NCDs: Fiji's Silent Killers

Fiji people are not eating enough fruits and vegetables

By Dionisia Tabureguci

Non-Communicable Diseases (NCDs) are casting deadly shadows on Fiji’s population; so much so that there is no shortage of horrifying stories about how these “silent killers” are preying on our working population and our children.

Put simply, they cause 82 percent of deaths in the country each year. The goriness is in the details. They are, for example, killing us early and leaving our children fatherless and motherless too early in life. 

National statistics provided by the Ministry of Health (MOH) show the number of deaths each year in Fiji begins to climb sharply at 35 years old.  When the numbers of people dying each year are classified by age, most deaths are happening between 35 and 59 years, mostly concentrated in the ages between 45 and 49 years—not only are these working ages, they are also parenting ages.

“Most people in Africa are motherless or fatherless because of HIV and AIDS,” said Dr Isimeli Tukana, the health ministry’s national adviser on NCDs. He spoke exclusively to FIJI BUSINESS on what has become, for the ministry, an alarming morbidity and mortality scenario for the nation. “In Fiji, it’s a different story. Most become fatherless or motherless because somebody died early from NCDs.

War

There is a national battle being waged against NCDs—not just because they are taking us early to the grave but also because there are indications that we may, although unintentionally, be delivering a population of sick children into the future; children who are fat, lethargic, who do little physical activities, thrive on junk foods and who live glued-to-the-TV lifestyle that, if not reversed, will kill them earlier than the age NCDs are killing Fiji’s adult population now.

But it’s a difficult battle at the outset as it boils down to the Ministry of Health loading an armoury to fight what really is up to the individual to counter. Simply because NCDs are lifestyle diseases, inflicted upon oneself after years of living an unhealthy lifestyle of smoking, excessive alcohol consumption, improper and unbalanced diet, and lack of exercise or physical activities. 

“NCDs in the Fiji context are five diseases: diabetes; heart diseases, including stroke, hypertension and high blood pressure; cancer; mental diseases; and accidents and injuries,” explained Dr Tukana. “We don’t know what cause most NCDs in Fiji but we know the four risk factors that contribute towards people getting an NCD; they are smoking, eating, alcohol and physical activities. That is standard worldwide." 

In fact, NCDs have penetrated Fiji's society much deeper than the society is aware of. Not only are they blamed for causing up to 80 percent of Fiji's death each year, some 80 percent of Fiji's hospital admissions is attributed to one of the NCDs, said Tukana.  "And even our disabilities—those who are disabled, most of them are caused by an NCD. The disabilities are they get blind, diabetes or hypertension or they get their foot amputated because of complications. They have kidney problems and they get disabled. Some have heart attacks, some have strokes. These are all complications of NCDs. And even with cancers, you get disabled. There’s a significant number of people in Fiji who are disabled because of NCD complications," Tukana added. “So we know that if we can reduce or at least let people know about the four risk factors and how to carefully manage them, their chances of getting an NCD will be much lower.

“But there are some facts of life we have to understand—as we get older, NCDs come nearer to us because of the lifestyle we live now. So really the challenge for us in the scenario of NCDs is to control the risk factors.” This is a fight against one of Fiji's top killers.  And it is one being waged by the health ministry through health campaigns and public awareness, and the government through relevant policies and budgetary support because of the insidious rot that has set in as a result of these diseases. 

Sick, ‘fast-food’ eating adult population

Since the last national survey on NCDs carried out for Fiji, the health ministry has spent thousands of dollars trying to keep these diseases at bay. The survey—known in the medical fraternity as the NCD STEPS Survey because of the many 'steps' involved in it—was a collaboration between the ministry, the World Health Organisation and the Fiji School of Medicine (FSM).

It was carried out in 2002, and although customarily held after every five years, the next STEPS survey for Fiji is due next month. The findings of the 2002 STEPS survey revealed alarming results. They showed a high indulgence of the population in the risk factors and indicated that Fiji had a sick population that was already moving towards NCDs vulnerability. “That survey showed that 36 percent of Fiji’s population smoke and of that, 42 percent smoked on a daily basis,” said Tukana. “That’s a big chunk, and the problem with smoking is the passive smokers—people who don’t smoke but are exposed to it—have four times more chances of getting cancer than those who actually smoke.   “The other big problem was eating. The survey found that only 1.25 percent of our population ate enough fruits and vegetables a day. To take enough fruits and vegetables a day, we are talking about a daily intake of 400 grams of fruits and vegetables. So that begs the question: what are the rest—99 percent of the population—eating?” 

Of the three types of foods—energy giving, health giving and body building—Fiji was having problems with people not eating enough health giving foods, which include fruits and vegetables. The subtle social changes over the years leading up to 2002 had culminated into a population that had made a significant lifestyle shift—towards one that predominantly survived on fast-food. “That’s where Fiji’s population is moving,” said Tukana.   “They eat a lot of fats and oils, foods with a lot of salt and sugar. The medical term for those kinds of foods is ‘high calorie’ where they give a lot of energy which you don’t really need. That actually creates another problem—people get bigger faster. “Compounded with not doing enough physical activities, it makes things worse. So our population has changed—it has moved from a physically active and fresh eating population to a now ‘fast-food-eating-and-glued-to-TV-and-games’ one, starting from our children.”  
The 2002 survey found that out of Fiji’s population aged between 15-64 years, 29.9 percent was overweight and an additional 18 percent was obese. The evidence collected indicated that most people were getting obese by the time they reached their thirties, which implied, according to the survey report, that the younger population in Fiji was gaining weight faster. 

Fat, unhealthy children

If the adults had not been aware of or least bothered by the dangerous path they were treading, the cost, it would seem, is a very steep tax on tomorrow's workforce. In a more recent survey done by the Fiji School of Medicine, it could be gauged that Fiji’s high school children—who would have been at primary school level in 2002—turned out to be as ill-aware as their parents of the perilous journeys they were taking.  

The FSM survey found that most of them tended to indulge in eating junk foods, were not doing enough physical activities and were overweight. “It showed that in our younger population, the risk factors are increasing. There are more bigger children who are not physically active. They are eating more junk food and are likely to get suffer from NCDs earlier than us [adults],” said Tukana. Children as young as 15 years old were suffering from stroke, diabetes and obesity, according to the findings of the FSM survey.  

This takes the issue of NCDs to another level, one that sees the health ministry trying to mete out preventative measures for Fiji’s adult population and the younger population as well. Clearly burdened by NCDs, the health ministry in its Strategic Plan 2011-2015, noted: "The growing burden of non-communicable diseases is demonstrated by the NCD STEPS Survey of 2002. This reported a prevalence rate of diabetes at 16 percent and hypertension as 19.1 percent. The report also highlighted that a third of all deaths were due to circulatory diseases. The prematurity of NCD deaths especially is becoming an economic and development issue, as the age of men dying from CVD (Cardiovascular diseases) falls every year." 

Again in its 2009 annual report, the health ministry acknowlegded the "challenge of reducing the burden of NCDs is enormous. CVDs, Diabetes Mellitus and cancer prevalence continue to increase, creating more threat to the limited resources that we are equipped with. However, our hope is in educating the young people to avoid the 'risk factors' that will lead to the early development of these diseases."  

The annual report said a 2002 study by the World Bank and the Secretariat of the Pacific Community revealed NCDs to account for 38.8 percent of all treatment costs. It may seem like a one-sided affair with a single government arm trying to fend off this ghastly spectre and a population that may not be getting the message despite millions of dollars being poured into creating nationwide awareness. 

That NCDs are lifestyle diseases makes this an uphill battle—people generally ignore the warnings until it’s too late, said Tukana.  And for those who have been diagnosed with it, they are prone to continue to live their unhealthy lifestyles as if accepting that their end is near and ignore medical advice that if they change their eating habits, cut down on smoking, drink less and do more physical activities, they could still live a quality life. 

“It’s a silent killer. We are walking around and we don’t know that we have one of the NCDs. It’s in the lifestyle and it doesn’t happen overnight. It’s not like I eat a lot of junk food today and I get sick tomorrow. All that bad habits accumulate and then after 10, 15 years, it shows. If you have a strong family history, then it comes earlier than that,” Tukana said.  “One of our biggest problems during the awareness campaigns is people tend not to heed the warning until they have the disease. That’s probably the way we do things in Fiji—we are more reactive than proactive. But the campaigns are slowly getting through.  We are especially working hard on children, first because it’s a chronic disease—our statistics show that people are dying early, in the early thirties, so they would have been developing the diseases much earlier when they were children. Secondly, 60 percent of Fiji’s population anyway are under 30 years old, so it makes sense for us to move to the youth and children, to create awareness there with the hope that we can change the mindset.” 

Intervention 

Death statistics released by the health ministry in its annual report paint a bleak picture about the health of the nation. Each year, the dying were getting younger, the death toll spiking at between 45 and 49 years old, averaging 400 annually. 

Tukana related an analogy that he often shared with his audience when deliberating on Fiji’s NCD status.  “I always say it’s equivalent to a Boeing 747, carrying its full capacity of 400 people, crashing each year and killing everyone onboard,” Tukana joked. “Because that’s what it is—it’s like, every year, since 1996, one of these Boeing 747s takes off with 400 45-49-year olds, crashes and kills them all.”

It’s relatively more difficult, said Tukana, to change the mindset of adults, despite such glaring evidence, than it is to change the younger population. For now, government intervention through relevant policies is needed in order to control NCDs in the adult population. Tackling NCDs by managing the four risk factors—smoking, eating, alcohol and physical activities—is the best way to go, said Tukana.

“You cannot stop the disease coming to you but you can delay its arrival. Now it’s arriving too early and taking people too early. Only 15 percent of the population are over 50 years old, which tells you that people are dying early. A joke I usually share with civil servants is if we are not careful, we will not get our FNPF (pension),” said Tukana. 

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NOTE: This article was published in the Fiji Business Magazine as: "Fiji's Silent Killers"; pp 3-5, January 2011 edition.  Fiji Business is part of Islands Business Magazine, available in Fiji and to subscribers.

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