The health care system in Tokelau is operated by the health department of the public service. Each of the three atolls of Tokelau has a hospital which works as part of the Western Samoa region to provide primary health care to the community. The crude birth rate is 22 per 1000 and the crude death rate 7 per 1000.
In Tokelau, skin infections, influenza, gastro-enteritis and upper respiratory tract infections are common, and the major causes of death are pneumonia, heart disease and cancer. In recent years diabetes and gout has increased, attributed to the reliance on imported foods and declining healthy lifestyles with approximately half of the adult population smoking, heavy alcohol consumption and a high incidence of obesity. The change in dietary trends has also seen a decline in dental health in Tokelau.
In Tokelau, there are plans for the installation of diagnostic services, an X-ray unit, a laboratory and an operating theatre to ease the amount of patients being transferred to Western Samoa. The health department is also involved in the improvement of water supplies and sanitation services and improvement of maternal and child health programmes.
The health services has a Director of Health based in Apia and a Chief Clinical Advisor who moves from atoll to atoll as required to assist the doctors attached to each hospital. In 2007 there was not always a doctor on each island and locums were appointed to fill the big gaps. Upcoming Tokelauan medical graduates are believed to be alleviating this shortage.