Nauru

Located in the southern Pacific Ocean south of the Marshall Islands, Nauru is the world's smallest independent republic with a total land area of 13 square miles. Nauru's importance has long been its rich phosphate deposits, and the export of phosphates has been the linchpin of the economy. That resource is expected to fail by the 2020s, and the government has diverted portions of the current export profits into a trust to cushion the blow of the loss. Borrowing from that trust has brought the government to the brink of bankruptcy, leading to a freeze on most expenditures, including hospitals, state employee wages, and crumbling infrastructure.

The current population is 13,300 with population growth at 1.81 percent annually. This may drop in coming years as the phosphate mines are fully played out; unemployment now stands at 90 percent. Over a century of mining has left a huge environmental mess in its wake, and less than 600 acres of the island are available for cultivation. As a result, everything on the island—including most of the drinking wa-ter—has to be shipped in from Australia and other Pacific countries. Life expectancy is currently 60 years for males and 67 years for females. Infant mortality is 12.7 deaths per 1,000 live births; under-5 mortality is 19.1. Maternal mortality is low, with 100 percent of women receiving prenatal care and giving birth under the supervision of a trained attendant.

Common infectious diseases have been mostly eradicated on Nauru. There were three new cases of leprosy diagnosed in 2002 and three cases of tuberculosis in 2003. There were no reported cases of HIV or AIDS. All Nauruans have access to clean water and adequate sanitation.

Noncommunicable diseases such as diabetes and hypertension are the leading health problems for Nauruans. Obesity rates are high. The island has the highest diabetes rate in the world, with 30.2 percent of the population suffering from the disease. Dealing with the crisis has become a major focus of the Ministry of Health, which has plans for an island-wide campaign focusing on healthy eating and lifestyle choices. It is also trying to finance more medical services for those suffering from these types of chronic health conditions.

The population is served by a general hospital and a primary care center. The Ministry of Health reports five doctors, 48 nurses, two midwives, and 180 other medical support staff working on the island. Fifty percent of medical personnel are expatriates. Healthcare is free to all Nauruans.