Paradise Lost: The Story of Nauru

Nauru, a small island nation in the Pacific holds two major distinctions. It is officially the world’s smallest republic- at 8 square miles you can drive around the whole country in 20 minutes. It also has the world’s highest obesity rate with 95% of its population either obese or overweight. In fact, 8 out of the top 10 most obese countries are all tiny island nations in the Pacific; in the middle of nowhere (the other two are the US and Kuwait).

Nauru’s story is a sad one: What was once a prosperous country is now a major health crisis. 45% of the population has type-II diabetes along with a host of other chronic diseases caused by obesity. The economy has ground to a halt- few people work, and the president is desperately trying to promote exercise programs for the locals in a bid to bring the country back to life.

So what changed in Nauru? How did a nation of rich, healthy islanders become the leading statistic in global obesity? The short answer is globalization.

Beginning in the 1970s, Nauru and other pacific island nations began industrializing their economies and opened themselves up to foreign investment. The population made a quick transition from mining and agriculture to white-collar desk jobs. At the same time, major changes in world trade policies saw Nauru begin to import processed food from the United States.  The islanders’ diet shifted dramatically from fish, fruit and vegetables to canned meats, cooking oils, soda, beer, sugar and rice.  A once healthy people (the former president was an Olympic athlete and has 12 medals from the Commonwealth games) are now the unhealthiest people on the planet.

Graphs show increasing imports and declining exports from the 80s.  (Taken from the Australian Treasury and data from Wolfram Alpha)

Nauru’s depleted mines and physically unfit workers have led to an economic collapse. The country now has a debt that is 27 times its GDP, and a large chunk of it was owed to a single US corporation – General Electric Capital. This pattern of complete economic and health shut down is unique to small nations faced with a sudden entry into a vicious global market. Countries in the Middle East, Africa and Asia that hit oil in the 1970s are also dealing with the massive health problems brought about by a sharp spike in prosperity (although unlike Nauru, they have oil wealth to keep the economy running).

Blame it on the Spam  (The Telegraph)

The pattern is visible nationally as well. A project I am currently working on for the Department of Health in New York City, examines food availability in parts of Brooklyn. The results are not surprising- food habits lean toward processed high-calorie and unhealthy foods in lower income areas. It is a matter of market economics. Fast food and processed food sellers see a huge market for cheap meals while fresh food retailers and supermarkets prefer more up-market areas.  For the same reason, retailers in Nauru prefer to stock their shops with imported cans of spam and mutton or beef. The result is that area inhabitants have very little choice (and very little desire to change) in the matter. Coupled with poor health information and education, corned beef and beer become the ingredients of a public health disaster.

Understanding the effects of national and international food and trade policy is vital. Intervention by most international agencies is almost always after the fact- mostly due to the compartmentalized nature of the problem. So the major trade and development agencies would push for increasingly open markets and industrialization and 30 years later WHO steps in to declare a health crisis. The truth is that development and all its pros and cons are one complete package.

Developing and maintaining a local food culture and industry is also an important step. Pacific island nations have begun imposing restrictions and “sin” taxes on importing high fat, poor quality meat (a 30 million dollar industry)  and processed foods. Price controls and incentives work at one level, but a community-led initiative toward healthy lifestyles also works well.  A community awareness of health risk may be the only incentive that works when imported beef is cheaper than local fish.

On an international scale, agencies such as AusAID and WHO are playing an active role in reversing the trend. The island states themselves are also working toward a regional level cooperation to enable a collective louder voice on the international stage. It is easy for the world to ignore Nauru. With a population of just 9500 people in a world of 6+ billion, Nauru has to compete in the global aid market for financial and health aid. And face it, most donors would rather give their time and efforts to starving children than well-fed islanders (or inner city residents for that matter).

It is ironic how both scarcity and plenty can be devastating.

Also, see this video from ABC news called the Fattest Place on Earth