Local food policies can help promote local foods and improve health: a case study from the Federated States of Micronesia.

The Federated States of Micronesia (FSM) and other countries throughout the Pacific are facing an epidemic of non-communicable disease health problems. These are directly related to the increased consumption of unhealthy imported processed foods, the neglect of traditional food systems, and lifestyle changes, including decreased physical activity. The FSM faces the double burden of malnutrition with both non-communicable diseases and micronutrient deficiencies, including vitamin A deficiency and anemia. To help increase the use of traditional island foods and improve health, the Island Food Community of Pohnpei has initiated a program in the FSM to support and promote local food policies, along with its Go Local awareness campaign. Such local food policies are defined broadly and include individual and family commitments, community group local food policies and policies established by government, including presidential proclamations and increased taxation on soft drinks. The aim of this paper is to describe this work. An inter-agency, community- and research-based, participatory and media approach was used. Partners are both non-governmental and governmental. The use of continuing awareness work along with local food policy establishment and the acknowledgement of the individuals and groups involved are essential. The work is still in the preliminary stage but ad hoc examples show that this approach has had success in increased awareness on health issues and improving dietary intake on both an individual and group basis. This indicates that further use of local food policies could have an instrumental impact in FSM as well as other Pacific Island countries in promoting local foods and improving dietary intake and health, including the control of non-communicable diseases and other dietary-related health problems.

Evaluation of a "traditional food for health" intervention in Pohnpei, Federated States of Micronesia.

Federated States of Micronesia (FSM) faces increasing rates of non-communicable diseases related to the neglect of the traditional food system and the shift to consumption of imported food and adoption of sedentary lifestyles. To reverse this trend, a two-year, food-based intervention in one Pohnpeian community in FSM promoted local food production and consumption using a variety of approaches including education, training, agriculture and social marketing following a "Go Local" message. Foods promoted were banana, giant swamp taro, breadfruit and pandanus varieties, green leafy vegetables and fruits for their provitamin A and total carotenoids, vitamins, minerals and fiber content. An evaluation was conducted in a random sample of households (n=47) to examine the extent of dietary changes following the intervention. Results indicated increased (110%) provitamin A carotenoid intake; increased frequency of consumption of local banana (53%), giant swamp taro (475%), and local vegetables (130%); and increased dietary diversity from local food. Exposure to intervention activities was high and there were positive changes in attitudes towards local food. The intervention approaches appear to have been successful in this short period. It is likely that similar approaches in additional communities in Pohnpei and other parts of the Pacific would also be successful in promoting local food. Evidence gathering should continue to document the long-term health outcomes of increased reliance on local food.

A participatory assessment of dietary patterns and food behavior in Pohnpei, Federated States of Micronesia.

Non-communicable diseases are escalating rapidly within the Pacific region, including Pohnpei, Federated States of Micronesia. A shift in dietary patterns from indigenous, high fiber, healthy local food to energy-dense, imported food with low nutritional value, and increased sedentary lifestyles are expediting this process. Essential to counteract this trend is an understanding of how people make food decisions. This participatory assessment utilized a quantitative and qualitative approach to capture diet patterns and knowledge, attitudes, beliefs and practices of food consumption. A structured 7-day food frequency questionnaire (FFQ) was used to quantify the diets of 293 adult Pohnpeian women attending an island-wide education/disability screening program. An ethnographic approach, including in-depth interviews, informal focus groups and observations documented food behavior practices and contributed to the design of the FFQ. Of those responding to the FFQ, 96% reported eating rice frequently (3-7 days/week) whereas 75% reported eating locally grown carbohydrate foods frequently. Factors associated with culture change, including availability, affordability, convenience, and status of food items were found to determine food decisions. Food-based, culturally sensitive and innovative strategies that utilize existing resources are required to promote local food production and consumption. Prevention programs with an information, education and communication (IEC) approach are needed to provide accurate and available health and nutrition knowledge and to increase the demand for local foods. Behavior modification requires the continued collaboration of the national, state, and community organizations that partnered on this research to strategize programs in order to target individual food choices and to transform the environment to support these decisions.

Pacific issues of biodiversity, health and nutrition.

Neglect of traditional food systems has led to serious nutrition and health problems throughout the Pacific Islands. At the same time, there is concern about the loss of traditional knowledge, customs and culture related to local foods, and of biodiversity. However, there is still a great diversity of nutrient-rich local food crops in the Pacific, along with considerable knowledge about these foods, their methods of production, harvesting, storage, and preparation. An integrated approach is needed in order to make a meaningful impact on increased production, marketing/processing and use of local food crops and foods for better health and nutrition, requiring greater collaboration between the health sector and agencies in other sectors. Priorities for action include: documentation and assessment of traditional food systems, including analysis of local foods and crop varieties for their nutrient content; innovative means of increasing awareness of the values of local foods among the general public and policy makers; conservation of rare varieties of crops and food trees and protection of the environment; and an increased focus on small-scale processing and marketing of local foods. Overriding all of this is the urgent need to mainstream consideration of these important issues into relevant national and regional policies. The rubric "Biodiversity for Health and Nutrition" incorporates all of these issues and provides a framework within which all partner agencies can be involved.

Carotenoid and vitamin content of Karat and other Micronesian banana cultivars.

We previously found high carotenoid levels in Karat and other Micronesian bananas, indicating potential importance for alleviating vitamin A deficiency and other nutritionally related health problems in the Federated States of Micronesia. Past work focused on carotenoid and mineral analyses, whereas here we investigated 16 cultivars (most not previously analysed) for a broader micronutrient profile, including seven vitamins. Karat carotenoid levels were higher than in previous analyses, confirming Karat as exceptionally carotenoid-rich. We identified an additional 10 carotenoid-rich cultivars, expanding the range having potential for alleviating vitamin A deficiency. A striking finding is the high riboflavin level in Karat, including high levels of uncharacterized flavonoids. Niacin and alpha-tocopherol are at levels that may contribute importantly to dietary intake within normal patterns of consumption. These data present a more complete basis for promoting the nutritional benefits of these banana cultivars where they are consumed in the Pacific, and potential benefits for promoting elsewhere.

An NGO approach for addressing the nutrition dilemma: Pohnpei focuses on awareness, food analysis, conservation, and food processing.

The establishment of the Island Food Community of Pohnpei, a non-governmental organization (NGO) based in Pohnpei, Federated States of Micronesia, presents a new approach for promoting Pacific Island food for its health and many other benefits. Its vision is holistic, stressing the importance of island food for sustainable development, economic benefits, self-reliance, improved health, cultural preservation, and human dignity, at the same time protecting the natural resources. A major reason for the establishment of this NGO is the emergence of an epidemic of nutrition-related health problems, including diabetes, heart disease, cancer, vitamin A deficiency, and anemia. Although health is at the cornerstone of the establishment of this NGO and health officers are integrally involved, the project is closely associated with the agriculture sector. The Island Food Community of Pohnpei works via an ethnographic participatory inter-agency approach, and its activities include the identification and promotion of nutrient-rich varieties of the traditional staple foods, incorporating the 'Yellow Varieties Message'. There are also activities to conserve rare varieties and to develop small-scale food processing.