The significance of DOHaD for Small Island Developing States

Abstract

Small Island Developing States (SIDS) are island nations that experience specific social, economic and environmental vulnerabilities associated with small populations, isolation and limited resources. Globally, SIDS exhibit exceptionally high rates of non-communicable disease (NCD) risk and incidence. Despite this, there is a lack of context-specific research within SIDS focused on life course approaches to NCD prevention, particularly the impact of the early-life environment on later disease risk as defined by the Developmental Origins of Health and Disease (DOHaD) framework. Given that globalization has contributed to significant nutritional transitions in these populations, the DOHaD paradigm is highly relevant. SIDS in the Pacific region have the highest rates of NCD risk and incidence globally. Transitions from traditional foods grown locally to reliance on importation of Western-style processed foods high in fat and sugar are common. The Cook Islands is one Pacific SIDS that reports this transition, alongside rising overweight/obesity rates, currently 91%/72%, in the adult population. However, research on early-life NCD prevention within this context, as in many low- and middle-income countries, is scarce. Although traditional research emphasizes the need for large sample sizes, this is rarely possible in the smaller SIDS. In these vulnerable, high priority countries, consideration should be given to utilizing 'small' sample sizes that encompass a high proportion of the total population. This may enable contextually relevant research, crucial to inform NCD prevention strategies that can contribute to improving health and well-being for these at-risk communities.

Supporting Cook Island communities to access DOHaD evidence

“…However, while there is a wealth of DOHaD research and an increasing presence of related early-life interventions within high-income nations, there is a lack of focus on low-and middleincome nations, most of which experience disproportionately higher rates of NCDs. 3,5,6 The Cook Islands is a small island developing state (SIDS) with a population of 17,430 located in the Western Pacific region. 7 In this nation, NCDs cause 80% of all deaths, and 91/72% of adults are affected by overweight/obesity.…”

“…As a result of changing trade policies and rising food imports, the Cook Islands has undergone a rapid nutrition transition from traditional diets of root crops, seafood and locally grown fruits to an increased reliance on imported foods high in fat and sugar. 6,22 Thus, while there is a clear disease burden and a need for improvement in health outcomes in the Cook Islands, the contextual differences between the countries necessitate that health promotion strategies take culture and context into account.…”

Assessing the effectiveness of planned adaptation in rural Pacific Island communities: case studies from Fiji and Kiribati

“…That is not to discount a biophysical hazard, but rather view it and account for it after understanding the contextual elements of the system first. As O'Brien et al (2007: 76) Despite such definitional ambiguities, and a lack of consensus of what vulnerability means in the current academic literature, practice, and policy there is a general acceptance that vulnerability refers to the combination of the exposure of a system to outside perturbation, and the potential of that system to be harmed (Jackson, McNamara and Witt 2017;Tu'akoi et al 2018). As such, vulnerability to climate change refers to both the severity of a climate related impact (such as sea-level rise, increased storm surge activity, drought, increased temperatures, tidal inundation), coupled with the propensity of the associated social and/or physical system to be harmed by such climatic impacts.…”

“…Vulnerability encompasses a variety of concepts and elements including sensitivity or susceptibility to harm and lack of capacity to cope and adapt" (IPCC 2014a(IPCC : 1775. Despite such definitional ambiguities, there persists a general informal acceptance that vulnerability refers to the exposure of a system coupled with the potential to be harmed (Jackson, McNamara and Witt 2017;Tu'akoi et al 2018). As such, vulnerability to climate change can refer to both the severity of climate related impacts (i.e.…”

“…For example, there is no single definition of vulnerability to climate change (Füssel 2007), and how different actors conceptualise, and frame vulnerability also influence the type of adaptation policy or program implemented (Barrowman and Kumar 2018;O'Brien et al 2007). Despite such ambiguities, vulnerability is generally considered and accepted to be a combination of both the forces acting upon a system and the propensity of that system to be harmed (Jackson, McNamara and Witt 2017;Tu'akoi et al 2018). In other words, vulnerability to climate change includes the impacts associated with climate change (i.e.…”