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Over the twentieth century, small island states in the Pacific experienced a dietary shift from traditional foods characteristic of the region to imported foods of poor nutritional quality. In Kiribati, noncommunicable diseases including diabetes and hypertension are now the largest burden of disease in the country and the primary cause of premature mortality. Food and nutritional security in Kiribati are now a major public health challenge. Climate change is likely to negatively affect traditional food production systems. In this study, twelve gender-segregated focus groups in six communities were carried out across Kiribati. Food charts were obtained from each focus group, where all food items mentioned by communities were listed and scored for health and importance. These were analysed using Excel and Stata. Health scores were on average 42.4% lower for imported food compared to local food with strongly significant findings at a p value of

Food security is identified as one of the main challenges for the 21st century. In the Pacific islands this is especially the case due to natural, topographical, social, environmental, and economic constraints and the influence of globalisation that has forced many populations to resort to imported food. While hunger is rarely experienced by households, poor nutrition leads to a considerable noncommunicable disease burden. The effects of climate change will further exacerbate food security challenges in the region. Kiribati has one of the highest prevalence rates for obesity, diabetes and hypertension anywhere in the world. While past studies have explored regional and state-level food security challenges, there is comparatively little literature on household-level decision making processes related to food. Through focus group discussions and semi-structured interviews, we identified several themes describing challenges to achieving food security in the island nation, including several environmental challenges that hinder food security. We also include some policy recommendations based on these findings. These challenges and policy recommendations may be applicable to other atoll island communities in the Pacific and other remote coastal communities worldwide.

Small island developing states such as Kiribati in the Equatorial Pacific are among the most climate vulnerable places on Earth. While there is a considerable body of literature on the scale of the problem, there is very little research on the lived experiences of communities, their concerns and priorities, and how they are coping with environmental and climate hazards. As a result, a top-down approach is often adopted in adaptation projects that may not meet the real needs of communities, endangering the long-term sustainability and viability of interventions. Through a series of participatory focus groups carried out in Kiribati in 2019, this study explores what communities prioritise and wish to see implemented to cope and build resilience to present and foreseeable future challenges. The outcomes of this research show environmental risks and hazards faced by communities are strongly associated with climate projections. Communities are currently trying to adapt to challenges, both old and new, with technologies and materials available. While there is a degree of spontaneous adaptation occurring, these problems are insurmountable without solving present challenges in Kiribati, such as access to better technology and markets without becoming over-reliant. Including communities in co-designed interventions can also ensure sustainability in climate adaptation projects. The findings of this research can inform policy and climate change adaptation measures in other similar atoll islands in the Pacific.