2.1 Communicable and noncommunicable diseases, health risk factors and transition

Transcription

1 1. CONTEXT 1.1 Demographics The population of Guam was estimated to be in 2006, with 104 males for every 100 females. Population density is 310 per square kilometre. life expectancy for both sexes is years. Men are expected to live to 75.3 years of age and women to 81.6 years. The crude birth rate decreased slightly from 20.6 in 2004 to in The crude death rate in 2005 was 4.41 per 1000 population, a slight increase from 4.2 in Political situation The political situation on Guam remains stable, with elections for the mayors of municipal civil districts (villages) and the unicameral legislature held in Cooperation between the Executive Branch and the Legislative Branch is growing. 1.3 Socioeconomic situation Guam has been in a financial crisis since the 1994 fiscal year. The economic decline is related to the Asian economic crisis and unforeseen events such as supertyphoons (which have destroyed much of Guam s infrastructure and left much of the island with little or no potable water for weeks and no electricity for two to three months in some areas), the war in Iraq, and the outbreak of severe acute respiratory syndrome (SARS). Guam s economy is heavily reliant on the tourism industry, with the majority of visitors originating from Japan and the Pacific rim. Tourist arrivals and expenditures have dwindled due to the aforementioned events, although there are indications of an upswing. The most critical impact of the crisis has been in the employment area. According to the local Department of Labour office, Guam s unemployment rate was 7.7 % as of March In 2002, the reported per capita gross island product was US$ Vulnerabilities and hazards No available information. 2. HEALTH SITUATION AND TREND 2.1 Communicable and noncommunicable diseases, health risk factors and transition No available information. 2.2 Outbreaks of communicable diseases There were two food poisoning outbreaks in The first occurred in September 2006 among over 100 students and four adults at Chief Brodie Elementary School. Victims complained of abdominal cramps, diarrhoea and vomiting, but none required hospitalization. The definite cause of the outbreak was not determined. However, the rapid onset and recovery from symptoms experienced by those affected suggests that it may have been due to Bacillus cereus or Staphylococcus aureaus intoxication, problems that may be facilitated when transporting food. COUNTRY HEALTH INFORMATION PROFILES 119

2 The Department Public Health and Social Services was notified of another food poisoning outbreak in October 2006 among 49 tourists staying in a local hotel. Investigation revealed that tourists complained of nausea, vomiting, diarrhoea and headache, but no hospitalization was required. The affected persons had eaten at a number of regulated establishments prior to their illnesses; no significant food establishment violations that might have contributed to this outbreak were identified. 2.3 Leading causes of mortality and morbidity Based on inpatient data, the leading causes of morbidity in 2005 were pregnancy, childbirth and the puerperium; influenza and pneumonia; certain infectious and parasitic diseases; ischaemic heart disease; and malignant neoplasm. Leading causes of death in 2003 were: diseases of the heart (119.4 per population), malignant neoplasms (68.4), cerebrovascular diseases (31.2), accidents (17.4) and bacterial diseases such as septicaemia (16.2). 2.4 Maternal, child and infant diseases In 2003, there was no maternal death. About 87% of total deliveries in 2004 occurred in health facilities. In the same year, the infant mortality rate was 12.3 per 1000 live births, a significant increase from the 2002 rate of 6.21 per 1000 live births. In 2006, the coverage rate for poliomyelitis and measles immunization was 85%, while it was 89% for DTP3, and 91% for hepatitis B Burden of disease No available information. 3. HEALTH SYSTEM 3.1 Ministry of Health's mission, vision and objectives Guam is dedicated to the attainment of health for all by In 1992, the Guam Health Planning and Development Agency identified 13 health service priority areas to be strengthened: human resource development; health planning; wellness promotion; health information systems; communicable disease control; disposal of hazardous and toxic materials; availability and accessibility of health services; environmental protection; drug and alcohol abuse; chronic disease prevention and control; injury prevention; maternal and child health; and vector control. Although some improvement has been made in the area of health information systems, wellness promotion and communicable disease control, the remaining areas continue to be top priorities. 3.2 Organization of health services and delivery systems No available information. 120 COUNTRY HEALTH INFORMATION PROFILES

3 3.3 Health policy, planning and regulatory framework See Section Health care financing health expenditure amounted to US$ million in 2000, with per capita total expenditure on health of US$ As of 30 September, government expenditure on public health for 2005 was US$ 64 million, about 9% of total government expenditure. 3.5 Human resources for health All public health services depend on having a basic infrastructure, especially in terms of personnel. Unfortunately, Guam is experiencing health workforce shortages due to the early retirement of its most experienced professionals. Human resources for health are still lacking in critical areas and must be developed locally to the greatest extent possible. The following training needs are priorities: environmental studies, with an emphasis on environmental law, policy, management, and planning and analysis; and short-term training on retail hazard analysis critical control point (HACCP), as well as on drugs, medical devices and controlled substances. The Guam Environmental Protection Agency (GEPA) relies heavily on its professional staff to provide technical expertise in all areas of environmental resource protection, management and policy. At the same time, this technical expertise is needed for the young professionals within GEPA, as the fields of environmental protection and science are constantly changing. However, due to early retirement and voluntary separation, all personnel with over 10 years of professional and technical experience have left GEPA, leaving half (two out of four) of the remaining personnel with less than four years of professional GEPA experience. Combined with the local hiring freeze, it is anticipated that no new professionals will be hired within the next two to three years. The lack of well educated and technically trained personnel is severely undermining the professional credibility of GEPA. To further complicate matters, GEPA also serves as the primary regulatory agency for all environmental issues and policies on Guam, and takes the lead for most other islands in Micronesia. The Division of Environmental Health of the Department of Public Health and Social Services (DPHSS) is also greatly understaffed. Over half the Division's staff have fewer than five years experience, and staff generally lack specialized training. Training in retail HACCP is lacking. The United States Federal Drug Administration is urging all locales, states and territories to explore HACCP as a requirement in retail and food service establishments, and to develop a model food code that incorporates HACCP principles. All health care products, from toothbrushes to prescription medications, are regulated and monitored by the Drug and Medical Device Programme. Because of Guam's geographical location and the ethnic diversity of its people, various drugs and medical devices of foreign origin are imported, distributed and marketed. These include many poorly labelled, misbranded and adulterated drugs, as well as hazardous medical devices. Training in the area of drug and medical devices is therefore necessary for staff of the Division of Environmental Health. Forged prescriptions, lack of accountability of controlled substances by businesses, and illegal dispensing of controlled substances are estimated to be significant problems. However, because of the lack of human resources, only urgent cases are pursued and investigated. 3.6 Partnerships No available information. 3.7 Challenges to health system strengthening Guam is faced with the challenge of maintaining a health care system that will adequately meet the needs of a predominantly young and growing population. At the same time, it is also facing COUNTRY HEALTH INFORMATION PROFILES 121

4 the added challenge of addressing the problems of the rapidly increasing number of older people, forecast to increase from 3.9% of the total population in 1990 to 7.5% in A reduction in human and financial resources has severely impacted the health system. An early retirement programme, instituted at the end of 1999, led many experienced health workers to retire. While the vacated positions have continued to be funded, there is not a large enough resource pool to fill all of them. Tightening government budgets have left some less critical positions vacant, and these vacancies have reduced the overall amount of services available to the uninsured and underinsured population. The vacancies have also affected progress in strengthening other health service priority areas, such as disposal of hazardous and toxic materials, environmental protection, vector control, and drug and alcohol abuse services. 4. LISTING OF MAJOR INFORMATION SOURCES AND BASES Title 1 : Guam statistical yearbook 2005 Operator : Bureau of Statistics and Plans, Office of the Governor Web address : Title 2 : Office of Vital Statistics, Guam Department of Health and Social Services Web address : Title 3 : United States of America Bureau of the Census Web address : Title 4 : Secretariat of the Pacific Community Web address : 5. ADDRESSES DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES Postal Address : 123 Chalan Kareta Mangilao, Guam Website : WHO REPRESENTATIVE There is no WHO Representative in Guam. Queries about WHO s programme of collaboration with Guam should be directed to the Director (Programme Management): Office Address : World Health Organization Regional Office for the Western Pacific, United Nations Avenue, Manila, Philippines 1000 Postal Address : P.O. Box 2932, Manila, Philippines 1000 Telephone : (632) (trunk line) Office Hours : 0700H-1530H Website : COUNTRY HEALTH INFORMATION PROFILES

5 6. ORGANIZATIONAL CHART: Department of Public Health and Social Services COUNTRY HEALTH INFORMATION PROFILES 123

6 COUNTRY HEALTH INFORMATION PROFILE WESTERN PACIFIC REGION HEALTH BANK, 2008 Revision Demographics 1 Area (1 000 km 2 ) Estimated population ('000s) est 1 3 Annual population growth rate (%) Percentage of population years years - 65 years and above est est est 2 5 Urban population (%) est 12 6 Crude birth rate (per 1000 population) Crude death rate (per 1000 population) Rate of natural increase of population (% per annum) Life expectancy (years) - at birth - Healthy Life Expectancy (HALE) at age fertility rate (women aged years) Socioeconomic indicators 11 Adult literacy rate (%) 12 Per capita GDP at current market prices (US$) a Rate of growth of per capita GDP (%) 14 Human development index Environmental indicators Urban Rural 15 Proportion of vehicles using unleaded gasoline (%) 16 Health care waste generation (metric tons per year) Communicable and noncommunicable diseases Number of new cases Number of deaths 17 Selected communicable diseases Hepatitis viral - Type A - Type B - Type C - Type E - Unspecified Cholera Dengue/DHF Encephalitis Gonorrhoea Leprosy Malaria Plague Syphilis Typhoid fever j COUNTRY HEALTH INFORMATION PROFILES

7 Communicable and noncommunicable diseases Number of new cases Number of deaths 18 Acute respiratory infections Diarrhoeal diseases Tuberculosis - All forms - New pulmonary tuberculosis (smear-positive) Cancers All cancers (malignant neoplasms only) - Breast - Colon and rectum - Cervix - Oesophagus - Leukaemia - Lip, oral cavity and pharynx - Liver - Stomach - Trachea, bronchus, and lung Circulatory All circulatory system diseases - Acute myocardial infarction - Cerebrovascular diseases - Hypertension - Ischaemic heart disease - Rheumatic fever and rheumatic heart diseases Diabetes mellitus Mental disorders Injuries All types - Homicide and violence - Motor and other vehicular accidents - Occupational injuries - Suicide Leading causes of mortality and morbidity Number of cases Rate per population 26 Leading causes of morbidity (inpatient care) 1. Pregnancy, childbirth and the puerperium 2. Influenza and pneumonia 3. Certain infectious and parasitic diseases 4. Ischaemic heart disease 5. Malignant neoplasm b b b b b COUNTRY HEALTH INFORMATION PROFILES 125

8 Number of deaths Rate per population 27 Leading causes of mortality 1. Diseases of the heart 2. Malignant neoplasm 3. Cerebrovascular disease 4. All other accidents 5. Bacterial diseases (septicaemia) Maternal, child and infant diseases 28 Percentage of women in the reproductive age group using modern contraceptive methods 29 Percentage of pregnant women immunized with tetanus toxoid NR (TT2) 30 Percentage of pregnant women with anaemia Neonatal mortality rate (per 1000 live births) Percentage of newborn infants weighing at least 2500 g at birth c Immunization coverage for infants (%) - BCG - DTP3 - POL3 - Hepatitis B III d Number of cases Number of deaths 34 Maternal causes - Abortion Eclampsia - Haemorrhage Obstructed labour - Sepsis 35 Selected diseases under the WHO-EPI - Congenital rubella syndrome - Diphtheria - Hib meningitis - Measles - Mumps - Neonatal tetanus - Pertussis (whooping cough) - Poliomyelitis - Rubella - Tetanus COUNTRY HEALTH INFORMATION PROFILES

9 Health facilities Number Number of beds 36 Facilities with HIV testing and counseling services 37 Health infrastructure Public health facilities - General hospitals 2 e Specialized hospitals - District/first-level referral hospitals - Primary health care centres f Private health facilities - Hospitals Outpatient clinics Health care financing 38 health expenditure - amount (in million US$) - total expenditure on health as % of GDP - per capita total expenditure on health (in US$) Government expenditure on health - amount (in million US$) - general government expenditure on health as % of total expenditure on health - general government expenditure on health as % of total general government expenditure External source of government health expenditure - external resources for health as % of general government expenditure on health g h Private health expenditure - private expenditure on health as % of total expenditure on health Exchange rate in US$ of local currency is: 1 US$ = NA 39 Health insurance coverage as % of total population INDICATOR 40 Human resources for health Urban Rural Public Private Physicians - Number 244 i Rate per 1000 population Dentists - Number - Rate per 1000 population Pharmacists - Number - Rate per 1000 population Nurses - Number - Rate per 1000 population Midwives - Number - Rate per 1000 population Paramedical staff - Number - Rate per 1000 population Community health workers - Number 41 Annual number of graduates - Rate per 1000 population Physicians Dentists COUNTRY HEALTH INFORMATION PROFILES 127

10 Urban Rural Public Private 41 Annual number of graduates Pharmacists Nurses Midwives Paramedical staff 42 Workforce losses/ Attrition Community health workers Physicians Dentists Pharmacists Nurses Midwives Paramedical staff Community health workers Health-related Millennium Development Goals (MDGs) 43 Prevalence of underweight children under five years of age 44 Infant mortality rate (per 1000 live births) Under-five mortality rate (per 1000 live births) est 2 46 Proportion of 1 year-old children immunised against measles Maternal mortality ratio (per live births) Proportion of births attended by skilled health personnel - Percentage of deliveries at home by skilled health personnel (as % of total deliveries) - Percentage of deliveries in health facilities (as % of total deliveries) Contraceptive prevalence rate 50 Adolescent birth rate 51 Antenatal care coverage - At least one visit At least four visits 52 Unmet need for family planning 53 HIV prevalence among population aged years 54 Estimated HIV prevalence in adults k 55 Percentage of people with advanced HIV infection receiving ART 56 Malaria incidence rate per population 57 Malaria death rate per population 58 Proportion of population in malaria-risk areas using effective malaria prevention measures 59 Proportion of population in malaria-risk areas using effective malaria treatment measures 60 Tuberculosis prevalence rate per population Tuberculosis death rate per population Proportion of tuberculosis cases detected under directly observed treatment short-course (DOTS) 63 Proportion of tuberculosis cases cured under directly observed treatment short-course (DOTS) 64 Proportion of population using an improved drinking water source Proportion of population using an improved sanitation facility Proportion of population with access to affordable essential drugs on a sustainable basis 128 COUNTRY HEALTH INFORMATION PROFILES Urban Rural

11 Notes: Data not available p Provisional est Estimate NR Not relevant a Figure reported as Gross Island Product b Figure refers to inpatients in Guam Memorial Hospital c Figure refers to birth weight equal to 2501 grams and above d Given as inactivated polio vaccine (IPV) e Figure includes one civilian hospital and one naval hospital f Figure refers to clinics which includes specialized services but excludes eye and dental clinics g Figure refers to total expenditure on public health as of 30 Septermber 2005 (audited) h Figure refers to percentage total expenditure on public health as to total government expenditure i Figure refers to physicians in Guam Memorial Hospital and includes licensed military physicians working on part-time basis j Disease contracted "off-island" k Not included in the official list of MDG indicators s: Pacific Island Populations - Estimates and projections , Secretariat of the Pacific Community, Noumea, Demographic Tables for the Western Pacific Manila, World Health Organization Regional Office for the Western Pacific, US Census Bureau [ Asia Pacific in Figures United Nations Economic and Social Commission for Asia and the Pacific [ Annual Summary of Notifiable Disease Guam Office of Epidemiology & Research, Department of Public Health and Social Services. Government of Guam. WHO Regional Office for the Western Pacific, data received from the technical units. Information furnished by the Department of Health and Social Services, Guam 16 June Guam Statistical book Bureau of Statistics and Plans, Office of the Governor, Guam, Guam Bureau of Statistics and Plans [ Information furnished by the Department of Health and Social Services, Guam 21 June World Health Organization and United Nations Children's Fund Joint Monitoring Programme for Water Supply and Sanitation (JMP). Progress on Drinking Water and Sanitation: Special focus on Sanitation. UNICEF, New York and WHO, Geneva, [ United Nations, Department of Economic and Social Affairs, Population Division (2007). World Population Wallchart (United Nations publication, Sales No. E.08.XIII.3). COUNTRY HEALTH INFORMATION PROFILES 129