Identifying opportunities to strengthen school food environments in the Pacific: a case study in Samoa

Abstract

Background Despite global recommendations to prioritise policies that create healthy food environments within education institutions, the implementation of effective healthy school food policies has proved challenging for many countries. This study examined the experience of Samoa subsequent to the 2012 introduction of a stronger policy to improve the healthiness of school food environments. Our aim was to identify opportunities to strengthen healthy school food policy implementation in Samoa and other comparable contexts. Methods We used a qualitative case study approach, underpinned by policy science theory. In 2018, we conducted in-depth semi-structured interviews with 30 informants, coupled with analysis of relevant documents, to generate a detailed understanding of the relevant policy implementation processes in Samoa, and the perspectives and capacities of key implementation actors. Data collection and analysis were guided by the Health Policy Analysis Triangle, supplemented by other policy theories relevant to policy process. Results Samoa’s school food policy operationalizes international ‘best practice’ recommendations. We found health policymakers and leaders in Samoa to be strongly committed to improving school food environments. Despite this, there continued to be challenges in ensuring compliance with the school nutrition standards. Key issues that negatively impacted the policy’s effectiveness were the lack of priority given to school food by stakeholders outside of health, the high prevalence of unhealthy food in the areas immediately surrounding schools, vendor knowledge and capacity, and the high degree of agency exercised by actors in and around the school. We noted several opportunities for policies to be effectively implemented and sustained. Respondents identified community-level leaders as potentially pivotal stakeholders, particularly where school governance arrangements draw heavily on community representation. Conclusions Sustained and effective implementation of healthy school food policies requires continued engagement from political and community leaders, beyond initial commitment. There is potential to capitalize on political will for diet-related NCD prevention by more clearly demonstrating the institutional and operational requirements for effective and sustained implementation. Strong incentives for compliance and effective enforcement mechanisms are also likely to be crucial to success.

Assessing the progress on the implementation of policy and legislation actions to address the Non-Communicable Diseases crisis in the Pacific

“…Schools play an important role to support children to learn and practice lifelong healthy behaviours and strong commitment from policy leaders is needed to create healthy environment within schools [ 29 ]. The findings also demonstrate that physical education in school curriculum and implementation of the syllabus has become mandatory and enforced in 15 PICTs.…”

The tide of dietary risks for noncommunicable diseases in Pacific Islands: an analysis of population NCD surveys

“…Further, Pacific Island countries have struggled to find capacity to carry out regular dietary surveys and demonstrate the potentially positive impact of food environment policies on consumption [40]. Pacific Island MANA as a component of Framework of action for revitalization of healthy islands in the Pacific has been an important step to promoting political accountability to NCD prevention [38,39], but countries will need to adopt a stronger cross sectoral approaches towards regulating, monitoring and enforcing food environment policies [33,39,89].…”

“…Concerned about the impact of these changes on individual and community health as well as national economies [32], Pacific governments have introduced a range of population-wide initiatives for preventing diet related NCDs [33][34][35]. Pacific countries have implemented taxes on SSB [31] and/or policies to reduce sales and marketing of unhealthy food in schools [32,33]. Tonga, Samoa and Fiji have used import excises to reduce sales of unhealthy fats and oils [34,35] or fatty meat cuts [36,37].…”

Growing our future: Introducing the Pacific School Food Network to support healthy school food and nutrition environments for better nourished children in the Pacific Islands

“…4 Where policies exist at a national or local level, they are not well monitored, often leading to poor compliance. 4 , 5 Additionally, limited standards are used to ensure that food provided in and near schools is nutritious and safe.…”