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The efforts commenced throughout the 1920's and 40's to improve hygiene and
sanitation end to deal with eonditions zuch as tuberculosis form an important part of the slow
but sleady overall improvement in health that was [aking lace in many of the Pacific
temitories large and small.
The present
F r.gm the viewpoint of health and disease the perspective , on health in the Pacif ic
Region has been infiueneed by the qreatly .increasqd moFi_litv.-gf -p:opl" in the Pacific -
pariicularly.sincetheendofWorldWffificlslandersinNewZealand
'has increased from I,500 in L946 to 55,000 in 1982. This includes rnigration from rural
villages to urban centres, from islands to towns and ciiies in larger land masses and
west-ernized societies zuch as Australia, and New Zealand. The process of urbaniza[ion with
its beneficial and less beneficial consequences are strong and important factors influencing
societies and lhe people in them. The move from subsislence to cash economies and the
struggle to meet famiiy, church and community requiremen[s all place a considerable number
of new strains m individuals and their families.
The strong sense of communily and ihe interdependence of people and communities that
is a part of tht culture and social pattern in many Pacific Societies has played a valuable
part in the community approach developed to a number of health problems. The control that
is being achieved for malaria and fiiariasis are good examples of conditions where real
progr""i had been made by environmental and eornmunity measures related to control of
mosJ uitoes, the important vectors and the carnier slate in the human hosts.
An example of community control would be filariasis. A changing pat[ern of filariasis is
being found in Tokelau where community control programmes have been instiLuted as a way
of rJducing microfilaria carriage in humans and so lessening the rate of new infections.
The public healLh measures which have led to greatly improved mosquito control have
been importanL for both malaria and filaria. This includes preventing water accumulation in
containers in villages in old coconuts, unprotected Lanks and similar sites on uninhabited
motus.
One of the explanations for the higher raLe of clinical filarias in men than in women in
Tokelau has been the men's greater exposure time to mosquitoes m the motus whereas women
stay mainly on the living motu. The community treatment pnogramrne in Td