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Guell C, Saint Ville A, Anderson SG, Murphy MM, Iese V, Kiran S, Hickey GM, Unwin N. Small Island Developing States: addressing the intersecting challenges of non-communicable diseases, food insecurity, and climate change. Lancet Diabetes Endocrinol 2024; 12:422-432. [PMID: 38782517 DOI: 10.1016/s2213-8587(24)00100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024]
Abstract
Small Island Developing States (SIDS) include 37 UN member countries sharing economic, environmental, and social vulnerabilities and intractable health challenges. In over 80% of SIDS, more than one in six adults die prematurely from a non-communicable disease (NCD), with poor diet being a major factor. Complex upstream food system determinants include marginalised local food production and reliance on low nutritional quality food imports. These drivers need to be seen against colonial and post-colonial political-economic legacies as well as the environmental and climate crises that challenge local production systems. A range of policy commitments (eg, the 2023 Bridgetown Declaration on NCDs and Mental Health) highlight these complex interdependencies and call for cross-sectoral food system policies to improve food security, food sovereignty, and nutrition, including integrating measures for climate change adaptation and mitigation. Although addressing these intersecting challenges will also depend on global efforts, the unique approach of SIDS can inform other settings.
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Affiliation(s)
- Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Penryn Campus, Penryn, UK
| | - Arlette Saint Ville
- Faculty of Food and Agriculture, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Bridgetown, Barbados
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, University of the West Indies, Bridgetown, Barbados
| | - Viliamu Iese
- Pacific Centre for Environment and Sustainable Development, The University of the South Pacific, Suva, Fiji; School of Agriculture, Food and Ecosystem Sciences, The University of Melbourne, Dookie, VIC, Australia
| | - Sashi Kiran
- Foundation for Rural Integrated Enterprises and Development, Tuvu, Lautoka, Fiji; Ministry of Women, Children and Poverty Alleviation, Suva, Fiji
| | - Gordon M Hickey
- Department of Natural Resource Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Nigel Unwin
- European Centre for Environment and Human Health, University of Exeter Medical School, Penryn Campus, Penryn, UK; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
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Rocke K, Howitt C, Hambleton I. Understanding the relationship between built environment features and physical activity in the Caribbean: A scoping review. DIALOGUES IN HEALTH 2023; 2:100088. [PMID: 38515496 PMCID: PMC10953899 DOI: 10.1016/j.dialog.2022.100088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 03/23/2024]
Abstract
Background Transforming the urban infrastructure to become safe, inclusive and sustainable remains a challenge in most developing settings. The Caribbean has high burdens of physical inactivity and non-communicable diseases. Therefore, understanding the role of the built environment (BE) in modifying individual activity is important for informing the design of community interventions to improve levels of physical activity (PA). Anecdotally, there is limited evidence on the BE in the Caribbean, however evidence from other Small Island Developing States (SIDS) and from Latin America (LA) may offer useful information given their similar urbanization profiles and shared geo-collaborative histories. Objective Our review identifies and characterizes individual features of the BE and examines their relationships with PA outcomes. Methods We systematically searched a range of multi-discipline research databases, including studies from SIDS and LA that objectively measured BE features as an exposure and PA as an outcome between 2010 and 2021. Grey literature was not considered for this review. We characterized BE measures into 9 neighbourhood design domains using the Walkability for Health framework, and mapped gaps in the published evidence. We performed a narrative summary of BE-PA relationships, focusing on association strength and direction of effect. Results Fifty-one studies from published scientific literature in Brazil, Colombia, Mexico, Chile, and Singapore were included that described 306 BE-PA relationships. The BE was mostly characterized by number of and proximity to spaces for social interaction, green spaces, increasing housing density or street connectivity, and mixed residential and commercial land use. BE-PA relationships, although inconsistent, largely promoted PA. Conclusion Although the review is suggestive of the benefits of the benefits of BE interventions for promoting active commuting and leisurely PA, translational research is needed to understand whether results can be successfully adapted for SIDS, which often have an urban structure defined by a single urban centre with connections to outlying communities.
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Affiliation(s)
- Kern Rocke
- The George Alleyne Chronic Disease Research Centre, Caribbean Health Research Institute, The University of the West Indies, Barbados
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados
| | - Christina Howitt
- The George Alleyne Chronic Disease Research Centre, Caribbean Health Research Institute, The University of the West Indies, Barbados
| | - Ian Hambleton
- The George Alleyne Chronic Disease Research Centre, Caribbean Health Research Institute, The University of the West Indies, Barbados
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Brown CR, Rocke K, Murphy MM, Hambleton IR. Interventions and policies aimed at improving nutrition in Small Island Developing States: a rapid review. Rev Panam Salud Publica 2022; 46:e33. [PMID: 36042710 PMCID: PMC9409607 DOI: 10.26633/rpsp.2022.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
Objective. To describe features of nutritional interventions implemented in Small Island Developing States (SIDS) in the past 20 years. Methods. A rapid scoping review was conducted by searching PubMed and Web of Science databases for interventions conducted in SIDS that sought to improve the nutrition of their populations between 2000 and 2019 inclusive. The Noncommunicable diseases progress monitor 2020 was also examined to assess nutritional policies in SIDS. Results. A total of 174 interventions were implemented in 49 of the 58 SIDS. The greatest proportion were conducted in the Caribbean (75 interventions; 43%), with the Pacific region, and the Atlantic, Indian Ocean, Mediterranean and South China Sea region each implementing about 30% of interventions. Using the NOURISHING framework, most interventions (67%) were implemented at the community and national or policy level, using multiple components of the framework. The greatest proportion of interventions (35%) were educational and awareness raising. Restrictions on physical availability of and increased taxation on alcohol were the most commonly reported policies that were partially or fully achieved; restrictions on fats were the least commonly reported. These findings were generally consistent across the SIDS regions. Conclusions. There is a paucity of nutritional policies in SIDS; the reasons may be linked to their social, economic, and environmental vulnerabilities. Interventions should be expanded beyond education to encompass multiple components of the NOURISHING framework, with multisectoral inclusion to ensure stronger stakeholder collaboration and buy-in. A systematic review is warranted using a fuller range of sources to assess the effectiveness of interventions.
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Affiliation(s)
- Catherine R. Brown
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Kern Rocke
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Madhuvanti M. Murphy
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Ian R. Hambleton
- George Alleyne Chronic Disease Research Centre, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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Guell C, Brown CR, Navunicagi OW, Iese V, Badrie N, Wairiu M, Saint Ville A, Unwin N. Perspectives on strengthening local food systems in Small Island Developing States. Food Secur 2022; 14:1227-1240. [PMID: 35528949 PMCID: PMC9067893 DOI: 10.1007/s12571-022-01281-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
Abstract
Small Island Developing States (SIDS) share high burdens of nutrition-related conditions, including non-communicable diseases, associated with an increasing reliance on imported, processed foods. Improving health through increasing the production and consumption of local, nutritious foods is a policy objective of many SIDS governments. This study aimed to understand contemporary challenges and opportunities to strengthening local food systems in two case study settings, Fiji and St. Vincent and the Grenadines. Fifty-two in-depth, semi-structured interviews were conducted with key stakeholders involved in local food production. Interviews were analysed by both country teams using thematic analysis. Local food production networks in both settings included formal governance bodies as well as more informal connections through civil society and communities. Their main function was the sharing of resources and knowledge, but levels of trust and cooperation between the stakeholders varied in a market open to intense competition from imports. Local food production was hindered by few and slow investments by local governments, dated technology, and lack of knowledge. Stakeholders believed this marginalisation was occurring against a background of rising preferences for imported foods in the population, and increasing disinterest in employment in the sector. Despite the challenges, strong narratives of resilience and opportunity were highlighted such as national pride in local produce for commercialisation and local diets. Efforts to support local food production in SIDS should focus on strengthening governance structures to prioritise local produce over corporate and import markets, assist collaboration and co-learning, and support alternative agro-food practices. Supplementary Information The online version contains supplementary material available at 10.1007/s12571-022-01281-0.
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Affiliation(s)
- Cornelia Guell
- University of Exeter, European Centre for Environment & Human Health, Truro, UK
| | - Catherine R. Brown
- The University of the West Indies, George Alleyne Chronic Disease Research Centre, Bridgetown, Barbados
| | - Otto W. Navunicagi
- Pacific Centre for Environment and Sustainable Development, The University of the South Pacific, Suva, Fiji
| | - Viliamu Iese
- Pacific Centre for Environment and Sustainable Development, The University of the South Pacific, Suva, Fiji
| | - Neela Badrie
- Department of Food Production, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Morgan Wairiu
- Pacific Centre for Environment and Sustainable Development, The University of the South Pacific, Suva, Fiji
| | - Arlette Saint Ville
- Department of Geography, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nigel Unwin
- University of Exeter, European Centre for Environment & Human Health, Truro, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
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Kousi T, Vivacqua D, Dalal J, James A, Câmara DCP, Botero Mesa S, Chimbetete C, Impouma B, Williams GS, Mboussou F, Mlanda T, Bukhari A, Keiser O, Abbate JL, Hofer CB. COVID-19 pandemic in Africa's island nations during the first 9 months: a descriptive study of variation in patterns of infection, severe disease, and response measures. BMJ Glob Health 2022; 7:e006821. [PMID: 35277427 PMCID: PMC8919133 DOI: 10.1136/bmjgh-2021-006821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/29/2022] [Indexed: 11/10/2022] Open
Abstract
The geographic and economic characteristics unique to island nations create a different set of conditions for, and responses to, the spread of a pandemic compared with those of mainland countries. Here, we aimed to describe the initial period of the COVID-19 pandemic, along with the potential conditions and responses affecting variation in the burden of infections and severe disease burden, across the six island nations of the WHO's Africa region: Cabo Verde, Comoros, Madagascar, Mauritius, São Tomé e Príncipe and Seychelles. We analysed the publicly available COVID-19 data on confirmed cases and deaths from the beginning of the pandemic through 29 November 2020. To understand variation in the course of the pandemic in these nations, we explored differences in their economic statuses, healthcare expenditures and facilities, age and sex distributions, leading health risk factors, densities of the overall and urban populations and the main industries in these countries. We also reviewed the non-pharmaceutical response measures implemented nationally. We found that the burden of SARS-CoV-2 infection was reduced by strict early limitations on movement and biased towards nations where detection capacity was higher, while the burden of severe COVID-19 was skewed towards countries that invested less in healthcare and those that had older populations and greater prevalence of key underlying health risk factors. These findings highlight the need for Africa's island nations to invest more in healthcare and in local testing capacity to reduce the need for reliance on border closures that have dire consequences for their economies.
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Affiliation(s)
- Timokleia Kousi
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Daniela Vivacqua
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jyoti Dalal
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- HACE: Data Changing Child Labor, Manchester, UK
| | - Ananthu James
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India
| | - Daniel Cardoso Portela Câmara
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Laboratório de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Núcleo Operacional Sentinela de Mosquitos Vetores (NOSMOVE), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Sara Botero Mesa
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Cleophas Chimbetete
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Newlands Clinic, Harare, Zimbabwe
| | - Benido Impouma
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Franck Mboussou
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Tamayi Mlanda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Arish Bukhari
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olivia Keiser
- Global Studies Institute, University of Geneva Faculty of Medicine, Geneve, Switzerland
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
| | - Jessica Lee Abbate
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- World Health Organization Regional Office for Africa, Brazzaville, Congo
- Geomatys, Montpellier, France
- UMI TransVIHMI (Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier), Montpellier, France
| | - Cristina Barroso Hofer
- The Global Research and Analysis for Public Health (GRAPH) Network, Association Actions en Santé, Geneve, Switzerland
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Developmental origins of health and disease research have cemented relationships between the early-life environment and later risk of non-communicable diseases (NCDs). However, there is limited translation of this knowledge in developing-economy nations, such as the Cook Islands, that carry exceptionally high NCD burdens. Considering the evidence, Cook Islands leaders identified a need for increased community awareness of the importance of early-life nutrition. Using a community-based participatory research approach, this study aimed to engage Cook Islands community representatives in the co-construction of a contextually relevant early-life nutrition resource. A booklet distributed to mothers in Australia and New Zealand was used as a starting point. Ten semi-structured focus groups (n = 60) explored views regarding the existing resource and options for contextual adaptation. Three core themes were identified: knowledge of the importance of early-life nutrition, recognition of the need for an early-life nutrition resource and the importance of resources being context specific. A draft booklet was created based on these discussions. Participants were invited to give feedback via a second round of focus groups. This confirmed that the voice of the community was represented in the draft booklet. Suggestions for additional material not included in the original resource were also identified. We report on the process and outcomes of the co-construction with community representatives of a resource that has the potential to be used to stimulate community-level discussion about the importance of early-life nutrition. It is crucial that communities have an active voice in research and in making decisions about interventions for their population.
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DOHaD in low- and middle-income countries: a systematic review exploring gaps in DOHaD population studies. J Dev Orig Health Dis 2020; 11:557-563. [PMID: 32314679 DOI: 10.1017/s2040174420000276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Low- and middle-income countries (LMICs) are disproportionately affected by non-communicable diseases (NCDs), accounting for more than 80% of NCD-related deaths globally. Research into early-life influences on these diseases via the developmental origins of health and disease (DOHaD) paradigm has informed health promotion interventions and policies focused on optimising early-life health. However, little is known about where this research occurs and whether it reaches and reflects the countries most affected by NCDs. This review searched for DOHaD studies that investigated relationships between factors during pregnancy and at birth, with later-life NCD incidence, risk and related mortality. The aim of this review was to identify where DOHaD research has been conducted and whether this focus is appropriate and relevant, given the differential burden of NCDs. Embase, MEDLINE and Scopus were searched, and eligibility screening processes identified 136 final articles. This review found that 49.7% of DOHaD research was conducted on populations within Western Europe, 15.9% in East Asia, 12.7% in North America, 8.3% in Latin America and the Caribbean, and fewer in Australasia, South Asia, the Middle East, the Africas, and Central Asia. When categorised by income, this review found that 76.4% of studies were based in high-income countries, 19.1% in upper-middle-income and 4.5% in lower-middle-income countries. No studies were based in low-income countries. There is therefore a marked disconnect between where DOHaD research is undertaken and where the greatest NCD disease burden exists. Increasing DOHaD research capacity in LMICs is crucial to informing local strategies that can contribute to reducing the incidence of NCDs.
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