Fish, food security and health in Pacific Island countries and territories: a systematic literature review

The degree to which individuals and households depended upon fishing for livelihood varied between and within PICTs. Four of the studies reviewed were conducted in Fiji, one of the more economically developed countries in the region [42, 45, 60, 61].

To highlight the heterogeneous nature of Pacific Islands, three PICTs, one from each of the cultural sub-regions, were examined in further detail. Demographic, nutritional and fish indicators from Vanuatu, Kiribati and Tonga (Tables 6, 7, and 8) demonstrate that fish consumption, as a percentage of total protein intake, varies considerably across the three cultural sub-regions. Fish consumption is much lower in Vanuatu, than in Kiribati and Tonga. This is presumably due to the relatively large population of Vanuatu and the limited area of coral reef capable of supporting coastal fisheries, resulting in low availability of fish per capita. The availability of beef cattle on some islands in Vanuatu, and the great importance of yams in the traditional diet, presumably also affect the role of fish in the nation’s food system.

Nevertheless, the patterns of fish consumption evident from the case studies summarised in Tables 6, 7 and 8 are representative of differences among the three sub-regions in general, with average national fish consumption in Micronesia and Polynesia, being much greater than in Melanesia [27]. The case studies support the data presented in the numerous individual country studies identified in this review and are used to present a succinct summary overview of factors influencing fish consumption patterns, food security and health status between the sub-regions.

Non-communicable diseases have been declared a crisis in the Pacific, and there are national response plans in place to address risk factors, particularly with regard to strategies to reduce population-level salt intake. Dietary survey work in Fiji identified the main sources of salt in the diet as salt (and MSG) added during cooking and at the table, as well as processed foods such as tinned fish and meat, biscuits, soy sauce, noodles, salty crisps and snacks, tinned fruit and vegetables, butter and bread [77]. Country consultations and Food Frequency Questionnaires (FFQ) carried out in Fiji, Samoa, Kiribati and Cook Islands, have confirmed this [78]. Locally salted, preserved fish and meat, and meals eaten in and out of the home, such as Chinese dishes, soups and curries are also a common part of the diet in the region.

An increase in the availability of fresh fish offers an alternative to foods with a high salt content. Increasing access to fresh fish also offers an alternative to imported meats, many of which are energy-dense and high in saturated fat (e.g., frozen chicken, canned mutton, turkey tails and sausages). These energy-dense foods have been associated with the prevalence of chronic diseases and over-nutrition in PICTs, and their inclusion in emerging dietary patterns confirms this, as identified by studies identified in the current review.

‘Modern’ dietary patterns, characterised by high consumption of foods such as potato chips, cake, rice, instant noodles, soup, and low intakes of local foods, have been shown to be associated with an increased prevalence of metabolic syndrome [58]. In contrast, ‘traditional’ Pacific Island dietary patterns high in fresh fish and seafood, as well as other local foods, such as coconut-based dishes, taro and papaya, have been associated with reduced prevalence of metabolic syndrome, increased HDL cholesterol and reduced waist circumference [58]. Heavy reliance on poor-quality imported foods [79] is exacerbating the genetic predisposition of people in FSM to obesity [80].

Whether fish is consumed fresh or canned needs to be considered. Findings have been inconsistent as to whether consumption of canned fish per se is a risk factor for obesity in PICTs. Data collected between 2001 and 2002 from rural Tongan communities reported that neither fresh fish nor canned fish were related to obesity [81]. However, the more recent finding of Dancause et al. [59] that consumption of canned fish was a risk factor for obesity in Vanuatu warrants further consideration, in the context of the nutrition transition [5]. Methodological limitations to dietary assessment should be noted; Dancause et al. used a single 24 h recall, which may not be appropriate to determine usual intake. Further, a higher consumption of tinned fish may simply be a proxy measure for a greater reliance on processed foods in place of fresh fish, as populations become more urbanized and adopt more westernised eating patterns. Both the nutrient content and the preparation methods of tinned fish may also contribute to its association with obesity. Tinned fish canned in oil or sauce has higher fat content than most types of fresh fish [82] and will often be served with instant noodles and rice [59]. Packaged instant noodles are popular in Vanuatu [83] and across most PICTs, and their inclusion in the diet has been shown to be associated with increased risk of obesity. In comparison, fresh fish and meat more often accompany dishes prepared with traditional root crops and vegetables, which are less energy-dense. A heavy reliance on tinned fish in urban areas was reported during the first nutrition survey conducted in Vanuatu as long ago as 1951 [84] and has since been observed in many other PICTs [83, 85, 86]. The Vanuatu Ministry of Health NCD survey in 1998 reported associations among obesity and daily consumption of non-traditional fat sources (OR = 2.19), including oil, margarine/butter, milk, fresh meat, poultry, tinned meat, and tinned fish [87].

In short, it appears that any association of canned fish with obesity and NCDs may well be related to the foods eaten with canned fish, as well as the added oil or sauce used to preserve fish when canned [59]. On its own, canned fish is a valuable alternative source of protein, when fresh fish is in short supply due to unfavourable fishing conditions. While fresh fish remains a major part of the diet in Vanuatu, it is not available in all areas and only seasonally in others as shown in Table 6. It has been proposed, somewhat controversially, by Dancause et al. [59] that fresh meat might be a better dietary option than tinned fish in some PICTs, at least from the point of view of preventing NCDs. This requires further investigation with well designed intervention studies, but is considered impractical due to the limited scope for grazing cattle in most PICTs, as well as lack of refrigeration for storage. Animal husbandry (chickens and pigs) is already practiced widely but may have limited potential for further expansion due to the high costs of imported feeds.

The challenge is to encourage Pacific Islanders to maintain traditional dietary patterns in the face of urbanisation accompanied by the nutrition transition. To date, there have been surprisingly few publications on interventions in this regard. In FSM, a health promotion programme that encouraged the consumption of local foods, including banana, taro and breadfruit, demonstrated increased dietary diversity through higher consumption of local foods and a decrease in consumption of imported foods (such as rice) [91]. Such efforts could be used to promote the consumption of fresh fish in areas where intake of imported meats has become increasing prevalent.

Fishing is critical to household food security in PICTs through subsistence production and income generation (which allows food purchases) especially for communities that have limited opportunity to engage in other agricultural or economic sectors to produce food and/or income [63, 88]. For example, although Fiji is one of the more developed PICTs, both subsistence and commercial fisheries remain an important source of food and livelihoods [60].

In 2010, at the Pacific Food Summit, a Framework for Action on Food Security in the Pacific was developed with four goals aligned to the WHO’s four pillars for food security. The first goal, availability of food, has been addressed to some extent in the literature, with predictions that the majority of PICTs will have sufficient fish for local consumption and commercial activities, as long as Pacific Island governments provide greater access to regional tuna resources and the bycatch from industrial fishing operations for local consumption [31]. Even so, inter-annual variation in where bycatch is landed by fishing fleets could cause temporary shortfalls in fish supply in some urban centres [88].

Strategies such as increasing nearshore FADs have shown promise in terms of how increased availability of tuna and other large pelagic fish can help provide the protein that communities need for food security and nutrition [65], however appropriate monitoring and management is required. Strategies based on facilitating the supply of locally-canned tuna to the large inland population of PNG have yet to be developed in any detail but are much needed [27, 31].

The overview study by Bell et al. [27] showed that ~50–90 % of fish consumed in rural areas of PICTs was obtained through subsistence fishing. Other research done by the Coastal Fisheries Programme at the Secretariat of the Pacific Community [89] shows that an average of ~50 % of surveyed coastal households in 17 PICTs derived their first or second source of income from catching or selling fish.

However, there is limited research relating to two of the other goals, namely access to food and food utilisation. These goals are concerned with households’ ability to grow or buy foods to meet dietary requirements for good health [90]. The fourth goal, relating to stability of food systems, is beyond the scope of this literature review.

When planning policies and interventions to increase availability of fish, ease of access to fish, and utilization of fish in PICTs, it is important to consider other factors that may affect food intake. A lack of nutrition education and a decrease in knowledge of traditional food sources in several PICTs also means that many Pacific Islanders do not have the knowledge or skills to make food choices that will benefit their health [55, 59, 91, 92]. This is increasingly problematic as more imported unhealthy foods become readily available. Qualitative evidence suggests imported, foods such as canned meats may be increasingly preferred by Pacific Islanders over local foods, such as fresh fish, because they are associated with wealth and status [37]. The ability to purchase imported foods is increasing for at least two reasons. First, more PICT communities are moving away from a subsistence to a cash-based economy. Second, increased migration to urban centres reduces opportunities for people to grow their own food, or have access to fish when it is difficult to transport them from remote areas to urban markets.

One of the limitations of this review is that the reported findings of detailed studies on consumption of fish are based on only a few of the PICTs, and primarily in coastal areas. Evidence from many PICTs has been limited to information derived from household income and expenditure surveys [27], with little data on the factors determining access to fish and use of fish at a local level. In addition, the majority of articles included in this review were cross-sectional, with only one longitudinal study and one case–control study. Comparison of fish consumption was also limited because measurement of fish consumption differed between studies in terms of daily frequency, meals per month and daily amount. No intervention studies were found assessing the effect of fish consumption on improved dietary intakes or health outcomes.

Finally, a lack of co-ordinated approaches between fisheries and health ministries has been acknowledged by the Secretariat of Pacific Communities (SPC) [93]. This has hindered the development of integrated policies designed to achieve food security through improved management and sustainability of coastal fisheries, while at the same time preventing NCDs. Such approaches are a priority for the region and will require inter-sectoral dialogue and partnership.