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HEALTH PROMOTION INTERNATIONAL
© Oxford Univenity Preu 1996
Vol. 11, No. 4
Printed in Great Britain
Healthy Islands—a truly ecological model of health
promotion
In March 1995 the Health Ministers of 14 Pacific
island nations signed the Yanuca Island Declaration on Health in the Pacific in the 21st Century
[World Health Organisation (WHO), 1995]. The
conference of Ministers of Health was organised
by the Western Pacific Regional Office of WHO
to examine strategies to promote and protect
health and to support health system development
which meets the unique health challenges of Pacific islands, and is sensitive to the social and cultural values of Pacific island societies.
Pacific island countries share many common
features in terms of geography, population size,
socio-economic status, colonial history, culture
and, especially, fragile ecosystems. The somewhat
glamorous picture of tropical paradise which is
presented through a travel agency on a cold winter's day, whilst visually accurate, masks the
many health, social, economic and environmental
problems which are faced by Pacific island countries.
Most islands are economically poor, in many
cases struggling to make the most of limited
resources to develop their economies and provide
essential health and social services for their
people. Economic development is restricted by
the small size and small populations of many
islands, which place severe limitations on the
development of natural resources. This is compounded by a remoteness which many of us find
difficult to comprehend. For example, the smallest
of the independent island nations which signed
the declaration was Niue, which is a coral atoll
with a population of little over 2500 people, a
land mass of 259 square kilometres, and which is
2500 km from the nearest large land mass, in this
case New Zealand.
There has been past over-exploitation of natural resources; for example, mining for phosphorus on the island of Nauru has seriously
compromised the physical environment of that
island. Whilst relative wealth has provided some
compensation in the present, for the future the
quality of life and health of the population on
that island may be seriously compromised as a
consequence. Present colonial exploitation, such
as the use of a Pacific atoll as a nuclear bomb testing site, may have future, yet unforeseen consequences for the environment and health of the
populations of the nearest islands.
The relationship between economic development and the management of the very fragile physical environment of the islands is intimately
bound up with the present and future health
status of Pacific island populations.
For these reasons, economic development,
environmental management and health promotion are linked to a much more tangible and
immediate way than is apparent in larger and
more developed countries, where greater wealth
and the complexities of economic and social systems provide substantial buffers.
In the Pacific islands, health is much more
overtly considered as a resource in itself, and is
seen from an holistic perspective. This holistic
understanding of health is evident in the Yanuca
Island Declaration which defines 'Healthy
Islands' as places where:
• children are nurtured in body and mind;
• environments invite learning and leisure;
• people work and age in dignity;
• ecological balance is a source of pride.
Such a perspective, which comfortably binds
human and environmental health into an ecological whole, fits very easily with our contemporary
understanding of health promotion. The health
promotion strategy of creating supportive environments for health has real meaning in such circumstances.
The situation in the Pacific islands provides an
especially good illustration of the importance of
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Don Nutbeam
creating meaningful partnerships between the sectors of society concerned with wealth generation,
environmental protection and health advancement. For example, preserving the ecological balance by effectively managing development is as
important for the future of wealth-generating
tourism—maintaining the very physical beauty
which attracts tourists—as it is for health.
The Fourth WHO International Conference on
Health Promotion is currently being planned. It
will be held in Jakarta, Indonesia in 1997 and the
major theme of this conference will be the development of new partnerships in health promotion
to meet global health challenges into the next century. Partnerships between and within governments form an important part of this.
Intersectoral collaboration, and international
co-operation are a matter of necessity among
Pacific island nations, not the abstract, conceptual
ideas which have been so often discussed but so
difficult to practice in many countries. For example, the governments participating in the Yanuca
Declaration have committed themselves to cooperation in the development of health professional education and training through the Fiji
School of Medicine, to co-operation in the purchase and distribution of medical supplies and
equipment and, alongside this, to co-operate in
the investigation and documentation of traditional and herbal medicines which can be used in
Pacific island countries. In addition, the countries
have agreed to establish an inventory of human
resources in health—skills and expertise—and to
promote access to and utilisation of this expertise
by all nations.
The 'Healthy Islands' initiative is being fostered
by WHO'S Western Pacific Regional Office, and is
presently supported by Australia's largest donor
agency AUSAID. Although the 'Healthy Islands'
initiative is in its early stages of development, it is
beginning to attract attention and achieve a profile alongside other WHO-supported programs
such as Healthy Cities and Health Promoting
Schools. Because the interlinking of problems of
economic development, environmental protection and health advancement are so clear in these
countries, the concept of a 'Healthy Island' is
more easily understood by the people and their
governments. The approach taken to problemsolving in the Pacific island countries is already
providing valuable lessons for the future in health
promotion. It is important that these efforts to
promote health within a truly ecological framework are supported and carefully monitored for
all our benefits.
We need to watch with interest, contribute
where we can, and learn from our colleagues in
the Pacific islands.
Don Nutbeam
Regional Editorfor the Western Pacific
REFERENCE
World Health Organization (WHO) (1995) Yanuca Island
Declaration. WHO, Regional Office for the Western Pacific,
Manila.