The Oceania region consists of more than 10,000 islands scattered throughout the Pacific Ocean, which are both countries and dependencies or territories of other foreign nations. This region has traditionally been divided into four parts, based on geographic location and culture: Australasia (Australia and New Zealand), Melanesia, Micronesia, and Polynesia. By the year 2000 about 12 million islanders lived in the Oceania region; many indigenous cultures were revolutionized by intensive contact with non-Oceanic groups who had intruded from various parts of the Western World, making this region culturally diverse. More than 2,000 languages are spoken in this region, which has a total population of 7.8 million; Papua New Guinea accounts for 73% of the population. The geographic location of this region has had a large impact on the overall health status, as well as the other health determinants.
Overview of the global health situation: Considering the geographic layout of/between each of the islands, the status of health in the countries varies drastically within Oceania. Fiji is close to having met each of the Millennium Development Goals, while Papua New Guinea is far from meeting most of them; this causes high differences in support and action towards health initiatives in the Oceania region and difficulty in assessing the health status of the region as a whole. Will aid be put to the countries who have shown the most improvement in this small time to make them further developed, or will more aid be put to the countries developing at a slower rate? Where the financial aid and support goes can and will cause more differences in the health of this region. Many countries in Oceania do suffer heavily from poverty because of their isolation and connection with developed countries, which leads to malnutrition and causes a lack of access to health care. This struggle with poverty has been a consistent problem because of their isolation from one another and from larger developed countries, and their inability to create productive business because of their physical environment. Poverty has been an issue in this region for a while, yet few initiatives have been taken to reduce it. The people of these countries in Oceania are failing to meet their basic needs because of poverty (shelter, clean water, a constant food source), and overall this is causing poor health for the people. Poverty in Oceania has caused much of the populations in these countries to live in overcrowded, unsanitary, low income areas, strongly impacting their health negatively as well. Specifically in this region, countries are faced with high poverty and hunger rates and are put in the poverty cycle that prevents them from development. Papua New Guinea is one of the poorest countries in Asia, and their financial situation shows in their overall health as they have high mortality rates and high maternal mortality rates. The population is so heavily concentrated in this country and within each community the people live in, making it more difficult to reach the eight MDGs . Consisting of many low income countries, Oceania also cannot afford to achieve many of the eight MDGs, especially the targets pertaining to improving health, so their global health situation cannot advance as it would for a higher income region. The countries that have made advancements in health have government funding for support, where countries falling behind in health do not have that funding or support. Oceania is lacking in strengthening their health systems as well- without more efficient and equitable health systems, the countries here are not able to scale up disease prevention and control programs needed. This lack of strength explains the high prevalence of HIV/AIDs and TB still existing and the new cases appearing. There is a lack of medication and prevention towards diseases in this region, then causing high child mortality rates as well and ill-health in children. Along with this, health has yet to be completely prioritized in all of the Oceania region, especially because each government system for each country varies in support and action throughout the region. The lesser developed and smaller islands of this region have not yet had enough action through their weaker governments, leading them towards a more poor health, which then accumulates for the region as a whole. The multitude of diverse cultures in Oceania have posed as a barrier for gaining a better overall global health status; each of the cultures live in different ways that bring about different diseases and different needs, making it hard for the region to come up with solutions to improve their health. Along with this idea, the lack of equality between male and female has also proved to be a barrier in allowing for health initiates to become implemented in Oceania and a barrier towards improving health. In many of the countries, the high sexual violence has created more disease and unfavorable economic conditions, preventing the Oceania region from achieving a better health status. This is especially prevalent in the Solomon Islands, where there are the highest rates of violence and discriminatory feeding patterns, where their health is poor and directly related to the inequality the women face. It was found that this region is lacking in education on how to prevent diseases and of practicing better hygiene, and this is limiting this region's potential towards better health. Lastly, the countries within this region have majority populations that live in rural areas, making their health status drop as development occurs less in rural areas and the people are far then from access to any health care. The health for those in rural areas has a large threat from greater isolation from the health initiatives that are implemented in the urban areas. Looking at the overall status of health through the eight MDGs, Oceania has a ways to go in achieving a better health for each country; the high poverty and physical environment are keeping Oceania from the more developed state they should be at.
Successful MDGs in the Oceania region:
- MDG 2: Achieve Universal Primary Education- As of now, primary education is very close to being met in all of Oceania. Since the mid 1990's the ministry of education has paid tuition fees for all primary school pupils in almost all Oceania countries (aside from Papua New Guinea), allowing high enrollment rates of students. Through joint efforts of local communities, churches and private organizations, schools have been able to assist under privileged children, an opportunity not available in other countries. The primary education will lead to better overall awareness of health.
- MDG 6: Combat HIV/AIDs, Malaria, and other major diseases- Although TB and HIV/AIDs cases are still active in this region, this goal has been successful in creating immense change and has begun to halt the spread of most diseases. In Oceania, most of the governments have increased investments greatly, particularly because the countries are at higher risk of disease because of the physical environment. The National Aids Council has worked through Oceania to promote education, put more focus on HIV discrimination, and promote safe sex in many provinces. In Papua New Guinea, the government invested 200 million dollars to education and increase health care, which has improved malaria treatment. This actions reason why this MDG has improved health, and therefore is a success, though the goal has not been met yet.
- MDG 7: Ensure Environmental sustainability- Considering geographic location, this region is affected by climate change from sea level rising and being surrounded by the ocean, and there are many extractive industries like mining, logging and fishing impacting the environment. However, this goal has been successful because it has causes the government to take strong action. They have implemented government programs such as the Pacific Islands Climate Change Assistance program and National Forest Action Coverage Plan, and this has allowed many of the targets of this goal to be close to reached or met. In the region as a whole, there is high forest coverage, improved drinking water, and high coverage to improve sanitation.
- MDG 8: Develop a Global Partnership- Small island developing states are extremely remote and due to this characteristic they are dependent on neighbouring transit countries to complete trade, but their trade is strong. Target 8C focuses just on these small island developing states which make up our entire region, which is why this goal has been successful in Oceania. Donor funding has been supporting social services, and has helped to stimulate private sector development as well, and Oceania has received support from Australia, the European Union, New Zealand, Taiwan, China, the World Bank, and the Asian Development Bank. There has been a wide variety of donor funding helping to aid Oceania in both financial and medical aid. They have seen health improvements within health policy and administration, management and in improving health. Overall, the government and donor support is high because of the global partnerships that have been developed.
- MDG 1: Eradicate Extreme Poverty and Hunger- more than 25% of Oceanic people are living in poverty; high migration rates of civilians are leading to an increase of poverty among the older and younger populations of people who are being left behind in the rural and outer islands. The proportion of children underweight has increased from 1990 to 2015. There are few initiatives being taken but setbacks such as migration, natural disasters and disease are making it difficult to meet this goal. Thirty-nine percent of Papua New Guinea's population live below the national poverty line, and this country concentrates 73% of the Oceanic population.
- MDG 3: Promote Gender Equality and Empower Women- In this region, gender disparity has become normalized, and empowerment has been weak; aside from the small efforts taken, women still lack power, work, and access to health care services. The government is just starting to acknowledge the issue of inequality, but the women in Oceania on average have low-medium employment in the non-agricultural sector and low representation in parliament. The policies have not been enforced as they should because the inequality is normalized in Oceania.
- MDG 4: Reduce Child Mortality- The population growth too fast in this region, especially from migration, so health care cannot keep up with this growth, causing higher child mortality. This means that children under five aren't receiving the right and adequate care to survive and reach their full health. Oceania has had difficulty in receiving vaccinations against preventable diseases, especially pneumonia (which globally causes 19% of deaths of children under five). Poverty and malnutrition rates are high in this region (18% of the children in Papua New Guinea are affected from malnutrition, 12% in the Solomon Islands, and 11% in Vanuatu), which directly is causing a higher child mortality and reasons why this MDG has not been met.
- MDG 5: Improve Maternal Health- The maternal mortality ratio has decreased in this region, but there is very low access to universal reproductive health, and a majority of the countries have moderate maternal mortality still. The pregnant women don't have the ability to rest because of the female role they have in the household in this region, and there is still high adolescent pregnancy. Many of the women live in rural areas and off-shore islands in Oceania, and pregnant women could walk up to an hour to reach their health care provider. This MDG did not work towards improving maternal health in rural areas, which is why this goal is mostly unsuccessful.
Post 2015 Plans
1. Advocate for a larger investment in maternal and newborn health, and emphasize maternal mortality as an equity issue to push for a higher importance, all through governmental support. Through this plan, Oceania should strengthen their health systems and promote interventions that are especially for the poor, and that are culturally tailored for each country within Oceania. This investment should be put towards training health practitioners and health service providers, so that they are aware of obstetrical protocols and guidelines from the beginning to end of pregnancy, and to teach the importance of pre natal care. Along with this, all mothers should be able to receive pre natal care and nutrition. The investment should update the infrastructure in this region, mainly in rural areas, to increase medical facilities and their equipment, and ensure enough supplies.
2. Advance child health and combat malnutrition, mainly for children under five, in order to decrease child mortality rates, decrease hunger in poverty areas, and to further increase enrollment in secondary education. Advancing child health will lead to better attendance in school. Oceania can then combat malnutrition by adopting successful initiatives taken in other countries, such as the Peanut Butter Project introduced in Malawi and Sri Leone. If Oceania were to put a small amount donor funding towards making and giving out a food source similar to this one, which is peanut/dairy/vitamin/mineral food, the recovery rate from malnutrition can increase substantially. Combating malnutrition could also decrease the diseases among the child populations because their better health will make them much less susceptible.
3. Government needs to show full support and take forceful initiative in eliminating the high gender inequality prevalent in the Oceania region, through law and funding. There needs to be an increase for women in the workforce outside of the agricultural sector, which means the governments need to work in creating opportunities specifically for the women. The workplaces should be required to not discriminate against women, and offer all positions to both sexes. Along with this, the governments of each of the countries need to push for women to reach the secondary education level, possibly by increasing funding for women to have the opportunity. Pushing to eliminate gender inequality will empower the women, and decrease the sexual violence that is currently high in Oceania. Women partaking in more jobs can increase income for the families and for the country as a whole.
4. Get out of the poverty cycle, by creating assistance programs to those struggling the most to make ends meet and b advancing the economy through agricultural work. Most of those living in poverty live in rural areas, and increasing opportunities to work in agriculture could give the people of Oceania a daily income. Agriculture will provide nutritious food to the surround villages, create higher and more resilient incomes, and provides jobs for smallholders and landless workers. This would require boosting spending on this work to increase productivity, increase access to markets, reduce risks, and boost rural employment. Offering assistance to civilians through governmental programs would get people on their feet in continuing to better their economic situation.
Conclusion
The region of Oceania has made incredible advancements since the baseline test in 1990 to this year of 2015, and yet even though many of the MDGs created change, many were not considered a success. The physical environment will be a constant battle in working towards developing each country in this region, yet their are steps and initiatives that can be taken to slowly make change happen and to improve the health of each population. In this region, the countries are too different in each of their governments, economies, and lifestyles that broad initiatives for the region as a whole will not work. In order for Oceania to meet these Millennium Development Goals and achieve a better global health status, the governments need to consider each culture and their needs in each country, and take further initiative in creating and following through with plans. Oceania has a long ways to go with their development and overall health, and yet its important to realize just how far they have already come.