Food System Transformation in Fiji: Exploring the Determinants of Diet Quality and Health Outcomes in Rural and Urban Households

Abstract

Rapid transformations of global agrifood systems, driven by technological change, trade liberalisation, foreign investment, urbanisation and rising middle-classes in developing countries have contributed to profound shifts in food production, and consumption. This shift is often referred to as the “nutrition transition”, which has had a subsequent effect on diet and health, with rising rates of obesity and non-communicable diseases (NCDs) currently observed across the world. Pacific Island Countries and Territories (PICTs) have the highest prevalence rates of adult obesity in the world. Fiji provides a unique context as one of the more developed and highest populated economies of all the PICTs. This thesis examined the determinants of diet quality and health outcomes in both rural and urban households in Fiji, with implications for wider PICTs. In Fiji, agriculture generates income for approximately 65% of the total population, with many rural households specialising in subsistence agriculture. Agriculture influences nutrition through a number of pathways, directly through the production of subsistence food crops or animals, and indirectly through the sale of agricultural goods and therefore capacity to purchase food. Chapters 3 and 4 examine the impact of farm production diversity, modern market access, and women’s empowerment in household decision-making on dietary quality and health outcomes amongst rural households in Fiji using data from face-to-face surveys undertaken in 600 rural households. A household dietary diversity score was developed based on previous studies, and it was found that households who sell their produce to modern markets have greater diet diversity, and households who lived closer to modern food markets were less likely to eat traditional staple foods. In households where the female contributed to decision-making, the household was less likely to consume unhealthy foods. Despite substantial economic growth, large inequalities remain in PICTs, and it is common to also see problems of underweight, stunting, and micronutrient deficiencies, signalling the “double burden” of undernutrition and obesity. Chapter 4 examines both adult and child health body mass index (BMI) outcomes in rural households. Regression analysis found that the consumption of home-grown produce had a significant effect in reducing child BMI-z and that households located further away from traditional food markets were more likely to experience child stunting. In households where the principal female contributed to agricultural household decision-making, there was a significant positive effect on adult BMI. The modernising of food retail sectors has been most prominent in urban areas of PICTs. Chapter 5 explores the link between the food market environment and other sociodemographic influences on diet quality in urban households in Fiji, using data from a unique survey of 1000 urban households. A household’s diet diversity score was positively and significantly impacted by an increase in income, frequency of eating out and nutritional information use. Households who purchased a greater share of their food from modern food markets spent relatively less on purchasing healthy foods. A positive relationship between the principal female’s education and the consumption of healthy foods by the household was also found. This thesis concludes with a number of policy insights for PICTs.