Health trends
Life expectancy at birth is 71 years for men and 74 years for women. The infant mortality rate is 6.83 per 1000 live births; the maternal mortality ratio has remained at zero since 1993. The crude birth rate is 21.7 per 1000 population, and the crude death rate is 7.4 per 1000 population. About 100% of the population has access to clean safe water supply, adequate sewage sanitation disposal and primary health care. During the 2004–2005 financial year, the country’s Expanded Programme on Immunization (EPI) hopes to achieve 100% coverage.
Infectious diseases are rarely seen and usually occur as imported cases. Parasitic intestinal worm disease has been greatly reduced by improved water and sanitation. A water supply and sanitation improvement programme, with the building of flush toilets in all schools and health centres on the outer islands, has enhanced the reduction in these diseases and probably also septic skin diseases, rheumatic fever and obstructive airways disease. Leprosy is rarely seen. There was one case of tuberculosis reported in 2002. No HIV infection has been detected up to the time of writing. The incidence of sexually transmitted infections (STI) in Cook Islands varies. Gonorrhoea and syphilis are rare, whereas trichomoniasis and chlamydia are relatively common. The prevalence of condom use is low. The mass drug administration (MDA) programme for elimination of filariasis continues as part of the WHO filariasis elimination programme. A small-scale blood survey was conducted before MDA 2001 in which 460 people were randomly tested from four different islands using ICT test kits. MDA coverage in 2001 was 91.3%. The only infectious disease outbreak since the dengue outbreaks in 1992–1993 and 1995 was the dengue outbreak of 2002 (2491 cases reported).
Noncommunicable diseases such as hypertension, diabetes, cancer, coronary heart diseases, obesity, and injury and poisoning continue to be major public health problems in Cook Islands. According to a WHO consultancy in 2001, the prevalence of diabetes is 11.8% for males and 3.8% for females (not including patients with well-controlled pre-existing diabetes). The prevalence of obesity is 48.4% for males and 36.2% for females. The hypertension rate is 55.3% for males and 24.5% for females. According to hospital records, almost 70% of patients were reported to have acquired hypertension disease, 14.2% having both hypertension and diabetes and 15.9% having only diabetes from 1980 to 2001. Of all the reported hypertension cases, 64.3% were in Rarotonga and 35.7% in the outer islands. For cases of diabetes, 50.4% were in Rarotonga and 49.6% in the outer islands.
While the population on the main island, Rarotonga, has access to the best health care in the country, those on the outer islands, especially the northern islands, do not. There is an urgent need to address and rectify these disparities. It is therefore of vital importance that the delivery of health services to the outer islands must be addressed, especially the availability of drugs, the deficiency in equipment and the provision of properly trained health staff to provide these services.
Health services
National health expenditure is NZD 4 285 000, representing 5.3% of total national expenditure in 2001. Health infrastructure is well developed. There is a general hospital with 80 beds in Rarotonga and seven primary health care centres. As of 2002, there were 22 doctors, 3 midwives, 67 nurses and 13 dentists.
Since August 2002, the health services of the outer islands, with the exception of Rakahanga and Palmerston, have been returned to the central administration in Rarotonga. The return of the administration of the outer islands to Rarotonga has solved several of the problems identified in the document “A Review of the Health Sector of the Cook Islands 2000”.
During the past two years, the Ministry of Health has concentrated on providing sufficient general practitioners to provide the delivery of health services in the outer islands. To date, there are only two islands—Palmerston and Rakahanga—without a resident doctor. However, there are health officers on these two islands. In the meantime, the Ministry of Health has also provided extra doctors at the Rarotonga Hospital so that service is provided 24 hours a day, but ensuring that no doctor is working more than eight hours a day.
In the absence of resident dental personnel, the Ministry of Health recently employed two flying dentists to visit the outer islands. Currently, in most of the islands there are no dental personnel, a lack of proper dental planning, and a lack of oral health promotion and education, preventive care and constant review. There are also no proper facilities and equipment. The high "decayed, missing or filled" (DMF) result clearly shows the lack of diagnosis of dental caries, the absence of restorative treatment for tooth decay. There is also a need to review and improve the oral health safety procedures to maintain the provision of quality health care services to the people.
The Ministry of Health opened a new hospital wing in 2001 that provides ample room for laboratory services, maternal health care, and statistics. There is also a library and a conference room to assist in continuous medical education.
A telehealth venture is also in the process of being established which would provide distance-learning education for doctors, nurses and other health staff in Rarotonga and some of the outer islands to improve human recourses development for health and to strengthen their health services. At the same time, Telehealth will be used to consult specialists overseas in regard to problematic patients. Efforts are also concentrated on continuing medical education and health staff training both in country and overseas.