When twin cyclones Judy and Kevin hammered their way through the 83 tropical islands of Vanuatu in March 2023, the government and NGOs were quick to distribute supplies. The South Pacific country’s crops had been decimated and the need to feed the 300,000-plus population was a priority.
The bags of rice, packets of noodles and tinned tuna that communities depend on for the months after a disaster were welcomed. But unlike native staples such as yams, taro and sweet potato, these emergency foods only serve to worsen the region’s non-communicable diseases (NCDs) problem, according to experts.
“Ultimately, while such aid aims to address immediate food security concerns, it can cause long-term health problems, such as raising the risk of obesity and NCDs,” says Shazna Buksh, an assistant lecturer and NCD researcher at the University of the South Pacific in Fiji.
In 2011, Pacific island leaders declared that the region was experiencing an NCD crisis, with diabetes, heart disease and high blood pressure playing a part in 75% of the islands’ premature deaths. Limited arable land, the cheaper cost of low-quality imported food and a lack of education are to blame, say experts, but if the food aid that governments provided was more nutritious it could help prevent such illnesses.
Anything that affects food access has an impact on NCDs, says Penjani Kamudoni, Unicef Pacific’s nutrition specialist. When natural disasters strike – an increasingly frequent occurrence as a result of the climate crisis – healthy diets are among the casualties, as harvests are often badly affected.
“It can take anywhere between six months and a year to get that supply back,” says Emma Dorras, the nutrition manager at the Vanuatu nonprofit Wan Smolbag Theatre, adding that people prioritise finding filling food instead of looking for nutritional benefits.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
Food aid, typically provided in the Pacific by governments and funded by international donors, mainly consists of “processed foods, which are sometimes high in fat, salt and sugar, which contribute to the increasing problem of overweight and obesity that can either lead to development of NCDs or are not helpful with the management of NCDs,” says Elisiva Na’ati, an NCD adviser at the Australian government-funded development organisation the Pacific Community.
NCDs kill 41 million people each year – equivalent to 74% of all deaths globally – according to the World Health Organization, which predicts approximately 250,000 additional deaths a year between 2030 and 2050 as a result of the climate crisis’s effect on nutrition, as well as malaria, diarrhoeal diseases and heat stress.
In the months after the cyclones, Flora Vano, the Vanuatu country director of ActionAid, says remote communities reported an increase in illnesses such as diabetes, which doctors attributed to a switch from fresh to processed foods. “Their diet is local food but there was no other option but to eat that rice because it was the only food that was around,” says Vano.
Wan Smolbag found rates of malnutrition in children aged one to five had doubled in some communities after the cyclones. Poor nutrition as a child can lead to health issues in adulthood, such as cardiovascular disease and hypertension.
The problem remains that after a natural disaster, fresh fruit and vegetables are scarce and and sold at inflated prices, making them an unrealistic option for cash-constrained governments.
As a potential solution, Wan Smolbag is working with Unicef and the University of the Sunshine Coast in Australia to develop healthier dry-food rations alongside recipes that promote the reintegration of nutritious foods into local diets. “We’re really trying to push for an increase in things like lentils and dried beans, which have fallen away from the traditional diet,” Dorras says.
On the island of Nguna in Vanuatu, Save the Children has spent the past year piloting a project where a community sends their excess crops to a local food supplier in the capital of Port Vila. Here, they are paired with a source of protein and, by using hermetically sealed packaging, turned into preservative-free ready meals that can be consumed up to two years later and still have nutritional value. The hope is to scale up the project, so that when a disaster strikes, communities have immediate access to nutritious food.
ActionAid also encourages Pacific women to divide vegetable gardens into three sections: for family consumption; produce to sell; and food for the community, “so that in the aftermath of a disaster there is food that can be sent to nearby villages,” Vano says.
After Cyclone Harold in 2020, women from Tafea province in the south of Vanuatu were able to send their excess crops to the most affected parts of the country in the north, says Vano.
While community-level action is key, more needs to be done to control imported foods, say experts. The Pacific region has already been “incredibly proactive” in working to tackle NCDs, says Briar McKenzie, a research fellow of food policy at the George Institute for Global Health. More than three-quarters of its countries and territories have imposed taxes on sugary drinks and some have gone further. Fiji taxes juice, ice-cream, biscuits and sugar confectionery, while Tonga does the same for more than 10 high-fat and high-sugar products and has waived import tax on fruit, vegetables, eggs and seafood.
But faced with the growing impact of the climate crisis, Dorras warns that progress on NCDs may be limited. “The more frequent cyclones become, the worse people’s nutrition will become,” she says.
