Drivers of change: dietary change, food and nutrition security and agricultural practices in peripheral communities in Pacific Island countries and territories: A scoping review protocol

UN Sustainable Development Goal (SDG) 2: Zero Hunger links ending hunger to achieving food security, improving nutrition, and promoting sustainable agriculture. The Pacific Island Countries and Territories (PICTs) is a region where such linkages can be investigated as the PICTs are confronting climate change while facing a decrease in available arable land and increasing rates of urbanisation. Around 80% of all Pacific Islanders still rely on agricultural produce from their own gardens or from small holder farmers to support or to supplement their diets. The Food and Agriculture Organisation (FAO) has declared the years 2019–2028 to be the Decade of Family Farming. Food imports are increasingly common in PICTs, and can provide cheap, although not particularly nutritious foods, leading to generalised health problems. Increased reliance on imports is itself an indicator of diminishing food security, and with the PICTs facing a range of food security challenges, it is timely to assess the existing literature in the PICTs on the relationship between smallholder farming and food security. This scoping review analyses 49 peer reviewed and grey literature studies in English from 1970–2019 concerning the relationship between food security and small holder farming in the PICTs. It identifies four main themes: (1) Community adaptation, resilience and crop diversification; (2) Decreased availability of local foods and land; (3) Changes in diet; (4) Gender and agricultural production. The review shows Pacific peoples quickly adapt to changing circumstances to plant different crops both for food and for sale, and it identifies the role of small holder agriculture as crucial to: (1) growing local foods to support food security, and (2) expanding domestic asset creation to promote economic development, especially for women.

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

BackgroundHistorically, Pacific island countries and territories (PICTs) have been more severely affected by influenza pandemics than any other part of the world. We herein describe the emergence and epidemiologic characteristics of pandemic influenza H1N1 in PICTs from 2009 to 2010.MethodsThe World Health Organization gathered reports of influenza-like-illness and laboratory-confirmed pandemic H1N1 cases from all 23 Pacific island countries and territories, from April 2009 through August 2010. Data were gathered through weekly email reports from Pacific island countries and territories and through email or telephone follow-up.ResultsPacific island countries and territories started detecting pandemic H1N1 cases in June 2009, firstly in French Polynesia, with the last new detection occurring in August 2009 in Tuvalu. Nineteen Pacific island countries and territories reported 1,972 confirmed cases, peaking in August 2009. No confirmed pandemic H1N1 cases were identified in Niue, Pitcairn and Tokelau; the latter instituted strict maritime quarantine. Influenza-like-illness surveillance showed trends similar to surveillance of confirmed cases.Seven Pacific island countries and territories reported 21 deaths of confirmed pandemic H1N1. Case-patients died of acute respiratory distress syndrome or multi-organ failure, or both. The most reported pre-existing conditions were obesity, lung disease, heart disease, and pregnancy.Pacific island countries and territories instituted a variety of mitigation measures, including arrival health screening. Multiple partners facilitated influenza preparedness planning and outbreak response.ConclusionsPandemic influenza spread rapidly throughout the Pacific despite enormous distances and relative isolation. Tokelau and Pitcairn may be the only jurisdictions to have remained pandemic-free. Despite being well-prepared, Pacific island countries and territories experienced significant morbidity and mortality, consistent with other indigenous and low-resource settings.For the first time, regional influenza-like-illness surveillance was conducted in the Pacific, allowing health authorities to monitor the pandemic’s spread and severity in real-time.Future regional outbreak responses will likely benefit from the lessons learned during this outbreak.

BackgroundNon-Communicable Diseases (NCD) are the leading cause of death in the Pacific Island Countries and Territories (PICTs) accounting for approximately 70% of mortalities. Pacific leaders committed to take action on the Pacific NCD Roadmap, which specifies NCD policy and legislation. To monitor progress against the NCD Roadmap, the Pacific Monitoring Alliance for NCD Action (MANA) was formed and the MANA dashboard was developed. This paper reports on the first status assessment for all 21 PICTs.MethodsThe MANA Dashboard comprises 31 indicators across the domains of leadership and governance, preventive policies, health system response and monitoring processes, and uses a ‘traffic light’ rating scheme to track progress. The dashboard indicators draw on WHO’s best-buy interventions and track highly cost-effective interventions for addressing NCDs. The MANA coordination team in collaboration with national NCD focal points completed Dashboards for all 21 PICTs between 2017 and 2018 in an agreed process. The data were analysed and presented within each area of the MANA dashboard.ResultsThis assessment found that PICTs are at varying stages of developing and implementing NCD policy and legislation. Some policy and legislation are in place in most PICTs e.g. smoke free environment (18 PICTs), alcohol licensing (19 PICTs), physical education in schools (14 PICTs), reduction of population salt consumption (14 PICTs) etc. However, no PICTs has policy or legislation on tobacco industry interference, controlling marketing of foods and drinks to children, and reducing trans-fats in the food supply, and only 7 PICTs have policies restricting alcohol advertising. Eighteen PICTs implement tobacco taxation measures, however only five were defined as having strong measures in place. Nineteen PICTs have alcohol taxation mechanisms and 13 PICTs have fiscal policies on foods to promote healthier diets.ConclusionThis baseline assessment fills a knowledge gap on current strengths and areas where more action is needed to scale up NCD action in a sustained ‘whole of government and whole of society approach’ in PICTs. The findings of this assessment can be used to identify priority actions, and as a mutual accountability mechanism to track progress on implementation of NCD policy and legislation at both national and Pacific level.

BackgroundComprehensive infection prevention and control (IPC) programmes are proven to reduce the spread of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). However, published assessments of IPC programmes against the World Health Organization (WHO) IPC Core Components in Pacific Island Countries and Territories (PICTs) at the national and acute healthcare facility level are currently unavailable.MethodsFrom January 2022 to April 2023, a multi-country, cross-sectional study was conducted in PICTs. The self reporting survey was based on the WHO Infection Prevention Assessment Framework (IPCAF) that supports implementing the minimum requirements of the WHO eight core components of IPC programmes at both the national and facility level. The results were presented as a ‘traffic light’ (present, in progress, not present) matrix. Each PICT’s overall status in achieving IPC core components was summarised using descriptive statistics.ResultsFifteen PICTs participated in this study. Ten (67%) PICTs had national IPC programmes, supported mainly by IPC focal points (87%, n = 13), updated national IPC guidelines (80%, n = 12), IPC monitoring and feedback mechanisms (80%, n = 12), and waste management plans (87%, n = 13). Significant gaps were identified in education and training (20%, n = 3). Despite being a defined component in 67% (n = 10) of national IPC programmes, HAI surveillance and monitoring was the lowest scoring core component (13%, n = 2). National and facility level IPC guidelines had been adapted and implemented in 67% (n = 10) PICTs; however, only 40% (n = 6) of PICTs had a dedicated IPC budget, 40% (n = 6) had multimodal strategies for IPC, and 33% (n = 5) had daily environmental cleaning records.ConclusionsIdentifying IPC strengths, gaps, and challenges across PICTs will inform future IPC programme priorities and contribute to regional efforts in strengthening IPC capacity. This will promote global public health through the prevention of HAIs and AMR.

Reef finfishing pressure risk model for Pacific Island countries and territories

Introduction: Alcohol has become embedded into the cultural, economic, and social fabric of Pacific Island Countries and Territories (PICT); however, it continues to be a neglected health issue for many PICT. This scoping literature review explores current alcohol advertising policies in each PICT.
 Methods: This review utilises the 'Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping reviews' to identify literature on alcohol advertising policies. Twenty-five sources, ranging from 1963 to 2020, form the final data synthesis.
 Findings: The results of this review reveal that not all PICT have alcohol advertising restrictions in place. Health warning labels as a means of deterring alcohol use are also inconsistent across PICT but aid in consumer decisions. A notable concern in alcohol advertising is the use of culture as a marketing ploy.
 Conclusion: This review provides essential information on alcohol advertising in PICT. Nine PICT enforce some form of alcohol advertising prohibition, and ten do not. In countries with alcohol advertising, drinking behaviours vary, demonstrating a need for further research on the implementation efforts of current policies. In countries with no alcohol advertising, alcohol use is normalised and portrayed as unproblematic. The use of health warning labels is also not consistent amongst PICT. The use of culture as a marketing ploy is unacceptable as it belittles culture and is disrespectful to leaders. Understanding the alcohol advertising restrictions that work in each PICT can help decrease alcohol consumption and the harms associated with its misuse across all PICT.
 Keywords: Alcohol, Advertising, Pacific.

Knowledge gaps in ecotoxicology studies of marine environments in Pacific Island Countries and Territories – A systematic review

The four species of tuna that underpin oceanic fisheries in the tropical Pacific (skipjack, yellowfin, bigeye and albacore tuna) deliver great economic and social benefits to Pacific Island countries and territories (PICTs). Domestic tuna fleets and local fish processing operations contribute 3–20 % to gross domestic product in four PICTs and licence fees from foreign fleets provide an average of 3–40 % of government revenue for seven PICTs. More than 12,000 people are employed in tuna processing facilities and on tuna fishing vessels. Fish is a cornerstone of food security for many PICTs and provides 50–90 % of dietary animal protein in rural areas. Several PICTs have plans to (1) increase the benefits they receive from oceanic fisheries by increasing the amount of tuna processed locally, and (2) allocate more tuna for the food security of their rapidly growing populations. The projected effects of climate change on the distribution of tuna in the tropical Pacific Ocean, due to increases in sea surface temperature, changes in velocity of major currents and decreases in nutrient supply to the photic zone from greater stratification, are likely to affect these plans. PICTs in the east of the region with a high dependence on licence fees for government revenue are expected to receive more revenue as tuna catches increase in their exclusive economic zones. On the other hand, countries in the west may encounter problems securing enough fish for their canneries as tuna are redistributed progressively to the east. Changes in the distribution of tuna will also affect the proportions of national tuna catches required for food security. We present priority adaptations to reduce the threats to oceanic fisheries posed by climate change and to capitalise on opportunities.

A generalized epidemic of HIV infection has been evolving in Papua New Guinea over the last decade, whereas in other Pacific Island countries and territories (PICT) HIV transmission has generally been less widespread. Programmes to detect HIV infection in pregnant women and to prevent mother to child transmission (MTCT) during either delivery or breast-feeding can decrease the incidence of infection in infants. The limited health infrastructure present in some PICT may delay the implementation of effective programmes to decrease MTCT of HIV. We used a standardized questionnaire to survey health-care providers in 22 PICT for information on the epidemiology of HIV infection and strategies used during 2004 to prevent MTCT of HIV infection in their country. We supplemented these survey responses with data obtained from regional organizations supporting national responses to HIV. We obtained responses from 21 PICT. The reported prevalence of known HIV infection was >150 per 100 000 persons in Papua New Guinea, approximately 100 per 100 000 persons in French Polynesia, Guam, New Caledonia and Tuvalu and <50 per 100 000 persons in the remaining 14 PICT. Other than in Papua New Guinea, where an estimated 500 pregnant women had HIV infection diagnosed in 2004, reported HIV infection among pregnant women was rare. Ten PICT reported that an HIV antibody test was offered as a routine component of antenatal care and 11 reported that antiretroviral medications were available for the prevention of MTCT of HIV infection. The prevalence of HIV infection differs greatly between PICT with a varying risk of MTCT of HIV infection. Successful prevention of MTCT of HIV infection throughout the PICT will require improved uptake of antenatal HIV antibody testing and better access to antiretroviral medications.

BackgroundClimate induced changes in water-related infectious disease (WRID) transmission are a growing public health concern. The effects of climate on disease vary regionally, as do key socioeconomic modifiers. Regional syntheses are necessary to develop public health tools like risk maps and early warning systems at this scale. There is a high burden of WRID in the Pacific Island Countries and Territories (PICTs). There has been significant work on this topic in the PICTs, however, to date, there has been no regional systematic review of climate variability and WRID.MethodsWe searched the PubMed, Web of Science and Scopus scientific databases in September 2022 using a combination of disease, climate, and country terms. We included studies that evaluated the association between climate or weather variability and a WRID in the PICTs using a quantitative epidemiological design. We assessed risk of bias using validated tools. We analysed spatiotemporal publication patterns, synthesised the outcomes of studies in relation to the international literature and identified missing evidence.Results &amp; discussionWe identified 45 studies of climate and malaria, dengue, diarrhoea, leptospirosis, and typhoid, which represent major WRIDs of concern in the Pacific Islands. More than half of the studies were set in Papua New Guinea or Fiji. The number of studies published each year increased exponentially over time from the 1980s to present. We found few comparable outcomes per disease and setting across epidemiological studies which limited the potential for meta-analysis. However, we identified consistent increased incidence of diarrhoea, dengue, leptospirosis, and typhoid following extreme weather events, highlighting the necessity for adequate water, sanitation, and hygiene access across the PICTs. Additionally, there were consistent positive associations between temperature and dengue incidence in New Caledonia, highly seasonal malaria in PNG, increased diarrhoea incidence with high and low rainfall, and positive associations between leptospirosis and rainfall. These findings are biologically plausible and consistent with the international literature. Future work on this topic in the PICTs can take advantage of increasingly available health and climate data to consolidate the field across a greater diversity of settings and apply these findings to strengthening climate resilient health systems.RegistrationThis review is registered with the international prospective register of systematic reviews (PROSPEROCRD42022353853), in accordance with PRISMA guidelines.

BackgroundOverweight, obesity and their consequences are challenges to sustainable social and economic development in Pacific island countries and territories (PICTs). Complementing previous analyses for adults, the purpose of this paper is to synthesise available data on overweight, obesity and their risk factors in adolescents in the region. The resulting Pacific perspective for the younger generation will inform both the national and regional public health response to the crisis of noncommunicable diseases.MethodsWe examined the prevalence of overweight, obesity, physical activity and carbonated sugar-sweetened beverage (SSB) consumption, by using published results of two cross-sectional surveys: the Global School-Based Student Health Survey (GSHS) and the Youth Risk Behavior Surveillance System (YRBSS). GSHS was conducted in ten PICTs between 2010 and 2013 and provided results for 13–15 year olds. YRBSS surveys, conducted repeatedly in five PICTs between 1999 and 2013, provided results for grade 9–12 students (approximately 14–18 years) and enabled examination of trends.ResultsObesity prevalence ranged from 0 % in female students in Vanuatu to 40 % in males in Niue (GSHS). Among grade 9–12 students (YRBSS), obesity was highest in American Samoa (40 % of males; 37 % of females). Approximately 60 % of students in the Cook Islands, Niue and Tonga (GSHS) and American Samoa (YRBSS), were overweight. In both surveys, less than half of students reported engaging in sixty minutes of physical activity on at least 5 days of the past week. Daily consumption of carbonated SSBs in the past month was reported by over 42 % of students in six PICTs (GSHS), and in the past week by more than 18 % of students in three PICTs (YRBSS). In PICTs conducting YRBSS, obesity prevalence remained high or increased within the period 1999–2013.ConclusionThere is a need for urgent action on overweight, obesity and their risk factors in Pacific youth. The multiple social, economic and physical determinants of this public health crisis must be addressed. This requires all sectors within government and society in PICTs to implement and evaluate policies that will protect and promote the health of their populations across the life course.

Introduction and AimsAlcohol use is a leading risk factor for disease and injury in Pacific Island countries and territories (PICT). This paper examines drinking patterns across 20 PICTs.Design and MethodsWe synthesised published data from the STEPwise approach to surveillance or similar surveys for adults 25–64 years, and from the Global School‐Based Student Health surveys and Youth Risk Behavior Surveillance System (YRBSS) for youth. We examined current and heavy drinking, and for adults also frequency of consumption. Using YRBSS, we studied trends in youth alcohol use in US‐affiliated PICTs between 2001 and 2013.ResultsAlcohol consumption in adults and youth varied considerably across PICTs. In eight PICT populations, over 60% of male adults were current drinkers. Male adults consumed alcohol more frequently and engaged in heavy drinking more than female adults. Similar gender differences occurred in current and heavy drinking among youth. Across 10 PICTs, current drinking prevalence in males 13–15 years ranged from 10% to over 40%. Declines in alcohol use among grade 9–12 students were observed in YRBSS, although the magnitude differed by island and sex.Discussion and ConclusionsAlcohol consumption varies widely between PICTs. There are marked gender differences in use and abstention. There is scope in PICTs for implementation of best practice strategies to reduce alcohol‐related harm. These need to be gender responsive and cognisant of concerning patterns of youth drinking. Strengthening surveillance of alcohol use and its consequences is vital to inform and monitor the impact of national and regional policies. [Kessaram T, McKenzie J, Girin N, Roth A, Vivili P, Williams G, Hoy D. Alcohol use in the Pacific region: Results from the STEPwise approach to surveillance, Global School‐Based Student Health Survey and Youth Risk Behavior Surveillance System. Drug Alcohol Rev 2016;35:412–423]

Background: Like other LMICs, many Pacific Island countries and territories (PICTs) have fragile and overburdened health systems with which to combat an increasing burden of cancer. Additionally, a combination of small geographically dispersed populations, limited resources, isolation and frequent natural disasters make cancer control in Pacific Islands also significantly different to elsewhere in the world. No prior work has provided a stocktake of current capacity for diagnosis and treatment of cancer across the region to date. Aim: To describe the specialized health services available for cancer control in the Pacific region, and show the complexity associated with accessing cancer care for Pacific Islanders. Methods: A cross-sectional review of medical services and human resources available for cancer control was undertaken for 21 Pacific Community (SPC) member countries and territories in April-May 2018 , specifically diagnosis (pathology and radiology) and treatment (chemotherapy, radiotherapy and surgical modalities and overseas referrals for services not available on-island) by contacting individual countries and territories. Common travel routes were mapped individually for 4 PICTs; Papua New Guinea, Solomon Islands, Kiribati and Tokelau; as examples of the unique challenges faced by rural dwelling Pacific Islanders when accessing the highest level of care available in-country. Results: Capacity for cancer diagnosis and care is extremely limited in the Pacific region. The exceptions are the 2 French territories (French Polynesia and New Caledonia) and Guam where a near full complement of services for diagnosis and treatment are operational. Some pathology services are generally available in the larger PICTs, while specimens are sent to affiliated off island laboratories for the rest. Plain x-ray and ultrasound are available at 1 or more locations in all PICTs. General and gynecologic surgery is the most widespread treatment modality available. Some to full chemotherapy administered in 7 and radiotherapy in 3 (formerly 4) PICTs. Overseas referrals for medical services not available in-country are a common feature to all PICTs health systems. A need to travel long distances to access health care is a challenged faced by Pacific Islanders on outer islands and rural villages. Examples will be presented. Conclusion: Cancer control services are few and far between in the Pacific region, and PICTs will always likely rely on overseas referrals for care not available. Access barriers exist for those on outer islands and in villages, and an unknown number seek treatment late or not at all for these reasons. Governments need to invest into strengthening primary and secondary care services, making them an option that is more easily accessible to remote populations. Collaboration between transport and health sectors to look at ways to improve frequency, regulation and safety of modes of transportation to outer islands to improve current systems.

The health impacts of climate change are increasingly evident in Pacific Island Countries and Territories (PICTs), a group of 22 nations facing significant and existential threats to their populations. This paper investigates the ways in which climate change exacerbates existing health issues in this vulnerable region, focusing on both communicable and non-communicable diseases, and the dynamic relationship between human and planetary health. Rapid urbanization, changes in food systems, and the ongoing epidemiological transition from infectious to chronic diseases reflect the complex interplay of colonization, globalization, and a changing climate. This paper reviews the unique climate challenges faced by PICTs, including rising sea levels, extreme weather events, and their impacts on food security, water resources, and healthcare. We explore the environmental and social determinants of health while highlighting how climate-induced changes compromise the health and well-being of communities throughout the Pacific region. We discuss the increasing prevalence of vector-borne and waterborne diseases, the exacerbation of the region’s immense noncommunicable disease burden, and the profound mental health impacts of climate change. The economic implications of these changes, particularly on tourism and fisheries, are also explored. Despite these challenges, PICTs have demonstrated remarkable resilience and remain at the forefront of global climate advocacy. This analysis underscores the urgent need for international solidarity and action to address climate change and protect the health and well-being of the vulnerable Pacific region.