Small Island Developing States: addressing the intersecting challenges of non-communicable diseases, food insecurity, and climate change.

Small Island Developing States (SIDS) include 37 UN member countries sharing economic, environmental, and social vulnerabilities and intractable health challenges. In over 80% of SIDS, more than one in six adults die prematurely from a non-communicable disease (NCD), with poor diet being a major factor. Complex upstream food system determinants include marginalised local food production and reliance on low nutritional quality food imports. These drivers need to be seen against colonial and post-colonial political-economic legacies as well as the environmental and climate crises that challenge local production systems. A range of policy commitments (eg, the 2023 Bridgetown Declaration on NCDs and Mental Health) highlight these complex interdependencies and call for cross-sectoral food system policies to improve food security, food sovereignty, and nutrition, including integrating measures for climate change adaptation and mitigation. Although addressing these intersecting challenges will also depend on global efforts, the unique approach of SIDS can inform other settings.

Food insecurity in Venezuelan migrants in Trinidad and Tobago using the food insecurity experience scale.

Economic, political, humanitarian and health crises in Venezuela have resulted in mass out migration -thousands of Venezuelans emigrated to Trinidad and Tobago. However, little is known about their food security status in the host country. This study assessed the food security status among Venezuelan migrants and asylum seekers in Trinidad and Tobago and tested the validity of the online application of the food insecurity experience scale (FIES), a tool to measure food insecurity, in a small group. This convenience, cross-sectional study applied an online questionnaire to 433 Venezuelan migrants in Trinidad and Tobago in 2020. Snowball sampling was used to connect to migrants based on their access to locally-based NGO service providers, and organizations directly connected to the Venezuelan migrant community. Researchers applied the 12-month reference period to the FIES to measure food insecurity at the individual level. Descriptive analyses, Rasch modeling and binary logistic regression were conducted. Overall, 61.9% of respondents displayed behaviors characterized as severely food insecure. Significant differences in food security status were observed when categories of employment status (p = 0.032) and paying rent (p = 0.005) were considered. There were greater proportions of unemployed individuals who were severely food insecure (67.6%) compared to those who were employed (56.7%). There were greater proportions of individuals paying rent who were severely food insecure (62.6%) compared to those who were not paying rent (50.0%). Logistic regression with adjusted odds ratios and 95% confidence intervals revealed that food insecurity was less likely among migrants who were employed (OR 0.112, 95% CI 0.016-0.763) relative to those who were not employed, while food insecurity was more likely among migrants who were paying rent (OR 7.325, 95% CI 1.965-27.312) relative to those not paying rent. The FIES was consistent in assessing food security status. These findings provide a rapid assessment that can be used to galvanize international, national and community-level stakeholders to devise and target responses to assist migrants experiencing food insecurity.

Dietary Patterns, Food Insecurity, and Their Relationships with Food Sources and Social Determinants in Two Small Island Developing States.

Small Island Developing States (SIDS) have high burdens of nutrition-related chronic diseases. This has been associated with lack of access to adequate and affordable nutritious foods and increasing reliance on imported foods. Our aim in this study was to investigate dietary patterns and food insecurity and assess their associations with socio-demographic characteristics and food sources. We recruited individuals aged 15 years and above from rural and urban areas in Fiji (n = 186) and St. Vincent and the Grenadines (SVG) (n = 147). Data collection included a 24 h diet recall, food source questionnaire and the Food Insecurity Experience Scale. We conducted latent class analysis to identify dietary patterns, and multivariable regression to investigate independent associations with dietary patterns. Three dietary patterns were identified: (1) low pulses, and milk and milk products, (2) intermediate pulses, and milk and milk products and (3) most diverse. In both SIDS, dietary pattern 3 was associated with older age, regularly sourcing food from supermarkets and borrowing, exchanging, bartering or gifting (BEB). Prevalence of food insecurity was not statistically different across dietary patterns. In both SIDS, food insecurity was higher in those regularly sourcing food from small shops, and in SVG, lower in those regularly using BEB. These results complement previous findings and provide a basis for further investigation into the determinants of dietary patterns, dietary diversity and food insecurity in these settings.

Perspectives on strengthening local food systems in Small Island Developing States.

Small Island Developing States (SIDS) share high burdens of nutrition-related conditions, including non-communicable diseases, associated with an increasing reliance on imported, processed foods. Improving health through increasing the production and consumption of local, nutritious foods is a policy objective of many SIDS governments. This study aimed to understand contemporary challenges and opportunities to strengthening local food systems in two case study settings, Fiji and St. Vincent and the Grenadines. Fifty-two in-depth, semi-structured interviews were conducted with key stakeholders involved in local food production. Interviews were analysed by both country teams using thematic analysis. Local food production networks in both settings included formal governance bodies as well as more informal connections through civil society and communities. Their main function was the sharing of resources and knowledge, but levels of trust and cooperation between the stakeholders varied in a market open to intense competition from imports. Local food production was hindered by few and slow investments by local governments, dated technology, and lack of knowledge. Stakeholders believed this marginalisation was occurring against a background of rising preferences for imported foods in the population, and increasing disinterest in employment in the sector. Despite the challenges, strong narratives of resilience and opportunity were highlighted such as national pride in local produce for commercialisation and local diets. Efforts to support local food production in SIDS should focus on strengthening governance structures to prioritise local produce over corporate and import markets, assist collaboration and co-learning, and support alternative agro-food practices. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-022-01281-0.

Food Sources and Dietary Quality in Small Island Developing States: Development of Methods and Policy Relevant Novel Survey Data from the Pacific and Caribbean.

Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (ß = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (-0.52 (95% CIs -0.91, -0.12)) and rural residence (-0.46 (-0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.

Using Group Model Building to Describe the System Driving Unhealthy Eating and Identify Intervention Points: A Participatory, Stakeholder Engagement Approach in the Caribbean.

Many Small Island Developing States of the Caribbean experience a triple burden of malnutrition with high rates of obesity, undernutrition in children, and iron deficiency anemia in women of reproductive age, driven by an inadequate, unhealthy diet. This study aimed to map the complex dynamic systems driving unhealthy eating and to identify potential points for intervention in three dissimilar countries. Stakeholders from across the food system in Jamaica (n = 16), St. Kitts and Nevis (n = 19), and St. Vincent and the Grenadines (n = 6) engaged with researchers in two group model building (GMB) workshops in 2018. Participants described and mapped the system driving unhealthy eating, identified points of intervention, and created a prioritized list of intervention strategies. Stakeholders were also interviewed before and after the workshops to provide their perspectives on the utility of this approach. Stakeholders described similar underlying systems driving unhealthy eating across the three countries, with a series of dominant feedback loops identified at multiple levels. Participants emphasized the importance of the relative availability and price of unhealthy foods, shifting cultural norms on eating, and aggressive advertising from the food industry as dominant drivers. They saw opportunities for governments to better regulate advertising, disincentivize unhealthy food options, and bolster the local agricultural sector to promote food sovereignty. They also identified the need for better coordinated policy making across multiple sectors at national and regional levels to deliver more integrated approaches to improving nutrition. GMB proved to be an effective tool for engaging a highly diverse group of stakeholders in better collective understanding of a complex problem and potential interventions.

Health inequalities and well-being in times of financial and political crisis in Brazil, a case study.

Background: Although global efforts have resulted in improvements in health and well-being across the world, economic downturns can rapidly undermine achievements in this area. Methods: Using Gallup World Poll data (n = 7,084) this study assessed the changes in health status and well-being before (2009-2013) and during (2015-2017) the current financial and political crisis in Brazil and their association with the Social Determinants of Health Inequalities. Health and well-being were measured by the Personal Life Index and the Life Evaluation Index. Descriptive analysis and logistic regression models were conducted. Results: A significant deterioration of well-being was found during the crisis, with a 29% decline (63-44%) in the prevalence of respondents classified as 'thriving' in life. Food security, age and social support were the best predictors of health status and well-being, mitigating the association of health and well-being with income and unemployment. Education and community environment also showed strong association with well-being, and satisfaction with healthcare system played an important role in health status. Conclusions: In order to protect health and well-being during such crisis, policies should pay particular attention on enhancing the access to food, healthcare system, educational system, community environment (quality of air, water and infrastructure) and fostering social support.