The Associate Minister of Public Enterprises, Papali’i Niko Lee Hang, launched two key household reports on Monday at the Development Bank of Samoa building in Apia. The reports were the Household Income and Expenditure Tabulation Report 2013/14 and the F.A.O report on Dietary patterns of Samoan households. Whereas the Household Income and Expenditure Survey establishes the average diet of Samoan households, and which households are most at risk of poor nutrition outcomes, the report on Dietary Patterns identifies the food items contributing to current nutrition outcomes and makes recommendations regarding which food items could assist Samoan households to satisfy their dietary requirements in the most cost effective way. The following is the conclusion of the Dietary patterns of households in Samoa. It is published here for the information of our readers:

Conclusions

Improving the availability of nutritionally superior food products at lower unit costs is critical to improving food security, and health, in Samoa. This study finds that the average (adult male equivalent) Samoan has access to 3509 Calories per day — slightly less than the average number of calories required to meet the average physical activity levels (high by international standards, given the large share of the population whose main activity is farming) and basal metabolic requirements (also high, given average reported weights) of a Samoan adult male: 3669 Calories. The study finds that the average Samoan has access to an insufficient amount of vitamin A and an excessive amount of sodium.

The study also finds that given the levels of calorie intake, average fat intake falls below the safe upper limit for fat (established at 30% of total calorie consumption) and that average protein and iron intake levels meet the recommended daily minimum intake levels.

The gender of the household head was found to have a significant marginal effect on the capacity of members of the household to have access to a diet satisfying all the nutrient intake thresholds, with members of female headed households found to have a slightly lower chance of accessing an adequate diet (or simultaneously satisfying all the nutrient intake thresholds). The level of income was shown as also to have a significant effect on the capacity of households to access a diet satisfying all the nutrient thresholds, with households in lower (both bottom and middle) income terciles less likely to access the recommended intake levels, when compared to households in the top income tercile. Household head education was found to have a significant impact on household member access to a nutritious diet, with members of households where the head had completed primary education — or the first 8 years of schooling — and gone on to further study, being more likely to access a diet satisfying all the recommended nutrient intake levels.

An increase in the education level of the household head, beyond primary education was found to also have a significant marginal effect on reducing Calorie and sodium intake levels. The reduction in calorie intake is perhaps indicative of the changed employment profile (movement from farming to office work) and lower levels of physical activity associated with households where the head has obtained a higher level of education. The reduction in sodium intake among households where the head has obtained a higher education perhaps indicates that educated household heads are more aware of the impact of high sodium consumption on diet and health, and are selecting food items with a lower sodium content, or adding less salt at table or when preparing food.

An increase in the age of the household head was found to have a relatively small impact on the volume of household member nutrient intake for Calories, protein, fat, sodium and vitamin A. This result perhaps indicates the minor impact of the lower productivity of waged/farm labour committed by aged household heads on household income. Alternatively these results could be interpreted as reflecting a voluntary preference for a lower rate of food intake among older household heads, perhaps reflecting a greater appreciation of the positive impact of moderation of food consumption.

A low level (bottom tercile) of income was a significant factor in five regression, with households in the bottom income tercile accessing a lower intake of fat, protein, sodium and vitamin A than households in the top income tercile. Households in the middle income tercile also accessed a lower intake of protein than households in the top income tercile. The reduced rate of protein intake among lower income groups is expected, given that more expensive meat products high in protein are less likely to feature as prominently in the food baskets of members of these households as among higher income households.

However the decreases in protein consumption among households in the bottom income tercile when compared to households in the top tercile were considerable. The lower rate of intake of sodium and fat when compared to the top income tercile is a positive outcome, given the high average intake levels reported earlier in this study. One can ascertain from this result, then, that high income does have a large marginal effect on sodium and fat intake, and that households in these income brackets should be targeted by policies aimed at reducing sodium and fat intake levels in the Samoan population.

The reduced intake of vitamin A among low income households when compared to higher income households is a cause for concern, given the low average rate of access to vitamin A in the Samoan population revealed by this study. As a result, interventions to improve vitamin A intake in the general population could be augmented by a particular focus on low income households.

Members of households in the ‘rural’ regions of Savaii and ‘Rest of Upolu’ were found to have higher intake levels of calories and iron, than households in Apia. The higher calorie intake of members of households in these areas would be proportionate with the increased energy intake required as a result of higher levels of participation in farming and ‘manual labour.’

The increased iron intake is perhaps a consequence of both consuming a greater number of calories, as well as these rural households consuming a diet containing more root crops (such as own produced taro) high in iron. The increased intake of protein in the ‘Rest of Upolu’ is proportionate with the increased intake of calories, indicating that members of households in this region are not shifting towards a diet higher in protein, but are eating more food (perhaps as a result of higher levels of participation in farming). The decreased intake of fat among members of households in the NW Upolu peri-urban Region, when compared to Apia, is perhaps indicative of lower income and capacity to purchase a diet high in fat.

The mean share of income spent on gifts to church and other households is a large financial outlay, and this study found that the marginal effect of households spending more than the mean share of income on gifts was to reduce household member intake of calories, protein and sodium, when compared to households spending less than the mean share of income on gifts.

This study found that only 4 of the top 10 food items by share of total expenditure are locally produced, and just 11 of the top 30 food items (by share of expenditure) are locally produced. These results indicate that while imported processed food items are far more important as a share of household food expenditure than locally produced items, local foods — particularly taro — are integral to assisting households to meet the recommended minimum nutrient intake levels. 

Taro (talo) represents the largest share of an average Samoan household's expenditure on food, and that it provides more than a third of the calories which an average household has access to; as well as the majority of a household's iron intake and an important source of protein and vitamin. Rice is a far less important source of Calories in the average household food basket.

The study finds that after taro, purchases of meat products are most important in the household food expenditure basket, with expenditure on imported chicken pieces/quarters twice that of local fresh fish.

Canned mackerel is the third most important source of protein and the most important source of vitamin A in household diet. Household expenditure on consumption of fruits and leafy vegetables was relatively low.

Table salt added for flavouring is by far the greatest source of sodium in household diets, at 41.1% of the total. Despite high levels of consumption of meat products, coconut (popo) is the major source of fat in Samoan household diets.

This study shows that the cost of a diet which meets the minimum food and nutrition needs of households — including their recommended calorie, protein, fat, sodium, vitamin A and iron intake, as well as providing their recommended intake of total dietary fibre, calcium, vitamin C and carbohydrates - is more expensive than the food poverty line (FPL) established for Samoa in 2015.

This study found that purchasing an ‘optimum food basket’ would cost US$3.23 per person (Adult Male Equivalent) per day, whilst the FPL was determined to be US$2.1789 per person per day. Therefore households whose level of income places them above the established national FPL may not have sufficient income to provide their family with an adequate diet.

The optimum food basket selected quantities of 6 food items identified as the most efficient for assisting Samoan households to obtain an adequate diet: taro, chicken pieces, pumpkin, bread and canned mackerel (eleni).

Given high levels of fat and sodium intake, this study recommends the introduction of a 20% excise on food items identified through nutrient profiling as ‘unhealthy’ in order to encourage substitution towards healthier products - given modelling done by the Samoan Ministry of Health indicates that this would have a positive impact on reducing sodium and fat intake. Working with manufacturers to reduce the sodium content of bread would also help to reduce household sodium intake.

Similarly sourcing canned mackerel with lower sodium content would help to reduce sodium intake levels. Encouraging households to reduce the addition of table salt and sugar to meals and beverages, and switch to healthier types of cooking oil, would also significantly reduce calorie, fat and sodium intake levels.

Fortifying flour products with micronutrients such as Vitamin A and Iron could help to increase intake levels of these important micronutrients.

Improving access to these local food commodities by reducing their price to households identified as ‘at risk’ of poor nutrition through the policy and programme interventions outlined in this paper, will be critical to improving health and nutrition outcomes in Samoa. This study finds that reducing the price of local fruit, vegetable and animal products (particularly as pawpaw and Chinese cabbage) identified as efficient sources of required vitamin A, would help to reduce the current deficiencies in daily intake among the Samoan population.

Increasing consumption of these items at the expense of the current major sources of vitamin A in diet — particularly canned mackerel (eleni) would also help to reduce average sodium intake levels below the current high levels. This could be achieved through investments in improving the efficiency of production and marketing, supplemented by targeted food voucher schemes for at risk households and school feeding programmes.

In addition, creating a more enabling environment to facilitate investment in improving the efficiency of local food production and distribution systems will be critical to reducing the cost of nutritious food for the wider Samoan population, in the long run.