January 16, 2018 matt.scott

Wendy Snowdon works in the World Health Organization’s Division of Pacific Technical Support. Her work involves designing, implementing, and measuring the success of new strategies to combat the spread of non-communicable diseases (NCDs). Wendy advised LAUNCH on the design of the LAUNCH Food challenge and helped review innovator applications. LAUNCH team member Ben Kreimer interviewed Wendy in November 2017. This interview has been lightly edited for clarity and brevity.

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BEN: Tell me about Health Promoting Schools, and your current work across schools in Fiji.

WENDY: Health Promoting Schools focuses on trying to create an enabling and supportive environment for children to make healthy choices. It’s a recognition of the importance of starting early in life with children, and it builds off some of the key principles of health promotion and also some of the frameworks from WHO about health promoting settings such as churches and villages and so on. In Fiji, the Health Promoting Schools program has been operating in schools across the country for a number of years. In the last 18 months, we’ve been working collaboratively with the Ministry of Health and the Ministry of Education here in Fiji to expand and strengthen the program.

BEN: What’s led the NCD problem in the Pacific to reach this crisis point?

WENDY: It’s a combination of factors. There have been gradual lifestyle changes happening in the Pacific Islands, perhaps more rapidly than in other countries. We have growing rates of obesity and changing diets, changing physical activity levels, increased access to less healthy behaviors such as alcohol and tobacco, and these have contributed to the growing rates of NCDs. It’s not clear really why the Pacific Islands are more heavily affected and experiencing such high rates compared to many other parts of the world, but we do know that the four key risk factors are diet, physical activity, tobacco use, and misuse of alcohol. These are significant problems in the Pacific Islands.

BEN: Your 2013 report [finding a widespread pattern of misleading or incomplete nutrition labeling on processed foods in the Pacific] was groundbreaking. Have nutrition labels been improved since your report?

WENDY: I think the accessibility and availability of appropriately labeled processed foods is improving all the time. I think if you’d done the same assessment 20 years ago, you would have found that most foods were hardly labeled at all — there was no nutritional information, or it was all in a foreign language that you couldn’t understand. But now that is improving significantly. So as you go around the region you do see that that change has happened. There are still signi cant gaps, but I think that all of the governments in the Pacific are recognizing the importance of well-labeled food. What we are seeing increasingly now is the phenomenal range of sourcing for these foods. Now we import foods from every corner of the world. If you’d have come 15 years ago, it was pretty much Australia, New Zealand, and maybe the US that were supplying food for the Pacific Islands. But now, you can find products here from every country in the world, really.

BEN: So what are some of the continued challenges?

WENDY: It puts quite a burden on the government, on the Ministries of Health, who have authority to enforce the food regulations to control the food supply. Because they have the responsibility to ensure that food is available, is appropriately labeled, safe to consume, and so on. But the more countries that comes from with different languages, and the constant turnover of sourcing of goods puts quite a lot more work on them, so they’re having to check a lot more carefully and I think that’s only going to be a continuing trend.

BEN: Part of our work across the LAUNCH consumer engagement projects is the reactivation of indigenous knowledge around healthy eating. Given that the Pacific, for the most part, doesn’t have a written history, are there reliable places, spaces, or libraries that have stories from the past about traditional foods?

WENDY: Yes, you’re right. It’s probably not really written down directly by the people of the islands. It has often been written down by visitors from outside. For example, the early missionaries that came to some of the islands have written stories about the foods they were given in welcome, and so on. So there are stories that capture those sorts of information from the perspective of an outsider. I think there’s still a lot of passed-down information among the generations about how you prepare foods and things like that. A lot of that is still there, although it’s good now that things are being written down so that they’re not lost with the generation changes. Some of the agencies and universities are really working quite hard to capture that information in written form so that it is more preserved.

BEN: We’re in conversation with IBM’s AI (artificial intelligence) for Social Good program — we’re looking at using AI and machine learning to reactivate indigenous knowledge. So for example, I asked the last question partially because, to get into the AI space, you have to have data to essentially feed it into the assistant. This is very forward-thinking and experimental, but this concept of taking indigenous knowledge and developing machine learning around it as a way to make it accessible in contemporary ways — is that something that sounds of interest to you?

WENDY: Yes, I think it’s about making the traditional practices palatable and easily accessible to all people. So you can see the kinds of transitions that have been happening. Initially it was just spoken word and people were writing it down and it’s in the libraries, and now you can access things online with documents that are accessible. So I think it’s responding to the trends of how we access information and find what we need. And that’s going to transition as well, as people find information in different ways. So I think it’s about responding to the needs.

BEN: In Tonga, you don’t have the kind of ethnic diversity that you have here in Fiji. So looking at the Fiji’s national strategic plan for the Ministry of Health and Medical Services, the first priorities are NCDs, nutrition, mental health, and the like. But there’s also this idea of the need for a whole-of-society approach to reduce NCD risk factors in the population. Given the diversity of the society here, when you’re developing these programs to address these NCD challenges, how do you weave in the different cultures so that it’s relevant to everybody?

WENDY: I think there are different layers of work that you’re trying to do with a multi-sectoral approach. There’s the policy layer, the setting layer, the community and individual layers. Some of the things would be the same regardless of ethnicity or geographic area — for example, if you wanted to increase the price of soft drinks, it wouldn’t really matter, it would be across the board. But I think once you get down to the community-level work that you’re trying to do at the individual level, that’s where you have to make small adjustments to accommodate for the particular dietary patterns, beliefs, practices, and so on. But your overall goal is the same — that you’re trying to change maybe what’s in the local store or what’s grown in the garden. There’s just slight amendments going on, but the overall delivery is the same.

BEN: Do you have thoughts on areas that the LAUNCH team should be concerned about? We hear a lot of positive feedback, but very rarely do we get the concerns, the harsher critiques perhaps, and those are very helpful because we want the project to succeed.

WENDY: We all know that changing behavior is phenomenally difficult. And we all expect that with children, we can change their behavior more easily because they’re less well-formed and habits are not really set. But they’re also heavily influenced, even controlled, by their external environment — particularly parents and other relatives and so on. That may be one of the bigger challenges, showing that the intervention doesn’t just target the child but also in uences the food that they’re given at home and in the community. Some of the studies in Fiji about why children eat what they eat — a lot of it is about, I saw it advertised and things like that. But it’s also about, I saw my big sister eat this, or my auntie said to eat this — it’s very much around family and community influences. So unless you can modify those influences as well, it’s hard for a young child to initiate a discussion with an older, respected peer, to say no, I think the apple is good, not the soft drink, or whatever it may be. I think that’s a very challenging area.

We don’t have the magic bullet for tackling obesity and poor nutrition and so on in children. We’re looking for options that can start to sort of nudge them into the right direction. So I think it’s going to be a combination of approaches, and I think we need to be constantly looking for new ways of engaging their minds, and really evaluating what the impact of that is.