New World Syndrome

In Kosrae, an island in Micronesia, new arrivals are a curiosity, and it seemed that half the island had come to greet me and Steven Auerbach, a Manhattan-based medical epidemiologist and an officer in the U.S. Public Health Service who had worked in Micronesia in the early 1990s, when we visited last year. Dazed from our 8,000-mile journey, we groped our way down the pockmarked coastal road, driving past groves of trees bent nearly double under loads of bananas, papayas, and breadfruit. We were on our way to a funeral feast.

We arrived to find the feast in full swing. Young men in lawn chairs played cards, while toddlers squatted, transfixed, around a television screen blaring taped cartoons. Hovering women filled plates and wiped faces. Perhaps a hundred people were there, and the dead man's wife looked bored. The deceased, buried four weeks earlier in a nearby crypt, seemed almost beside the point.

Kosraeans die young (the man in the crypt was fifty-six), but not for reasons commonly associated with the developing world. There is no famine here, and with the notable exception of upper-respiratory infections, little evidence of the diseases that cut life short in, for example, sub-Saharan Africa. The big killer in Kosrae—what some epidemiologists call New World syndrome—is a constellation of maladies brought on not by microbes or parasites but by the assault of rapid Westernization on traditional cultures. Diabetes, heart disease, and high blood pressure—scourges of affluence that long ago eclipsed infectious diseases as killers in the West—have only recently appeared here.