Promoting Nutrition Education in the Marshall Islands
By Kristina Canale, MPH/MA
Nutritious meals are essential to maintaining a healthy, well-balanced life. Eating healthy is one way to prevent many chronic diseases and some cancers.
Unfortunately, Asian Americans (AAs), Native Hawaiians (NHs), and Pacific Islanders (PIs) are disproportionately impacted by specific chronic diseases. In a recent Uniform Data System analysis, AAPCHO found that 37% of NH health center patients and 38% of PI patients have uncontrolled diabetes, and 39% of NH patients and 37% of PI patients have hypertension. When uncontrolled diabetes data is disaggregated, Filipinos/as/xs, South Asians, and Hmongs, have higher rates of diabetes compared to other AA subgroups and white persons. Culturally competent and linguistically appropriate education from trusted community leaders and members is critical to supporting access to nutritious meals for AAs, NHs, and PIs, and in turn, maintaining a healthy lifestyle.
For National Nutrition Month, join AAPCHO in raising awareness of the importance of culturally competent nutrition through our limited blog series, Nutrition and Healthy Communities. Get a sneak peek at the work that our members, our partners, and we are doing to ensure that AAs, NHs, and PIs can live a nutritious and healthy life.
According to 2011 census data, Kwajalein is the second most densely populated atoll in the Republic of the Marshall Islands (RMI) with an estimated 11,408 people or 21.5% of its total population, living on just over 6 square miles. Within the Kwajalein Atoll, most of its population resides on Ebeye Island. Ebeye and RMI-at-large have a history of colonization, nuclear testing, and environmental contamination, which continues to impact the health and wellness of the Marshallese people.
Prior to Japanese colonization during World War I and the subsequent presence of the U.S. military during World War II, Marshallese staples included taro, breadfruit, pandanus, fish, chicken, pork, and coconut, however, this has drastically changed over time. Between 1946 and 1958, land and water sources were contaminated as a result of nuclear testing. Because land sources have not recovered and do not provide nutrient-rich soil, the Marshallese people became heavily accustomed to and reliant on unhealthy foods and imports, such as white rice, processed, and canned goods.
In addition to poor access to traditional foods and poor diet, low levels of physical activity have greatly increased the rates of chronic, or non-communicable diseases, including diabetes and obesity, within the RMI. The RMI is cited as having the highest age-adjusted comparative prevalence of diabetes in the world, with one-third (30.5%) of adults aged 20–79 years old estimated to have diabetes. Furthermore, 62.5% of the RMI population has been found to be overweight or obese. Compared to other places within the Republic of the Marshall Islands, Ebeye residents disproportionately struggle to obtain access to healthy foods; they are the most dependent on imports, with only 9% reliance on local fruits and vegetables. Despite these challenges, organizations like Kwajalein Diak Coalition continue to make concerted efforts to improve access to fresh, local foods and alter the culture around eating. With their support, people can make healthier choices for themselves and their families.
The Kwajalein Diak Coalition (KDC), formerly known as Kwajalein Diabetes Coalition, has been active in promoting health programs since 2010. KDC originally formed as a means to address the burden of diabetes in Kwajalein Atoll, partnering with AAPCHO in 2010 to implement the CDC National Program to Eliminate Diabetes-Related Disparities in Vulnerable Populations. In 2015, the group merged with other local coalitions, including local cancer, diabacco (tobacco), diabetes, and Komaron Ukot Mour Ilo Tomak — You can change your life based on belief (KUMIT) coalitions. It was during this time that Kwajalein Diabetes Coalition changed its name to Kwajalein Diak Coalition. This was to reflect their changing priorities; the coalition had shifted from raising awareness of diabetes to becoming advocates for policies and practices related to health and wellness, including access to healthy foods. Fittingly, “Diak” is a Marshallese sailing term that means, “changing course.” From 2015 onward, KDC began receiving Annual Diabetes and Cancer Funding Support from the RMI Ministry of Health. In 2017, KDC began delivering the Pacific Islander Diabetes Prevention Program (PI-DPP) in partnership with AAPCHO. To date, they have enrolled 145 participants and screened over 300 additional participants to become enrolled in their lifestyle change program.
Today, the members of KDC say that they are seeing some of the fruits of their labor through changes in people’s attitudes towards creating a healthy lifestyle. Members of KDC have noticed an increased interest in growing, purchasing, and preparing healthy foods. Grocery stores shelves which once held rotting produce are increasingly empty, an indication of the rise in demand. More people have begun attending local healthy cooking demonstrations and vegetable distributions as well. Still, barriers to healthy eating persist. As stated by Romeo Alfred, chair of KDC,
“With the conditions on Ebeye, [people] have no choice but to rely on imported foods; local crops are available on the outer islands of the atoll, but to get there, you need fuel which is very expensive.”
In response, KDC is improving access to food through building local gardens. One of their projects, Atake in Ajmour (Garden of Life) was established in 2013, with the goal of increasing the number of servings of fruits and vegetables consumed by individuals with type 2 diabetes by August 2015.
Most recently, the coalition established Kwajalein Diabetes Day on April 14. This year will mark the first year of its celebration and will be a large community event, featuring a gardening competition. DPP classes, schools, and church groups, will compete for prizes in quality and quantity of produce. To encourage community participation, the coalition is providing Earth Boxes, soil, seeds, fertilizers, and gardening instructions to local organizations, schools, and other groups who participate.
Despite the long history of poor access to healthy foods, community leaders and organizations like KDC are making sure that their communities are getting educated about and motivated to commit to a healthy lifestyle. To learn more about KDC and see updates as they celebrate this day, you can follow them on Facebook (Kwajalein Diabetes Coalition).
If you have any questions about the content above, please contact us at communications@aapcho.org or visit our website for resources addressing social determinants of health.
