Island HEART for reducing inequities in Pacific island communities

Suva, Fiji is becoming a healthy city. Where there once was a modest foot path and sparse trees, there are now welcoming wide foot paths, children’s parks, picnic shelters, and physical activity stations along the shore looking out onto the Pacific Ocean to promote physical activity. Where once green waste was piled by the side of the road, there is now consistent green waste pick-up and an established city composting site to deter burning. These health promoting activities were implemented as part of Suva’s Healthy City initiative, which is a global movement to engage local governments and communities in health development.

Island HEART: identifying opportunities for improvement

Suva City Council (SCC) partnered with the Fiji Ministry of Health to improve the health and quality of life for Suva residents by taking action to become a healthy city. The Fiji Ministry of Health, with support from WHO introduced the Urban Health Equity Assessment and Response Tool (Urban HEART). The SCC decided to add a Pacific twist to the name and adapt Urban HEART as Island HEART. The Island HEART guides communities through assessment of community health and well-being by identifying major health challenges, barriers to addressing their root causes, and actions to mitigate the challenges. The six major steps in applying the Island HEART in Suva are described in Box 1.

Communities leading the way to a healthier Suva

Soon after a workshop on Island HEART, the Suva City Task Force was identified as the inclusive team to lead the implementation. The Taskforce included members of SCC, Ministry of Health, faith-based organizations, community members and other stakeholders.

The Island HEART was then taken to communities in each of the six wards that comprise Suva. The Island HEART analysis helped the SCC and communities identify disparities among wards and target areas for action. For example, the Taskforce heard from health centre representatives that the rates of NCDs in each of the wards are increasing. One way to halt the trend is to increase physical activity, however stakeholders noted there were limited safe and affordable physical activity options within Suva. Providing affordable options such as well-lit walking paths would increase access to physical activities.

Another example was the concern among several wards about the large amount of green waste that communities burn, creating air pollution. Through the application of Island HEART, the SCC identified ways they could deter burning of green waste such as establishing regular pick up of green waste and a city composting site for collection. Communities have been active in holding green waste clean-up days

Healthier Suva, healthier Fiji

Just over one year later, the Taskforce continues to monitor progress by reviewing its Island HEART monitoring matrix at quarterly meetings. The Suva City Taskforce identified next steps for the Suva Healthy City initiative which include introduction of cycling lanes and expansion of evening aerobics classes to further encourage physical activity options. Also, participants noted that fresh fruits and vegetables are only available at the market and in order to promote greater availability and easier access to healthy food choices, the Taskforce also plans to establish fruit and water stalls near Suva-based government workplaces to promote healthy snacking options in otherwise fast food-heavy areas of town.

As for the rest of Fiji, additional healthy cities are to come. This past August, Fiji’s Ministry of Health in collaboration with WHO held a workshop on Healthy Cities and Island HEART to expand the programme across the country.