Beyond individual choices: understanding Oceania’s growing diabetes crisis

Diabetes and other noncommunicable diseases (NCDs), according to Pacific Island studies scholars, are rising across Oceania. With this, Pacific Island communities face health challenges shaped by changing diets, economic barriers and cultural shifts.

‘Ulise Funaki, an adjunct faculty member in history, anthropology and Pacific Island studies from Hawaii, said noncommunicable diseases such as diabetes are a growing concern across Oceania because they stem from a combination of biological, environmental and social factors rather than a single cause. “These diseases are not contagious,” he said. “They are a result of different factors,” such as genetics, physiology and personal factors.

According to Funaki, the increase in diabetes rates in Oceania’s communities is caused by changing diets. Traditional foods such as fish, root crops and fruits have increasingly been replaced with heavily processed products high in sugar and carbohydrates. At the same time, healthier and traditional foods are more expensive and less accessible than processed alternatives, specifically among Pacific Islanders living outside of the islands. “It’s expensive to maintain that healthy eating lifestyle that many of our ancestors had,” he said.

Dr. ‘Inoke Hafoka, associate professor of Pacific Island studies from Utah, said the shift away from traditional diets can also be understood through a historical lens. Following World War II, processed foods such as Spam and corned beef were introduced through military presence, but gradually became integrated into Pacific diets. “I’m not saying these foods are bad,” he said. “But I think they’ve taken over a lot of the existing foods, and we’re eating it at such a higher rate than before.” Over time, he added, these imported foods became common staples in many Pacific households.

Beyond diet, Funaki said Pacific Islanders traditionally view health as holistic. Diet, he emphasized, is only one part of overall well-being; spiritual, emotional, mental and social health are equally as important. “To be a healthy person, [you need] to not only be physically healthy, but also mentally, emotionally and socially healthy,” he said. While many Pacific Islanders place strong emphasis on family, community and culture, he said mental health often gets overlooked.

Despite these challenges, Funaki said Pacific Island communities are making progress through education and community outreach to return to traditional practices. Addressing the issue of NCDs, he added, requires more than encouraging healthy eating or exercise. “We need to attack the problem from a multitude of areas — from a multitude of perspectives,” he said.

Hafoka said several Pacific nations have implemented initiatives to address NCDs, including taxes on sugary foods and drinks to reduce consumption. He added there has been a growing effort to reintroduce people to traditional diets and reconnect people with the custom of growing and preparing their own food. The Public Health Communication Centre noted, “Well-designed taxes on unhealthy food and drinks have health benefits. They decrease consumption of unhealthy foods and drinks and this can lead to reductions in chronic disease.”

Funaki also encouraged people to honor their ancestors by embracing traditional diets and strengthening connections to family, culture and the land. “They knew what they were doing. They understood the importance of the types of food they ate,” he said. “And how they kept their relationship to not only each other, not only with their health, but also with the land, that was a part of their health.”

Hafoka said NCDs have become so common across Oceania that many use humor when discussing them. While the humor reflects how widespread the diseases have become, he said it also demonstrates the level of awareness many communities have about their impact.

While serving a mission in Tonga, Hafoka recalled eating a meal with members as they prepared lamb. When he and his companion were trimming away the fat, the mother asked them why they were cutting off what was considered to be “the best part.” Looking back on this experience, he said it revealed a broader narrative that lower-quality and imported foods have become normalized in Pacific Island nations over time.

Rather than viewing NCDs as simply the result of individual choices, Funaki said addressing them requires understanding the complex relationship between culture, economics, access to healthy and traditional foods and social conditions impacting many Pacific communities.