Disease
133,620
Nerve Damage
172,744
$3,341,857
Total
The GDP of Nauru in 2004 in current dollar terms was US$25.4
million which includes US$24.4 million fi-om the government of Australia in
the form of payments to the govemment of Nauru to house refugees from the
56
Philip Szmedra and K.I. Sharma/Small Island Stales in Crisis:
The Economic Impact of Lifestyle Diseases in the South Pacific
Middle East and Southeast Asia that have attempted to enter Australia
illegally,'" The drag on the overall economy as a result of lost work time due
to the treatment, hospitalization and debilitating effects of NCDs amounted to
approximately 14 percent of 2004 GDP or a loss of L)S$581 per capita for each
member ofthe workforce. No current projections exist for GDP growth on
Nauru, The tenuous state ofthe economy with its reliance on an essentially
depleted stock of phosphate as its principal foreign exchange earner makes
future economic viability dubious. But whatever future resource prospects, the
deteriorating state of public health among the island's population bodes ill for
any revitalization of the Nauruan economy and for the social and physical
welfare of its people,
B
Fiji
1,
Diabetes - The incidence of diabetes in our surveyed sample was
52,8 percent ofthe 308 respondents. However, we assume an overall
population incidence of 15 percent aggregating the indigenous Fijian
and Indo-Fijian segments into one group. Further, the five Fiji survey
sites (CWM, Raiwaqa, Valelevu, Lautoka, and Labasa) were merged
into one dataset with weighted averages used to determine overall
incidence and disease impact, the weights based on the number of
observations taken at each site,
2,
Heart Disease - our results indicate that 79 of 308 individuals in our
survey reported being diagnosed with heart disease. Sixty-eight of
these respondents reported losing an average of 33,8 days of work the
previous year due to the effects of their illness including days
involving hospital or clinic visits and instances in which the
respondents felt too ill to work,
3,
Kidney Disease - approximately 5 percent ofthe population of Fiji
suffers from sort of kidney ailment , Sixteen people in our survey
sample reported losing 16,2 days of work during the previous year
due to kidney disease. In spite of the relatively advanced state of
public health delivery in many areas of Fiji compared with other
nations in the region, the effective management of kidney disease
varies greatly according to geographic location and financial means.
The Labasa Hospital on Vanua Levu has no kidney dialysis facility.
Kidney disease patients in need of dialysis and without the means to
secure overseas treatment usually succumb to their illness.
57
JOURNAL OF THIRD WORLD STUDIES. FALL 2007
4.
Eye Disease-weestimated that 5 percent ofthe population of Fiji is
afflicted with diseases of the eye, many related to diabetic
complications. In our survey 74 of 308 respondents reported losing
11.3 days of work during the previous year due to these conditions.
5.
Hypertension - A large majority of survey participants reported
being diagnosed with hypertension. Two hundred and thirty four of
308 people reported suffering from the effects of elevated blood
pressure. Ofthese, 213 reported losing an average of 17 days of work
in the previous year because ofthe effects ofthis condition.
6.
Nerve damage -A total of 21 respondents reported this condition
with 17 people indicating a mean loss of 10.8 work days during the
previous year from its effects.
7.
Fiji Macroeconomic Effects
Table 7 provides the estimates of overall dollar loss to the formal
economy of Fiji in the previous year due to lost work time and subsequent lost
income. The GDP of Fiji in 2005 was approximately US$1.9 billion." Our
estimates indicate a loss to the revenue generating capacity ofthe labor force
of US$26.9 million or approximately 1.4 percent of GDP. This figure should
be taken as a minimum value since the loss in national income would have
negative multiplier effects in the overall economy which we have not attempted
to quantify.
Table 7. NCD Economic Impacts to Fiji
NCD
Estimated Dollar Loss (US$)
Heart Disease
$ 15,570,000
Kidney Disease
2,313,964
Hypertension
5,524,233
Eye Disease
1,856,171
Nerve Damage
1,581,209
Total
S 26,845,577
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Philip Szmedra and K.I. Sharma/Small Island States in Crisis:
Ihe Economic Impact of Litestjle Diseases in the South Pacific
DISCUSSION
The Pacific region has seen an increase in the incidence of NCDs as
infectious disease has become less common and as the relative wealth of most
ofthe region has improved. The burden of these illnesses is both financial to
the individuals afflicted through lost productivity, and emotional, through the
pain and suffering caused. The financial impacts are also severe and mounting
for the govemments involved due to the significant costs of disease treatment.
The cost of managing lifestyle-related NCDs in the Pacific accounts for about
half of health care expenditures in some Pacific island countries. Our work has
assigned dollar values to the productivity and income losses experienced by
those in the overall population that are economically active in the formal
sector. Our estimates are undervalued probably by a number of orders of
magnitude. They are admittedly and necessarily so because ofthe difficulties
in accurately estimating physical debility due to disease in populations that are
essentially rural where most economic activity occurs in the informal sector.
However, our estimates provide a first approximation of the losses to the
formal sector in these two nations as a result of NCDs, In that light they offer
individuals involved in health policy formulation, information and insight to
guide the budgetary and policy process to more effectively target these
increasingly menacing afflictions,
NOTES
1,
2,
The authors would like to thank the University ofthe South Pacific
University Research Committee for their generous financial support
which allowed us to undertake the research. We also are indebted to
the Ministries of Health in Nauru and Fiji for their sanctioning of our
field work allowing the research team access to rural and urban clinics
and hospitals. Our gratitude also goes to the physicians, nurses and
other medical staff in each island nation that worked with us during
the survey process. Finally, we dedicate this work to the noble people
who we met and spoke with that were being treated at the medical
facilities we visited that carry on with their lives with exuberance and
vitality in spite ofthe health problems and issues they face. We hope
that the policy impact of this work does in some way positively affect
their lives,
D, Kromhout, A, Menotti and H, Blackbum, Prevention of Coronary
Heart Disease. Diet, Lifestyle, and Risk Factors in the Seven
Countries Study. (New York: Kluwer Academic Publishers, 2002,)
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JOURNAL OF THIRD WORLD STUDIES. FALL 2007
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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60
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61