Healthy food on Tutuila; Is it available? Is it affordable?
American Samoa is on the radar once again with the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia as the Atlanta based public health institution recently sent a team to the Territory to investigate, research and offer solutions to the problems of obesity which have plagued our population for years, reaching epidemic levels at this point in time.
Samoa News visited the head of the CDC team while she was here, and she was full of hopeful information and solid recommendations. An energetic and vivacious young woman, Dr. Seung Hee Lee-Kwan serves as an Epidemic Intelligence Service Officer with the CDC Obesity Prevention and Control Branch.
For two weeks in April, she and her team of four combed the island doing their research, talking to farmers, store owners, wholesalers and government officials at the Department of Health, and other areas related to food production and distribution.
Earlier this year, under a directive from Governor Lolo, an Obesity Task Force had been launched, and as a member and co-chair of that Task Force, Director of Health Motusa T. Nua took this threat to public health seriously.
In an effort to understand and curtail the problems associated with obesity and the diseases related to it — such as diabetes — Motusa appealed to the CDC, which he had visited earlier in his travels. The DOH director had met members of the CDC on a trip to Atlanta, and among them was Dr. Lee-Kwan.
She told Samoa News, “When I heard what Director Nua had to say about the problem of obesity here, I told him that we had seen very similar concerns among other U.S. communities as well as our recent work completed with the Navajo nation, led by team member Dr. Gayathri Kumar.”
Dr. Kumar's experience with tribal retail food options and obesity levels among the Navajo led to a report which she gave to Director Nua, and he kept in touch with her and with Lee-Kwan, extending a request to come to the territory and help us in the fight against our number one health problem.
Here for two weeks, the team visited supermarkets, grocery stores, convenience stores and restaurants, assessing what was readily available and promoted in terms of healthy food choices.
“Initially, we drove around the island, making a map of all the stores and where they’re located on the island. We identified 121 stores, and from among those, we chose 70 as representative samples. We used a tool called a “Nutrition Environment Measures Survey”, which we modified to account for foods specific to American Samoa (papayas instead of strawberries, for example). We looked at availability, pricing and promotion of both healthy and unhealthy food options.”
The team asked questions about healthy food such as: “Is it available? Is it affordable? How — and where — is it placed in the store? (Store placement can make a big difference in sales, as retail store owners will acknowledge.)
The EIS Officer said, “Many store owners were very kind, most were very welcoming; but a few were suspicious, so we made sure that they knew we were here under the auspices of DOH.” She said that established the trust they needed to do their work.
The team also studied our restaurants. “The restaurant culture here was interesting,” said Lee-Kwan. “It was concentrated in central areas, whereas out in the villages in the far east and far western ends, it was all about the food available in the stores, since there were no restaurants in those remote villages.”
“Through our assessment, we heard there was a positive trend in the stores in terms of availability,” she said. “And the store owners reported that they are seeing people buy much more in the way of fruits, vegetables and other healthy choices in the past few years.”
In terms of meat, the team discovered that a mere 2% of stores had any lean meat available, whereas almost every store had plenty of fatty meats for sale. Another fact which they noted was that healthier options were often more expensive.
Said Lee-Kwan, “Eating healthy is somewhat challenging on the island. You have to go out of your way to fix a truly healthy meal.”
One complaint heard consistently from store owners is the fact that they must rely on shipments from wholesalers, which come in at the same time. "And when an item is sold out — it’s out everywhere, until the next shipment.”
The team noted that a wide variety is still lacking, but things are definitely improving.
Lee-Kwan said, “We heard very positive reactions from the store owners, they want to sell more healthy foods.” But they also told the team, “We need our customers to let us know what they want. If customers say they want more of an item, we are more likely to bring it in.”
After all, she said, it is a business, and the owners are there to make money.
ADVERTISING AND HEALTHY FOOD CHOICES
The Epidemic Intelligence Service Officer noted that “Advertising is dominated by less healthy food options. Lots of ads for chips and treats and beverages, and very limited advertising of healthy foods other than water were found in the venues.” Because advertising plays a key role in what people buy, the push for advertising healthy choices is important.”
Lee-Kwan stated that they need to do further analysis.
“We’re going to create a “healthy food availability” scorecard for the island, she said. Certain villages will show the least availability of nutritious foods, and other villages will show a high availability.”
MESSAGES MADE CLEAR
Many messages can come out of this research, she noted.
1) Spend a little more money now on the healthy choices, and you will spend less money later on costly medical problems.
2) Consider ways to promote locally grown produce and local fish. Value your local goods; make sure they are affordable and widely available.
3) Using the research data, determine which areas of the island lack healthy foods. “American Samoa could be considered a food swamp — which means plenty of food is available, but most of it is less than healthy, with limited healthy food options.”
Lee-Kwan stated: “We need to go beyond awareness, health education and health promotion. People know in general what is healthy and what isn’t healthy, but circumstances can lead to making less healthy choices. In addition to ensuring adequate opportunities for physical activity, making healthy food more available and more affordable will go a long way toward fixing the obesity problem.”