From Crisis to Action: Addressing Fiji’s Noncommunicable Disease Challenges

Fiji’s Ministry of Health and Medical Services recently completed a national survey providing critical data on key NCD risk factors to target interventions that will ease the health crisis. It reported five key findings:

1. Noncommunicable diseases and risk factors remain widespread across Fiji’s adult population. Approximately two-thirds of adults are overweight or obese, and nearly all adults have at least one WHO major NCD risk factor. Obesity, hypertension, diabetes, and raised cholesterol increase sharply with age, affecting both men and women. This adult burden is being reinforced earlier in life, as evidence from Fiji and the wider Pacific shows rapidly increasing obesity among children and adolescents, driven by unhealthy diets and physical inactivity.
2. Dietary risks are severe, particularly low fruit and vegetable intake and excessive salt consumption. Nearly 90% of adults consume fewer than five servings of fruits and vegetables per day, while average salt intake is almost double the WHO recommended level. Processed foods and high salt use in household cooking remain major contributors to hypertension and cardiovascular risk.
3. Tobacco, alcohol, and kava use continue to drive clustered health risks. Over one‑third of adults smoke tobacco, with much higher prevalence among men. While half the population abstains from alcohol, heavy episodic drinking persists among men. More than half of adults consume kava, often alongside tobacco use and unhealthy snacking.
4. Physical activity levels are relatively high, but important gaps persist. About three‑quarters of adults meet WHO physical activity recommendations, driven largely by work‑related and transport-related activity. However, over half of the population do not engage in vigorous physical activity, with women and older adults particularly affected.
5. Screening coverage is improving, but treatment and control outcomes are weak. While most adults have been screened for blood pressure or blood glucose, fewer than half of those with hypertension or diabetes are aware of their condition. Only a small fraction receives effective treatment or achieves disease control.

Based on the survey results, suggested targeted interventions include

• creating promotion campaigns to encourage healthy eating and physical activity, with strong emphasis on improving health-seeking behavior and uptake of early, routine preventive care;
• enacting legislation that restricts tobacco and sugary drink consumption;
• advocating for the health ministry to rebalance spending away from tertiary curative services toward strengthening primary-level infrastructure, awareness, early NCD screening, and accessible treatment programs;
• expanding digital health systems to improve patient data, referral pathways and service delivery, enabling early detection and continuity of care; and
• expanding the health-promoting school policy to address rising childhood obesity and reduce long-term NCD risks across the life course.

While these priority actions are well-aligned with Fiji’s policy framework, progress has been uneven. Structural and financing constraints remain the main barriers to effective implementation at scale:

• Under-resourced prevention. Investment and action remain skewed toward treatment rather than prevention and early intervention.
• Weak treatment and control cascades. Screening coverage is relatively high, but large drop-offs occur in diagnosis, treatment initiation, continuity of care, and disease control for hypertension and diabetes.
• Unhealthy food environments. Poor diets, excessive salt and sugar intake, and widespread availability of unhealthy foods indicate insufficient regulatory and fiscal controls.
• Limited multisectoral enforcement. Policies related to food systems, urban planning, taxation and marketing regulations affect access to healthy foods, opportunities for physical activity, and exposure to harmful products, such as tobacco and alcohol. However, enforcement and coordination across sectors require strengthening.
• Inequities by gender, age and location. Women, younger adults and urban populations face distinct gaps in physical activity, diet quality, and access to effective preventive services.

Fiji’s 2025 STEPS survey for NCDs, the health ministry’s strategic plan, and the National Development Plan align around a shared NCD challenge and prevention first approach. These documents recognize NCDs as a major threat to wellbeing, productivity, and fiscal sustainability, and highlight the need to prioritize early detection, risk reduction, and behavior change. They also emphasize strengthening primary health care through service decentralization, improved screening, continuity of care, and better access for rural and vulnerable populations. Further, there is clear convergence on a multisectoral response, linking health outcomes to education, nutrition, urban design, climate resilience, and community engagement. All three documents stress the importance of data, accountability, and implementation, with measurable targets, monitoring frameworks, and partnerships to translate policy into sustained health outcomes. stress the importance of data, accountability, and implementation, with measurable targets, monitoring frameworks, and partnerships to translate policy into sustained health outcomes.

However, Fiji’s health sector remains under-resourced, with total health spending sitting at 4% of gross domestic product (GDP), below Fiji’s structural peers and the WHO-recommended 5%. Equally important, spending is heavily skewed toward hospital-based curative care, which accounts for around 79% of government health spending. Improving NCD outcomes will therefore, require both increased overall health investment and a strategic rebalancing toward primary and preventive care, where early detection and risk reduction deliver far greater returns.

Raising public health expenditure to at least 5% of GDP can be a challenge. Strategies toward this goal can include expanding excise tax coverage to include additional high-sugar products and applying tiered excise rates based on sugar content. These measures can incentivize product reformulation and provide healthier consumer choices. Additional revenue from such interventions can also be channeled toward reducing NCD prevalence and enhancing primary healthcare service delivery via soft earmarking in the national budget.

Fifteenth Pacific Health Ministers Meeting. 2023. Tackling the Drivers of Obesity, Particularly for Children and Young People. Meeting Document.

Government of Fiji. 2024. Fiji National Development Plan 2025–2029 and Vision 2050. 

Government of Fiji (Ministry of Health and Medical Services). 2026. Fiji 2025 STEPS Survey Country Report.

K. Aldwell et al. 2018. Tackling the Consumption of High Sugar Products Among Children and Adolescents in the Pacific Islands: Implications for Future Research. Healthcare. 6 (3). 81.

United Nations Children’s Fund (UNICEF). 2025. Feeding Profit: How Food Environments are Failing Children. Child Nutrition Report 2025. UNICEF.

World Bank. 2025. Fiji Health Sector Review 2024: Investing in People. World Bank.