The Gilbert Islands where 90% of the Kiribati population live, boast some of the highest population densities in the Pacific, rivalling, without any tall building, cities like Hong Kong or Singapore. This overcrowding produces a great amount of pollution, worsening the quality and length of life. Due to insufficient sanitation and water filtration systems, worsened by the fragility of the water lens of the atolls and by climate change, only about 66% have access to clean water. Waterborne diseases grow at record levels throughout the islands. Poor sanitation has led to an increase in cases of conjunctivitis, diarrhoea, dysentery, and fungal infections. Around 57% of adults smoke tobacco products on a regular basis, the highest proportion in the world. Due to this and other lifestyle diseases, such as diabetes, there has been a drastic spike in amputations on the islands, doubling in a few years.