Health Promotion

Health Promotion

Health promotion is the process of enabling people to increase control over and improve their health. Health promotion is not just the responsibility of the health sector alone, but also requires people, families and communities to adopt healthy lifestyles and wellbeing.

When people have the right information, understand their health status, the risks and what they want for their future health needs, then they are empowered to make healthy decisions.

People from all walks of life are involved as individuals and as members of families and communities. As a result, health promotion strategies and programmes should be adapted to the local needs of individuals and communities and take into account different social, cultural and economic structures.

Risk Factors

Non-communicable diseases (NCDs) such as diabetes, cardiovascular disease, cancer and chronic respiratory disease are the most common form of morbidity and mortality in the Cook Islands. The key risk factors for NCDs include overweight and obesity, low level of physical activity, inadequate fruit and vegetable consumption, alcohol abuse and smoking).

Te Marae Ora, with support from the WHO, completed the second NCD Risk Factors STEPS report from 2013-2015. Over 1200 people participated in the survey. The statistics from the report show Cook Islanders are at high risk of developing an NCD, with 99.4% of all Cook Islanders having more than one of the key risk factors and over half are high risk, with more than three of the key risk factors. The report emphasised the need for continued focus on prevention and management, and regular surveillance of NCDs to monitor trends and guide public health interventions.

Alcohol abuse

Report findings
  • Current alcohol drinkers (consumed alcohol in the last 30 days) were almost half of all respondents
  • More males (56.8%) than females (36.95%) were current alcohol drinkers
  • Male drinkers consumed 9.5 standard drinks on average on a drinking day, while female drinkers consumed 6.3 standard drinks
  • Younger men (18-44 years) consumed a higher amount of standard drinks (up to 10.1) than older men (up to 8.2), and more than older and younger women
  • A small percentage of male (3.4%) and female (2.0%) were Category 3 high-end drinkers (defined as >60g pure alcohol for males and >40g pure alcohol for females)

One standard drink contains approximately 10g of pure alcohol

Almost half of the Cook Islands population have consumed alcohol – more common among males than females. However not all will have problems with alcohol. Excessive, uncontrolled and continued misuse of alcohol contributes to problems such as alcohol poisoning, motor vehicle accidents, violence, sexually transmitted diseases and cancers.

Alcohol abuse, addiction and dependency

Alcohol abuse can refer to a number of problems such as binge drinking, drinking while pregnant or underage drinking. This type of behaviour can put individuals or others in risk situations such as alcohol poisoning, motor vehicle accidents, and assault.

Binge drinking is defined as 5 or more drinks in 2 hours for males and 4 or more drinks for females. It can lead to numerous problems such as cancer, memory and learning difficulties. In a report on NCD risk factors in the Cook Islands, male drinkers consumed 9.5 standard drinks on an average drinking day, while female drinkers consumed up to 6.3 standard drinks.

Drinking while pregnant is dangerous as the alcohol can be passed on from mother to baby. This can cause miscarriage, stillbirth and development issues (physical, behavioural and intellectual) such as vision and hearing problems, low birth weight and learning disabilities.

Underage drinking due to the accessibility of alcohol and peer pressure, are one of the most common forms of alcohol abuse in the country. A report on NCD risk factors in the Cook Islands, with over 1000 respondents, alcohol consumption was high in males between 18 to 44 years old. Teenagers who misuse alcohol show signs of alcohol abuse such as declining academic performance, rebelling, smelling of alcohol, mood swings, changing social circles and friend groups, and learning problems. They may also participate in unsafe activities and assault, or get injured or die in motor vehicle accidents.

Alcohol addiction

Alcohol addiction involves uncontrolled and continued substance use despite the harmful consequences. Addiction can lead to alcohol use disorder (AUD) or dependency on alcohol.

Alcohol use disorder is a chronic disease defined by the compulsive consumption of alcohol and inability to control how much you drink. Signs include neglecting personal and family responsibilities, depression, failing in attempts to quit, and drinking more alcohol in order to feel its effects.

Alcohol dependency

Alcohol dependency is more severe than addiction and is defined as a state where the body requires alcohol in order to function normally. This can lead to blackouts, severe withdrawal symptoms and problems functioning at home, school, work or in the community.

Treatment

Individuals seeking help for alcohol abuse, addiction or dependence can opt to receive counselling from trained professionals. Some people are identified and referred for care based on population health screening and assessments.

Alcohol and drug abuse is serious. If you (or someone you know) feel unsafe because of another person’s drinking or drug use, call the police. If you find someone unconscious, call an ambulance – dial 999.

Support for alcohol and drug problems

If you or someone you care about has an alcohol or other drug problem, or you want to change your habits, there is help available. It’s important to remember that you aren’t alone. If you’d like confidential advice and support to get help for yourself or someone you know, contact 0800 1814 to speak to a trained professional.

Alcohol and drug abuse is serious. If you (or someone you know) feel unsafe because of another person’s drinking or drug use, call the police. If you find someone unconscious, call an ambulance – dial 999.

Smoking

Report findings
  • Current smokers (those who smoked in the last 12 months) comprised 32.6% of all respondents
  • A higher proportion of current smokers were men (37.9%) rather than women (27.7%)
  • Younger men (18-44 years) make up a higher proportion of smokers (41.7%)
  • Three quarters of all current smokers smoked daily – with the mean age of men being 18 years old and 19 years old for women
  • Almost all daily smokers smoked manufactured cigarettes
  • More than two thirds of current smokers tried to quit smoking over the last 12 months

The results suggests a clear need to provide support and extend smoking cessation programmes.

Quitting is one of the best ways to protect yourself and others. You will be so much healthier, and your family will be happier when you quit. If you need support to quit smoking, free call us on 0800 1819.

Smoking is bad for your health and others. It can cause a range of problems including cancer, lung disease, stroke, vision problems and high blood pressure. In the Cook Islands, tobacco consumptions is high at approximately 30% of the population (roughly 5,000 people).

Second-hand exposure to smoking is just as bad and people who are exposed to second-hand smoking can also get many of the same problems as smokers do. Women who smoke while pregnant have a higher risk of babies dying of sudden infant death syndrome (SIDS). Mothers who breathe second-hand smoke while pregnant are also more likely to have preterm labour or babies with low birth weight. Children exposed to second-hand smoke also have a greater chance of developing ear infections, colds, pneumonia, bronchitis and severe asthma.

There are also other forms of tobacco other than cigarettes to be mindful of. Some of these tobacco products contain harmful chemicals and nicotine – some in higher concentration than that in a pack of cigarettes. Electronic nicotine delivery systems (ENDS) also known as ‘e-cigarettes’ or ‘vaping devices’ are harmful to your health. The pods in e-cigarette liquids can contain as much as 60-75 cigarettes worth of nicotine.

Smokefree Islands Ngaputoru

The Minister of Health, Secretary of Health and leader of the House of Ariki travelled to the Ngaputoru in May 2019 to launch the Smokefee Islands programme. This programme is part of the Pacific Smokefree Islands initiative to reduce the proportion of smokers to less than 5% by 2025.

Mobile Smoking Cessation programme

From October to December 2019, we piloted a text message smoking cessation (mCessation) research programme to encourage up to 100 smokers to quit. The messages were specially designed to help people through the different stages of quitting smoking. The programme was implemented with support from the WHO, University of Auckland in New Zealand and Vodafone Cook Islands (then Bluesky Cook Islands). The results from the pilot were diverse but provided areas and options for improving the delivery of telehealth initiatives.

Who took part?

In total, 90 people, predominantly from Rarotonga took part in the study. Of these people, half (52%) were female, and most people tried to quit smoking at some stage in the past. Most people smoked less than 10 cigarettes a day; and the majority of people wanted to quit smoking (82%). This information was helpful as it showed that there is a need for people to quit smoking.

What makes it hard to quit smoking?

The results from the trial shows that the majority of people feel having family and friends who smoke and stress make it hard to quit smoking. This makes sense, it is always harder to change habits when others around you are continuing to do the same thing. Stress is a part of everyone’s life to some extent; there is a misconception that smoking eases stress. This is not true, but it can feel like a stress-relief when you are addicted to nicotine.

What did people think about the text message programme?

The feedback was mostly positive, with many people telling us that the messages made them think about quitting (78%) and even reduce the number of cigarettes smoked (59%), or even try to quit (53%). Other benefits including increased thoughts about quitting (78%), assisting them to make a quit attempt at least once (53%) and learning new ways to stop smoking in the future (47%).

Things we learned

Some people were not ready to quit and therefore the programme did not offer much help - it is important that you make a quit attempt when you are ready to quit.

Alcohol is often consumed when smoking – it is harder to quit smoking when you are a drinker. We need to consider how to reduce alcohol consumption as well as smoking.

“I think keep doing it (the programme) until the message sinks in”

 “I think that all people who smoke should get it – [it would be] good for my sister who is a smoker and lives on the other island”

 “If they are ready, it would helpful. I didn't want to get messages as I was not ready to quit”

 “It would be good [the programme] as long as you have the right support - buddying up with someone to help you to stay on track”

Quit smoking during COVID-19

With the threat of COVID-19, where the virus targets the lungs, it is more important for smokers to quit. Smoking involves touching your face frequently and this increases your chance of becoming infected and transmitting the virus. The latest research from the WHO shows smoking puts you at higher risk for developing life-threatening illness if you contract COVID-19. It damages your lungs and weakens your immune system making it harder for your body to fight off infection. Smoking puts your life at risk in other ways. Smokers are also more likely to need treatment for other serious conditions like heart attacks, stroke, diabetes, cancer and emphysema.

How to quit?

Giving up smoking is hard, but COVID-19 should give you extra motivation to put it behind you:

  • Start by avoiding the things that trigger your urge to smoke, like a morning routine associated with smoking
  • Tell friends and family you are quitting so they can support you and hold you accountable
  • Remember, there has never been a more important time to give up the habit. Note smoking is one of the most important things you can do to stay safe.
  • We can help: free call 0800 1819 or 54880.
Electronic Nicotine Delivery Systems

Electronic Nicotine Delivery Systems (ENDS) also known as ‘e-cigarettes’ or ‘vaping devices’ are electronic devices that vaporise a nicotine-containing liquid that the user inhales. These do not contain tobacco but nicotine is usually present.

E-cigarette liquids are commonly available in 3% and 5% nicotine concentrations in 2mL pods and sold in retail in Guam, Commonwealth of Northern Mariana Islands, Fiji, Niue and New Zealand. A 3% nicotine concentration means there are more than 30mg of nicotine per mL. So if pods are 2mL, then each pod contains 60mg of nicotine. This is roughly equivalent to 60-75 cigarettes worth of nicotine.

Food & Nutrition

Report findings
  • Over 80% of respondents were overweight and obese
  • Over 80% men and women consume less than 5 servings of fruits and vegetables on an average day
  • Men consume less fruits and vegetables than women
  • More than one third (36%) of participants always or often added salt to food before or while eating, and almost half (48%) added salt to their food when cooking or preparing foods at home
  • Almost one quarter (24%) experienced oral pain or discomfort in the past 12 months, and 14% experienced difficulties in chewing food
Overweight and obesity is a major problem in the Cook Islands, and for most people it leads to non-communicable disease (NCDs) resulting in poor quality of life. Eating well, including fresh and whole foods to your diet, being active and getting enough sleep are key ingredients for a healthy life and reversing the obesity trend in the Cook Islands.
Tips for healthy living
It is important to ensure you only eat what you need and avoid overeating. You should also eat a wide range of foods to ensure you receive a balanced diet and your body gets all the nutrients it needs.
  1. Eat real, healthy, fresh and whole foods
Avoid foods that are altered by humans such as processed foods or packet foods. If the packet says ‘lite’, ‘low fat’ or ‘fat-free’, avoid buying it as it will likely be high in sugar. Wherever possible, use natural foods as it grows on the land or in the sea. Try to eat 2-3 nutritious meals a day and avoid snacking.
  1. Eat plenty of non-starchy vegetables
Up to 80% of our diet should be plant-based. Wherever possible, eat vegetables that grow above ground and are edible when raw – mostly greens.
  1. Drink lots of water
Water is important for your body. It helps keep you hydrated, protects the skin, helps with weight loss, maintains body fluids and regulates body systems to keep you going.
  1. Stay active and keep moving
Low levels of physical activity and movement can have harmful effects on your health, wellbeing, quality of sleep, and quality of life. It is important to keep moving wherever possible to reduce stress, prevent muscle and joint pain, and stay in good health.
  1. Get lots of sleep
Lacking sleep or sleep deficiency can contribute to weight gain, poor eating habits, and lower concentration and productivity. These can also put you at high risk of heart disease, high blood pressure, diabetes and stroke. Counselling services on healthy eating and living are provided at Rarotonga Hospital and the Tupapa Community Clinic by a trained clinical dietician. Please contact Rarotonga Hospital on 22664 to make an appointment. Studies repeatedly show that a diet low in carbohydrates (especially those that are processed) and higher in healthy fats comes out on top for the treatment of obesity, diabetes, metabolic syndrome and in helping to correct unhealthy cholesterol.
COVID-19 resource

Physical Activity

Report findings
  • On average, 22.8% of men and 39.5% of women had a low level of physical activity
  • 15% of men and 22% women had moderate levels of physical activity
  • 61% of men and 38.5% women had high levels of physical activity
  • Half of men’s physical activity was work-related (51.4%) followed by recreation-related (35.9%) and transport-related (12.8%) activity
  • Women’s physical activity was 38.5% recreation-related, 35.7% work-related and 25.8% transport-related
Exercise or physical activity can improve your health and reduce your risk of disease. By staying active and increasing movement every day, your quality of life will improve and it strengthens your bones and muscles.

5-17 years

  • At least 60 minutes of moderate to vigorous-intensity physical activity daily

  • Additional benefits - more than 60 minutes

  • Activities that strengthen muscle and bone - 3 times per week

18-64 years

  • At least 150 minutes of moderate-intensity physical activity or 75 minutes vigorous-intensity activity throughout the week

  • Additional benefits - increase to 300 minutes

  • Muscle-strengthening activities

65 years and above

  • At least 150 minutes of moderate-intensity physical activity throughout the week or at least 75 minutes

  • Additional benefits - increase to 300 minutes

  • Poor mobility - enhance balance and prevent falls

  • Muscle-strengthening activities

Muscle-strengthening activities include:
  • Lifting weights
  • Heavy gardening, such as digging and shovelling
  • Climbing stairs
  • Hill walking
  • Cycling
  • Dance
  • Push ups, sit-ups and squats

Tips to be active

Being active does not always mean going to the gym or buying expensive gym equipment or gear. Being active simply means moving more. With urbanisation, we are increasingly living sedentary lifestyles with more sitting and less movement.

  1. Walk more

Walking is one of the easiest and most convenient activities you can do. Brisk walking (or walking faster) is considered a good way to burn calories. Another goal for walking is to get 10,000 steps a day – this measure is available on most mobile phones and devices.

  1. Stand up at work or hold standing meetings

Working in the office can mean sitting for hours at a desk. Standing helps break that habit and helps burn calories while increasing leg strength and endurance.

  1. Clean your home and yard

There are many benefits to cleaning, and using this time as opportunity to stay active during the week is important. Vigorous cleaning in and around the home is good for your health, whether by sweeping and mopping your home, gardening or going to the plantation.

Injury & Violence Prevention

Motor vehicle crashes, domestic violence, child abuse and neglect, elderly and disabled abuse and neglect are important public health concerns in the Cook Islands. In addition to their immediate health impact, the effect of injuries and violence extend well beyond the injured person or victim of violence, affecting families, friends, co-workers, employers and communities. The long term effects of injury and violence include:

  • Hospitalisation
  • Brain injury
  • Poor mental health
  • Disability
  • Premature death