Scaling-up food policies in the Pacific Islands: protocol for policy engagement and mixed methods evaluation of intervention implementation

Abstract
Background: There is a crisis of non-communicable diseases (NCDs) in the Pacifc Islands, and poor diets are a major
contributor. The COVID-19 pandemic and resulting economic crisis will likely further exacerbate the burden on food
systems. Pacifc Island leaders have adopted a range of food policies and regulations to improve diets. This includes
taxes and regulations on compositional standards for salt and sugar in foods or school food policies. Despite increas‑
ing evidence for the efectiveness of such policies globally, there is a lack of local context-specifc evidence about
how to implement them efectively in the Pacifc.
Methods: Our 5-year collaborative project will test the feasibility and efectiveness of policy interventions to reduce
salt and sugar consumption in Fiji and Samoa, and examine factors that support sustained implementation. We will
engage government agencies and civil society in Fiji and Samoa, to support the design, implementation and moni‑
toring of evidence-informed interventions. Specifc objectives are to: (1) conduct policy landscape analysis to under‑
stand potential opportunities and challenges to strengthen policies for prevention of diet-related NCDs in Fiji and
Samoa; (2) conduct repeat cross sectional surveys to measure dietary intake, food sources and diet-related biomark‑
ers; (3) use Systems Thinking in Community Knowledge Exchange (STICKE) to strengthen implementation of policies
to reduce salt and sugar consumption; (4) evaluate the impact, process and cost efectiveness of implementing these
policies. Quantitative and qualitative data on outcomes and process will be analysed to assess impact and support
scale-up of future interventions.
Discussion: The project will provide new evidence to support policy making, as well as developing a low-cost, high-tech, sustainable, scalable system for monitoring food consumption, the food supply and health-related outcomes