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Diabetes Prevention and Care Programs in the US-Affiliated Pacific Islands: Challenges, Innovation, and Recommendations for Effective Scale-Up

  • Nicola L. HawleyEmail author
  • Rachel Suss
  • Haley L. Cash
  • Nia Aitaoto
  • Raynald Samoa
  • Britni Ayers
  • Pearl McElfish
Economics and Policy in Diabetes (AA Baig and N Laiteerapong, Section Editors)
  • 74 Downloads
Part of the following topical collections:
  1. Topical Collection on Economics and Policy in Diabetes

Abstract

Purpose of Review

This review describes some of the unique challenges faced by the US-Affiliated Pacific Islands (USAPIs) in addressing diabetes prevention and care and presents innovative population-level strategies that have been employed to address them.

Recent Findings

Challenges include an unhealthy food environment and a strained health care infrastructure, both compounded by geography. Innovations in addressing these challenges include attempts to modify the food environment, a focus on early life prevention, and task shifting among the health workforce. Many of the successful interventions share a focus on culture, community, and capacity building.

Summary

Although the USAPIs are uniquely challenged by environmental, structural, and health system barriers, there have been a number of innovative and successful strategies employed that highlight the resilience of these island nations in addressing their current disease burden when provided with the opportunity and resources to do so. Health policies to protect, support, and promote diabetes prevention and care are essential and may be informed by the interventions described.

Keywords

Diabetes US-Affiliated Pacific Islands Prevention Treatment Pacific Islander 

Notes

Compliance with Ethical Standards

Conflict of Interest

Nicola L. Hawley, Rachel Suss, Haley L. Cash, Nia Aitaoto, Raynald Samoa, Britni Ayers, and Pearl McElfish declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    GBD. Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease study 2016. Glob Health Metr. 2016;2017(390):1151–210.Google Scholar
  2. 2.
    • NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387:1513–30. Describes global prevalence and recent trends in diabetes, highlighting the disproportionate burden in the Pacific Islands. CrossRefGoogle Scholar
  3. 3.
    McElfish PA, Purvis RS, Esquivel MK, Sinclair KA, Ing CT, Hawley NL, Haggard-Duff LK, Keawe‘aimoku Kaholokula J. Diabetes disparities and promising interventions to address diabetes in native Hawaiian and Pacific Islander populations. Curr Diab Reps. 2019;in press.Google Scholar
  4. 4.
    International Diabetes Federation. IDF Diabetes Atlas, 8th edn. 2017. Available at: www.diabetesatlas.org. Accessed 18 Oct 2018.
  5. 5.
    Central Intelligence Agency. The World Factbook. Available at: https://www.cia.gov/library/publications/the-world-factbook/. Accessed 14 Oct 2018.
  6. 6.
    World Bank. Current health expenditure per capita. Available at: https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD. Accessed 2 Jan 2019.
  7. 7.
    McElfish PA, Hallgreen E, Yamada S. Effect of US health policies on health care access for Marshallese migrants. Am J Public Health. 2015;105:637–43.CrossRefGoogle Scholar
  8. 8.
    Howells L, Musaddaq B, McKay AJ, Majeed A. Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews. BMJ Open. 2016;6:e023806.CrossRefGoogle Scholar
  9. 9.
    Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck A, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012;55:1577–96.CrossRefGoogle Scholar
  10. 10.
    Popkin B. Nutrition transition and the global diabetes epidemic. Curr Diab Rep. 2015;15:64.CrossRefGoogle Scholar
  11. 11.
    Hughes RG, Lawrence MA. Globalization, food and health in Pacific Island countries. Asia Pac J Clin Nutr. 2005;14:298–306.PubMedGoogle Scholar
  12. 12.
    Snowdon W, Raj A, Reeve E, Guerrero RLT, Fesaitu J, Cateine K, et al. Processed foods available in the Pacific Islands. Glob Health. 2013;9:53.CrossRefGoogle Scholar
  13. 13.
    Seiden A, Hawley NL, Schulz D, Raifman S, McGarvey ST. Long-term trends in food availability, food prices, and obesity in Samoa. Am J Hum Biol. 2012;24:286–95.CrossRefGoogle Scholar
  14. 14.
    Areta A. ASCC/CNR conference to focus on food security in American Samoa. Samoa News; 2009.Google Scholar
  15. 15.
    International Institute for Energy Conservation. Technical analysis of appliance markets to support the Pacific Appliance Labelling and Standards (PALS) Programme. 2012. Available at: https://www.reeep.org/sites/default/files/IIEC%20Country%20Report_Marshall%20Islands_8November2012.pdf. Accessed 2 January 2019.
  16. 16.
    Kahn S, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444:840–6.CrossRefGoogle Scholar
  17. 17.
    Hu FB. Globalization of diabetes. Diab Care. 2011;34:1249–57.CrossRefGoogle Scholar
  18. 18.
    NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.CrossRefGoogle Scholar
  19. 19.
    Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377:557–67.CrossRefGoogle Scholar
  20. 20.
    American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41:S1–S159.CrossRefGoogle Scholar
  21. 21.
    •• Carlin M, Mendoza-Williams A, Ensign K. Half an ocean away: health in the US-affiliated Pacific Islands. J Public Health Manag Pract. 2016;22:492–5. Excellent summary of health care challenges experienced by the US Affiliated Pacific Islands. CrossRefGoogle Scholar
  22. 22.
    Person DA. The Pacific Island Health Care Project. Front Public Health. 2014;2:175.CrossRefGoogle Scholar
  23. 23.
    Fiji National University, Pacific Island Health Officers’ Association. Cost of running dialysis in Freely Associated States. Available at: http://www.pihoa.org/fullsite/newsroom/wp-content/uploads/downloads/2014/07/COST-OF-RUNNING-DIALYSIS-IN-FAS-PIHOA-BOARD-MEETING.pdf. Accessed 26 Oct 2018.
  24. 24.
    Health Resources Services Administration. HPSA Find. Available at: https://data.hrsa.gov/tools/shortage-area/hpsa-find. Accessed 14 Oct 2018.
  25. 25.
    Braun KL, Kuhaulua RL, Ichiho HM, Aitaoto NT. Listening to the community: a first step in adapting Diabetes Today to the Pacific. Pac Health Dialog. 2002;9:321–7.PubMedGoogle Scholar
  26. 26.
    Braun KL, Ichiho HM, Kuhaulua RL, Aitaoto NT, Tsark JU, Spegal R, et al. Empowerment through community building: Diabetes Today in the Pacific. J Public Health Manag Pract. 2003;9:s19–25.CrossRefGoogle Scholar
  27. 27.
    Ichiho HM, Aitaoto N. Assessing the system of services for chronic diseases prevention and control in the US-affiliated Pacific Islands: introduction and methods. Hawaii J Med Public Health. 2013;72:5–9.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Hosey GM, Rengill A, Maddison R, Agapito AU, Lippwe K, Wally OD, et al. U.S. associated Pacific Islands health care teams chart a course for improved health systems: implementation and evaluation of a non-communicable disease collaborative model. J Health Care Poor Underserved. 2016;27:19–38.CrossRefGoogle Scholar
  29. 29.
    Pacific Islands Health Officers Association. Declaring a regional state of health emergency due to the epidemic of non-communicable diseases in the United States-Affiliated Pacific Islands. Board Resolution #48–01. Available at: http://medicaid.as.gov/wp-content/uploads/2015/10/PIHOA-Resolution-48-01-NCD-Emergency-Declaration.pdf. Accessed 26 Oct 2018.
  30. 30.
    Hoy D, Durand AM, Hancock T, Cash HL, Hardie K, Paterson B, et al. Lessons learnt from a three-year pilot field epidemiology training program. Western Pac Surveill Response J. 2017;8:21–6.CrossRefGoogle Scholar
  31. 31.
    Gittelsohn J, Dyckman W, Lynn Tan M, Boggs MK, Frick KD, Alfred J, et al. Development and implementation of a food store-based intervention to improve diet in the Republic of the Marshall Islands. Health Promot Pract. 2006;7:396–405.CrossRefGoogle Scholar
  32. 32.
    Englberger L, Lorens A, Pedrus P, Albert K, Levendusky A, Hagilmai W, et al. Let’s go local! Pohnpei promotes local food production and nutrition for health. In: Kuhnlein HV, Erasmus B, Spigelski D, Bulingame B, editorsd. Indigenous peoples’ food systems and well-being: interventions and policies for healthy communities. Food and Agriculture Organization of the United Nations Centre for Indigenous Peoples’ Nutrition and Environment: Rome; 2013. [25]Google Scholar
  33. 33.
    Englberger L, Marks GC, Fitzgerald MH. Insights on food and nutrition in the Federated States of Micronesia: a review of the literature. Public Health Nutr. 2002;6:5–17 [26].Google Scholar
  34. 34.
    Wilken LR, Novotny R, Fialkowski MK, Boushey CJ, Nigg C, Paulino Y, et al. Children’s Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity. BMC Public Health. 2013;13:944.CrossRefGoogle Scholar
  35. 35.
    Novotny R, Davis J, Butel J, Boushey CJ, Fialkowski MK, Nigg CR, et al. Effect of the Children’s Health Living Program on young child overweight, obesity, and acanthosis nigricans in the US-Affiliated Pacific region. JAMA Netw Open. 2018;1:e183896.CrossRefGoogle Scholar
  36. 36.
    Children’s Healthy Living Program. Training Program Overview. Available at: http://www.chl-pacific.org/training/program-overview. Accessed 26 Oct 2018.
  37. 37.
    Johnson K. Children’s Healthy Living Program presents: voices of the Pacific. CHL Trainess Project Status and Updates. Available at: https://prezi.com/x2vcxojyxj6c/childrens-healthy-living-program-presents-voices-of-the-pacific/?utm_campaign=share&utm_medium=copy. Accessed 26 Oct 2018.
  38. 38.
    DePue JD, Dunsiger S, Seiden AD, Blume J, Rosen RK, Goldstein MG, et al. Nurse-community health worker team improves diabetes care in American Samoa. Diabetes Care. 2013;36:1947–53.CrossRefGoogle Scholar
  39. 39.
    Rao M, DePue JD, Dunsiger S, Elsayed M, Nu’usolia O, McGarvey ST. Long-term impact of a community health worker intervention on diabetes control in American Samoa. Prev Chronic Dis. 2015;12:e180.CrossRefGoogle Scholar
  40. 40.
    Tokuda L, Lorenzo L, Theriault A, Taveira TH, Marquis L, Head H, et al. The utilization of video-conference shared medical appointments in rural diabetes care. Int J Med Inform. 2016;93:34–41.CrossRefGoogle Scholar
  41. 41.
    McLaughlin LA, Braun KL. Asian and Pacific Islander cultural values: considerations for health care decision making. Health Soc Work. 1998;23:116–26.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nicola L. Hawley
    • 1
    Email author
  • Rachel Suss
    • 2
  • Haley L. Cash
    • 3
  • Nia Aitaoto
    • 4
  • Raynald Samoa
    • 5
  • Britni Ayers
    • 6
  • Pearl McElfish
    • 6
  1. 1.Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenUSA
  2. 2.Yale CollegeYale UniversityNew HavenUSA
  3. 3.Regional Epidemiology UnitPacific Island Health Officers’ AssociationHonoluluUSA
  4. 4.Department of Nutrition and Integrative Physiology, College of HealthUniversity of UtahSalt Lake CityUSA
  5. 5.Department of Diabetes, Endocrinology and MetabolismCity of Hope HospitalLos AngelesUSA
  6. 6.College of MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA

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