Rt€@lll

-4r
of real improvements must be part of future developments which will have widespread
benefits in the control of a number of food, fly and faecal borne conditions.
Maternal and child health
Malernal and child health is me of the ereas which has e mejor affect m population
growth and overall fitness of individuals and communities. The beneficial changes that have
occurred within a rnrmber of the Pacific Island countries in the past twenty years must be
taken into account as we gether data m which to base our perspective m health for the 80s
and to the year 2000.
Data now available suggests that improvenents are taking place in a rumber of health
area8. It is important Lo realize that there has been a considerable inprovement in
docurnentation of mortality statistics based m death certification using international WHO
coding classification over the past 20 years and this should improve further. It is important
to recognize that in a country such es the Philippines up to 60% of deaths in rural areas may
not be certified by a medically trained graduale. ln the South Pacific this is not the case and
much greater confidence can now be placed in data from countries such as Tonga, Western
Samoa, American Sarnoa, Cook lsland, Niue, Fiji, and Tokelau.
Availability of oral salt mixture for use in the early treatment of acute diarrhoea in
infants and young children represents sre of [he most imporLant recent advances in public
health and cutling down morbidity and mortality. The fact that they are cheap, freely
available, ean be kept in the houses and that parents and grandparents can be taught how to
use them and to use them early in the illness is an excellent example of how simple ffEesureg
can be developed if new thinking is applied to problems.
Maternal and child health and their progress provide a good measure of health
developments in a community, since they involve the management of complications relating to
pregnancy, the mother and the child in the neonatal period (birth to I month), and the next
period from I year to 5 years when adequate vaccination programmes and slpervision of
childhood chest infections will provide evidence of improved status.
Effective child health care requires considerable understanding of health and illness
and its management by parents, particularly the mother, and development of this through
effective contacts with well trained health professionals. The tradition of breast feeding has
been one of the important mainstays of infant care in Lhe Pacific Island countries. -fhe
erosion of this by a desire [o move to arlificial feeding and so to follow what npthers hear
is so eommon in the developed meccas such as New Zealand and Australia is becoming
widespread. This increases the risk of gastrointestinal infections and other upsets particularly
where mothers are inadequately trained in milk preparation and bottle sterilization. Sorne
reversal of this trend with moves back to a higher percentage of breast feeding may be
occurring .
Vaccinations in infancy including BCG in the f irst 2 weeks, polio vaccinations,
whooping cough, diptheria and measles can be used as measures of the effectiveness of health
programmes in the area of infant and child heallh.
Primarv health care
The development of lhe concept of Primary Health Care may prove to be me of the
most important factors in bringing about improved health in many parts of the world,
particularly in developing countries. Up to the present these countries have often placed
exeess reliance on small numbers of medically trained persons which has led to great
inequalities in the distribution and quality of medical care.
The WHO/UNICEF Conference at Alma Ata in 1978 was of major importance and gave a
lead to the adoption of Prirnary Heallh Care programmes. Certain of the important principles
in the Declaration of Alma Ata ane set out in Annex I as Lhey constitute a central part of
the changes taking place in ideas on health care (WHO, 1978).
It can be seen from the Declaration that real efforts to develop and implemenl primary
health care by efforts of the world comrnunity to support national and in[ernational