# Evolution of a sustained health promotion programme exploring adolescent metabolic health in the Cook Islands

## TL;DR

This paper describes a long-term health program in the Cook Islands that helps adolescents understand and track their metabolic health, aiming to reduce non-communicable diseases.

## Contribution

The study demonstrates a culturally appropriate, transdisciplinary approach to adolescent health promotion and NCD risk tracking in a small island community.

## Key findings

- 27.7% of students had ≥3 metabolic risk factors, highlighting significant adolescent NCD risk.
- The program successfully integrated health tracking with curriculum-based learning and received positive student feedback.
- Sustained support was achieved through culturally aligned co-design and evidence-sharing with schools.

## Abstract

The non-communicable disease (NCD) burden in the Cook Islands is severe; 62% of adults 18–69 years live with 3–5 risk factors. Understanding NCD complexity and developing evidence-based actions to mitigate this burden is crucial. This article reports on the evolution of a sustained health promotion programme contributing to understanding adolescent metabolic health in Rarotonga. Ora’anga Tūmanava (established 2013) is a transdisciplinary initiative engaging adolescents in exploring NCD-related challenges through curriculum-linked learning. Community-based participatory research integrated within the Tivaevae framework guides co-design. In 2013, inclusion of health measures within this initiative was considered but rejected. Feedback in 2015 identified that, after examining population-level NCD burdens, adolescents wanted greater access to personal health information. Consequently, inclusion of health measures was revisited and agreed for trial alongside learning about metabolic health within a Year 9 programme. Data from 2016 to 2019 and 2022 to 2023 (n = 783; 65% total cohort; median age 13.8 years) indicated overweight 22.1%; obesity 37.6%; waist-to-height ratio > 0.5, 39.1%; elevated blood cholesterol, 8.1%; and elevated blood glucose, 15.6%. Where all measures were available (n = 321), 27.7% of students were living with ≥ 3 risk factors. Feedback confirmed the programme met student expectations, contributed to school-based health promotion, offered an acceptable strategy for tracking metabolic health indicators and highlighting NCD risk factors in this age-group, and encouraged health-related discussions. Alignment with curriculum-based learning and evidence-sharing has ensured sustained school-level support. This study highlights how transdisciplinary partnerships built via culturally appropriate co-design can support educational and health promotion goals and simultaneously inform public health in small island communities.