Disease and development: ciguatera fish poisoning.

Ciguatera, a form of fish poisoning with a pantropical distribution, has been a recognized health problem in the Caribbean and the Pacific for centuries (in the decade from 1973 to 1983 for the island Pacific region as a whole, reported incidence, conservatively 20% of actual incidence, was 97/100,000). Island peoples in subsistence communities have developed strategies to minimize its impact. These strategies are less effective when people move to towns, cities and wage labor. The existence of ciguatoxic fish, which are indistinguishable from those that are not, has serious implications for development in island states. Furthermore, development activities which result in disruption of the marine environment increase the potential for ciguatoxic biotopes. The distribution of this health risk in the Pacific region is presented, adaptive strategies discussed, and implications for health, nutrition, resource development and tourism explored.