BY AKIELLY HU
On my second day of living with a host family in Samoa, my host siblings and I rode a bus into the capitol city of Apia. I vividly remember peering over the railing at the top of the Apia government building, wide-eyed at the novelty of the view: stark white buildings with bright orange, green, and blue rooftops dotted the mountainous green landscape beyond the crowded city center. The straight, wide roads were fringed with palm trees and bustling with cars – so unlike the empty, winding paved roads of our host village, Satapuala.
The winter of my junior year, I stayed in Satapuala for three weeks with the American Youth Leadership Program with Samoa. The purpose of the trip was to study the factors that contribute to obesity and food insecurity in Samoa and reflect upon the similarities and differences with our own country’s nutritional issues.
According to the World Health Organization, over 80% of adults in Samoa are overweight (classified as having a body-mass index or BMI of 25 or greater) and 41.6% of adults in Samoa are obese (having a BMI of 30 or greater).1 As a result, Samoa also has high rates of obesity-related diseases, with 23% of adults affected by diabetes and 21% by hypertension.2 As startling as these figures might seem, the United States’ own statistics don’t trail too far behind — United States’ adult obesity rate is 34.9%, with about 68.8% considered overweight and 9.3% diagnosed with diabetes.3
With such similar statistics, I assumed before visiting Samoa that, like the United States, the prevalence of cheap fast food chains like McDonald’s must play a significant role in this high rate of obesity. Yet squinting at the vivid colors against the sunny blue sky on top of the government building, I only spotted one set of tiny golden arches in Apia. In fact, throughout my five or six trips into the small capital city, Samoa’s only urban, commercialized area, I only ever saw that one lone McDonald’s.
According to a doctor we met in Apia, barely anyone in Samoa was obese fifty years ago. While Samoa has only recently faced obesity issues, my experience in Samoa revealed that clearly, the abundance of globalized fast food chains was not the reason for this drastic change.
Physical Isolation and Agriculture
In order to understand Samoa’s public health issues, one might begin by describing its geographical context. With an area of about 2,800 square kilometers, Samoa is a bit smaller than the state of Rhode Island.4 There are two main islands, Upolu and Sacaii, but most people live on Upolu. While about 37,000 people live in Samoa’s only city (the capital, Apia), the rest of Samoa’s population of about 200,000 lives in villages.4 Samoa is also very isolated; it is located in the chain of Pacific islands that includes Fiji, Tonga, and American Samoa, and lies over 2,000 miles away from New Zealand and over 3,500 miles away from Australia.4
This physical isolation means that imports are both costly and inconvenient. While not entirely inaccessible, buying imported produce requires a substantial trip away from rural villages to a slightly more populated area with a grocery store. During the three weeks I lived with my host family in the village of Satapuala, the only non-native produce I remember eating are carrots, bok choy (perhaps once or twice), and the occasional apple. By and large, the most affordable and therefore most-eaten foods are locally grown starches: ulu (or breadfruit – a starchy fruit grown on abundant, large-leafed trees that reminded me of both potatoes and plantains), talo (taro – a large export of Samoa), niu (coconut), and fa’i (bananas), along with tropical fruits like fala (pineapple) and esi (papaya).
Poor soil quality contributes to the lack of food diversity. “In the United States, you might have 15 feet of top soil. In Samoa, we only have about 8 inches”, a government employee informed us at the Ministry of Agriculture and Fisheries. Because Samoa’s soil is scarce and rocky, people grow local crops on subsistence-level family farms rather than mass-producing a variety of produce on the mechanized, industrial farms we have in the United States. This resulting lack of crop variety, in addition to the country’s lower middle income economic status, leads to less consumption of expensive produce like leafy greens and vegetables and a higher demand for cheaper, imported processed foods.
Diet, Income, and Culture
This recent increase in consumption of processed, imported foods is perhaps the largest contributing factor to Samoa’s obesity rate – and yet another aspect of Samoan life I didn’t anticipate. Having only seen idyllic pictures of a tropical paradise before traveling to Samoa, I expected to eat nothing but fresh fruits and locally caught fish. In reality, the foods I most often ate included corned beef, ramen, white bread, crackers, and “Spaghetti-o’s”. While Samoa’s physical isolation and low crop diversity makes purchasing imported foods a necessity, most imported fresh produce are too expensive to purchase regularly. These barriers result in high consumption of processed canned and packaged foods including Spam, chips, and soda.
“All over the world, poor quality and highly energy-dense food is the cheapest,” says Jonathan Shaw, associate director of Baker IDI Heart and Diabetes Institute of Australia.5 These canned or packaged goods are non-perishable and cheaper than expensive imported fruits and vegetables, so the Samoan families we encountered overwhelmingly bought these as staples of their diet. Temo Waqanivalu, program officer with the WHO’s Prevention of Non-communicable Diseases department, notes that in many Pacific Island countries, the price of imported processed foods is lower than even native foods, with “fishermen often selling the fish they catch to in turn purchase canned tuna.”5 Ironically (as the ocean was a mere five-minute walk away), I only ate fish once with my host family – and it was tinned. According to Aliioaiga Feturi Elisaia, Samoa’s ambassador to the US and the United Nations, before the arrival of cheap foreign foods, few people in Samoa were obese.6 Now, as a result of this demand for cheap imports, regular consumption of high-energy, processed foods has contributed to Samoa’s poor nutrition and alarmingly high obesity rate.
Despite this recent shift towards unhealthy imported foods, traditional food is still a culturally significant part of Samoan life. Evening prayer every night (as 99.1% of Samoans are Christian) was usually accompanied by treats like sweetened milky black tea and homemade cake.4 Samoans still frequently prepare food using their traditional method of cooking with an umu – a fire pit that’s prepared with hot coals, with banana leaves layered over the food to help it cook. For example, an umu is used to create palusami, a coconut cream dipping sauce baked inside taro leaves, freshly baked breadfruit and taro, and pulini, a warm and fluffy banana-based cake steamed inside a banana leaf. Each week, we helped prepare these traditional foods for the to’onai – a large meal for village residents and church leaders held every Sunday after church. Interestingly, Samoan livestock is relatively healthy and most families raise their own chickens and pigs. These free-range Samoan chickens provide both lean meat and fresh eggs.
It is shocking to note how the advent of global trade has transformed Samoan diets and the nation’s economic fabric – family-run kiosks selling imported candy, chips, cookies, and soda, frequented almost daily by my host siblings, were ubiquitous in every village I visited. Dr. Jan Pryor, the Director of Research at the Fiji School of Medicine notes: “Even if you go into a store in a remote village you’ll find shelves of Spam and corned beef.”7 A typical dinner prepared by my Samoan host mother combined both traditional food and Westernized imported food: for example, chicken soup made with ramen, baked breadfruit and taro, and a chop-suey made with corned beef. Almost everywhere I went I encountered a similar mix of traditional foods combined with or made with packaged imported foods and local starches, with few vegetables. This trend is common in the isolated, recently industrialized developing Pacific Island region. A World Health Organization study of eight different Pacific Island countries found that less than 20% of people surveyed reported eating the recommended five or more portions of fruit and vegetables a day.8 Addressing obesity in Samoa would therefore first and foremost require improving access to fruits and vegetables.
Although obesity remains a pressing issue, Samoa has made several efforts to lower obesity rates and improve food security. In our visit to the Ministry of Agriculture and Fisheries of Samoa, government officials informed us of several programs to overcome challenges of low crop variety, including promotion of the export economy and research into genetically modified crops and local farming methods. Delegates of the Pacific Food Summit in 2010 agreed to increase regulation on nutrition labeling on imports, which often vary in language and content. 8 Additionally, the Ministry of Health in Samoa has initiated physical activity programs in 173 of its primary and secondary schools.9 Continuing and increasing these efforts in agriculture, import regulation, and health education is crucial to further reducing Samoa’s obesity rate.
The Complexity of Public Health Issues
During my time in Samoa, I quickly learned that a single obesity statistic – 41.6% –encompasses a variety of economic, environmental, and cultural factors. Issues including the price of imports, lack of top soil, poor crop variety, and a food culture now dominated by processed imported foods all contribute to this nutritional imbalance. My observations in Samoa taught me that only by experiencing public health issues first-hand and considering them holistically can we avoid reducing people to mere statistics and begin to address these challenges.
Akielly Hu is a freshman in Berkeley College. Akielly is an undeclared major from Washington. She can be contacted at firstname.lastname@example.org.
1) Streib, L. (2007). World’s Fattest Countries. Forbes. Retrieved from http://www.forbes.com/2007/02/07/worlds-fattest-countries-forbeslife-cx_ls_0208worldfat.html.
2) Samoa. (n.d.). World Health Organization. Retrieved from http://www.wpro.who.int/countries/wsm/en/.
3) Adult Obesity Facts. (2015). Centers of Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/adult.html.
4) The World Factbook: Samoa. (n.d.). Central Intelligence Agency. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/ws.html.
5) Senthilingam, M. (2015, May 1). How paradise islands became the world’s fattest place. CNN News. Retrieved from http://www.cnn.com/2015/05/01/health/pacific-islands-obesity/.
6) Barclay, E. (2013, May 14). Samoans Await The Return Of The Tasty Turkey Tail. NPR News. Retrieved from http://www.npr.org/sections/thesalt/2013/05/14/182568333/samoans-await-the-return-of-the-tasty-turkey-tail.
7) Squires, N. (2008, April 12). Spam at heart of South Pacific obesity crisis. The Daily Telegraph. Retrieved from http://www.telegraph.co.uk/news/worldnews/1578329/Spam-at-heart-of-South-Pacific-obesity-crisis.html.
8) Parry, J. (2010). Pacific islanders pay heavy price for abandoning traditional diet. The World Health Organization. Retrieved from http://www.who.int/bulletin/volumes/88/7/10-010710/en/.
9) Health Education and Promotion Section. (n.d.). Samoa Ministry of Health. Retrieved from http://www.health.gov.ws/AboutUs/Divisions/HPPSD/HealthEducationandPromotionSection/tabid/5400/language/en-US/Default.aspx.