Community priorities following disaster: A case study from Tonga

Disaster victims have been thought to be disoriented and irrational to express their needs. Therefore they have been largely assessed through external observers. However, this study in the South Pacific Kingdom of Tonga suggests that disaster victims were capable of prioritising their needs to guide the provision of immediate help and later rehabilitation programmes. Some inconsistencies in the experiences of this study sample compared to large developing population centres (e.g. low disease prevalence after the cyclone) highlight the need for special consideration of small island states separate from those of the developing continents. Overall, this study explored a method of giving the community an opportunity to participate in their rehabilitations after a disaster. The validity of this approach needs to be tested for other communities.community participation disaster South Pacific food consumption sanitation health status

Marketing and primary health care: An approach to planning in a Tongan village

Expensive health facilities have failed to meet most health needs. This perceived failure has been interpreted as failure of scientific medicine with subsequent alienation of health facilities. It is therefore necessary to develop primary health care (PHC) programmes shaped around the life patterns of the population it serves. This paper discusses the similarity between marketing concept and providing PHC, and as it was applied to development planning in a village of the Kingdom of Tonga. The issues, circumstances, and approaches discussed, reflect what is desirable from the villagers' viewpoint. In the absence of epidemiological data, there was greater reliance on the villagers' observations to rank priorities. The process of arriving at the final objectives used the marketing approach to provide direction and guideline for discussions of the problems. Marketing can be of assistance in the search for more acceptable and accessible health service and will help to focus on the communities' perspective of their total needs.

Kava, alcohol and tobacco consumption among Tongans with urbanization

The prevalence of kava (Piper methysticum), alcohol and tobacco consumption in Nuku'alofa (urban) and Foa (rural) are described. Current kava consumption was males 48% and females 1%. Prevalence was significantly higher among rural males. Current alcohol consumption was almost exclusive to the urban population and predominantly male, but only 2 (1%) rural males were current alcohol consumers. 169 (84.0%) of the rural males were irregularly or had ceased consuming alcohol. Tobacco consumption also showed a significant male predominance. There was a significantly higher total tobacco consumption in the urban population. Concordance of the three habits was evident among males, with 27 concordant positive (expected = 5.98) and 46 concordant negative (expected = 6.60). It appears that kava, a traditional Pacific beverage may have lost ground to alcohol as urban Tongans adopt a more cosmopolitan life style. Kava, if proved relatively harmless, may be promoted as a less unhealthy alternative to tobacco and alcohol.

Ageing in the South Pacific : Physical changes with urbanization

The process of ageing, the place the elderly hold in the South Pacific societies and the care they receive as they move from adult independence to geriatric dependence varies considerably in different Pacific Polynesian populations. This provides unusual opportunity to examine the physical changes of ageing in people of the same broad genetic make-up exposed to environmental changes brought about by urbanization. Epidemiological surveys carried out since 1962 among New Zealand Maoris, Tongans, Cook Island Maoris in Rarotonga and Pukapuka, and Tokelauans living in Tokelau and following migration to New Zealand, provide the main data base for this presentation. The pattern of blood pressure, body weight, serum lipids and clinical disorders show considerable variation which relate most closely to the adoption of westernized life-style and moving into an urban environment. Analysis of the ECG pattern, in Pukapukans, in whom blood pressure shows only a minor increase with age, compared with age and sex-matched subjects studied in Newcastle, England provide insights into the ageing heart. An examination of mortality based on risk factors at entry shows an inverse relationship of serum cholesterol to total mortality in New Zealand Maori men and women, in Tokelau men but not women. Increasing systolic blood pressure was related to mortality in New Zealand Maori men, Tokalau men and Caucasian women, but not in the other race sex groups. The pattern of ageing and risk factors must clearly be examined in individual populations because while death is the end the pathways vary.

Genetic Diversity and Linkage Disequilibrium in the Polynesian Population of Niue Island

Isolated populations that recently have been derived from small homogeneous groups of founders should have low genetic diversity and high levels of linkage disequilibrium and should be ideal for mapping ancestral polymorphisms that influence complex genetic disease susceptibility. Populations that fulfill these criteria have been difficult to identify. We have been looking for Polynesian populations with these characteristics, because Polynesians have high rates of complex genetic diseases. In Niue Islanders all ancestral female (mitochondrial HSV1 sequence) and 90.4% of ancestral male (Ychromosome haplogroup) lineages are of Southeast Asian origin. The frequency of European Y-chromosome haplogroups is 7.2%. The diversities of mitochondrial HSV1 sequences (h 0.18 0.05) and Y-chromosome haplogroups (h 0.18 0.05) are lower than values published for any other population. Ten autosomal microsatellites spaced over 5.8 cM show low allele numbers in Niue Islanders relative to Europeans (55 vs. 88 total alleles, respectively) and a modest reduction in heterozygous loci (0.71 0.02 vs. 0.78 0.02, p 0.04). The higher linkage disequilibrium (d2) between these loci in Niue Islanders relative to Europeans ( p 0.001) is negatively correlated (r 0.47, p 0.01) with genetic distance. In summary, Niue Islanders are genetically isolated and have a homogeneous Southeast Asian ancestry. They have reduced autosomal genetic diversity and high levels of linkage disequilibrium that are consistent with the influence of genetic drift mechanisms, such as a founder effect or bottlenecks. High-powered linkage disequilibrium studies designed to map ancestral polymorphisms that influence complex genetic disease susceptibility may be feasible in this population