x Abu Dhabi, UAE Thursday 20 July 2017

It was only after losing its wealth that Nauru began to get healthier

Hugo Berger looks at the lessons developing nations can draw from Nauru in stopping the rise of type-2 diabetes.

The island nation of Nauru in Micronesia saw a dramatic rise in type-2 diabetes when per capita income skyrocketed. Planet Observer / Universal Images Group via Getty Images
The island nation of Nauru in Micronesia saw a dramatic rise in type-2 diabetes when per capita income skyrocketed. Planet Observer / Universal Images Group via Getty Images

Earlier this year The Review caught up with Dr Manal Taryam, an Emirati ophthalmologist who is at the vanguard of treating diabetes-related blindness in the UAE. Dr Taryam told us that, thanks to the efforts of the government's health authority, incidence of type-2 diabetes - the kind that's often linked with obesity - were on the wane.

In fact, its occurrence had dropped so much that whereas the Emirates had, in 2008, been second-worst in the world for rates of the disease per capita, it had fallen to 10th by 2011.

One nation continuously used to supersede it on the list and that place was Nauru, a minuscule island state located in a remote corner of the South Pacific.

Back in 2008, figures from the World Health Organisation showed that one in three of its population of just 11,000 people (although the CIA's World Factbook estimates that figure will have shrunk to 9,368 by July this year) were afflicted with diabetes. So how did this come about?

Nauru's journey towards its health crisis can be traced to the huge deposits of fossilised bird droppings that used to be found on the island. The phosphates in this natural resource make excellent fertiliser, and that led to it being prodigiously mined, first by foreign companies, and then, after Nauru won independence from Great Britain in 1968, by the islanders themselves.

Such droppings brought untold riches and by the 1980s, Nauru was the wealthiest per capita nation on Earth. And like many other nouveau riche, they abandoned their traditional lifestyles and diets and adopted western habits such as overeating, drinking and smoking. Consequently, rates of diabetes, heart disease and other chronic illnesses skyrocketed.

However, by the turn of the 20th century, the phosphates had all but run out, with the island's lush interior ravaged beyond recognition by mining.

With its natural resources depleted, from 2001 to 2007, the Nauru government consented to house a detention centre for immigrants seeking asylum in Australia in return for a generous aid package.

By then, the Nauruans had squandered much of their wealth, on both opulent living and bad investments, meaning that, by a cruel twist of fate, they lacked the capital to fund treatment for the conditions affecting their well-being.

This is where the World Diabetes Foundation stepped in, offering finance and expertise to the island's government.

Heading this mission was Dr Ruth Colagiuri, an associate professor at the University of Sydney, who has spent considerable time on Nauru coordinating its healthcare programmes. She recalls the severity of the situation on her inaugural trip there.

"On my first visit to Nauru in the early 1990s, diabetes was rampant and there weren't the facilities to cope," she remembers. "A large number of the people with diabetes were suffering from amputations and blindness."

Dr Colagiuri set about attempting to curb the problems.

She says: "We asked,'what were the recommended standards of diabetes care internationally, and how could Nauru progress towards them, recognising that there were resource constraints? Could Nauru meet the same standards as Australia, the US or the UK, or if a certain level of care couldn't be achieved, what would be the next best thing?'

"We had to change the way the health system worked. This meant changing policy to demonstrate to the government that if people got better care it would reduce costs. The better controlled diabetes is, the less likely the people were to have complications. And so we saw hospital admissions fall by a huge amount."

All of this has had to be achieved with limited funds.

She says: "It had to be within their resources, because money wasn't going to fall from the sky. Ultimately funding has to come from their own budgets and the government was convinced it had to make these things a priority, because of the impact on their productivity."

Such was the success of this mission that rates of diabetes dropped from more than 30 per cent of adults in 2008, to around 16 per cent last year.

Yet, Dr Colagiuri readily admits other factors also contributed to this reduction.

"Obviously the rapid rise of affluence and then its sudden fall meant that noncommunicable diseases fell too. It's an incredibly salient illustration of external forces on these kind of diseases. They were the wealthiest nation on Earth per capita, now they're back to being one of the poorest. This is a tough way to lose your diabetes problem."

Yet, as they were forced to give up their extravagant lifestyles, their impoverished existence created other health issues.

"They still fish, but 90 per cent of the fish that's hauled from the sea is shipped overseas. People who live there cannot afford to eat their own fish. So they're reliant on a ship that comes every six weeks and [richer nations] tend to offload all the worst food to these poor countries around the world. They're not eating such extravagant western diets any more, but they tend to eat tinned Spam and other fatty foods that are just doing them harm."

Although the UAE is clearly not in any danger of seeing its primary income source disappearing overnight, as happened in Nauru, Dr Colagiuri believes that both countries could learn from each other's examples.

"On paper, there doesn't appear to be any similarities between [the UAE] and Nauru," she suggests. "But yes, both have come into wealth very quickly and are suffering the consequences of it.

"The Nauruans had previously been living a traditional lifestyle where they got plenty of exercise and lived off root vegetables and fish. So there was little or no diabetes back then. But I think what it does show is that you can make a difference in affecting these conditions, without huge resources.

"You just have to focus on getting the basics right. You don't [always] need top-of-the-range equipment. As long as you have a well-trained staff, diagnose cases early and get the right medications, you can make a real difference."

There are also stark lessons for other developing nations to learn from Nauru's story, although Dr Colagiuri predicts these were not likely to be heeded.

"The situation there shows that we have to manage our societies better and so-called advances in technology and living standards," she contends. "When these nations become rich, in many ways we are powerless to stop the effect it will have on their people's health and well-being.

"But we have to make low- and middle-income countries aware that wealth generation does bring with it a huge range of other problems.

"But can we in the wealthy countries really tell the developing world to avoid these kinds of traps? You know, TVs, mobile phones, big cars are all very seductive and enticing. And if you've been poor all your life, can you really stop them wanting all these luxuries? I guess they have to live through their own experiences."

Hugo Berger is a features writer for The National.