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Health workers often communicate to people from a position of power rather than focusing on the needs of the receivers. This is usually clouded with jargon and the so-called principles of scientific accuracy. Often the use of science is to justify the health worker's position rather than to precipitate actions to promote health and achieve people's control over their lives. Communication involves a tripartite reciprocal interaction between the sender, receiver and the medium. This involves both science and art specific to the message, language, values and participants. If the ultimate purpose of communication is healthful action and community control, then scientificness of the explanations must be secondary. Therefore the art of getting the message across must be the priority rather than it being scientifically sound. This conflict is discussed in relation to experiences in the Pacific Islands. The communication of health risks in the Pacific involves the multi-tiered translation of scientific concepts and language into those of the target populations. The scientific concepts are usually occidental and need to be translated into vernacular worldviews and languages. Experiences in and examples from the Pacific have challenged the primacy of scientific explanations over the need to minimise health risks and increase of community control. For health promotion to succeed in multicultural and multilingual Pacific, New Zealand and Australia, the art and science of communicating health risks must be titrated against scientific explanations to appropriately and primarily promote health.

History, economics, culture, and politics have created health systems that can no longer meet the health challenges in the Pacific. An analysis of the health situations in the region revealed health trends, health service deficiencies and the various issues that need to be addressed. The morbidity and mortality experience in the Pacific has been approaching that of the developed countries. The contributing factors to diseases and death have been changing but other health issues, such as matters pertaining to environmental sanitation, management, health information, food and nutrition, ethnic pluralism, colonialism, and technological arrogance, may exacerbate these experiences. To appropriately meet these constraints, the health services need reorientation. However, these need new types of health leadership. Doctors, being the most socially acceptable and politically powerful, should be trained for this new leadership role. This training must be guided by the biopsychosocial model to produce community health physicians. This is being undertaken at the Pacific Basin Medical officer Training Program, Pohnpei. It is characterized by an integrated, community-oriented, student-centered, career-ladder and competency-based approach. The graduates will then provide the leadership and catalyst for the needed health service reorientation.