The Human Rights Measurement Initiative finds that the Federated States of Micronesia are fulfilling 94.9% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, the Federated States of Micronesia achieve 97.1% of what is expected based on their current income. In regards to the right to health amongst the adult population, the country achieves only 91.9% of what is expected based on the nation's level of income. The Federated States of Micronesia fall into the "good" category when evaluating the right to reproductive health because the nation is fulfilling only 95.8% of what the nation is expected to achieve based on the resources (income) it has available.
Life expectancy at birth in the Federated States of Micronesia was 66 for men and 69 for women in 2018.
Pingelap in Pohnpei State is notable for the prevalence of an extreme form of color blindness called achromatopsia, and known locally as maskun. Approximately 5% of the atoll's 3000 inhabitants are afflicted.
History
19th century: Devastating epidemics The sanitary conditions prior to initial contact with the West are unknown. At the time of the Europeans' arrival in the Pacific Ocean, the Micronesian populations had reached demographic equilibrium.
In the first half of the 19th century, increased contact led to a demographic decline. The indigenous people were exposed to new bacteria and viruses from whalers, traders, settlers, and missionaries. Added to the devastating effects of these diseases was alcohol dependence, a substance discovered by the Micronesians. These various factors had a devastating effect on island communities, whose social customs, lifestyle practices, and ideas about disease made the spread of disease inevitable. A few missionaries, who were trained doctors, provided medical care.
From the 1840s to late 19th century, the island of Pohnpei was affected by numerous epidemics of influenza (1843, 1856, 1871, 1874, and 1879) and measles (1861 and 1894). Tuberculosis and dysentery were also common causes of death there. In 1854, a smallpox epidemic, triggered by the American whaling ship Delta, which brought two sick people and a corpse to the island, decimated the island, which lost about 40% of its population, or 4,000 people, despite the efforts of a missionary and an American doctor who practiced variolation on hundreds of natives. However, the most affected place was Kosrae, where 90% of the population disappeared between 1838 and 1890, leaving only 300 people. In Pohnpei and Kosrae, smallpox was common, as were sexually transmitted diseases, which sometimes reduced births to almost zero, contributing to the decline in population. The Yap Islands and the Truk Islands were much less affected, although influenza arrived in the Yap Islands in 1843 and 1863, brought each time by the same British trader. The Yap Islands were not often visited by ships until a flourishing copra trade began in the 1870s, while the Truk Islands did not become a port of call and place of residence for company agents until the end of the century.
Arrival of Western medicine in the first half of the 20th century
German efforts In 1887, the Spanish built an infirmary in their colony of Pohnpei, but it was inaccessible to Micronesians. At the turn of the century, Germany acquired the Caroline Islands, where the current Federated States of Micronesia are located. It assigned doctors to the Yap Islands and Pohnpei and sent medical personnel to other islands for short periods. A 40-bed hospital opened in 1903 on the Yap Islands, and in 1913, the German administration proposed opening another one on the Truk Islands, but the Japanese annexation the following year prevented this. At the beginning of the 20th century, alcohol consumption was prohibited and remained so until 1959-1960.
In order to reduce the spread of infectious diseases by foreign crews, quarantine measures were implemented in certain districts. Regular vaccination was also introduced, and by 1907, the western part of the Caroline Islands, comprising the present-day states of Yap and Pohnpei, was almost immune to smallpox. During German colonization, physician Robert Koch identified pian as the cause of disfigurements and bodily lesions previously attributed to syphilis and highlighted the prevalence of respiratory diseases, ranging from whooping cough to tuberculosis.
During the German era, the population of the Yap Islands declined rapidly, falling from 7,400 to 6,200 inhabitants during the first decade of the 20th century. In 1907 and then in 1908-1909, dysentery epidemics killed a total of 700 people, and in 1910, influenza claimed many victims. In addition, the birth rate was low, which the authorities attributed to the spread of gonorrhea and the widespread practice of abortion. In an attempt to counter this decline, the German administration sought to prevent prostitutes from boarding ships and infected sailors from going ashore. Similarly, it attempted to prevent the practice of bringing girls from other villages to serve as hostesses (mispil) in the men's houses.
Japanese health policy After the arrival of the Japanese at the end of 1914, whose occupation was legalized by the mandate of the South Seas Mandate in 1919, the population of the indigenous peoples, after having fallen sharply, now stagnated, except in the district of Yap, where it continued to decline due to tuberculosis, an unidentified respiratory problem causing inflammation, infantile diarrhea, and gonorrhea, which prevented births. +Births and deaths 1925–1930BirthsBirth rateDeathsDeath rateYap9914.430344.1Chuuk35823.837224.1Pohnpei19925.516921.7 During the Japanese occupation, the normal workload of hospitals and clinics consisted of treating intestinal parasites (nearly 90% of the population was affected by roundworms and half by hookworms), respiratory disorders and skin diseases (90% of the population was affected by yaws).
In February 1915, the Japanese naval authorities authorized garrison doctors to provide free medical treatment to local populations and Japanese civilians. A small hospital was established in each naval district headquarters, and efforts were made to improve sanitation and personal hygiene among the Micronesians. The transfer of power to civilian authorities in 1922 was accompanied by the creation of government hospitals on Yap Island, Truk Island, Pohnpei, and later Kosrae. Compulsory vaccination programs were carried out even on remote islands, and some indigenous women received paramedical training. Leper colony and 50-bed tuberculosis sanatorium established on Yap in 1935. A leper colony was established on the Yap Islands to cope with the increase in cases, and in 1935, a 50-bed sanatorium was established to isolate tuberculosis patients. Epidemics still occurred but were gradually brought under control. Subsidized models of healthier houses, i.e., brighter, better ventilated, and less vulnerable to bad weather than traditional buildings, were proposed. On the larger islands, public baths and latrines were established and access to drinking water was provided. However, according to Mark R. Peattie, the Japanese public health program is a failure due to insufficient funding for the actions taken. In the Yap Islands, Japan's actions are rejected, perceived as an attempt to abolish customs.
Early American health policy World War II military actions caused few deaths. Whereas until then the community had been primarily responsible for providing healthcare, with the American presence formalized by the creation of the Trust Territory of the Pacific Islands, it is now the government. When the United States moved in, the islanders were generally in poor health, even though they had recovered well from the immediate post-war period. By the late 1940s, the birth rate was rising, the death rate was falling, and life expectancy was increasing.
In 1965, WHO was severely criticized by the World Health Organization for the poor quality of its public health services. The WHO pointed to a lack of coordination in planning, budgeting, and overall supervision of health issues, the absence of a health action plan, a prevalence of diseases resulting from poor hygiene, outdated or dilapidated medical equipment, under-equipped hospitals, and often insufficiently trained staff.
Under pressure from negative UN reports on land management, the United States significantly increased the health budget, among other things. US legislation on health planning was extended to the Federated States of Micronesia. The US administration hired and supervised local doctors and paid all the bills. In the 1980s, a conglomerate of federal and international programs is made available to Micronesian governments. One of these, called the Medical Referral Program, allows patients to be sent to the Tripler Army Medical Center in Hawaii. Larger, more modern hospitals are built.
Smallpox was quickly eradicated thanks to penicillin, and oral medication was provided to treat intestinal parasites. Pulmonary tuberculosis, which affected 5% of the population of the Yap Islands, which were particularly hard hit, was combated from 1960 onwards through a vaccination program. All district hospitals had special rooms to isolate victims. The constant spitting of betel nuts may have contributed to the spread of the disease on the Yap Islands. In Chuuk State, a measles epidemic caused a few deaths in the mid-1960s, but epidemics remain rare.
New diseases with changing living conditions
Consequences of improved living standards During the 1960s, US subsidies and the population grew, and wealth increased due to the rise in employment. Between 1962 and 1977, per capita income tripled. Imported foodstuffs, once prohibitively expensive, were now affordable for many Micronesians. The purchase of motorized land and sea vehicles led to a decline in physical activity.
The introduction of baby bottles and powdered milk allows many women to circumvent prohibitions on sexual relations during breastfeeding. Powdered milk is also perceived as a sign of distinction because of its cost. In addition, many mothers who have found government jobs, tired, entrust their children to relatives, usually elderly or very young, who cannot always serve as nannies. These people have no experience in using bottles (sterilization, boiling water) and may have poor hygiene practices. In addition, to make the formula last longer, the doses may be reduced or diluted with Kool-Aid or other beverages. For weaned children, healthy traditional foods are replaced by white rice or junk food, and the nutritional values of store-bought foods are unknown. This change in diet leads to vitamin A deficiencies, particularly in Chuuk State, to a lesser extent in Pohnpei and Kosrae States, and more generally to child malnutrition. Thus, breastfeeding, which was once highly valued and still widely practiced on the islands after World War II, was adopted by only a minority in many places in the early 1970s. Since the early 1990s, this practice has been making a comeback, but between 1991 and 1996, a quarter of child deaths in Chuuk State were still attributable to malnutrition.