Economics of public health in the South Pacific: an overview of health status, health services and health expenditure in Fiji, Solomon Islands, Vanuatu, Tonga, Western Samoa and Kiribati.

The Pacific Islands comprise a wide range of health situations which vary from high mortality patterns with a traditional cause structure of morbidity and mortality (infectious and respiratory disease and undernutrition), through transitional stages, to low mortality patterns with a modernized cause structure (cardio-vascular disease, injury and neoplasm). Populations in the intermediate range often have a combination of health problems related both to modernization and to underdevelopment. The health care systems in the Pacific Island countries under consideration are mainly governmental, and no information was obtained on the private modern sector or the traditional sector. Health care funding is complex because often a large proportion of expenditure emanates from bilateral or multilateral aid donors, and thus central government expenditure on health significantly underestimates spending by the Ministry of Health. There is a wide range of population:hospital bed ratios and population:health staff ratios in the various Pacific Island countries, and apparently different degrees of emphasis on prevention and primary health care. Health departments are impeded in their attempts to improve health status in the populations they serve because many important determinants of health status (such as water supply and sanitation, education and food availability) are outside of what is traditionally defined as the health sector. The public health and preventive sections of health departments are usually small and often orientated in very narrow and sometimes inappropriate directions. The health requirements of Pacific populations depend on their level of socioeconomic development, which determines the levels and cause structure of morbidity and mortality, and their respective positions in the demographic and health transitions characteristic of developing countries