REPUBLIC OF THE MARSHALL ISLANDS
HEALTHY STORES PROJECT
The Healthy Stores pilot program was completed in December 2001. Currently, other Pacific Island nations are considering their own Healthy Stores programs modeled after the Marshall Islands project. This work would be conducted in collaboration with the Healthy Living in the Pacific Islands (HLPI) project, which is funded by the USDA Agricultural Development Assistance Program (ADAP).
HEALTH CHALLENGES IN THE MARSHALL ISLANDS
The Republic of the Marshall Islands has seen a dramatic increase in obesity and related chronic diseases as its population has become more dependent on imported (and mostly high-fat, high-calorie) food sources. Pacific Islanders, like minority populations in the United States (African American, Hispanic, Native American, and others) are disproportionately affected by diabetes, cardiovascular disease, hypertension, and other chronic conditions.
HEALTHY STORES PROJECT GOAL
To improve diet and reduce obesity and disease risk on the Marshall Islands, Dr. Gittelsohn and colleagues, in collaboration with the RMI Ministry of Health and Environment, developed, implemented, and evaluated a pilot intervention trial with 22 large and small food stores. This was the first carefully evaluated environmental, store-centered, intervention program to take place in a developing country. It was developed with particular attention to the unique cultural and economic factors at work in the Marshall Islands and to the need for a sustainable program to address diet and nutritional status.
REPUBLIC OF THE MARSHALL ISLANDS FACTS
- Located 2,000 miles southwest of Hawaii
- Population ~ 50,000, spread across 33 islands grouped into two parallel chains.
- Sixty percent of the population lives in one of two urban centers.
- There is little diversity in edible fruits and vegetables, and therefore a limited supply of local food.
- Six supermarkets and wholesale stores supply over 95 percent of all imported food consumed in the country.
- Approximately 80-90 percent of all food/kcals consumed in the urban areas is supplied by imported foods.
- Approximately 25-50 percent of all food/kcals consumed in the outer islands is supplied by imported foods.
FEATURES OF THE RMI HEALTHY STORES INTERVENTION
- Intervention developed based on substantial formative research.
- Used motivational themes: how to avoid diabetes, being healthy in life, being there for your children and grandchildren.
- Identified key foods for promotion
- 10 week intervention period, August-October 2001
- Four phases of intervention where different foods/themes promoted
- Twelve stores (9 small and 3 large) part of intervention, 10 comparison stores
- Radio announcements of key events and themes
- Newspaper ads
- Promotional video
- Owners encouraged to stock healthy food
- Shelf labels to identify healthy foods
- Cooking demonstrations and taste tests
- Recipe cards and flyers
- Joel Gittelsohn, PhD
- Neal Palafox, Md, MPH
- Julia Alfred
- Heather Haberle, MHS
- Malia K. Boggs, MPH
- Kevin Frick, PhD
- William Dyckman, MHS
- News Article – ‘Healthy Stores’ Program Boosts Demand for Better Food in Marshall Islands (09/15/2006)
- Research article – Formative Research to Inform Intervention Development for Diabetes Prevention in the Republic of the Marshall Islands
- Research article – Macro- and microlevel processes affect food choice and nutritional status in the republic of the marshall islands.
- Research article – A Pilot Food Store Intervention is Associated with Improved Health Knowledge, Food Purchasing and Preparation in the Republic of the Marshall Islands (PDF File)
Cortes, L.M.*, Gittelsohn, J., Alfred J, and Palafox, N. (2001) “Formative Research to Inform Intervention Development for Diabetes Prevention in the Republic of the Marshall Islands,” Health Education and Behavior 28(6):696-715.
Gittelsohn, J., Haberle, H., Vastine, A.*, Dyckman, W.*, and Palafox, N. (2003) “Macro and Micro-level Processes Affect Food Choice and Nutritional Status in the Republic of the Marshall Islands,” Journal of Nutrition 133(1): 310S-313S.
Gittelsohn, J., Dyckman, W.*, Tan, M.L.*, Boggs, M.K., Frick, K.D., Alfred, J., Winch, P.J., Haberle, H., and Palafox, N. (2006) “Development and Implementation of a Food Store Intervention to Improve Diet in the Republic of the Marshall Islands,” Health Promotion Practice, Aug 2; [Epub ahead of print].
Gittelsohn J, Dyckman W*, Alfred J, Boggs MK, Haberle H., Fricke KD, Vastine AV*, and Palafox N. (2007) “A Pilot Food Store Intervention is Associated with Improved Health Knowledge, Food Purchasing and Preparation Behaviors in the Republic of the Marshall Islands,” Pacific Health Dialogue, 14(2): 43-53.