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Childhood Obesity: U.S Pacific
George CruzPacific Partners for Tobacco Free IslandsPat LucesPacific Chronic Disease CoalitionNia AitaotoAdvisor/Advocate
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Pacific Islanders: Who we are?
Polynesians Hawaiians, Samoans, Tongans, Maori, Tahitians,
Cook Islanders, etc.
Micronesians Chamorros, Carolinians, Chuukese, Pohnpeians,
Yapese, Marshallese, Palauans, Kosraeans, etc.
Melanesians Papuans, Solomon Islanders, Fijians, Vanuatu
Islanders, etc.
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U.S Pacific
Territories (Guam & A.S) Commonwealth (CNMI) Freely Associated States
(Republic of Belau, Republic of the Marshall Islands and the Federated States of Micronesia)
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History
Rock IslandsRepublic of Palau
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Early 1800’s: What the first Europeans saw…
Early 1800’s Carolinians on the Island of TinianSource: Micronesian Seminar
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History & Colonization
Spanish German Japanese American
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Early 1900’s: Germans & Japanese Era
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Early 1900’s: Germans & Japanese Era
Palauan
Traditional
Healers
Source: MicSem
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After World War II (mid 1940’s)
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Change of Diet & Physical Activities
Marshall Islands Kwajalein Atoll
1944
Source: MicSem
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Relationship with U.S
The Promise Health Education Protection
The Reality High Poverty Disparity in Health Spending Migration to the United States
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Per Capita Health Budget
$4,700
$614 $510 $320 $151 $143 $128 $92$0
$500$1,000$1,500$2,000$2,500$3,000$3,500$4,000$4,500$5,000
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WHO Top 10 Obese Countries
1. Nauru 94.5%2. Micronesia 91.1%
*CNMI 91.1%3. Cook Islands 90.9%4. Tonga 90.8%5. Niue 81.7%6. Samoa 80.4%7. Palau 91.1%8. Kuwait 74.2%9. U.S.A 74.1%10. Kiribati 73.6%
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CNMI Saipan
Chamorro 33.6% overweight47.3% obese 6.1% extremely obese 87% overweight obese
Carolinians 22.2% overweight50% obese16.7% extremely obese88.9% overweight obese
Other Pacific 42.9% overweight50.0% obese7.1% extremely obese100% overweight obese
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Diabetes Rates
American Samoa 47.3%
CNMI 35.0%
FSM 24.4%
Guam 9.2%
Palau 38.9%
Marshall Islands 29.8%
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Health Concerns Non-Communicable Disease
Heart Disease & StrokeDiabetesCancer (Tobacco Related)
Communicable DiseaseTuberculosisMeasles Sexually Transmitted Disease
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Health Concerns
Hansen’s Disease Dengue Hepatitis B
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That was not always the case…
1940’s U.S Navy health survey Found: intestinal parasites,
yaws, tuberculosis and skin diseases
Complete absence of malnutrition or obesity
No indication of diabetes Almost no hypertension
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Globalization & Health Western Diet but lack Western Med and
Tech Traditional Healing
Model Spirit – Mind - Body Health Delivery
Western Medical Model
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Obesity & Pacific Individual Level
Cultural beliefs Attitudes
Relationship Collectivistic Strong Family/Clan influence
Community Social Justice Poverty and Hardship Racism and Discrimination
Organization Lack of Data and Analysis Obesity NOT a priority
Societal Health Policies Access (health, housing, social
services, etc.)
Paddling to the Outer Islands
Chuuk – Lagoon Islands
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Needs
Assessment (Information) Research (Unique Health
Issues) Culturally appropriate health
care system Culturally appropriate outreach More Pacific Islanders in
Health Care Field Pacific Islanders: learn how to
navigate in the new system.
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Coalitions in the Pacific
Driftwoods
Laura, Marshall Islands
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Pacific Partnership for Tobacco-Free Islands
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Coalition Members
American Samoa Dottie Siavii Roseann Tuiasosopo
CNMI Rebecca Robles George Cruz
Guahan Gil Suguitan Roselie Zabalas
FSM Wahlberg Hadley Shra Alik
Marshall Islands Ione deBrum Donny Andrike
Palau Kambes Kesolei Roman Oseked Sr.
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Partners Legacy Papa Ola Lokahi Tobacco Technical Assistance Consortium Queens Medical Center (Hawaii) American Cancer Society Kellogg Foundation Asian Pacific Partners for Empowerment,
Advocacy and Leadership Asian Pacific Island Health Forum Pacific Chronic Disease Coalition Cancer Council of the Pacific Islands
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Mission Statement
To weave together our resources, appropriate practices and experiences; and drawing strength from our cultures and relationships for a Tobacco-Free Pacific
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Five Year Action Plan 2008-2013
Share successes, struggles and experiences Guam Meeting March 2007 NCTOH - Minnesota, Oct. 2007 Hawaii Gathering April 2008 NCTOH - Arizona, June 2009
Improve tobacco programs in the region Brief tobacco intervention training in CNMI and FSM
(Trainers from Guam) Regional Intense tobacco intervention training in Guam
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Advocacy International
World Tobacco Conference (India) WHO Philippines World Tobacco Framework
U.S Federal CDC Office of Smoking and Health Office of Minority Health NIH NCMHD HRSA
Pacific Regional WHO – Western Pacific Regional Office Pacific Islands Alliance of Non-government Organizations Pacific Islands Health Officers Association
Pacific Jurisdiction FSM – Tobacco Law Amendment Guam – Increase Tobacco Tax ($3.00 tax per pack) CNMI – Smoke-Free Air Act Palau – RJ Reynolds donation to Palau
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Five Year Action Plan 2008-2013 continue Develop a monograph of successes and
resources
Establish and publish local best practices SOPHE Journal of Health Promotion and
Practice (in progress)
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Regional Challenges
Legislation for Tobacco Control & Taxes Enforcement of Existing Laws Increase Tobacco Sponsorship of Events Little or No Implementation of the FCTC Betel Nut and Tobacco
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American Samoa: (2) Loata Sipili TBA
Commonwealth of the Northern Mariana Islands: (2) Tayna Camacho TBA
Federates States of Micronesia: (5) Kipier Lippwe (National
Coordinator) – Vice Chairman
Robina Anson (Pohnpei) Moria Shomour (Chuuk) Frank Limfang (Yap) Maria Mongkeya (Kosrae)
Guam: (2) Patrick S Luces - Chairman Lawrence O. Alam
Republic of the Marshall Islands: (3) Ione deBrum (Majuro) –
Secretary/Treasurer Johannes Seremai (Ebye) Donny Andrike (Outer Islands)
Republic of Palau: (2) Yorah Demei TBA
Members
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Pacific Chronic Disease Coalition’s Vision
Prosperous Pacific people living a healthy lifestyle in a healthy Pacific environment.
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Pacific Chronic Disease Coalition’s Mission
Reduce the Chronic Disease Burden Bridge the Gap in Disparities Share & Mobilize Resources Advocate with Policy Makers and Recognize the Uniqueness of the Pacific Islands.
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PCDC Activities Collaborated w/ Pacific Partners for Tobacco Free Islands
Hosted an integrated Diabetes, Tobacco, Cancer conference in Honolulu, May 2008
UH – Dept of Native Hawaiian Health Collaboration NIH Funded – Diabetes needs assessment in all PIJ.
FASC Recommendations for improving capacity and infrastructure for diabetes programs in the PIJ. Office of Global Health & CDC
Professional development training NACDD Academy PDEP
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PCDC Collaboration
Pacific Chronic Disease Coalition & Pacific Partners for Tobacco Free Islands
PIHOA – Policies & Human Resources PCDC & PITCA collaboration
Association of Diabetes & TBSharing Resources Improving service for DM & TB patientsSharing of data and technology
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Obesity Project
Technical Assistance: Planning, Implementation and Evaluation
Resources: Pacific Island Obesity Council Training
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Kinnisow – Kommol – Kulo