Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

Background
There is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.

Methods/Design
Intervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.

A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.

Discussion
Salt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.

East Rennell World Heritage Site : misunderstandings, inconsistencies and opportunities in the implementation of the World Heritage Convention in the Pacific Islands

Continuing traditional land tenure and resource use pattern the landscapes and seascapes of the Pacific Islands, and the rights of customary land owners are enshrined in the constitutions of many Pacific Island states. The implications of this for heritage conservation programs implemented by national governments under international Conventions and Agreements are explored through a case study of East Rennell World Heritage site, the first site to be inscribed based on natural criteria under customary ownership and management. Dissatisfaction with World Heritage listing expressed by the community of East Rennell is argued to reflect inconsistencies in the requirements for inscription of the property and a tension between the conservation and ‘beauty pageant’ functions of the World Heritage List.