Objectives: Mortality level and cause of death trends are evaluated to chart the epidemiological transition in Fiji. Implications for current health policy are discussed.

Methods: Published data for infant mortality rate (IMR), life expectancy (LE) and causes of death for 1940–2008 were assessed for quality, and compared with mortality indices generated from recent Ministry of Health death recording. Trends in credible mortality estimates are compared with trends in proportional mortality for cause of death.

Results: IMR declined from 60 deaths (per 1,000) in 1945 to below 20 by 2000. IMR for 2006–08 is estimated at 18–20 deaths per 1,000 live births. Excessive LE estimates arise by imputing from the IMR using inappropriate models. LE increased, but has been stable at 64 years for males and 69 years for females since the late 1980s and early 1990s respectively. Proportional mortality from diseases of the circulatory system has increased from around 20% in the 1960s to more than 45%. Extensive variation in published mortality estimates was indentified, including clearly incompatible ranges of IMR and LE.

Conclusions: Mortality decline has stagnated. Relatively low IMR and proportional mortality trends suggest this is largely due to chronic diseases (especially cardiovascular) in adults.

Implications: Reconciliation of mortality data in Fiji to reduce uncertainty is urgently needed. Fiji's health services and donor partners should place continued and increased emphasis on effective control strategies for cardiovascular disease.