Gade Waqa

Background/Objectives: This study aimed to describe dietary intake among adults 55 years and older living in the Central Division of Fiji and identify food sources of energy, macronutrients, and micronutrients. Methods: A retrospective dietary dataset consisting of 171 adults aged 55 and over was collected using the 24 h multiple-pass recall (24 h MPR) and assessed using the Intake24 Fiji smartphone application. Analyses were restricted to 147 participants with complete dietary record data. Energy, macronutrient, and selected micronutrient intakes were assessed against recommended amounts, and nutrient sources were reported for 15 food groups. Results: Mean daily energy intakes (6.6 MJ/day) were lower than recommended, especially for Those > 70 years (5.3 MJ). The participants had acceptable contributions of energy from fat (28%) and carbohydrates (56%) but lower contributions for protein (13%) than the recommended range (15–25%). The mean protein intake for men and women was 0.68 g/kg/day. More than half of these older adults consumed less than the Estimated Average Requirement (EAR) of retinol, thiamin, folate, vitamin C, vitamin E, calcium, iron, manganese, selenium, and zinc, while vitamin B₆ requirements were met by approximately half of the participants. The primary sources of energy and nutrients were from bread and bakery products, mixed dishes, and sugar-sweetened beverages. Conclusions: The dietary intakes of older adults in Fiji’s Central Division met carbohydrate and fat intake guidelines but were low in protein as well as retinol, thiamin, folate, vitamin C, vitamin E, and minerals such as calcium, iron, manganese, selenium, and zinc; however, approximately half of the participants met the vitamin B6 requirements. These findings highlight the need to improve overall diet quality for older Fijians by increasing the accessibility of nutrient-dense, protein-rich foods and addressing low energy and micronutrient intakes.

Purpose : This study examines the proportion of children and adolescents in Fiji meeting the Asia-Pacific physical activity (PA) and screen time (ST) recommendations, and to explore associated factors. Method : A cross-sectional sample of caregivers (n = 1015) and their children aged 5–17 years completed an online survey based on Ajzen’s conceptualization of attitudes within the Theory of Planned Behavior. Data included meeting PA and ST behaviors recommendations, sociodemographic factors, knowledge of recommendations, and attitudes toward meeting PA and ST recommendations. Generalized linear mixed models were used to identify factors associated with meeting recommendations. Results : 53% of children met both PA and ST recommendations, 87% met PA recommendations, and 62% met ST recommendations. Girls (odds ratio [OR] = 0.568; 95% CI, 0.360–0.896) had lower odds of meeting PA recommendations compared with boys. Children with less positive attitudes toward PA were less likely to meet PA recommendations (OR = 0.520; 95% CI, 0.312–0.868) compared with those with the most positive attitude. Children who live in rural (OR = 1.900; 95% CI, 1.233–2.929) and remote/very remote (OR = 1.681; 95% CI, 1.128–2.505) had higher odds of meeting ST recommendations compared to urban children. Children who speak English (OR = 0.567; 95% CI, 0.399–0.806) and Fijian-Hindi speakers (OR = 0.644; 95% CI, 0.469–0.883) had lower odds of meeting ST recommendations versus iTaukei/Fijian speakers. Conclusion : There is a need for targeted interventions promoting PA among girls and addressing ST across demographic groups.

The Pacific Islands have high rates of non-communicable diseases (NCDs), which are preventable by ensuring healthy levels of physical activity (PA) and sedentary behaviour in childhood. This study explored barriers and facilitators to children meeting PA and sedentary behaviour guidelines through the lens of stakeholders involved in the care and education of children in four Pacific Islands. Qualitative interviews were conducted English or French in Fiji (n = 10), French Polynesia (n = 6), New Caledonia (n = 7), and Wallis and Futuna (n = 4) between 2019 and 2022. French recordings were transcribed using HappyScribe.com and translated. Deductive and inductive qualitative analysis was conducted and presented based on Bronfenbrenner's ecological theory and classified into the five categories of the Social Ecological Model (SEM). At the intrapersonal level, concerns were expressed about the lack of awareness of PA and sedentary behaviour guidelines from children and caregivers. At the intrapersonal level, negative caregiver attitudes towards PA perceived inability to control screen time rules were highlighted, alongside challenges within school settings. At the organizational level, the importance of sports organizations to provide opportunities for children to be active was highlighted. At the environmental level, the lack of urban planning, green space, and safe outdoor areas emerged as key barriers. At the policy level, the need for policy changes to support PA promotion in schools, particularly regarding prescriptive curricula, was stressed. Future interventions need to be culturally responsive, while including strategies that consider the urban-rural divide in the Pacific Islands. Schools and religious institutions can play a key role in promoting active lifestyles for children.

In 2006, the Fiji Government introduced a 0.05FJ$ (0.03USD) per litre excise tax on domestically produced sugar-sweetened beverages (SSBs). Since then, the tax has been abandoned, reintroduced, or adjusted at least ten times, while tariffs on imported SSBs have also undergone reform. These rapid iterations of Fiji's SSB tax raise questions about which interests and motivations underpin the tax, what instigated the multiple adjustments, and implications for its impact on health versus economic and political considerations. Using case study methodology, this study maps the history of SSB tax adjustments in Fiji and examines the political economy forces that have shaped, and continually re-shaped, this policy landscape. We used policy analysis and theories of power to analyse the intersection of ideas, interests and institutions, drawing on policy documents (n = 304), key informant interviews (n = 32) and direct observations of socio-political events (n = 7) as data sources. Findings from this study indicate that the introduction of the SSB tax and subsequent adjustments were motivated more by economic, than health, imperatives. The relationship of mutual dependence between the Fiji Government and domestic SSB industry actors led policymakers to make multiple adjustments, seesawing in an attempt to balance the immediate need for revenue and long-term economic development through strengthened local industries. Early SSB tax lobbying from health actors alone had minimal impact. However, a subsequent alliance between government health actors and politically savvy and well-positioned civil society actors proved persuasive in both increasing the tax rate and ensuring a health and rights focus, arguably achieving a health and economic 'win-win'. Global adoption of SSB taxes is increasing. Examining the protracted history of Fiji's SSB tax reveals the political ebbs and flows that alter how prospective population health 'wins' are weighed up against other policy imperatives. For health-interested actors, these insights point to important strategic in-roads around the explicit use of political economy analysis to complement technical policy insights. Building and maintaining coalitions that extend beyond government and into civil society also proved pivotal. Health system leadership that champions political thinking and cross-sectoral partnerships holds great promise for enhancing health actors' engagement with SSB tax-specific policy making and other multisectoral reform in Fiji and elsewhere.

Taxes on sugar-sweetened beverages (SSBs) in Vanuatu and Fiji are praised for their alignment with the World Health Organization’s noncommunicable diseases Best Buy policy recommendations. SSB taxes also intersect with economic, trade and commercial interests as well as complex domestic and international power dynamics. Yet, to date, the role of these broader interests and power dynamics in shaping SSB tax adoption in Vanuatu and Fiji has remained underexamined. Drawing on Bourdieu’s forms of capital and triangulating interview (n = 50), document (n = 461) and observational data, this cross-case political economy analysis sought to understand where forms of power reside, how they manifest, and what impact they have on the alignment between SSB tax in Vanuatu and Fiji and national and global goals and priorities. Three interconnected themes emerged from the analysis: the influence of domestic industry actors in a context of shifting fiscal and trade incentives; the pivotal agenda-setting role of pro-tax multisectoral coalitions and the way political instability lent importance to informal policy processes. Findings evidence the varying influence of economic, social, and cultural capitals across the policy cycle and showcase the way in which actors strategically deployed, lost or re-imagined their capitals to secure policy influence. Importantly, cultural capital was essential to leveraging influence across the policy cycle and more inward-facing systems favoured the protection of domestic actors and industries, including their economic capital. From a health perspective, these political forces ultimately culminated in weaker or ‘watered down’ SSB taxes in both Vanuatu and Fiji.

Objectives: This study aimed to assess salt and sugar-related knowledge, attitudes and behaviours (KAB) of adults in the Central Division of Fiji. Methods: A randomised stratified sample of 700 adults were selected. Questions on salt and sugar-related KABs were developed. The survey took place from March to June 2022. For analyses, population and sample weights were applied, and differences between predefined subgroups (sex, age, ethnicity and area) were compared using weighted chi-square tests. Results: 534 adults participated (response rate 76%). Over 80% of participants (82% (95% CI 78.5 to 84.9%)) identified that consuming too much salt or salty sauce can lead to hypertension. More than 90% recognised that consuming too much sugar can lead to diabetes (92.3% (89.7 to 94.3%)). Approximately 80% of participants thought it was somewhat or very important to lower salt and sugar intake in their diet (79.8% (76.1 to 83.0) and 84.2% (80.8 to 87.1%), respectively). However, almost 40% reported adding salt or salty sauces when cooking (37.3% (32.7 to 42.2%)) and 65% (60.6 to 68.5%) adding sugar to drinks daily. Conclusions: Despite having positive knowledge and attitudes, many people reported behaviours likely to contribute to excess salt and sugar intake, highlighting the need for interventions that support behaviour change and the creation of healthier food environments.

Background: Excessive salt and sugar intake influence the global burden of non-communicable diseases. This study aimed to describe the knowledge, attitudes and behaviours (KAB) of Fijian adults relating to salt and sugar consumption to inform policy interventions in Fiji. Methods: A randomised stratified sample of 700 adults in the Central Division of Fiji were selected. Questions on salt-related KAB were adapted from the World Health Organization Noncommunicable Disease Risk Factor survey, and questions on sugar were developed following a similar structure. Locally trained research assistants collected data. For analyses, population and sample weights were applied, and difference between predefined subgroups (sex, age, ethnicity and area of residence) were compared using weighted chi-square tests. Results: 534 adults participated (response rate,76%). Over 80% of participants (82% (95% CI 78.5 to 84.9%)) identified that consuming too much salt or salty sauce can lead to hypertension. More than 90% recognized that consuming too much sugar can lead to diabetes (92.3% (89.7 to 94.3%)). Approximately 80% of participants thought it was somewhat or very important to lower salt and sugar intake in their diet (79.8% (95%CI, 76.1 to 83.0) and 84.2% (80.8 to 87.1%), respectively). However, self-reported behaviours did not align, with almost 40% adding salt or salty sauces as standard practice when cooking (37.3% (32.7 to 42.2%)) and 65% (60.6 to 68.5%) reporting that they add sugar to drinks daily. Younger compared to older individuals (18 to 44 years vs 45 years and older) and men compared to women, had lower levels of KAB. Conclusion: Despite having knowledge of the health impacts of consuming excess salt and sugar and positive attitudes towards reducing consumption, many people reported behaviours likely to contribute to high salt and sugar intake. These findings highlight the need for interventions that incentivise healthier choices, through behaviour change communications and the creation of supportive food environments.

Introduction: Limited data on 24-hour movement behaviors of children aged 5–8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region. Methods: Cross-sectional representative data from 1192 children aged 5–8 years living in the US-Affiliated Pacific region were drawn from the baseline 2012–2014 Children’s Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60 min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11 h/d) and ST (≤2 h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables. Results: Twenty-seven percent (95% confidence interval, 24.6–30.0) of children met integrated guidelines; 98% (96.2–98.0) met PA, 78% (75.4–80.0) met sleep, and 35% (32.6–38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence interval, 1.03–1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49–3.54]) were more likely to meet ST guidelines. Overweight children (0.62 [0.40–0.96]), those aged 8 years (0.39 [0.22–0.69]), and children with caregivers of an education level of high school or beyond (0.44 [0.29–0.68]) were less likely to achieve ST guidelines. Children from midrange annual household incomes were less likely to meet combined guidelines (0.60 [0.39–0.92]). Conclusions: Three-quarters of children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed.

Health System strengthening is high on the agenda of the global health community. We review some of the specific challenges faced by Small Island Developing States in the development of their health systems. We propose a list of action points for aid actors willing to adapt their health programs and interventions.