Fiji-Gender

A gendered approach to reduce diet-related disease in Fiji

A new study shows the need for a greater focus on gender in nutrition policies to reduce diet-related non-communicable diseases (NCDs) in Fiji.

Published in the International Journal for Equity in Health, the paper came from a collaboration between The George Institute for Global and Fiji National University, with support from researchers from New Zealand and the UK.

Lead author, Dr Briar McKenzie, Research Fellow at The George Institute, says, “We analysed nutrition and health-related policies in Fiji and while Fiji does have a cross-cutting gender policy, this study found there was scope for including gender considerations across policies in an actionable way to achieve more equitable health outcomes across the population.”

Diet-related non-communicable diseases are the leading causes of death globally.

The burden of NCDs is increasing disproportionately among women in low- and middle-income countries compared to high-income countries. Within Fiji’s population of approximately 900,000 people, 42% of women and 22% of men live with obesity. In 2011, Fijian women were found to be more likely than men to have three or more of five key NCD risk factors: current smoking, consuming less than five servings of fruit and vegetables per day, low levels of physical activity, being overweight and/or having raised blood pressure.

Further, a high prevalence of iron deficiency anaemia - particularly in women - was identified in the country’s 2014 National Nutrition Survey. Creating and implementing gender responsive policies is therefore important for Fiji achievement of the UN Sustainable Development Goals of good health and well being and gender equality.

“These numbers show that there are gender differences in NCD risk in Fiji, so there is an urgent need for a gender-responsive national policy response,” says co-author Gade Waqa from Fiji National University.

The study included three components:

  • current policy content analysis of gender inclusion in nutrition and health-related policies
  • policy analysis using the WHO Gender Analysis tool to identify opportunities for strengthening future policy
  • stakeholder interviews to understand perceptions and scope for gender considerations.

It found that while gender equality is a stated goal in several nutrition and health-related policies in Fiji, only one policy was ranked as gender responsive, namely The National Gender Policy. The new analysis has identified further opportunities and suggestions to steer a gendered response to nutrition and health challenges.

The recommendations include:

  • framing gender considerations in policies
  • driving advocacy through actor networks across key stakeholders including government, industry, civil society
  • ensuring that data collected to monitor policy implementation is disaggregated by sex, and inclusive of gender identities
  • promoting equitable participation at a community and governance level.

 “We believe action across a few key areas are likely critical enablers to more gender-equitable NCD reduction in Fiji,” adds Briar.

This study is part of a broader program of work funded by the Australian National Health and Medical Research Council and undertaken by researchers from Fiji National University, The George Institute for Global Health, University of Sydney, and Deakin University to support the scale-up of food policy interventions in Pacific Island countries.

Find out more about this project.

 

Research funding

George Institute researchers to benefit from new funding announced by Australian Government

Seven George Institute researchers have been announced as recipients of the Government’s 2022 Investigator Grant scheme, designed to support emerging and established leaders in health and medical research across Australia to tackle our greatest health challenges.

The Institute’s successful projects encompass a wide range of these challenges from better ways of treating cardiovascular disease and sepsis, encouraging uptake of salt substitutes, improving the food environment, reducing risks of drowning, and helping Aboriginal and Torres Strait Islander peoples into employment for better health and wellbeing. These are summarised below.

Alta Schutte, Professorial Fellow at The George Institute for Global Health

One third of Australian adults have raised blood pressure, half are unaware of it, and only a third have their blood pressure controlled, leading to preventable strokes, heart attacks and deaths.

Professor Schutte’s research will test four new approaches proven to be effective in other countries – salt substitutes, community awareness, self-monitoring and combination pills - that could be scaled up in Australia with the potential to save millions of lives.

Professor Anushka Patel, Vice Principal Director & Chief Scientist, The George Institute for Global Health

Many subgroups of people with or at risk of cardiovascular diseases and diabetes have not benefitted from treatment advances, either because they have not been adequately tested in these groups, or because some are not receiving treatments already proven to be effective.

Projects will test if a ‘polypill’ can help women with or at risk of a certain type of heart failure, whether drug treatments for diabetes can prevent disease progression in women with recent gestational diabetes and expand the remit of The George Institute’s SMARThealth digital platform to help under-resourced health systems better manage a broader range of chronic conditions.

Simon Finfer, Professorial Fellow in the Critical Care Division at The George Institute for Global Health

Almost half of the 18,000 Australians treated for sepsis in ICUs each year die, and those who do survive have considerable long term health consequences, leading to annual treatment costs of over $1.5 billion.

As sepsis can result from any type of infection, people respond differently to treatment. Professor Finfer and his team will use existing research and new studies to better match the right treatment to the right patient, ultimately reducing death and disability from sepsis.

Polly Huang, Senior Data Analyst, The George Institute for Global Health

Globally, excess salt consumption (more than five grams per day) is responsible for three million deaths each year, with four out of five occurring in low- and middle-income countries, and nearly half among people younger than 70.

Dr Huang’s project will expand on The George Institute’s existing research to further build the case for wider adoption of salt substitutes – in which some of the sodium is replaced by potassium – which could prevent millions of deaths each year, particularly in low-income countries.

Jacqui Webster, Head of Advocacy and Policy Impact, The George Institute for Global Health

Unhealthy diets are now the leading cause of chronic disease around the world, driving catastrophic levels of obesity, cardiovascular disease, type 2 diabetes and some cancers, particularly in remote communities.

Professor Webster and her team will work across Australia and the Pacific Region to improve the food environment by making food policies more effective, improving food and water security, and reducing sodium in the food supply by encouraging adoption of the WHO Sodium Benchmarks and increasing the uptake of reduced sodium salts. 

Jagnoor Jagnoor, Program Lead, Injury Program, The George Institute for Global Health

Globally 270,000 people die by drowning each year, mainly in low- and middle-income countries with the majority in the 1-10 year age group, and those living in rural areas. In high-income countries, ethnic minorities, migrants, and rural residents are over-represented.

This project aims to better understand the role of social disadvantage in drowning risk in order to design and implement more effective solutions and identify “best-buy” policies to reduce drowning deaths in the most affected communities.

Bobby Porykali, Research Fellow, Guunu-maana (Heal) Aboriginal and Torres Strait Islander Health Program

Employment is a key social determinant of health - the longer someone is unemployed the greater their risk of suffering from a range of physical and mental health issues.

Building on previous findings that culturally appropriate driver licensing programs can increase Aboriginal and Torres Strait Islander peoples’ workforce participation, Dr Porykali’s project aims to connect such programs with self-determined pathways into employment, thereby improving health and wellbeing.  

Event

The Who, What and How of Systems thinking for Health Systems Strengthening in the Asia Pacific region

Health Systems Strengthening event

In 2021, the WHO Alliance for Health Policy and Systems Research (WHO AHPSR) launched a Systems Thinking Accelerator (SYSTAC) as a global community of practice of systems thinkers consisting of multisectoral stakeholders across the six WHO regions interested in promoting and advocating for a greater use of systems thinking in implementation and policymaking, especially in Low and Middle Income Countries (LMICs).

Since then, the SYSTAC network has been trying to more meaningfully network, document and amplify the application of systems thinking across regions. In 2022, SYSTAC members from Southeast Asia began a collaboration to document applications in our region and create a resource for implementers, decision-makers and researchers within and beyond our region.

Objective:

  • The aim of the session is to introduce this documentation, share some of our training materials and for this to serve as a resource for researchers, practitioners and decision makers. In addition, we aim to showcase SYSTAC as a network in order to share its contributions and grow its membership.
  • The rationale and process of documenting applications of systems thinking tools and methodologies will be explained in order to set the scene.
  • We will then present diverse perspectives on the application of systems thinking tools and methodologies across Southeast Asia to capture the potential for narrowing the gap between knowledge and practice of systems thinking in the context of health policy and practice across domains like district planning, human resources for health, urban health, women’s health and more.

Learning Objectives:

  • To describe case examples of applying systems thinking tools and methodologies within health systems
  • To understand how to apply systems thinking tools in health systems based on context, goals and constraints
  • To build connections with others interested in this domain of research, including membership of global SYSTAC network

Speakers

  • Prashanth N Srinivas, Assistant Director, Research,The Institute of Public Health, Bengaluru

    Prashanth N Srinivas is a medical doctor and public health researcher with experience in working in primary health care and community settings in southern Karnataka. He has worked at the intersections of healthcare and health systems with ecological and social systems with a particular focus on health inequities and social determinants of health. He leads the health equity cluster at the Institute of Public Health, Bengaluru where his work critically examines the apparently transformative dimensions of technological solutions to health inequities vis-a-vis addressing fundamental issues of social inequality, exclusion and governance. He has been a champion of open knowledge and continues to contribute actively to English Wikipedia, Wikimedia Commons, Internet Archive and various other open knowledge and open data projects.

    Since 2014, he lives and works at a public health research field station in BRT Tiger Reserve in southern India and is setting up a planetary health information centre at Pakke Tiger Reserve in Northeast India through collaborations with local communities and ecologists. He served as the Chair of Emerging Voices for Global Health (2015-2019) and is a member of the General Council of the Institute of Tropical Medicine, Antwerp (Belgium) and has several publications in international peer-reviewed journals. Through a fellowship from the DBT/Wellcome Trust India Alliance, he has set up collaborations to examine health inequities in indigenous communities in multiple remote forested locations in southern, central and northeast India. He has experience with using health policy and systems research methods particularly realist evaluation, implementation research and participatory action research approaches in addition to experience with quantitative epidemiological methods. He is part of research consortia on health systems strengthening for OneHealth and mental health in primary health care.

    prashant-srinivas
  • Natthawut Iangtanrat, MD

    Natthawut is currently studying Health System Science at Faculty of Medicine, Ramathibodi Hospital, Mahidol University. He has work experience as a general practitioner in the 60-bed public hospital in a rural area of northern Thailand. He facilitated the quality improvement for Hospital Accreditation (HA) as the Vice President of Patient Care Team (PCT) in 2019-2021. He wants to incorporate the insights from systems thinking and the concept of value co-creation to redesign the care delivery models based on a comprehensive understanding of patient needs. He wants to foster cross-sector collaboration, which can be an open innovation arena in identifying potential areas for strengthening the overall supply of health.

    Natthawut Iangtanrat
  • Dr. Antonio Bonito Systems Thinking Coordinator, WHO Country office, Timor Leste

    Prior to his current role in the WHO regional office, Antonio served as the executive director at the National Institute of Health at Timor Leste, where he managed the functioning of the institution, training, research implementation and monitoring and evaluation activities. Antonio has also served as the Director of Human resources services at the Ministry of Health and has developed policies relating to human resources development. He has also conducted mobilisation of health professionals in their workplace and managed scholarship inside and outside the country. In addition to his current role, Antonio is a part time lecturer at Dili University with expertise across the disciplines of Health Promotion, Hospital and Community Health Center Management. He holds a Master's in Public Health from Diponegoro University, Semarang, Indonesia.

     

    Dr. Antonio Bonito
  • Dr. Sohana Shafique, Deputy Project Coordinator, Urban Health, Icddr,b, Bangladesh

    Dr. Sohana Shafique is a Global Health researcher with specific interest in Urban Health and Nutrition as well as Health Policy and Systems Research. For the past 15 years, her research has been focused on inequalities in healthy child growth and development and double burden of diseases in South and South-East Asia. She has vast experience in designing and conducting implementation research and facilitating knowledge translation activities through generating evidence and conducting policy dialogues and citizen engagement activities to achieve. Universal Health Coverage in Bangladesh. Dr. Shafique obtained her B.Sc and M.Sc in Nutrition from University of Dhaka; MPH from University of Queensland, Australia; and her PhD from University of Toronto, Canada. Currently she leads the 'Urban Health Research Group' at the Health Systems and Population Studies Division at icddr,b, Bangladesh.

    Dr. Sohana Shafique
  • Dr. Borwornsom Leerapan Associate Professor, Deputy Director of Center for Health Policy and Management, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Borwornsom Leerapan is an associate professor at Ramathibodi Medical School of Mahidol University in Bangkok, Thailand. He is a preventive medicine physician and health systems researcher. Before academia, Dr. Leerapan worked as a general practitioner and the hospital directorate a 30-bed community hospital in the rural north of Thailand, directly observing inequitable access to care while managing and implementing health programs in the communities. His current research has focused on applying systems thinking in healthcare quality management and health systems strengthening, addressing the cross-subsidization of healthcare financing in public hospitals, the new regional healthcare governance structure of Thailand’s Universal Health Coverage, the community-based health interventions for the vulnerable population in Thailand, the national strategic health workforce planning, and the system dynamics modelling to support policy decisions in response to COVID-19. He is currently the Deputy Director of the Centre for Health Policy and Management at the Medical School, and also serves on organizational and national committees including the Scientific Advisory Committee of the Prince Mahidol Award Foundation under the Royal Patronage. He obtained his Doctor of Medicine with honours from Mahidol University, Master of Science in Health Policy and Management from Harvard University, and Doctor of Philosophy in Health Services Research, Policy and Administration from the University of Minnesota.

    Dr. Borwornsom Leerapan
respiratory system

2020 bush-fires and COVID-19: what does it mean for our respiratory system?

In this talk Professor Jenkins reflects on key events this year – Bushfires and the Coronavirus-19 pandemic – and explores their impact on our health. Her talk investigates the comparison between this coronavirus and the Spanish flu, takes a look at the virus globally, and uses the latest evidence and statistics to demonstrate how COVID-19 is a virus like no other, including identifying key risk factors and potential solutions.

Professor Jenkins is the Head of the Respiratory Group at The George Institute, and will be joined in conversation with Professor Bruce Neal, Executive Director of The George Institute in Australia. There will be an opportunity for you to ask questions.

Goran & Seye

Limitations of global governance for health: Motivating change

Recording of a talk by Professor Göran Tomson on the limitations of global governance for health, in the context of achieving the United Nations Sustainable Development Goals. Drawing upon case studies and The Lancet-University of Oslo Commission on GG4H, he addresses five global governance dysfunctions: inadequate policy space; institutional stickiness; democratic deficit; weak institutions and weak accountability.

Seeing the full picture podcast series

Seeing the full picture

‘Seeing the full picture’ is a special podcast series about systems thinking for health systems strengthening from the Alliance for Health Policy and Systems Research. It was developed with the George Institute for Global Health. This short trailer provides an overview of the series.

Seeing the full picture podcast series

Alliance foundations in systems thinking: why then, what now?

This episode looks back to the publication of the 2009 Alliance Flagship report: Systems thinking for health systems strengthening to understand the motivations and needs for such a resource at that time. We speak to members  from the Alliance, then and now, about what’s happened since the report and consider what opportunities systems thinking has for strengthening health systems today. 

Guests:Don de Savigny, epidemiologist and health systems specialist, and co-editor of Systems thinking for health systems strengthening: a methodological handbookTaghreed Adam, Scientist in the Research for Health Department, World Health Organization, and co-editor of Systems thinking for health systems strengthening: a methodological handbookAku Kwamie, Technical Officer at the Alliance for Health Policy and Systems Research, World Health Organization