Diabetes in the Marshall Islands

Far into the waters of the Pacific Ocean, lies a strip of land which holds within it a unique and fascinating culture. Sadly, that island’s culture is slowly being undermined by Western culture.

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The Marshall Islands has been suffering several epidemics such as diabetes and other non-communicable diseases due to unhealthy diet and lack of proper nutrition. Marshallese have influenced their traditional eating styles by the western eating styles, causing great problems.

This report consists of three sections. Section 1 discusses the affects of a slowly developing country on the Marshallese diet. Section 2 discusses how the epidemic of diabetes has worsened due to the loss of culture and the difficult task of bringing old eating traditions back. Section 3 discusses improvements in which have been done to the epidemic and the greatest benefactor that has been granted to the Marshall Islands.

This essay will hopefully provide a shocking realization of why Marshallese people and many others need to act now. Prevention of other Marshallese suffering what most of their ancestors have suffered needs to start now.

Section 1: A Shift in the Daily Diet of a Marshallese Person Through the 1940s in the Marshall Islands, statistics did not exist about non-communicable diseases caused by unhealthy eating habits. The Marshallese people’s daily diet consisted of fish, breadfruit, pandanus, and coconuts.

Not one person ate canned foods with added preservatives. Marshallese people during that era were not as dependent on the US Government compared to Marshallese people now. Due to the Marshall Islands’ isolation from other developed countries, prices for importing goods are costly for its economy.

This situation forces Marshallese people to buy the cheapest foods, which are canned and compounded. Now, with their desire of adopting Western culture ways, Marshallese people often choose imported foods over local foods. (JN, 2013)

To make matters worse, the population has risen disproportionally in Majuro because more Marshallese people are moving there in order to enjoy a more Western culture. According to the 2011 RMI Census Report, nearly 27,800 people lived on a landmass of 3.75 square miles. People move to Majuro because it is the capitol of the Marshall Islands, and most of the importing of goods takes place there. (Ibid)(RMI Census, 2013)

Marshallese people now depend heavily on canned foods, accounting for 80% to 90% of their daily calorie intake. Meanwhile in the outer islands, that have declining populations, local foods still make up 50% to 75% of their population’s calorie intake.

The main reason why those horrific statistics on canned food calorie intake in the Marshall Islands exist is because few Marshallese families have enough money in order to buy healthy foods due to the expense. In addition, they lack knowledge on how to prepare the foods and the capability of acquiring a taste for them. (Today’s, 2008)

According to a study done by students from the Washington University School of Medicine, 95% to 98% of the stores surveyed in Down Town and in Delap lacked variety of food choices. This means that most of the stores supplied basic Marshallese essentials in which are white rice, canned meats high in fat and sodium, alongside a scarce amount of fresh fruits and vegetables. In addition, they did not supply healthy alternatives for the Marshallese staple foods. For example, only 18.5% of the stores had canned tuna in water while 92.6% of them had canned tuna in oil. (Pacific Journal, 2013) During the study, researchers categorized the stores into two types: walk-in and walk-up.

Walk-up stores are the small stores that have no entry for customers and only a window for them to see what items they need. Walk-in stores are stores like Island Pride that display grocery items in aisles and customers handle them. Although walk-in stores scored remarkably higher than walk-up stores in terms of variety, they scored less when it came to the price of their items. This dilemma encourages a majority of local Marshallese families to visit walk-up stores more than walk-in stores. (Ibid)

Section 2: The Difficult Task of Improving the Marshallese Diet In a report issued in 2008, it stated that the Marshall Islands is among the several countries with soaring numbers of type 2 diabetic patients. The survey consisted of different age and sex categories. For example, 75% of 15 year olds are diabetic and 50% of those older than 35 years old are as well. These numbers indicate the reason why in 2008, 50% of all surgeries conducted in Majuro Hospital were amputations due to diabetes. Recently, president Christopher Loeak declared a Non-Communicable Disease Crisis. (Today’s, 2008)

Beyond diabetes, the unhealthy Marshallese diet can cause Vitamin A deficiency, iron deficiency, and anemia in young children. In a survey that collected data from 919 children in the Republic of the Marshall Islands (RMI) from the ages of 1 to 5, 59.9% of them suffered Vitamin A deficiency. Several symptoms of Vitamin A deficiency are night blindness, a low immune system, but more importantly morbidity and mortality. (SciVerse, 2003)(Nutrition Journal, 2004)

According to the New York State Department of Health, morbidity is a severe illness in which can kill a person while mortality means a person is definite of dying. In a 2009 report, the World Health Organization reported that the Marshall Islands has a mortality rate of 961 per 100,000. The 2009 Millennium Development Goal Report, presented by Ben Graham, stated that Goal 6 of combating diseases would not be met by the year 2015. (NYSDH, 2013)(World Health, 2009)(MDG Report, 2009)

The main reason why the Marshall Islands struggles to improve every person’s health, is because of overpopulation and limited funds on a small island. There is an island on the other side of the Pacific that found itself in similar circumstances prior to 2006 but worked to do something about this problem. It is called Alert Bay in which is off the coast of Vancouver Island, British Columbia. Although it has a greater landmass than Majuro, it has a small population of 1,500 people in which eases the task of combating diseases for them. (Bissell Mary, 2008)

It suffers a loss of culture just as the Marshall Islands has. Dr. Jay Wartman believes that “food is our culture”. However unlike the Marshall Islands, this island acted in 2006 to combat the epidemic of diabetes they were suffering. Multiple citizens decided to go on a year long diet of traditional foods that ultimately changed their lives. (Ibid)

Dr. Jay Wartman, from the University of British Columbia, conducted the project with the motive of bringing back old, traditional eating styles and to eliminate western eating styles. One of the local residents, Art Dick, has witnessed the changing eating habits of everyone on the island due to culture loss.

“We used to go out and get what we want to eat,” he says because there is now a scarce amount of local foods. Since Alert Bay’s local fishing industry collapsed, the great loss of local foods has created a “threat to food supply which jeopardizes culture”. In order to bring back some of that culture, participants were not allowed to eat any carbohydrates in which were replaced by traditional foods during their “Big Fat Diet”. (Ibid)

As the study gained attention, more people started to join the fight against diabetes. Within four days of the diet Art Dick, who suffered from diabetes, was able to stop using 75% of his medications that kept control of his diabetes and blood pressure. Another participant, Jill Cook, who had been on various diet programs prior to this diet, was finally able to lose 63 pounds by the end of the program. (Ibid)

With the extraordinary things the diet has been able to do for its participants, it would seem wise to start a “Big Fat Diet” on Majuro. However, it would not be an easy task to take on in the Marshall Islands. Alert Bay has a population that is only 1/8th of Majuro’s population and more money available to its residents. In addition, there is only one supermarket that supplies all the fruits and vegetables available in Alert Bay. With only one option for a store, participants are more capable of watching what they eat and making better choices.

Marshallese people have it more difficult because there are more than a hundred different supermarkets available to them. As stated before, most stores supply the same unhealthy items but in varying prices. One of the participants was able to lose 20 pounds within two months of the diet because one of his methods was to simply spend more time in the supermarket.

Most stores on Majuro are walk-up stores, and are usually more preferred by the Marshallese people than walk-in stores. It is a difficult task because the first priority of all Marshallese parents is to put food on the table, even if it is only white rice smothered in Soy Sauce.

Section 3: Past Efforts to See Healthier Marshallese People
In the mid 1970’s, Jamie and Jacque Spence left their careers in order to sail across the Pacific Ocean. Thinking they would find themselves in tropical paradises, they were stunned to find horrific things about the islands’ people instead.

They discovered that the people of the Marshall Islands were suffering due to health issues and their futures seemed hopeless. Arriving back to the United States in 1981, the two started the construction of a catamaran, named Canvasback, which would later aid those in need throughout the Pacific and helping them learn healthier lifestyles. (Canvasback, 2013)

They specifically built their vessel to be capable of delivering equipment needed for medical, dental, and eye care. In addition, the vessel was designed to deliver 200 dedicated and skilled volunteers that consisted of professional physicians and dentists who worked a period of two to six weeks.

Within four years of providing health care, education about good health, and supplies to local hospitals, Canvasback Missions spent more than 4.1 million US dollars to accomplish their mission. After 14 years of successful programs and services, the US Congress donated Canvasback’s replacement which was the US Coast Guard cutter named White Holly. Eventually the creation of the Diabetes Wellness Center embarked in 2005. (Ibid)