Cholera in Oceania

Marine water quality of a densely populated Pacific atoll (Tarawa, Kiribati): Cumulative pressures and resulting impacts on ecosystem and human health

The resilience of coastal ecosystems and communities to poor environmental and health outcomes is threatened by cumulative anthropogenic pressures. In Kiribati, a developing Pacific Island country where human activities are closely connected with the ocean, both people and environment are particularly vulnerable to coastal pollution. We present a survey of environmental and human health water quality parameters around urban South Tarawa, and an overview of their impacts on the semi-enclosed atoll. Tarawa has significant water quality issues and decisions to guide improvements are hindered by a persistent lack of appropriate and sufficient observations. Our snapshot assessment identifies highest risk locations related to chronic focused and diffuse pollution inputs, and where mixing and dilution with ocean water is restricted. We demonstrate the importance of monitoring in the context of rapidly changing pressures. Our recommendations are relevant to other atoll ecosystems where land-based activities and ocean health are tightly interlinked.

Health Challenges of the Pacific Region: Insights From History, Geography, Social Determinants, Genetics, and the Microbiome

The Pacific region, also referred to as Oceania, is a geographically widespread region populated by people of diverse cultures and ethnicities. Indigenous people in the region (Melanesians, Polynesians, Micronesians, Papuans, and Indigenous Australians) are over-represented on national, regional, and global scales for the burden of infectious and non-communicable diseases. Although social and environmental factors such as poverty, education, and access to health-care are assumed to be major drivers of this disease burden, there is also developing evidence that genetic and microbiotic factors should also be considered. To date, studies investigating genetic and/or microbiotic links with vulnerabilities to infectious and non-communicable diseases have mostly focused on populations in Europe, Asia, and USA, with uncertain associations for other populations such as indigenous communities in Oceania. Recent developments in personalized medicine have shown that identifying ethnicity-linked genetic vulnerabilities can be important for medical management. Although our understanding of the impacts of the gut microbiome on health is still in the early stages, it is likely that equivalent vulnerabilities will also be identified through the interaction between gut microbiome composition and function with pathogens and the host immune system. As rapid economic, dietary, and cultural changes occur throughout Oceania it becomes increasingly important that further research is conducted within indigenous populations to address the double burden of high rates of infectious diseases and rapidly rising non-communicable diseases so that comprehensive development goals can be planned. In this article, we review the current knowledge on the impact of nutrition, genetics, and the gut microbiome on infectious diseases in indigenous people of the Pacific region.