health & science

Cultural shift needed to tackle Pacific nutrition issues

Pacific culture and tradition revolves around food, but the prominence of processed food has led to a nutrition crisis. Laura Walters travelled to the Pacific to find out about the complicated relationship between malnutrition and obesity.

Small shops - the Pacific equivalent of local dairies - are scattered along the roadside in the Kiribati capital of South Tarawa.

The corrugated iron stalls have a few shelves holding easy-to-make meals like ramen noodles, along with soft drinks and other assorted goods.

Alongside the stalls sit pallets piled high with sacks of white rice and refined sugar.

For many of the country’s 110,000 people, this is the basis of their daily diet.

In the local supermarket, an entire side of an aisle is dedicated to different sized cans of corned beef. Other fatty processed meats are also on offer.

The Pacific’s current relationship with food is complicated.

While more than half of the world’s malnourished children live in Asia and the Pacific, the region is also home to the fastest growing prevalence of childhood obesity in the world.

There has also been a rapid rise in the rates of diabetes. World Health Organisation figures show most countries in the Western Pacific were expected to double the number of people living with diabetes between 2000 and 2030.

In the Western Pacific Region alone, it is estimated that 131 million people (8.4 percent prevalence) were living with diabetes in 2014.

Experts have also now linked malnutrition and stunting – which occurs when a child has not had essential nutrients early in life, including while in the womb - to obesity and type 2 diabetes.

Small convenience stalls on South Tarawa sell snacks, quick meals, assorted goods, and a lot of sugar and rice. Photo: Laura Walters

The UNICEF 2018 food security and nutrition report says this double burden of malnutrition sees undernourished and overweight children living in the same communities and households and it can even occur in the same child.

Roughly two-thirds of Pacific countries have high rates of stunting, but there is a lack of up-to-date, available data.

UNICEF figures show 35 percent of i-Kiribati children under five are stunted, along with 37 percent of children in Tuvalu, and 33 percent in the Solomon Islands.

UNICEF Pacific programme manager Sheldon Yett says this has been a hidden problem.

Stunting has not been widely recognised until recently, due to a focus on over-nutrition and obesity. It is also less obvious than severe malnutrition.

Being stunted and having under-nutrition as a child changes the body, and its ability to absorb nutrients, and how the body reacts to food and nutrients, Yett says.

"This paradox is attributed to a nutrition transition with children increasingly exposed to cheap and convenient unhealthy processed foods rich in salt, sugar and fat but poor in essential nutrients."

Kids who have been underfed, and have had an issue with stunting earlier in life, are more likely as adults to have issues with hypertension, obesity, and have cardiovascular disease.

The body's ability to absorb nutrients is also affected by exposure to faecal matter - something that happens in areas of open defecation in the Pacific, including Kiribati.

The issues of malnutrition and obesity are inextricably linked.

“This paradox is attributed to a nutrition transition with children increasingly exposed to cheap and convenient unhealthy processed foods rich in salt, sugar and fat but poor in essential nutrients,” the report says.

In the past 30 years, big brands have run successful marketing campaigns around their food products.

Now status and success are tied to these low-nutrient, high-energy foods. This paired with a change to a less active lifestyle, has had a drastic impact on the health of Pacific people and rates of non-communicable diseases (NCDs).

Some countries are pushing back, and traditional food sources are making a resurgence in some corners. In 2017, the Guardian reported Torba province in Vanuatu was imposing import restrictions on western foodstuffs and instead taking advantage of its own agriculture.

But more of a cultural shift across the Pacific is needed to combat future health issues.

The move to processed foods

UNICEF Kiribati nutrition officer Tinai Iuta says her country’s population has increasingly turned to processed food for its convenience, status, and high energy content.

In over-crowded South Tarawa land is at a premium, and arable land is hard to come by, making it difficult for families to grow their own crops.

In the outer islands, where people have historically relied on traditional food sources like coconut, there has been a recent move towards processed foods, white rice and white sugar, Iuta says.

Government subsidised work programmes have meant higher income, but that extra money is going towards buying convenient foods.

Like all Pacific countries, food is also a core part of culture and celebrations. Nowadays, people are expected to provide soft drinks and fast foods at gatherings.

“They don’t live luxuriously, it’s just the food,” she says.

Canned corned beef takes up an aisle at a Kiribati supermarket. Photo: Laura Walters

UNICEF now has a focus on the first 1000 days of a child’s life, including nutrition. The delivery of this programme is partly funded by the New Zealand’s aid and development programme.

In Kiribati, this includes educating parents about what to eat while pregnant, as well as the preference for breastfeeding and complementary feeding.

There are new education programmes, and cooking classes, and a cookbook. The idea is to teach people that cooking a meal from traditional ingredients can be easy and affordable.

Meanwhile, other development programmes help set families up with small gardens, or teach them how to grow plants – often leafy greens - in baby formula cans or tyres if their soil isn’t suitable.

Jonathan Rowe, Aid Programme team leader based at New Zealand’s High Commission in Suva, says combatting disease linked to nutrition is difficult in the Pacific due to the cultural and societal part food plays in daily life.

“You’ve got this clash of traditional and cultural approaches… and modern, high-calorie foods,” Rowe says.

“It’s a little bit of a perfect storm.”

A different approach to nutrition

Instead of lecturing populations, the Ministry of Foreign Affairs and Trade is using its Aid Programme to jointly fund a new approach, alongside Australia’s Department of Foreign Affairs and Trade's InnovationXchange.

Celebrity chef Robert Oliver is fronting the new reality television show Pacific Island Food Revolution.

“The NCD crisis in the Pacific is a very recent phenomenon, and it has an absolute relationship with when the tsunami of processed foods invaded the lifestyle of the Pacific,” he says.

But rather than linger on the negatives, the show aims to showcase Pacific cuisine in a positive light.

The show – think a Pacific My Kitchen Rules – uses a popular format, featuring great personalities, and has had high audience engagement across the Pacific, since launching earlier this month.

“The role of glamour is really important.”

“It’s really about moving tradition into popular culture,” Oliver says.

The show aims to make traditional and natural ingredients relevant, and help the cuisine evolve into something fit for the next generation.

Education can only go so far in changing behaviour and attitudes, he says.

“The role of glamour is really important.”

While the TV show, and accompanying social and mainstream media, have helped with the project’s initial reach, the team has created wraparound elements to make sure there is an impact after funding for the series finishes.

Global communications director Faumuina Felolini Maria Tafuna’i says the aim is to have a long-term impact, by targeting the grassroots to achieve cultural and societal change.

Capacity building workshops in media and communications run alongside the show. People can also sign up to be a “food warrior” to get recipes, and the project is working on education resources for schools and other partnerships to take the project forward.

This is a good example of how New Zealand does aid: figuring out how limited funding can be used to have a long-term impact, and focusing attention on soft projects around health, nutrition and education, rather than flashy and expensive infrastructure.

Laura Walters' travel to the Pacific was funded by the Ministry of Foreign Affairs and Trade through its Pacific Journalism Grant.

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