- Rising levels of obesity is one of the greatest health challenges in the South Pacific. As it is partially caused by the food available to Pacific Islanders, it is also a food security issue.
- The large proportion of the Pacific Islander population with obesity poses large public health risks that, in turn, affect social and economic outcomes.
- Food imports are not the only cause of high obesity rates. A lack of nutritional education, limited land to produce healthy food, the commonly held belief that, often highly processed, imported food is superior to local goods and limited access to health care are an equal, if not greater, cause of obesity in the region.
- Regional food policies need to address all of the factors that contribute to obesity if they are to reduce the high rates of obesity experienced in Pacific Island communities.
The prevalence of obesity worldwide almost tripled between 1975 and 2016. It has been described as a “time bomb” that, if left unaddressed, will have severe health ramifications. Obesity rates have risen faster in the South Pacific than anywhere else over the last 30 years and are expected to continue to increase for the foreseeable future. The importation of fatty, cheap cuts of meat is often blamed for the high prevalence of obesity in most Pacific Island countries. While those products are likely to be responsible for some of the problem, it is simplistic to suggest that they are the only cause of high obesity rates in the Pacific region.
Obesity is a growing threat to global health; the number of obese people has tripled worldwide since 1975. The World Health Organization estimates that more than 1.9 billion adults over the age of 18 are overweight and, of those, more than 650 million are obese. Put another way, almost 39 per cent of the world’s adult population is overweight and 13 per cent are obese; most of those people live in Asia and the Pacific.
That trend is not expected to slow in the near future. The number of obese children is predicted to reach 250 million by 2030, compared to 150 million currently. Without intervention, it is to be expected that those children will live most of their lives overweight or obese.
The risk of contracting non-communicable diseases (NCDs), such as heart disease, hypertension and diabetes, is considerably greater for those who are overweight or obese. The countries with the highest prevalence of obesity are all located in the Pacific. NCDs have become more common across Pacific island countries and up to 80 per cent of the deaths in the region are attributed to them. In Tonga alone the prevalence of type 2 diabetes has almost quadrupled over the last 40 years. NCDs have become so widespread and so severe in that country that average life expectancy has declined as a result.
Unhealthy diets are only one contributing factor and other lifestyle changes have also added to the problem. A number of possible explanations have been put forward to explain the region’s obesity problem ranging from the legacy of colonialism (even though colonial authorities suggested measures to improve diets from the 1920s onwards), globalisation, the decline of traditional diets, an increase in the consumption of imported (and often highly processed) food, the unique genetic traits of Pacific Islanders, and traditional cultural norms that value larger bodies and habits that encourage the consumption of large quantities of food (although ethnographic fieldwork suggests that the reality is more complex than often presented).
The smaller Pacific Island countries struggle to produce enough food to meet domestic demand for obvious reasons. Tuvalu and Kiribati, for example, have extremely limited land and soil resources to sustain agriculture systems. Similarly, Nauru, which is the world’s smallest country, is a single coral atoll that is about six kilometres long and four kilometres wide. Most of its territory is made of high-grade phosphate from decomposed marine organisms. As a result of decades of large-scale mining operations, which left the interior uninhabitable and largely devoid of vegetation, most of the population lives on a narrow coastal strip of land that is no more than four square kilometres in area. Professor John Connell, the head of Geosciences at the University of Sydney, explains that:
the phosphate develops within coral pinnacles, so you have to scoop the phosphate out from within the pinnacles themselves. Those scooped areas descend about three metres, on either side of those there’s coral pinnacles. So it produces an extraordinary landscape, which is visually quite dramatic, and is totally useless for anything else.
On other atoll islands, such as Kiribati and Tuvalu, urbanisation has become so extensive on the main islands that there is very limited land left for food production.
A lack of land is not the only limiting factor, however, as other factors constrain food production. Perhaps the greatest challenge is the lack of nutrient-rich soil as Dr James Quilty, the Research Program Manager for Soil and Land Management at the Australian Centre for International Agricultural Research, explained to Radio New Zealand, ‘In the atolls there is no scientifically defined soil. It’s just calcium carbonate (or crushed coral).’ He explained that the traditional food systems in Tuvalu ‘relied on the natural vegetation composting on the ground.’ To help that process people would ‘dig out areas and create sort of swampy areas that they could grow [food] up the sides of … but those areas are now becoming affected by salt water incursions.’ A similar situation exists in Kiribati where Dr Exekiel Nukuro, the local World Health Organization Country Liaison Officer, stated that ‘the atoll nature of Kiribati makes it very difficult to grow most root crops, fruits and vegetables, so only a limited variety of foods can be grown. Most people can’t afford imported fruit and vegetables, and climate change impacts, such as drought, sea level rise resulting in coastal erosion and increased salinity of soil, makes the situation even more difficult.’
The islands have access to large fishing grounds and depend on foreign food imports. Imported foods include: corned beef, turkey tails and meat flaps (the fattiest, and often cheapest, cuts of meat), rice, sugar, instant noodles, biscuits and soft drinks. Tinned fish and imported chicken is often preferred to locally produced meat. As the anthropologists Deborah Gewertz and Frederick Errington argue:
it is not necessarily the case that eating fatty meat contributes significantly more to lifestyle diseases than eating the equivalent calories in refined starches and sugars … However, because the analogies suggested by flaps are so clear and vivid – fatty (sheep) flesh makes fatty (Pacific Island) bodies – they become convenient and compelling symbols of what many people see as unequal relationships between whole categories of differently located people.
Mutton and lamb flaps are exported to Pacific Islands mainly from New Zealand and Australia. ‘Mutton flap, known locally as “sipi,” has become a staple protein in poor Pacific nations. While islanders regard it as a delicacy, governments have condemned New Zealand for “dumping” the inferior meat.’ New Zealand Government ministers, however, have stated that ‘it would be “morally imperious” to dictate what other countries ate. Meat producers said they were merely meeting demand.’ At various times over the past 40 years some Pacific Island countries have attempted to replace fatty meat products with domestically produced chicken. The poultry products were usually more expensive than the imported meat, however, and did little to encourage people to purchase healthier cuts of meat.
Some countries in the region have banned the importation of some cuts of meat. In 2000, for instance, Fiji banned the importation of lamb and mutton flaps. Tonga proposed a quota for imported mutton flaps in 2004 while Samoa banned the importation of turkey tails in 2007. A series of interviews with local consumers in each of those three countries suggested that there was broad support for the bans, as they were perceived to support improved public health outcomes. A large minority were concerned about the possible effect on financially insecure people, however, who might not be able to afford more healthy and expensive cuts of meat. The bans were challenged by the World Trade Organization, which suggested that they were discriminatory and contravened the principle of trade liberalisation. A singular focus on the kinds of meat consumed in the Pacific is unlikely to reduce the high incidence of obesity in the region.
There are multiple factors that contribute to the prevalence of obesity and NCDs in the Pacific. Limited nutritional information and a widespread belief that certain, often highly processed, foods are preferable to locally produced goods and a sign of modernity. A lack of medical facilities and professionals further weakens food security in the region and contributes to the high obesity rate.
Health interventions have occurred in parts of the region for more than 50 years, but have failed to reduce the prevalence of obesity and diet-related NCDs. Most Pacific Islands lack medical schools to train local doctors (only New Zealand, Hawaii, Fiji, Papua New Guinea, Samoa and the Cook Islands have medical training facilities). The outward migration of doctors and other health workers is high, with more Samoan, Tongan, Fijian and Niuean nurses and midwives working in Australia and New Zealand than in the combined domestic workforces of the island states.
The region depends on volunteer healthcare workers from overseas, usually the United States, Australia and New Zealand. The withdrawal of a US-based medical charity from Kiribati, possibly as a consequence of the switch in diplomatic recognition from Taiwan to the People’s Republic of China, is likely to be self-defeating. It will be seen by Beijing as another small step in its long-term strategy of reducing US influence in the Pacific region. The Kiribati Government has stated that it wants the charity to remain in the country and has suggested that the decision to withdraw ‘is an example of alarming propaganda.’
A focus on the most popular kinds of food eaten in the Pacific is unlikely to reduce the high incidence of obesity in the region. Holistic policies that take diet, nutrition, health care and domestic food production into account will be more likely to help address unhealthy dietary habits in the region.