The Pacific food system has become progressively more integrated into global food regimes. This integration has had impacts on availability and consumption of food, population health, and vulnerability to external drivers. We describe major elements of the contemporary food system to provide a foundation for analysis of food system transitions and public health outcomes. Although crop production has doubled in the last fifty years, it has not kept pace with population growth. This deficit is increasingly filled by imported foods, particularly staples, meat and sugar. The burden of malnutrition and poor health outcomes are increasingly apparent. We propose seeds for transitioning the Pacific food system to a hybrid form that supports historical continuity with healthy regionally-produced food.

The Kiribati 2019 Integrated Household Income and Expenditure Survey (Integrated HIES) embeds novel ecological and human health research into an ongoing social and economic survey infrastructure implemented by the Pacific Community in partnership with national governments. This study seeks to describe the health status of a large, nationally representative sample of a geographically and socially diverse I-Kiribati population through multiple clinical measurements and detailed socio-economic surveys, while also conducting supporting food systems research on ecological, social, and institutional drivers of change. The specific hypotheses within this research relate to access to seafood and the potential nutritional and health benefits of these foods. We conducted this research in 21 of the 23 inhabited islands of Kiribati, excluding the two inhabited islands-Kanton Islands in the Phoenix Islands group with a population of 41 persons (2020 census) and Banaba Island in the Gilbert Islands group with a population of 333 persons (2020 census)-and focusing exclusively on the remaining islands in the Gilbert and Line Islands groups. Within this sample, we focused our intensive human health and ecological research in 10 of the 21 selected islands to examine the relationship between ecological conditions, resource governance, food system dynamics, and dietary patterns. Ultimately, this research has created a baseline for future Integrated HIES assessments to simultaneously monitor change in ecological, social, economic, and human health conditions and how they co-vary over time.