Health expert tackles Samoa's health crisis

The Vice-Chancellor of the Oceania University of Medicine, Manufalealili Dr. Viali Lameko, says Samoa’s obesity crisis will not be solved by asking people to change their behaviour alone.

Manufalealili, who is in the midst of investigating Samoa’s vast policy suite on this issue, believes more structural or institutional change is needed first. He says for 20 years, Samoa has tried to tackle the growing obesity and non-communicable disease epidemic by encouraging healthy eating and regular exercise.

But evidence shows this has not been enough.

“I think everybody should be asking the question why, why is it not working? We have to admit failures,” he said.

According to the latest health survey in 2014, the number of diagnosed cases of hypertension has risen since 2009, with 23 per cent of households with over-25-year-olds reporting they have been diagnosed. 

Wealthier households appear to have higher rates of diabetes and hypertension, according to the Samoa Bureau of Statistics 2014 Demographic Health Survey. While 14 per cent of the lowest wealth quintile households have a diabetes diagnosis in the home, 32 per cent of the highest wealth-income group does. 

The high burden of non-communicable diseases can result in blindness, loss of limbs, extended dependence on dialysis treatment and in some severe cases patients are sent to New Zealand or Australia for medical treatment unavailable in Samoa. 

Other research projects obesity rates for 2020 to be nearly 60 per cent of all men and 80 per cent of women, with obesity causing the most disability in Samoa, Manufalealili said.  

The next D.H.S. will be published soon, but preliminary results released in July indicate the issue has not gone away. 

It found 8.7 per cent of children under five are moderately overweight and 2.5 per cent of children who are severely so, against W.H.O. standards.

Approximately 85 per cent of women between 15 and 49 years were categorised as overweight or obese. Indicators comparable to the 2014 survey were not available.

Manufalealili said enough time has passed to prove the current efforts are not enough, with not even a slight downward trend in obesity rates to show for the investment of the last two decades. 

“People say this does not change overnight. But we should at least see a change in the trend of obesity in Samoa over the past ten or 15 years but it’s not changing, the numbers are still rising.

“I believe the obesity problem in Samoa has not changed much because we have focused more on trying to change behaviour – stop smoking, stop eating this, exercise more – and this has failed.

“It’s hard to change the behaviour of people, so that is why I argue that perhaps we should focus more on structural factors.”

Taxing fatty or sugar-sweetened foods to make them less affordable and desirable and even banning advertising them might be two ways forward, he suggested.

But more drastic than that even is to work as a region to address the free trade barriers to banning the import of some of the worst contributors to the obesity epidemic.

Food like turkey tails and mutton flaps, which have been widely criticised as being unhealthy, is hard to ban from Samoa because World Trade Organisation regulations forbid such policies and Samoa was prevented from joining the international body over the bans.

But Manufalealili says even without a formal policy, campaigning against the import and consumption of these meat products could do some good.

“It doesn’t necessarily mean we can’t make noise, we have to make noise,” he said.

“Another way to tackle that policy was for the policy makers in Pacific Island countries to say why are you dumping all the mutton flaps in the Pacific Island countries?

“I believe that the Ministry of Health and the Government are trying their best to mitigate the effects of obesity and the trend but there are things they can’t control,” he said. 

In 2013, Member of Parliament Gatoloaifa’ana Amataga Alesana-Gidlow did exactly that, at a Pacific Parliamentary Forum in New Zealand.

She asked the country to stop exporting fatty products to its Pacific Island neighbours in a bid to help lower consumption.

“It's easy for people to say it's your own fault for eating those things. But the point is, it's there, it's available and that's why locals buy it,” she said at the time.

“We ask New Zealand to stop exporting to any poor and less developed neighbours in the Pacific all your fatty products that are not for sale in your own country because they are not considered to be of consumable standards.”

Manufalealili has published an overview of Samoan diet in the past and today in the next edition of the Journal of Samoan Studies, out later this month.

He is currently working through a review of all Samoan N.C.D., health promotion and food policies Samoa has implemented and comparing them to regional standards and against their own successes to see where the gaps may lie.

Structural changes like taxes and trade regulations are his top guesses for what could change the situation, as well as radically improve the minimum wage across Samoa.

 “One of my suggestions is to raise the minimum wage so that people can buy good food. I know the government is not going to like that, [but] you can’t get people to buy healthy food if the minimum wage is so low.”