Within the Pacific, Tonga is recognised to have some of the highest overall health standards, implementing a combination of preventative and immediate strategies to curb rates of communicable disease, child mortality and overall life expectancy. The Tongan government aims to continue such levels of health through achieving their Millennium Development Goals (MDG) detailing their focus on improving their healthcare system within the areas of maternal and infant health as well as improve access to immunisation, safe water and sanitation.
Through data formulated by the World Health Organization and Tonga's Ministry of Health, its population of over 105,000, 75% of the country's mortalities are attributed to non-communicable diseases (NCD) such as strains of cardiovascular and ischemic heart diseases and diabetes. Additionally, 99.9% of the adult population is vulnerable to developing NCDs and despite the launch of Tonga's National Strategy to Prevent and Control NCDs the prevalence of such conditions has continued to rise. Such increases are attributed to the processes of urbanisation and modernisation which popularised a more sedentary lifestyle amongst Tongans and introduced processed and saturated fats into their everyday diets.
Through modernising and nationalising their healthcare system, as well as initiatives headlined by WHO, the overall life expectancy has been on the slow incline being rated at 77 in 2020. Tonga has also had an increased prevalence of infectious diseases such as hepatitis A due to contamination of food and water in more remote areas as well as in 2019 an outbreak of measles which was declared an epidemic across the Pacific due to a decrease in measles vaccinations across the islands.
The Human Rights Measurement Initiative finds that Tonga is fulfilling 74.4% 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, Tonga achieves 98.3% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 86.9% of what is expected based on the nation's level of income. Tonga falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 38.1% of what the nation is expected to achieve based on the resources (income) it has available.
Life expectancy Life expectancy in Tonga has experienced some fluctuation due to the increased prevalence of non-communicable diseases (NCD) and also the arise of epidemics in more recent times. The life expectancy (at birth) in 2020 is estimated to be 77 years for both sexes combined. For females at birth the life expectancy is 78.8 which is both higher than the overall rating and also male life expectancy which is 75.4. Infants up to 5 years of age are expected in 2020 to only live a total of 66.86 years, which has slightly increased from 58.76 in 1950–1955. The projected crude birth rate for 2020 is 24.5 per 1,000 people, while the total fertility rate is 2.87 which has dramatically decreased from 7.30 in 1950–1955. The crude death rate from 2015 to 2020 was 4.9 per 1,000 people and the infant mortality rating was 10.3 for both sexes combined per 1,000 live births. As of 2017, the leading causes of deaths in Tonga were Ischemic heart disease increasing by 6.5% since 2007, diabetes which increased at a rate of 16.6% since 2007 and strokes which increased by 5.1% from 2007. +Tonga's top ten causes of death and disability adjusted life years (DALYs) in comparison to other low-middle Socio-demographic Index (SDI) nations.Cause of Death Tonga (age-standardised rate per 100,000) Comparison group mean (low-middle SDI)Diabetes3,678.9957.2Ischemic heart disease 2,450.82,132.1Stroke 1,492.2 1,994.4Neonatal disorder 1,463.91,667.1Chronic kidney disease1,197.7537.6Lower respiratory infection1,164.2824.7COPD1,070.41,102.9Low back pain 765.9648.8Cirrhosis704.6480.3Road injuries671.3888.8
Indigenous medical practices
Herbal medicine
Herbal and natural medicines play an important role in both past and current health treatments within Tonga. This process is referred to as ethnomedicine where local produce and technologies are used to form medical practices. These practices and illnesses are referred to as mahaki faka-Tonga which are unable to be treated or translated through western medical practices. Treatment falls under three categories which include: invocation, external operations and sacrifices. These can also be further divided into spirit related illnesses, which are often treated through invocation and sacrifice, and ordinary/physical illnesses, treated through surgery and herbs.
Traditional Tongan medicines have incorporated over one hundred plants found locally around the islands and wider Pacific which are used frequently to treat both physical and mental illnesses and also in traditional ceremonies. Native Tongans developed their natural medical and surgical practices from Fijian tribes during conflict. Natural medical processes included the use of plants as well as offerings and symbols such as sacrifice and torture which were believed to alleviate the sickness of a noble. Practices such as tootoonima and nawgia which mean the removal of the fingers and strangulation of children were used traditionally in the past to reverse the pain and illness of a noble.
The details below show the most common plants used within traditional Tongan medicines and the ways they are used to treat a variety of conditions.
Ango Hina Has similar properties to turmeric and is used through a process which extracts the nutrients from the root which is then placed on various skin conditions such as rashes.
Manonu tree
The bark and leaves are removed from the tree and then wrapped around various parts of the body to treat wounds or ailments which function in similar ways to cloth and cotton dressings used more commonly in western medicine.
Kava Contained within the pepper family, Kava is a root which is crushed or ground into a powder before being added to water to create a drink used often in traditional ceremonies or gatherings. The root is also classified as a depressant and therefore can serve as an alternative treatment for conditions such as anxiety or to be used as a relaxant. However, due to this, the root is also classified as a drug and when used recreationally outside of traditional or medical purposes can have serious long term effects such as bipolar disorders and severe weight loss.
Nonu or Noni Leaves are extracted from the noni tree and are typically pressed into a juice which can be drunk daily or used to treat more specific infections such as sores, boils and thrush of the gums.
Common conditions and treatment It is seen that predominately women receive treatment with natural medicines particularly for issues which arise during pregnancy as it is viewed as less invasive and harmful for the child. Women also predominately use traditional medicines due to the Tongan syndrome of Kahi which affects mostly adult women caused by an increased intake of salty or fatty foods, smoking, withholding bowel motions and drinking carbonated beverages which then causes swellings in the vulva, backaches and is even linked to infertility. Traditional methods of treatment for Kahi and other obstetric or gynaecological conditions include remedies from native flora easily accessible along the islands. Mango leaves and Tavahi bark scrapings are infused and drunk daily by women to relieve their symptoms.
Herbal medicines are also particularly important sociologically as they are linked to traditional Tongan beliefs and traditions in regards to their nation specific diseases. In Tongan culture the term mahaki faka Tonga which translates to "Indigenous or Tongan diseases" refers to the first wave of diseases that existed prior to European invasion and the arrival of Western Medicine in 1797, were only to be treated through traditional methods. These diseases include disorders related to the presence of ghosts or spirits of a dead person, which are said to inhabit the nervous, gastrointestinal, urinary and musculoskeletal system and causing various symptoms of joint sprains, vomiting and hysteria.
Traditional healers
Natural medicine within Tonga also incorporates the role of traditional healers, referred to as Kau faito'o, who are considered to have a high level of knowledge and expertise regarding ethnomedical practices and pharmacology. Traditional healers are known to have extensive knowledge of Tongan spirit illnesses which are caused by disturbances in the relationship between the physical, such as society or the land, and the spiritual, being gods and supernatural beings. Initially this was done by 'Priest' healers prior to the spread of Christianity throughout Tonga and they were viewed to be the only entity able to communicate between sick individuals and the gods.
A healer will apply techniques of conversation and discussion, natural and native remedies and massaging affected areas where appropriate. Healers are predominately women and acquire their skills through observation of elders within their family or native tribe allowing for traditional medical practices to be passed from generations with little change. Healers also are said to only receive their power to heal through the process of fanofano which means the washing of one's hands. This ritual takes place at the end of a prospective healer's learning journey, when they are seen to have acquired the necessary knowledge and skill required to be a healer. In more contemporary times the ceremony and exchange of power has been replaced by simpler acts such as a handshake.
Healers are respected within local communities however still retain the same social standing as the rest of the population as healing is considered a side practice to normal daily duties and tasks. Healers often also do not expect or receive compensation in the form of money like general practitioners, rather they are presented with small gifts or tokens such as food or cultural artefacts as a thank you for their treatment. In the cases of illnesses related to spirits and possession by a spirit, known as āvanga or lo'oa, the healer will utilise techniques of massage and fragrant medicinal plants infused as oils to help heed the presence of the spirit.
Healthcare
The healthcare system provided to the population of Tonga is controlled and subsidised by the Ministry of Health and Tongan Federal Government under the Health Services Act 1991. The Ministry of Health takes sole responsibility of the health of the population, with the s. 4 of the Act stipulating their need to:
(a) to preserve and protect the public health of Tonga;
(b) to establish and maintain a service, available to all, to promote the physical and mental health and well-being of the populace;
(c) to provide and maintain comprehensive hospital and community health services with facilities for the investigation, diagnosis, treatment, rehabilitation from, and prevention of disease and ill- health.
Hence the universal healthcare system provided by the Ministry of Health is subsidised for the population with majority of the financing being done by the Ministry of Health in addition to corporate partnerships and donor funding. Government expenditure on healthcare attributes to an annual average 12% of total spending as well as 4% of its Gross Domestic Product (GDP). The Tongan Government finances 47% of healthcare, with 38% being paid by development partners and the remaining 15% by out-of-pocket expenses from the population. These partners include and are not limited to the Governments of Australia and New Zealand, Australian Department of Foreign Affairs and Trade (DFAT), WHO, UN and the United Nations International Children's Emergency Fund (UNICEF).