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“Is ethnicity a factor in Fiji’s obesity problems?” (FT 25/1/2020)

25/01/2020

Is ethnicity a factor in Fiji’s obesity problems?
Professor Wadan Narsey

Last week I quoted a BioMed Research International paper by Hendricks, Delai and Jansen (“Perspectives of Fijian Policymakers on the Obesity Prevention Policy Landscape”) concluding that Fiji women are more overweight than men, and indigenous Fijian women are more overweight than Indo-Fijian women.

I noted in an aside that I found this strange because the 2008-09 EUS data that I had analyzed showed that indigenous Fijian women played more sports than Indo-Fijian women and, ceteris paribus, Indigenous Fijian women should be less obese than Indo-Fijian women.

I present that graph here (Graph 1) which the differences between Indo-Fijian women (lowest graph) and indigenous Fijian women (second from the bottom) at all age groups, both of which have terribly low hours of sports.

[Note that such data disaggregated by ethnicity is no longer produced by the Fiji Bureau of Statistics – another article].

Note also that this graph shows as well the significant differences between the hours of sports played by Fijian males (top graph) and Indo-Fijian males (second graph). Is that part of the explanation of the high rates of NCDs among Indo-Fijian males and their lower life expectancy?

But to come back to the earlier question, why should indigenous Fijian women be more obese than Indo-Fijian women who play very little sports, at all age levels?

According to health experts, diets provide part of the answer.

And some part of the explanation may be derived from statistics in Household Income and Expenditure Surveys by the Fiji Bureau of Statistics for 2002-03 and 2008-09, which I also disaggregate by ethnicity, something the FBS is not doing any more.

Dietary risks

The Fiji Ministry of Health website not only has a good section on obesity, its health risks and possible causes, but a fascinating Fiji STEPS Report, which the MOH quotes very selectively, leaving out all references to ethnicity, despite their great relevance.

The MOH website states that one of the risk factors in obesity, apart from the lack of exercise I wrote about last week, is changing diet patterns whereby Fiji people are moving away from traditional foods towards “convenience packed foods such as juice, soft drink, crackers, noodles and fried foods”.

In the section on “Quality Foods”, there is a subsection titled “Examples of Quality Foods” of which many good examples are given, such as fruit, vegetables, nuts, and meats.

But very strangely, a subsection titled “Examples of Low Quality Foods” is left totally blank.

Is there a censorship story here about someone higher up in the Ministry of Health deleting the “low quality food” examples that the MOH experts, nutritionists and dieticians must have given for this subsection on the website?

And might this exclusion be due to the influence of the corporate interests behind tobacco, alcohol , soft drinks and convenience modern foods who would not be happy at their products being labelled on the MOH website as “low quality” foods”?

Any whistleblowers on this story can write to me anonymously (wadan.narsey@gmail.com).

But the 2011 STEPS Report (p. 41), freely available on the MOH website, also has this revealing statement “However despite efforts to tackle other lifestyle behaviours through a combination of approaches (as outlined in the NCD Strategic Plan 2010-2014), the situation is worsening….  ongoing exposure to secondhand smoke, promotion of alcohol and unhealthy foods and drinks and other issues should be tackled”.

That and much else in the STEPS Report is also unfortunately not mentioned on the MOH website. I will come back to that STEPS Report conclusions and recommendations in another article.

But here, let me present some data on how diets of different ethnic groups and their trends may have a bearing on Fiji’s obesity problem.

Reduced Own Food Production

The MOH concern that Fiji people are moving away from their own traditional foods is born out by the HIES data.

Note first of all that the changes described below are only for a five year period 2002-03 to 2008-09, which was ten years ago. The situation today is probably far worse, and the changes if taken from say 1970 would be even more spectacular.

Graph 2 shows that the percentage of food that is grown by themselves declined from 27% in 2002-3 to 19% in 2008-09, a reduction of 30% (solid black line).

Fiji households in 2008-09 were purchasing the vast majority of their food consumption, and therefore terribly vulnerable to inflation of food prices. There is clear reduction of household food security and increased dependence on stores.

While this reduction was evident for all ethnic groups, Own Production of food even for indigenous Fijians declined from 54% in 2002-03 to 43% in 2008-09, a reduction of 21% (top dotted line).

That for Rural Indo-Fijians declined from an already low figure of 16% down to a miserable 11% in 2008-09 (second dotted line).

There are fascinating stories to be drawn out here about our rural Indo-Fijian people who once upon a time used to produce a very large proportion of their vegetables and meat (chicken, duck and goats) are now dependent on purchases from shops.

Such stories would be just as fascinating as that of the sugar cane farmers who have now become dependent on outside cane cutters, even all the way from Vanuatu. Wow.

From local carbohydrates to imported

While the stories are the same for virtually all the major food items, the largest story is to be told about the reduced consumption of local root crops like dalo, cassava, yams, kumala and the increased consumption of imported carbohydrates like rice and imported flour products like noodles.

Graph 3 gives the clear and consistent patterns of local root-crops declining for all ethnic groups.

Graph 3 indicates clearly that Fiji as a whole has reduced its consumption of local root crops from 42% to only 33% a decline of 23%.

What is horrifying is that even rural indigenous Fijians have reduced their consumption of local root crops from 67% to 56%, a decline of 16%, while Urban Indigenous Fijians saw a decline from 39% to 31%.

Rural Indo-Fijians also saw a decline from their already low value of  7% down to 5%, a decline or 27%.

Graph 4  gives the mirror image of the above picture, in that Imported Carbohydrates as a percentage of all carbohydrates has increased in this five year period from 58% in 2002-03 to 67% in 2008-09, an increase of 17%.

Horrifying again, Rural Indigenous Fijians increased the proportion from 33% to 44%, by an even higher increase of 33%, while Urban Fijians went from 61% to 69%.

Indo-Fijians, both rural and urban, reached 95%.

Impact on economic welfare

Of course, there are many negative impacts on the welfare of the different ethnic groups.

Producers of local root crops are seeing reduced market demand for their products and hence reduced incomes, unless they increase prices which is a vicious cycle for them as consumers buy even less.

Producers of imported carbohydrates (rice and noodles in particular) are seeing increases in demand for their products and increased profits.

Of course, Fiji consumers are therefore in total becoming more vulnerable to international prices of imported carbohydrates and must suffer the ill effects of inflation, since domestic food production cannot be switched on and off, like an electricity switch.

Moreover, once rural farmers leave their farms and come to the urban areas, their land goes out of production, unless some more hard-working Chinese immigrants take over, as they have very efficiently and productively around the outskirts of Suva, even employing the indigenous Fijian landowners as laborers on their farms.

For Indo-Fijians, imported carbohydrates have always been part of their diet from the time they arrived in Fiji and calling them “Fijians” has not implied that they are consuming more Fijian foods.

Impact on nutrition

While cassava is not particularly nutritious, dalo, yams and kumala certainly are.

Nutritionists have long been worried about the lack of nutritional content of rice and noodles, even if they do have some additives and even if they are terribly convenient, especially for working people.

Without any doubt, however, the companies that produce rice and noodles have the great advantage of these being convenience foods: just drop them in boiling water and it is done, as opposed to the long process of cleaning muddy local root crops which deteriorate if left uncooked and unfrozen.

Also without any doubt, whatever the preaching of the MOH and nutritionists, the marketing campaigns of producers of imported carbohydrates, often with Government collaboration and support, are far more successful than the non-existent campaigns of producers of local root crops.

Are you ever likely to see the national athletics games being called the Dalo Games or the Kumala Games?

Fatty foods

There are many items of food which increase obesity and diabetes, such as sugar and sugar products.

But let me just look at one important meat item, lamb and mutton products, not including sausages which requires separate analysis. (Graph 5)

Note that the 2008-09 dollar values do not take account of inflation in the price of lamb which actually reduced demand for lamb between these two periods, because of increased hardship for many families.

Nevertheless, the messages are clear that Indo-Fijians are consuming far more of this fatty meat than indigenous Fijians and that consumption is increasing.

So what are Fiji people consuming less of?

Graph 6, which gives  2008-09 values deflated to 2002-03 values (i.e. taking account of the inflation in fresh fish prices of around 30% in this five year period), gives one clear possibility- all ethnic groups are consuming less fresh fish.

There are two alarming messages here.

The first is that Indo-Fijians are consuming very little of this extremely healthy meat item with protein and omega 3 oils which nutritionists say are good for one’s health.

The second is that even rural indigenous Fijians are showing a steep downward trend of consuming less fresh fish.

They are presumably eating more chicken, lamb, sausages and tinned meats.

Let me throw in one more Graph which has many stories behind it.

Graph 7 indicates the Junk Food Expenditure per child (not deflated) by ethnicity.

Even these levels and trends ten years ago indicate massive potential problems for nutrition of Indo-Fijian children.

Goodness knows what has happened in the ten years since then, especially given the enormous advertising campaigns that are run by the corporate giants who make their profits from these products.

Conclusion

Have we established why indigenous Fijian women may be more obese than Indo-Fijian women?

No.

What we have done here is explored just a few factors that, according to the nutritionists, have a clear bearing on obesity and good health of Fiji people, with the overall result being a sum total of what has been discussed here and many more factors not even touched upon.

There are more fascinating stories to be told from the FBS’s HOES data, about the consumption of sugar and sugar products, kava, alcohol and tobacco, all having an enormous bearing on the health of Fiji citizens.

With the HOES data also including incomes of households, it is also possible, as I did previously for the FBS, to conduct similar analysis by poor and rich households- again with many fascinating results which nutritionists would find so useful.

Good research students, with the help of nutritionists can do many Masters and PhD theses with the treasure troves of information contained in the Household Income and Expenditure  Surveys done by the Fiji Bureau of Statistics. Why don’t they?

It is clear from even the examples I have given here that most of these factors have ethnic dimensions, whose levels of consumption and growth trends are totally different from each other, and which are largely hidden by national aggregates and averages.

The Fiji Bureau of Statistics conducted  another Household Income and Expenditure Survey in 2013-14.

Sadly, apart from a few tables on poverty statistics, six years on there has been no report on expenditure patterns of the kind that was done by the FBS, with my assistance, ten years ago.

Sadly also, there has been no disaggregation by ethnicity, which is so important for getting at the truth of what is happening to the health and general welfare of Fiji citizens.

Next week’s article will bring out the terribly complex findings of health researchers who are begging policy makers for in-depth research, analysis and statistics by ethnicity, easily possible if only the FBS and the MOH was allowed to do so, as they did with previous HIES and STEPS surveys.

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