Local Food Policies Can Help Promote Local Foods and Improve Health: A Case Study from the Federated States of Micronesia

Abstract

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.

Introduction

The Federated States of Micronesia (FSM), as well as throughout the Pacific, is experiencing an epidemic of non-communicable diseases, including diabetes, heart disease, and cancer.^1–3 One in three Pohnpei adults is now diabetic.² In addition, the FSM has serious problems of vitamin A deficiency and anemia.^1,3 Over half of FSM children suffer from vitamin A deficiency.³

The major contributing factors to this situation are lifestyle changes, including less physical activity; the growing trend towards the consumption of imported refined foods; such as white rice, flour, sugar, fatty meats, and other imported processed foods and the neglect of the traditional food system, including the physical activity involved in growing, harvesting, preparing, and consuming local island food.³

Many people have indicated that there is a misperception held by many people that local food, in particular, the local staples of breadfruit, taro, and banana, are “just starch” and that this is related to the shift to turning away from local food. However, local food is not just starch. For example, giant swamp taro, Cyrtosperma merkusii, is rich in fiber, which protects against diabetes; and provides essential minerals, including calcium for building bones and teeth, iron for building strong blood, and zinc for fighting infection; and essential vitamins. Recent studies on FSM giant swamp taro show that there are many yellow-fleshed varieties that are particularly rich in provitamin A carotenoids, as well as essential minerals.^4,5 The studies on the yellow-fleshed banana varieties are also rich in provitamin A carotenoids, and special mention is made of Utin Iap and Karat, which were once neglected but after the promotion of their nutrient content are now being revived.^4,5

Due to the urgency of the situation in the region, the Pacific Island Health Officers Organization (PIHOA) has proclaimed a Regional State of Health Emergency due to the epidemic of non-communicable diseases in the United States-affiliated Pacific Islands.⁶

In order to help address the problems in Pohnpei and promote local foods, the Island Food Community of Pohnpei (IFCP) was founded in 2003⁷ and chartered in 2004. In 2005, it initiated a campaign known as “Let's go local!” a campaign to promote local island food for their “CHEEF” benefits: Culture, Health, Environment, Economics, and Food security.

As part of a global health program led by the Centre for Indigenous Peoples' Nutrition and Environment (CINE), the IFCP carried out a successful intervention promoting island food.⁸ At the end of a two-year intervention in the target community, Mand of Madolenihmw Municipality, the community's diets showed significant improvements along with a positive change of attitude toward local food in the community.⁸

Although the major part of this campaign started in 2004 with the establishment of the Island Food Community of Pohnpei, the work started in 1998 after the analysis of Karat, other bananas and giant swamp taro. The Micronesian community became excited about the results of these analyses, which showed how rich they were in nutrient content. It is estimated that over 50,000 people have been reached through this campaign since that time, through newspaper, radio, television, video, email, workshops, poster campaigns, and face-to-face encounters. Many of these people were also reached many times through different methods and media.

Awareness has been a major thrust of this campaign, but the IFCP also focuses on local food policies as another powerful tool to help increase the use of local food and increase physical activity. The aim of this paper is to describe this work and impact to date.

Methods

An inter-agency, community and research-based, participatory and media approach, using ethnography, is used as the cornerstone of all our work. A social ecologic approach⁹ was followed.

Many agencies, governmental and non-governmental, are involved in the planning and initiating local food policies, which helps provide support for the program as well as to expand it. The FSM National, as well as state government agencies were included, in particular those of health, education, agriculture, and resources and development. Non-government agencies included environmental groups, church, women and youth groups, as well as the private sector and businesses. Individuals from those agencies were selected as members of task forces, the IFCP board, and carrying out projects for promoting local food production and consumption. Individuals and institutions were recruited for membership in the Island Food Community of Pohnpei.

Working with communities is a particular focus. Research is used to analyzing local foods to establish the values of their nutrient content, and the scientific justification of their value towards health contributions. Also research is used in assessing community dietary and nutrition status for project evaluation. Data on process indicators are collected regularly for assessment of progress on local food policy establishment and maintenance. Such process indicators include, number of newspaper articles published, number of radio press releases broadcast, number of Island Foods GO LOCAL Email network messages and number of members receiving these emails, number of workshops and school visits held, number of films made and times shown on local television, and number of participants. Ad hoc quotes are collected from community members as to their impressions of local food, barriers to promoting these foods as well as successes in promoting these. Data on dietary intake are collected by use of a 7-day food frequency questionnaire, designed and tested for use in Micronesia, in community surveys. These surveys also collect information on varieties of food crops planted and knowledge of local foods, their nutrient content, and health. These data are used for baseline information and evaluation of project impact.

A participatory approach is used in initiating the idea of local food policies, involving people in the planning process, thereby increasing support. The media, including radio, newspaper, email, and newsletters, are used in sharing about the news of local food policies, acknowledging those who establish such policies, giving the idea to others, and helping the idea of local food policies to spread. The ethnographic approach, including interviews, informal focus group discussions, observation, literature review, and photography, is used to gain understanding of the situation and plan strategy more effectively.

Results

Local food policies have been established at the personal and family levels, community levels, and government levels. All are important and help to inspire other individuals and groups in establishing such policies.

Personal and Family Level

Personal commitments to eating local food and stopping or limiting the consumption of imported foods have created awareness and sparked others to follow. Rice is imported and is mainly white non-enriched rice, low in fiber and other nutrients, but energy-dense and is thought to have contributed much to the non-communicable disease burden in FSM. A founding member of IFCP stated at the IFCP Foundation Meeting in 2003 that he had tried an experiment and had gone one year without eating rice, despite his desires for eating that food, and that this had had a positive impact in his family and community for promoting local food⁷. His statement led another founding member and IFCP board member officer to stop eating rice for health reasons and to promote local foods. He said after he stopped eating rice, “Now I feel better.” After several years of eating this way, he was so moved when one of his grandchildren said that he also wanted to stop eating rice and to “go local.” As a testimony, he then brought his grandchild and five other family members to an IFCP board meeting so that the story could be told.¹⁰ IFCP board members were also moved and applauded this progress.

Another personal story was told in 2007 by a top Pohnpei state government leader during a government workshop at Pohnpei Agriculture where the topic of local food promotion was raised. He stated, “I too have a story to tell. I stopped eating rice myself, as long as I am on-island where I can get local food, and now I feel better.” He also told that two of his daughters followed him and stopped eating rice. He agreed that his story be reported in the local newspaper.¹¹

Community Level

At its very establishment in 2004, IFCP members agreed that only local foods would be served at IFCP events and this included the exclusion of rice. At that time, it was quite unusual to have a group event and not serve rice. Members brought forth questions as to whether people would complain. However, no one complained and members and guests often commented about how they looked forward to the IFCP meals with totally local foods. As for drinks, either drinking coconuts or water were served. Soft drinks were not accepted.

From 2005 to 2007, Mand Community took part in the CINE-supported global health project mentioned above and had many community meetings and workshops. At all the community meetings, only local dishes were served. Community members were warmly encouraged for bringing traditional dishes and there was strong feedback from the community that they enjoyed these foods. A film was made of traditional foods and Mand Community members gathered together to demonstrate making traditional mahr (fermented breadfruit) recipes using a traditional umu (oven) and other local traditional delicacies.¹²

In 2010, three communities established bans on using soft drinks at their community events. These included Mand Community in Madolenihmw, the Pingelap Peoples' Organization, Inc, and the Kosrae Kolonia Congregational Church.

The leader of Mand Community joined a workshop in Thailand in 2009 on supporting traditional food systems and improving health as part of the CINE global health project. On his return to Pohnpei, he shared at an IFCP board meeting his personal belief that not enough is being done to promote local foods. Separately, he and the IFCP Research Advisor discussed about various actions that could be taken and the Research Advisor pointed out the evidence that the consumption of soft drinks has caused major health problems world-wide. Soft drinks contain no vitamins or minerals, and are the only food item that has been significantly associated with overweight.¹³ As soft drinks have basically nothing healthy to offer and are associated with overweight, they are a good item to avoid. The Mand Community leader decided that he would put the matter to his community and let them vote on it. Later he reported that the vote was unanimous in banning soft drinks from use in their community events. As he explained to others “we want our community to be healthy, so we don't want to have our community consuming something that would keep us from being healthy.”

The news of Mand Community's decision spread quickly, not only through the “coconut wireless” but also through the media as press releases were announced in the radio and newspaper.¹⁴ Following the decision by Mand Community, the Pingelapese Peoples' Organization, Inc (PPOI), announced that it had decided to ban soft drinks from their events. This was also reported in the local media.¹⁵

Another group, the Kosrae Kolonia Congregational Church, banned soft drinks from their church events in 2009. The pastor in charge there explained that he had asked church members to follow this practice in order to improve health and to provide a good example to their children. In 2011, the IFCP asked if the pastor would like to have a story on this for the newspaper and he wholeheartedly agreed. He said, “Wouldn't it be great if the other churches would follow?”¹⁶

Government Level

In 2005 Karat was proclaimed as the Pohnpei State Banana, based on its traditional value and exceptionally rich nutrient content. As the banana has been neglected in recent years, this gave it important prestige and is an example of how a government proclamation can serve to promote local foods. This was a Pohnpei State Government Proclamation, signed by Governor David in 2005.¹⁷

A bold step was taken in 2010 with the FSM Department of Health and Social Affairs banning all imported foods from their offices. The FSM Secretary of this department pointed out that people can still leave the office to eat such foods outside but that their office should lead in setting the example for healthy eating and thus should not allow imported foods in the office. The information was shared first informally and later the story was released in the Go Local Email Network¹⁸ and local newspaper.¹⁹

A powerful step was also taken on June 7, 2010, with the FSM President encouraging the use of local food at all FSM Government events in a Presidential Proclamation.²⁰ The policy included this statement:

“Now therefore, I proclaim that the National Government of the Federated States of Micronesia is committed to a policy that encourages enhanced local food production, consumption of local produces and import substitution to the fullest extent possible, and practices based upon sustainable use of food resources. In all government events and festivities and official ceremonies, utilization of local food is encouraged to create people's awareness on the continuing need to adopt a healthy and balanced lifestyle. All the departments and agencies in the National Government are to give effect to this mandate.

The discussions for this started as part of the discussions of the World Food Day activities in 2009 and continued during the discussion in preparation for the FSM Food Summit in 2010. The FSM Department of Resources and Development carried out the final follow-up with the FSM President's Office to finalize the proclamation.

Another government level type policy is that of increasing import taxes on food items. The IFCP and a small working group with members representing the FSM State and National health government agreed to focus on increasing the import tax on soft drinks. Other Pacific Island nations already had established such taxes and the outcomes had been positive toward health improvement.²¹ There are two good reasons for increasing taxes on soft drinks: firstly, such a tax could decrease soft drink consumption and lead to health improvements and secondly, the revenue from such a tax could generate revenue for health improvement programs.²² The IFCP led efforts on this, along with staff from the FSM Department of Health and Social Affairs and Pohnpei State Department of Health. Discussions were initiated informally with the Pohnpei State Lieutenant Governor at the FSM Food Summit about the possibility and he was in favor of the step. A formal letter was then submitted to him with the scientific information regarding the health problems associated with soft drink consumption. The information was forwarded to the Pohnpei Attorney General's Office, which then wrote the bill to be submitted to the State Legislature. At the time of writing this paper, the bill has been developed but is still being considered by the Legislature. Public talks have been made to point out the importance of this for health improvements. It is stressed that if the price of soft drink is considerably more than the price of a coconut, then there would be a greater incentive for purchase of drinking coconuts.

Lessons Learned So Far

A number of lessons have been learned so far. In order to establish local food policies, a certain level of awareness is first needed in order to motivate the initiation of policies. For example, it was learned that many people did not know about the nutritional values of local food, especially giant swamp taro. People have been using it to feed their pigs. However, on learning of its nutritional values, they indicated that they will start eating it and feeding it to their families.

One lesson learned related to raising awareness was that a community-and inter-agency-based approach is important. Another was “Walking the Talk”: if workshops are held to promote local foods and health, it is essential to serve local foods, and not to present a “mixed message” by serving imported foods. Repetition cannot be underestimated: messages needed to be repeated many times. Mass media (radio, newspaper, email, videos, television) help in reaching many people at one time and also in repeating messages, as these are often sent multiple times.

Our slogans “Let's go Local” and “Go Yellow” (for the yellow-fleshed nutrient-rich varieties) helped our awareness campaign greatly, providing branding and unity. Social marketing tools, such as promotional Go Local pens, pencils, t-shirts, stickers, posters, brochures, and newsletters, were very useful in capturing attention and passing on messages. Face to face encounters were also important in creating awareness. Community people wanted scientific findings on their own local foods. Food analysis was critical to establishing the nutrient content and value of local food. Assessment and evaluation of the work was important to show progress. Finally, but not at all the least, frequent acknowledgement of individual and agency involvement increased motivation and interest.

Conclusions

Personal and family commitments to local food, as well as community and government and non-government level food policies can all have important impact to promoting local food. One such policy can “spread” by motivating another group to follow the same direction and also adopt a similar policy. Awareness of the importance of the commitment or policy is needed. Use of the media, including radio, newspaper and email, are also essential in spreading the news, helping motivate the development of further policies, providing acknowledgements, and motivating groups to keep up with their good work. This case study in the Federated States of Micronesia could provide insight for similar work in other Pacific Island countries with similar health problems.