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Malnutrition in the Pacific

Author: Dr. Sukheshni Natsumi

Malnutrition is a major health problem in the South Pacific and is a factor that contributes to or are the underlining causes of other principal health problems in the subregion [8]. Malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of nutrients. The term malnutrition covers 2 broad groups of conditions [6]. One is ‘undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals) [6]. The other is overweight, obesity and diet-related non-communicable diseases (such as heart disease, stroke, diabetes and cancer).

Historical evidence suggests that adults in the Pacific island countries suffered neither nutritional deficiency nor surfeit [8]. Individuals in the past followed traditional food habits and consumed a healthful diet low in fat, high in fibre (though also high in carbohydrates) and adequate in protein. However, urbanization has resulted in a diet heavily reliant on processed and imported foods [1][4][5]. These produce have the advantage of often being more accessible, more convenient to prepare and consume, and cheaper [8]. However, from a nutritional standpoint, the contemporary diet contains excessive animal fat, salt and calories [8]. Less beneficial bread, rice, and tinned meats and fish have replaced the traditional high-fibre root vegetables (taro, sweet potatoes and yams) [8]. Food imports accounted for one-fifth of total imports throughout the Pacific in 1978 and in Tonga, they comprised nearly 28 % of imports [3]. Jane Parry reported that replacing traditional foods with imported, processed food has contributed to the high prevalence of obesity and related health problems in the Pacific islands [7]. In addition, food was previously imported from Australia and New Zealand, but now it comes from much further afield: China, Malaysia and the Philippines. Nutrition labels are not only inconsistent but often not in English [7].

Scattered across the Pacific Ocean are thousands of islands, which make up three regions known as Melanesia, Micronesia and Polynesia [8]. Among women, both malnutrition (especially in Melanesia) and obesity (more characteristic of Polynesia and Micronesia), as well as anaemias caused neonatal health. Anaemia was also reported to be severe among children in Fiji, Solomon Islands and Vanuatu [7]. Micronutrient deficiencies are also common in this region. WHO reported that in 15 out of 16 countries surveyed, more than one-fifth of children and pregnant women were anaemic [8]. In Fiji, Papua New Guinea and Vanuatu, iodine deficiency and related goitre are endemic [8]. Despite, Fiji and Papua New Guinea, great progress was made through salt iodization, however, micronutrient was still prevalent. In many other Pacific countries and territories, the situation is yet to be assessed. Vitamin A deficiency is also a significant public health risk in Kiribati, the Marshall Islands, the Federated States of Micronesia and Papua New Guinea [8].

Moreover, breastfeeding duration is now a debility, and malnutrition correlates with early halting among children in Samoa and Solomon Islands. Bottle-fed Samoan children would be hospitalized more frequently for gastroenteritis [8]. Furthermore, according to Darnton-Hill, malnutrition occurs more frequently among bottle-fed Fijian children and there was a lower incidence rate of infections among Polynesian children that breastfed for longer periods [2].

On the other end of the spectrum, obesity, which was once considered a desirable attribute and common mostly among chiefs and wealthier islanders, is now routine. It is important to note that obesity has been associated with diabetes and hypertension [8]. WHO defines overweight as having a body mass index (BMI) equal to or more than 25 [7].

According to the meeting on obesity prevention and control strategies in the Pacific held in Samoa in September 2000, about 40% of the Pacific island region’s population (total pop: 9.7 million) has been diagnosed with a non-communicable disease, particularly cardiovascular disease, diabetes and hypertension [7]. These diseases account for three-quarters of all deaths across the Pacific region and 40–60% of total health-care expenditure [7]. At the Pacific Food Summit held in Vanuatu in April, delegates agreed that the region’s governments need new laws to better regulate the food industry. “There isn’t a lot of clarity in regulating the food industry, which is saying it wants a level playing field. For example, food labels vary as much as the countries the food comes from,” says Dr Colin Bell, technical officer, noncommunicable diseases, at WHO’s Western Pacific Regional Office in Manila [7].

The Minister of Health of Fiji states that increasing the proportion of locally grown, nutritious and less energy-dense traditional foods in the diets of Pacific islanders is also essential [7]. “We are also challenging our own agriculture and fishing sectors to strike a balance between local supply and commercialization. There have been ‘go local’ campaigns in [the Federated States of] Micronesia and other countries to promote local foods” says Waqanivalu [7]

He goes on to state that tackling such widespread health problems in the region will require changes in food imports and agricultural policy that can best be achieved by cooperation between different sectors and throughout the region. Establishing the importance of collaboration was one of the key successes of the summit. “What the summit has brought out is the multisectoral approach. We tried to put things in terms of health and development and a need to work hand-in-hand if we are going to make an impact, says Waqanivalu [7].

The high cost of conducting national food consumption surveys limits the extent to which they can collect information on the causes of vitamin and mineral deficiencies [7]. In an effort to overcome this problem, countries are working with WHO and partner agencies to pool the data and resources of different sectors, to improve data collection, analysis and use for planning [7]. This month, the Secretariat of the Pacific Community in collaboration with The World Bank is holding a workshop of national statistics officers to improve data collection and use [7].

Determinants of malnutrition

The comparatively recent shift in dietary patterns corresponding with “modernization” is the major factor underlying poor nutritional status in the Pacific region. Urbanization and modernization have involved relocation to urban areas and that has meant that:

  • Availability of processed food and limited traditional foodstuffs (or are extremely expensive compared with alternative foods, including imports) [8];

  • Families become reliant on wages and no longer cultivate rural lands, cutting off traditional subsistence foodstuffs [8];

  • Foods are processed using “modern” techniques employing various additives, notably salt and sugar, but are nutritionally inferior to traditional foods (e.g. lower in fibre and complex carbohydrates) [8];

  • Migrations from rural areas to urban [7]

  • Limited reinforcement on nutritional education in schools by promoting healthy eating practices [7]

  • Lack of multi-sectoral collaboration to enforce healthy habits (countries and territories unanimously endorsed a framework for action on food security) [7]

  • Lack of clarity in regulating the food industry [7]

  • Introduction of nutritionally valuable weaning foods, low protein diets among children under two years of age, and more closely spaced births resulting from disuse of traditional birth-spacing methods [2].

Improving nutrition in the Pacific

Numerous measures have been suggested for improving nutrition in the island countries, some more practical than others. Some are reminiscent of a return to a more pastoral, labour intensive, subsistence agricultural lifestyle and are probably unrealistic. Assuming that a trend towards urbanization continues, measures that may improve nutrition include:

  • Governmental awareness of nutrition problems (e.g., completion of national nutrition surveys and specialised studies where warranted [8]);

  • Formulation of national nutrition policies to ensure co-ordinated, adequately financed nutrition programmes (Tonga and Fiji have well-established National Food and Nutrition Committees) [8];

  • Increasing the proportion and production of locally grown, nutritious and less energy-dense traditional foods in the diets of Pacific islanders [7]

  • Intensified agriculture techniques, more efficient and competitive local transport and marketing systems; governmental research into traditional crops; and development of guidelines on appropriate food-processing [8]

  • Decreased reliance on imported foods were economically and politically practical [8];

  • Enhanced nutritional awareness on the part of the population through nutrition education in schools and communities, or via mass media including responsible advertising [7];

  • Training of indigenous nutrition experts, some at a paraprofessional level, to become staff members of nutrition education programmes. A mix of production, marketing and promotional strategies will be necessary for each setting, and these must address realistic issues such as food imports and continued consumption of monetarily costly and nutritionally undesirable but very convenient, processed imported foods [3].

In the Pacific, malnutrition is more prevalent than it should be as the nations are land filled with nutritious fruits, vegetables and root crops; and an ocean full of seafood. Malnutrition is the leading cause of childhood mortality and predisposes health conditions such as diabetes, hypertension and cardiovascular disorders. Malnutrition is detrimental to the physical growth, strength, immunity and mental development of children. Even if it is treated, the child may never live up to their full potential throughout adulthood. Therefore, prevention is the best strategy. Exclusive breastfeeding for the first 6 months of the child’s life gives them the best start to life, followed by a balanced diet (including all three-food groups) for all. Furthermore, ensuring all people have access to healthier and more sustainable diet; as well as creating more public awareness to shift people’s mindsets from a convenient diet to a healthy diet is key to eradicate all forms of malnutrition.

Speak to a GP or specialist if you have a health problem that puts you at increased risk of malnutrition.

1. Coyne, E.T. “The Effect of Urbanisation and Western Diet on the Health of Pacific Island Population.” South Pacific Commission Technical Paper 186, J.C. Badcock and R. Taylor (eds.) pp. 1-175. 1984

2. Darnton-Hill, I., J. Badcock, R. Taylor. “Nutrition Problems in the Pacific – An Overview.” Paper presented at the Second International Symposium of Clinical Nutrition, Sydney, Australia, September 1985.

3. Harris, G.T. “Food Imports and Macroeconomic Policy in the South Pacific.” Developing Economies, vol. 22, No. 1, March 1984, pp. 69-85. 1984

4. Parkinson, S. “Nutrition in the South Pacific Past and Present.” Journal of Food and Nutrition, vol. 39, No. 3, pp. 121-125. 1982

5. Thaman, R.R. “Deterioration of Traditional Food Systems, Increasing Malnutrition and Food Dependency in the Pacific Islands.”Journal of Food and Nutrition, vol. 3, pp. 109-121. 1982

6. World Health Organization. What is Malnutrition. 2016

7. World Health Organization. Pacific islanders pay heavy price for abandoning traditional diet. 2020

8. Penny Kane and David Lucas. An Overview of South Pacific Population Problems. 34-37.

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