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Our Oceania: ‘Part of being there for your kids is being healthy'
7:48 pm GMT+12, 21/06/2018, Northern Mariana Islands

Non-communicable diseases or NCDs like diabetes, cancer, and hypertension are ravaging the Saipan community. They’ve been doing so for years.
The late Governor Eloy S. Inos declared that the CNMI was suffering from an NCD crisis back in 2013, when he signed the NCD Directive. Unfortunately, the crisis rages on today, with more casualties than ever.
“So many kids here don’t have their grandparents because of NCDS,” Dr. Don Hardt told a crowd assembled at the Pacific Islands Club on Tuesday. “I have so much respect for the family values here, but part of being there for your kids is being healthy, being there in the first place.”
His listeners were attendees of a three-day Strategic Planning Workshop put on by the Non-Communicable Disease Bureau in association with the Commonwealth Healthcare Corporation, the Division of Public Health Services and the Office of the Governor.
The workshop invited community members from all spectrums of the public — from senators to high school students — to share their perspectives and work together toward finding solutions to the CNMI’s NCD epidemic.
While the workshop discussed cancer and tobacco, alcohol, and betel nut use, its main focus was tackling obesity and diabetes on the island. Dr. Don Hardt and his brother, Dr. David Hardt, head the Hardt Eye Clinic and Diabetes Education Center. During his presentation, he listed some alarming statistics:
Twelve percent of mainland America suffers from Type 2 Diabetes. According to a 2016 survey, the numbers are much worse in the CNMI, where 22 percent of Carolinians and 25 percent of Chamorros have been diagnosed with the disease. These proportions are even more severe when the age of the CNMI population is taken into consideration; the U.S. mainland has four times as many people over the age of 75, meaning the diabetics in the CNMI are relatively young, and there is plenty of time for their numbers to grow over the next few decades.
“We should be lower, not double,” said Dr. Hardt. “And the diabetes we have is much, much worse.”
According to Dr. Hardt, this health epidemic isn’t just a human issue. It’s also an economic blight on the CNMI government; given that 72 percent of the 182 Saipan residents on dialysis are receiving treatment for their diabetes and twelve months’ worth of dialysis costs US$88,000, Hardt estimates that diabetes treatment as a whole drains US$150 million-US$200 million from the local economy each year.
To be sure, an individual’s diet and exercise play a major role in contracting diabetes. According to the CNMI’s Non-Communicable Disease and Risk Factor Hybrid Surveillance Report of 2016, 74 percent of the CNMI population drinks at least one sugar-sweetened beverage each day; 30 percent drink two or more. And around 75 percent of locals eat fewer than their recommended five servings of fruits and vegetables per day. Add an island-wide unbalanced diet to the fact that 33 percent of CNMI residents reported not exercising even once in the past month, and it starts to become clear how 83 percent of Chamorros, 86 percent of Carolinians, 77 percent of other Pacific Islanders, and 54 percent of Filipinos are currently overweight and/or obese.
With numbers this drastic, many believe that blaming the individual for his or her poor health is over-simplifying a more complicated societal issue. As Dr. Deborah Cohen explains in a Ted Talk titled “A Big Fat Crisis,” community- and country-wide factors can play into people’s capacity to control and understand their health.
And many of those larger factors ring true to the CNMI: people are more likely to make poor nutritional choices if they live in “food swamps” where unhealthy food is “ubiquitous, cheap, and marketed relentlessly.” People are less likely to live active lifestyles if they live in villages and cities where it is difficult to walk, bike, or take public transportation. In fact, a lack of easy, affordable transportation makes it harder for community members to receive healthcare and depletes a community’s social ties, more factors that lead to isolated, unhealthy, sedentary lifestyles.
But, as regulations on alcohol and tobacco have proven in the past, governments and public interest groups can curb the negative societal factors leading to health epidemics and instead open the door for healthier living in their communities.
The Strategic Planning Workshop participants set off to do exactly this. Attendees broke off into groups depending on their specialties and formed goals and strategies for improving health in the CNMI.
The clinical linkage group seeks to lower the number of people who reported never having had a check-up from 21 percent to 20 percent by 2021. The nutrition group hopes to raise the number of community gardens in the CNMI from 33 to 100. The cancer group plans to increase the number of cancer screenings made available throughout the CNMI. The policy group plans to launch a pilot programme that creates more safe, walk-able and bike-able paths in one village on Saipan, in hopes of expanding such pathways across the CNMI. The tobacco group will train more tobacco prevention and cessation experts, and the physical exercise group hopes to increase the number of people who report having exercised in the past month from 67 to 80 percent.
Ultimately, improving health in the CNMI will come down to government agencies, public interest groups, families, and individuals working in tandem. As George Cruz, past president of the Diabetes Prevention Coalition, told the Strategic Planning Workshop on Wednesday: “Live like your life depends on it — stay active, eat healthy, live healthy.”.


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