Guam’s chronic problem
Covid-19 highlights the continuing challenge of managing non-communicable diseases
By Jasmine Stole Weiss
Almost every Covid-death report released by the government contains the term “comorbidity,” which has now become a household word. In the Covid era, we have come to better understand the severe impact of chronic diseases on the community where the health care system leaves much to be desired.
In 2010, the Pacific Islands Health Officers Association declared a regional state of health emergency for Pacific islands affiliated with the United States in response to the fatal prevalence of chronic diseases among islanders.
“The rates of (chronic diseases) and their risk factors in the (U.S.-Affiliated Pacific islands) are among the highest in the world,” states the association’s 2010 board resolution.
Eleven years later, chronic diseases continue to plague the islands, and the Covid-19 pandemic highlights their risks.
As of the last week of November, Guam’s Covid-19 death toll was 264, a number too large for an island with a population of 160,000. A majority of Covid-19 patients who died had comorbidities, among them were fully vaccinated individuals. Local health authorities have, in fact, attributed the high rate of breakthrough deaths on Guam to the prevalence of chronic diseases on island.
In her state of the island address earlier this year, Gov. Lou Leon Guerrero said, “85 percent of those we lost to Covid-19, and over 70 percent of those hospitalized at Guam Memorial Hospital, had pre-existing conditions that made them especially vulnerable to the effects of this virus.”
Last year, heart disease accounted for about 29 percent of the deaths on Guam, making it the top cause of death followed by cancer. Covid-19 was the third leading cause of death in 2020.
“I think the pandemic has shown the negative outcomes related to chronic diseases and their risk factors and SARS-CoV-2/Covid-19, especially diabetes, end-stage renal disease, cardiovascular diseases and hypertension,” said Dr. Ann Pobutsky, Guam’s territorial epidemiologist.
Pobutsky said the risk factors for Covid-19 include diabetes, obesity, hypertension, high blood pressure, cardiovascular diseases and lung diseases.
Diabetes on Guam received special attention in November, which was proclaimed Diabetes Awareness Month. A related education campaign spearheaded by KUAM News consisted of a series on diabetes awareness discussions featuring health specialists and industry stakeholders.
"Overall, there is a very fatalistic view of diabetes on Guam. Most families have multiple members with diabetes, and unfortunately, it has now become a normal part of life,” said Dr. Erika Alford, an endocrinologist at American Medical Center.
Guam Regional Medical Center, American Medical Center and Calvo’s SelectCare have teamed up with AI Health to launch a research partnership to bring cutting-edge artificial intelligence medical research to Guam. The planned study will focus on aggregating healthcare data from different sources and applying artificial intelligence to identify critical risk factors and provide insights into treating patients with diabetes.
Dr. David C. Klonoff, a member of the AI Health advisory board, said Guam is an ideal place to study diabetes using artificial intelligence. “Guam is uniquely positioned to create meaningful impact around the study globally, and most importantly, it allows us to leave a positive legacy of making an impact in the community for those who suffer from diabetes,” he said.
Besides a very sizable representative sample for the study, Klonoff noted that Guam has ethnic diversity, the presence of most chronic diseases and a sophisticated medical community. “The island is also small enough so we can conduct a controlled and efficient study, where we are able to directly engage many of the key stakeholders in the healthcare ecosystem,” Klonoff said.
Frank J. Campillo, health plan administrator for Calvo’s SelectCare, said the diabetes study will be groundbreaking for the local population as it may help the future medical management and coordination of care for the diabetic population. “As part of our quality initiatives, we continue supporting innovative and more effective methods of care for our members, and this study can provide results that directly impact their overall health and well-being,” he said.
Dr. Hoa V. Nguyen, a founding member of American Medical Center, confirmed that the prevalence of diabetes on Guam is extremely high. “Every day, we care for numerous patients not only with diabetes, but also with complications associated with diabetes, including chronic kidney disease, diabetic retinopathy, diabetic neuropathy, peripheral artery disease, heart disease and strokes,” he said. “Improving diabetes care is a crucial step toward preventing these long-term complications associated with diabetes.”
Guam outlined goals to combat chronic diseases in its strategic plan released in 2019. It aims to reduce tobacco consumption, alcohol use, obesity and physical inactivity which are four major risk factors for non-communicable diseases or NCDs. The plan showed that by 2023, officials hope to have reduced obesity by 10 percent and increased physical activity by 10 percent.
Officials plan to accomplish these goals through increased sin taxes on tobacco, screening and identifying residents at risk of alcohol use at the clinic level, and media campaigns to promote eating fruits and vegetables, increase available fruits and vegetables in schools, establish more community gardens, enforce laws aimed at promoting healthy eating and improve parks and places people can exercise.
Guam did not achieve its previous goal of reducing obesity by 5 percent in its strategic plan for 2014 and 2018. Officials decided to aim higher.
“Obesity prevalence increased for the youth and remained unchanged for adults,” according to the public-private partnership, Guam Green Growth. "As one of the top priorities identified under the NCD Strategic plan for 2019-2023, the new goal is to achieve a reduction in obesity by 10 percent by 2023.”
· Diabetes is a primary contributor to two of the three leading causes of death in Guam– heart disease and stroke;
· Adults diagnosed with diabetes are two to four times more likely than people without diabetes to die of heart disease or experience a stroke;
· Approximately half of the individuals who have died from Covid-19 in Guam had diabetes as a comorbidity; and
· The prevalence rate of diabetes in Guam grew from 13.7% in 2018 to 14.7% in 2020. (Source: Diabetes Month Proclamation )
The obesity rate for adults is 33 percent, while the youth obesity rate on Guam in 2019 was 23.8 percent.
Pobutsky said teaching people about managing chronic disease is important, She also endorses yearly flu shots, pneumonia shots and Covid-19 vaccines for elderly people.
Pobutsky said in addition to conventional advice given to people to prevent chronic disease, there also needs to be more emphasis on the non-medical factors that influence health outcomes, such as the social determinants of health, including living conditions, income, access to education and health care and the quality of health care that shapes their health.
Policies must respond to relevant questions, she said. "How can the social and physical environment of Guam become more conducive to exercise and eating healthier? How can we raise the general level of education and health literacy in our population? How can we ensure that all people on Guam have opportunities for decent jobs and decent housing?”
As people get older, chronic health conditions increase. “So we know that it is important for people to take care of themselves as they age, especially if they have chronic ailments,” Pobutsky said. (With additional reports from Mar-Vic Cagurangan)