Non-communicable diseases in Kiribati and Pacific Island nations

Botaki food

Early last year, I organised a free health check to come in to my old workplace. It was a free government initiative and I thought, why the hell not?  A nurse comes in with her medical gadgets, asks us a few questions and gives us an individual report and there you have it, easy as pie.

Most Australian’s know that when filling in a medical form there is usually a little box somewhere  that says ‘Do you identify as Indigenous Australian or Torres Strait Islander?’.  Obviously I don’t identify as either of these, so I usually just ignore the box and keep going through the rest of the form.

On this day, I was chatting to the nurse as she was taking my blood pressure and she started asking me questions.  ‘Do you exercise? How often do you exercise? Would you describe it as intense exercise? Describe your diet to me.’ etc.  Pretty general health questions.

And then I mentioned that I have a family history of diabetes on both sides of my family and that a big factor for exercise for me was due to this history.  She then stopped and asked ‘Do you identify as Pacific Islander?’


‘Why didn’t you tick the box?’

I looked back at the form and towards the box she was pointing to.  On second (and proper glance) the line she was notioning to was ‘Do you identify as Indigenous Australia, Torres Strait Islander or Pacific Islander?’

Huh? When did they add Pacific Islander on the forms?

Non-communicable disease is Kiribati’ biggest killer.  These types of diseases are also known as chronic diseases.  They are not passed from person, generally have a slow progression and cause approximately 36 million deaths worldwide a year.  Non-communicable diseases are highest in low middle income countries and the four main contributors of the disease are: tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets.

These four contributors are Kiribati in a nutshell.  And so no wonder Australian health forms are starting to ask if you’re Pacific Islander.  When being medically tested, the practitioners are aware that ethnicity places a major factor on your genetic make up and want to know what health risks you may be susceptible to.  Due to so many Pacific Islanders being in Australia and so many of them with health problems, it is now starting to be recommended that you tell your practitioner that you are Islander.

Diabetes and obesity influenced diseases are the biggest health worries in not just Kiribati but throughout all of the Pacific Islands.  I remember when I was little, we would be at the airport waiting to board Air Nauru to get to Kiribati and we’d sit there trying to figure out who were Nauruans and who were I-Kiribati.  The most obvious difference?  We followed the rule that ‘Nauruans are the fat ones and I-Kiribati are the small ones’.  My apologies to all the Nauruans out there that I just offended, I was 10!  Now I’m not too sure whether this same rule still applies.


Kiribati people are naturally small.  They aren’t the big islanders like Tongans or Samoans.  Their frames are small (like Marshall Islands and PNG) and they are much shorter than the other Pacific Islanders that look like The Rock.  Over the years I have seen the usually small I-Kiribati people get bigger and wider.  This is single handedly due to the amount of processed food now available on the island.  What was once a diet of coconuts, fish, rice, babai and pandanas is now replaced with copious amounts of sugar in tea (about a tablespoon of sugar per cup), 2 minute noodles and soft drink that has been imported onto the island.  Not many people drink plain water with the norm now being a cup of water with an added tablespoon of sugar.  The unhealthy, imported products in Kiribati are now considered a norm in the daily diet.

In 2008 non-communicable diseases (NCDs) in Kiribati accounted for an estimated 68% of all mortality and with life expectancy in Kiribati one of the lowest in the world at 64 years old, Kiribati’ future is not looking great.  The World Bank is trying to tackle this problem by implementing a Package of Essential NCD interventions which include programs in Kiribati that work with communities to grow vegetable gardens and organise sports activities and weight loss competitions.

But the thing that worries me is that Kiribati shouldn’t be waiting for these programs to come to them.  There are plenty of I-Kiribati people that live in other countries and are able to see how bad the Kiribati diet is.  They need to be going back home and try to reduce the amount of sugar in the cups of tea.  I try to be respectful of my elders and relatives in Kiribati but whenever I’m told to add six tablespoons of sugar to the pot of tea, I have my own silent victory when I only add three and I watch them drink it.  Sure, they walk away saying ‘that Nei Marita makes a terrible pot of tea’ but I don’t care.  I can’t bear to continue to add and extra three tablespoons to their health risks.

So I’m asking all Pacific Islanders to take your health into your own hands.  Drag your Mum out for a walk, ask your aunties to show you a new dance and start asking more men to fish and climb coconut trees for you instead of buying it.  64 years is a bloody young age to die and I’m not going to sit around let them eat the fat of the freshly cooked pork just for their little moment of ‘this is delicious’.

Get your family  moving and stop being respectful by adhering to their dietary demands and instead give them what they need, not what they want.

Kiribati Volleyball

5 Comments Add yours

  1. mareemax says:

    Oh my darling Marita, that is exactly what I’ve been hearing in my lectures for the past 3 days. Have taken myself off to uni to do a Master of Public Health and the school is the School of Population and Global Health. My eyes have already been opened wide to the many global health inequities and the plight of indigenous populations because of those very four factors. Australia is leading the work in curbing smoking but the tobacco companies target developing nations. Europe has just adopted our plain packaging laws. We still have a along way to go with food and when you look at the power of Nestle, Coca Cola and McDonalds and Monsanto you wonder who is controlling our food and ultimately our health. Great article. You will change the world. xx

    1. Oh Maree, if only I could change the world! I wouldn’t know where to start.
      Your studies sound fascinating. I am always dumbfounded how these major companies are so successful when all they are doing is increasing disease and health problems throughout the world. I just find it so confusing when people seem to not have a moral compass!
      The companies you mentioned are so prominent in Kiribati (except for McDonalds but they’re part of Coca Cola anyway) but it’s almost as if it’s their dumping ground. There are out of date chip packets for sale on the shop shelves and old promotional stock from China, Taiwan and Japan is everywhere. It’s disheartening to see but I’m also concerned that Kiribati residents don’t have the education or awareness to see this themselves. So much to change! Thanks for always reading my articles and responding to them. It keeps my drive going!

  2. Hey Marita, another excellent post and well done you for bringing us these terrible statistics about life on Kiribati, made up of so many “Robinson Crusoe desert islands”. And while i echo mareemax’s concerns about global health inequities and the plight of indigenous populations because of those very four factors, i tend to think your sound advice could help a lot of people in the western world too. Onwards!

  3. Eric Larson says:

    You might add rice as one of the culprits. It’s an easy, imported source of starch/sugar and one more reason diabetes is so high. Hard to see an easy solution to this one. It’s very difficult to grow crops in the coralized soil. That said, you are absolutely right: adding more exercise to one’s day and adding more coffee to one’s sugar would help! (Another way of saying: stop loading your coffee or tea with seven teaspoons of sugar!)

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