| Summary: | Statement of the problem: Non-communicable diseases (NCDs) today can be explained mainly with reference to globalisation and a food system based on a commercial capitalist model rather than a health and wellbeing model, sedentary lives, and other factors such as stress and pollutants. Given this complex situation the response to NCDs needs to be multifaceted including health promotion and prevention associated with healthy foods and food systems. In Fiji, approximately 78% of all deaths and 40% of premature deaths before age 60 are due to NCDs and they are a leading cause of hospitalisation and death (Ministry of Health and Medical Services (Fiji) [MOHMS Fiji], 2016). Overall, efforts at reducing NCDs have been aimed at the reduction of single risk factors or micronutrients, such as reducing sugar and salt, and treatment, but there has been less focus on changing systems and multisectoral approaches towards better health. Although no difference was noted in ethnic background regarding the consumption of fruit, for the consumption of vegetables, it appears that 16% of Indo- Fijians compared to 32% of Indigenous Fijians or 39% of other ethnic groups in Fiji eat less than one serving of vegetables a day. Irrespective of ethnicity, the number of individuals eating the recommended dietary intake of vegetables is below 5% for the entire population. Methods: Talanoa is a Pacific methodology that is growing in popularity. It is characterised in the Fijian context by the sense of community and sharing which promotes ideas regarding veivukei (lending a helping hand), veilomani (a sense of love and kindness to each other), yalo vata (from the same spirit), and veinanumi (thinking for others). Talanoa is a process involving two or more people whereby there is a storyteller and listeners. Talanoa interviews are used in Pacific research to share knowledge in a culturally appropriate and comfortable way for interviewees and researcher, with the interviewee as storyteller and the researcher as listener. Talanoa interviews were utilised for the purpose of this study. They served to provide an informal space, as it allows for a relaxed sense of discussion not afforded to traditionally formal processes; and the ability to talk with a peer, as the researcher and participants were young Pacifica, which under the right circumstances provides opportunities for more intimate sharing. For the purpose of this study, four talanoa interview sessions where held with five Fijian migrant youth who live in New Zealand and maintain their ties to family and friends by regular visits to Fiji. Participants were asked for their views on the eating of fruit and vegetables within the Fijian community and their suggested strategies for promoting fruit and vegetable eating in Fijian communities. Findings: Young Fijians agreed that fruit and vegetables are necessary for health and a necessary part of the Fijian diet, suggesting that the benefits of eating fruit and vegetables are known. However, the participants state that the food choices available dictate consumption. Perceived problems included the lack of accessibility of fruit and vegetables in general, higher status given to unhealthy options, limited access to traditional Pacific fruit and vegetables in New Zealand, and a lack of advertising and promotion of fruit and vegetables in Fiji and New Zealand. They proposed strategies to increase fruit and vegetable consumption, which were: 1. Decolonising the relationship with food would involve reinforcing traditional Fijian food and cooking methods, within a food systems approach that supports culture at its core. 2. Using youth as 'wave-makers' by utilising the school setting to teach traditional agricultural practices. 3. Creating 'trends' through modern marketing techniques which make messages regarding fruit and vegetable eating more relatable and relevant. 4. A more critical approach to food systems within the Pacific context. Conclusion: Treatment of NCDs and a focus on individual responsibility is current practice when it comes to addressing NCDs in the Pacific. By considering the strategies suggested by youth as future-forward initiatives, prevention and a systematic approach is provided. Youth recognise the need for system wide change that is multisectoral and modern in application. At a higher-systems level recommendations that are applicable to Fiji and New Zealand include considerations to implement social networking forums led by youth acting as prosumers of health, and advocacy towards policies regarding the cultural application of socio-economic factors that contribute toward NCDs, dialogue regarding the fashions of food, and marketing and advertisement development for the promotion of fruit and vegetables. Fijian culture and protocols require interventions at differing levels. In Fiji, there is the potential to contribute to change by empowering communities. This reflects Fijian cultural values while at the same time allowing for a sense of modern cultural fluidity. However, this by itself will not be sufficient to change the food system. For that to occur there is need for wider and more systemic change involving all actors in society - including government and the private food sector. An additional challenge which has come to prominence more recently is the recognition that food systems in the Pacific need to be sustainable in relation to planet as well as people. This provides a further level of complexity to addressing NCDs in a systems way.
|
|---|
