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Wang J, Wu H, Liu Y, Wang W. Health welfare in the digital era: Exploring the impact of digital trade on residents' health. ECONOMICS AND HUMAN BIOLOGY 2024; 54:101414. [PMID: 39089003 DOI: 10.1016/j.ehb.2024.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/03/2024] [Accepted: 07/25/2024] [Indexed: 08/03/2024]
Abstract
As a product combining information and communication technology, digital technology, and traditional trade, digital trade represents a new form of international trade development in the context of economic globalization. As its scale continues to expand, digital trade not only profoundly impacts consumer health behaviors and environmental pollution control but also enhances opportunities for residents to access healthcare products and services. This could potentially have a significant promoting effect on residents' health levels. However, the extent and mechanisms through which digital trade affects residents' health remain unclear. Accordingly, this study fills in a gap in the research by calculating the provincial-level digital trade index for China from 2012-2020 and matching it with data from the China Family Panel Studies. The goal is to find the micro-causal mechanisms of digital trade on residents' health from green consumption and environmental improvement perspectives. The results show that digital trade reduces residents' medical expenses and improves their health. We use a quasi-natural experiment by treating the cross-border e-commerce comprehensive pilot zone as a digital trade treatment group and conducting a difference-in-differences estimation, finding that the health effects of digital trade remain significant. Heterogeneity indicates that the health effects of digital trade are powerful for middle- and high-income households and rural residents. In the east and center, in regions with well-developed transportation infrastructure and digital financial inclusion, the development of digital trade is more conducive to residents' health. Additionally, we demonstrate that digital trade can affect residents' health by promoting green consumption, eliminating energy poverty (i.e., improving indoor air pollution), and enhancing environmental quality (i.e., improving outdoor environmental pollution). This study provides solid scientific empirical evidence for enhancing human sustainable development through global digital trade.
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Affiliation(s)
- Jianlong Wang
- School of Economics, Sichuan University, Chengdu 610064, China.
| | - Haitao Wu
- International Business School, Hainan University, Haikou 570228, China.
| | - Yong Liu
- School of Economics, Sichuan University, Chengdu 610064, China.
| | - Weilong Wang
- School of Economics, Sichuan University, Chengdu 610064, China.
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Burgaz C, Van-Dam I, Garton K, Swinburn BA, Sacks G, Asiki G, Claro R, Diouf A, Bartoletto Martins AP, Vandevijvere S. Which government policies to create sustainable food systems have the potential to simultaneously address undernutrition, obesity and environmental sustainability? Global Health 2024; 20:56. [PMID: 39068420 PMCID: PMC11282665 DOI: 10.1186/s12992-024-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION A transformation of food systems is urgently needed, given their contribution to three ongoing and interlinked global health pandemics: (1) undernutrition and food insecurity, (2) obesity and non-communicable diseases (NCDs), and (3) climate change and biodiversity loss. As policymakers make decisions that shape food systems, this study aimed to identify and prioritise policies with double- or triple-duty potential to achieve healthier and more environmentally sustainable food systems. METHODS This study undertook a 4-step methodological approach, including (i) a compilation of international policy recommendations, (ii) an online survey, (iii) four regional workshops with international experts and (iv) a ranking for prioritisation. Policies were identified and prioritised based on their double- or triple-duty potential, synergies and trade-offs. Using participatory and transdisciplinary approaches, policies were identified to have double- or triple-duty potential if they were deemed effective in tackling two or three of the primary outcomes of interest: (1) undernutrition, (2) obesity/NCDs and (3) environmental degradation. RESULTS The desk review identified 291 recommendations for governments, which were merged and classified into 46 initially proposed policies. Based on the results from the online survey, 61% of those policies were perceived to have double- or triple-duty potential. During the workshops, 4 potential synergies and 31 trade-offs of these policies were identified. The final list of 44 proposed policies for healthier and more environmentally sustainable food systems created was divided into two main policy domains: 'food supply chains' and 'food environments'. The outcome with the most trade-offs identified was 'undernutrition', followed by 'environmental sustainability', and 'obesity/NCDs'. Of the top five expert-ranked food supply chain policies, two were perceived to have triple-duty potential: (a) incentives for crop diversification; (b) support for start-ups, and small- and medium-sized enterprises. For food environments, three of the top five ranked policies had perceived triple-duty potential: (a) affordability of healthier and more sustainable diets; (b) subsidies for healthier and more sustainable foods; (c) restrictions on children's exposure to marketing through all media. CONCLUSION This study identified and prioritised a comprehensive list of double- and triple-duty government policies for creating healthier and more environmentally sustainable food systems. As some proposed policies may have trade-offs across outcomes, they should be carefully contextualised, designed, implemented and monitored.
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Affiliation(s)
- Celia Burgaz
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
- Department of Geosciences, Environment and Society, Free University of Brussels (ULB), Brussels, Belgium.
| | - Iris Van-Dam
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Kelly Garton
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Deakin University, Melbourne, Australia
| | - Gershim Asiki
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Rafael Claro
- Nutrition Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adama Diouf
- Laboratoire de Recherche en Nutrition Alimentation Humaine, Université Cheikh Anta Diop, Dakar, Senegal
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Tapsoba VA, Compaore EWR, Zeba AN, Some JW, Manga JS, Diouf A, Moubarac JC, Vandevijvere S, Dicko MH. Food environment in Burkina Faso: priority actions recommended to the government using Food-EPI tool. Front Nutr 2024; 11:1420323. [PMID: 39091684 PMCID: PMC11293057 DOI: 10.3389/fnut.2024.1420323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/25/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction The food environment is an important factor in the efforts of countries worldwide to achieve a transition to sustainable food systems. The objective of this study is to formulate and prioritize actions to be addressed to the government of Burkina Faso for the creation of a healthy food environment, which will contribute to reducing malnutrition in all its forms and non-communicable diseases. Methods National experts were brought together to identify and prioritize actions to fill the gaps identified through a multi-step assessment process following the methodology of the Healthy Food and Environment Policy Index (Food-EPI). Results Up to 20 priority policy actions were recommended to the Burkina Faso government. Actions in the policy component focused mainly on regulation of food promotion and marketing, particularly to children, and others in the infrastructure support component focused largely on political leadership, i.e., strong and visible political support from the government to improve the food environment, population nutrition, diet-related non-communicable diseases and their inequalities. Conclusion The priority actions to be recommended to the government will strengthen advocacy for government decisions to create a healthier food environment in the country.
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Affiliation(s)
- Viviane Aurelie Tapsoba
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Ella W. R. Compaore
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | | | | | | | - Adama Diouf
- Laboratory for Research into Human Nutrition and Food (LARNAH), Department of Animal Biology, Faculty of Science and Technology, Cheikh Anta Diop University (UCAD), Dakar, Senegal
| | | | | | - Mamoudou Hama Dicko
- Laboratory of Biochemistry, Biotechnology, Food Technology and Nutrition (LABIOTAN), Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
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Peng W, Zhang L, Wen F, Tang X, Zeng L, Chen J, Galea G, Wen D, Wang Y. Trends and disparities in non-communicable diseases in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100938. [PMID: 38456093 PMCID: PMC10920054 DOI: 10.1016/j.lanwpc.2023.100938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/03/2023] [Accepted: 09/29/2023] [Indexed: 03/09/2024]
Abstract
The WHO Western Pacific region bears disproportionate deaths from non-communicable diseases (NCDs), with increased overall NCD proportional mortality over the past two decades. The disease burden of mental health increased, resulting from rapid ageing, enhanced stress, and the COVID-19 pandemic, but it was largely neglected. The highly diverse cultures, religions, political systems, socioeconomic contexts, lifestyles, and environmental factors probably have led to massive disparities across countries in NCD mortality, risk factors, and NCD management. Geographically, East Asia had the lowest NCD mortality whilst Pacific islands had the highest. Economic booms, ageing, nutrition transition, social stress, prevalent tobacco use, and fast-increasing obesity and hyperglycaemia are important drivers of NCDs. Men tended to have more adverse behavioural and metabolic risk factors. Rural residents are catching up with their urban counterparts in metabolic risk factors and conditions. Sustainable strategies tailored to NCD patterns are needed to fight the NCD epidemic and related disparities.
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Affiliation(s)
- Wen Peng
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, People's Republic of China
- Qinghai Provincial Key Laboratory of Prevention and Control of Glucolipid Metabolic Diseases with Traditional Chinese Medicine, No. 16 Kunlun Road, Xining 810008, People's Republic of China
| | - Ling Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10 Xitoutiao, Youanmenwai, Beijing 100069, People's Republic of China
| | - Fuyuan Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing 100069, People's Republic of China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, No. 10 Xitoutiao, Youanmenwai, Beijing 100069, People's Republic of China
| | - Xiao Tang
- Nutrition and Health Promotion Center, Department of Public Health, Medical College, Qinghai University, People's Republic of China
- Qinghai Provincial Key Laboratory of Prevention and Control of Glucolipid Metabolic Diseases with Traditional Chinese Medicine, No. 16 Kunlun Road, Xining 810008, People's Republic of China
| | - Lingxia Zeng
- The First Affiliated Hospital of Xi'an Jiaotong University Public Health Institute, Global Health Institute, School of Public Health, International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
| | - Jiapeng Chen
- China Population and Development Research Center, No. 12 Dahuisi Road, Beijing, 100081, People's Republic of China
| | - Gauden Galea
- WHO China Representative Office, No. 23 Dongzhimenwai Street, Beijing 100600, People's Republic of China
| | - Deliang Wen
- Health Sciences Institute, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, People's Republic of China
| | - Youfa Wang
- The First Affiliated Hospital of Xi'an Jiaotong University Public Health Institute, Global Health Institute, School of Public Health, International Obesity and Metabolic Disease Research Center, Xi'an Jiaotong University, Xi'an 710061, People's Republic of China
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He P, Liu Z, Baiocchi G, Guan D, Bai Y, Hubacek K. Health-environment efficiency of diets shows nonlinear trends over 1990-2011. NATURE FOOD 2024; 5:116-124. [PMID: 38332359 PMCID: PMC10896724 DOI: 10.1038/s43016-024-00924-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Abstract
Understanding the impacts of diets on health and the environment, as well as their association with socio-economic development, is key to operationalize and monitor food systems shifts. Here we propose a health-environment efficiency indicator defined as a ratio of health benefits and four key food-related environmental impacts (greenhouse gas emissions, scarcity-weighted water withdrawal, acidifying and eutrophying emissions) to assess how diets have performed in supporting healthy lives in relation to environmental pollution and resource consumption across 195 countries from 1990 to 2011. We find that the health-environment efficiency of each environmental input follows a nonlinear path along the Socio-Demographic Index gradient representing different development levels. Health-environment efficiency first increases thanks to the elimination of child and maternal malnutrition through greater food supply, then decreases driven by additional environmental impacts from a shift to animal products, and finally shows a slow growth in some developed countries again as they shift towards healthier diets.
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Affiliation(s)
- Pan He
- School of Earth and Environmental Sciences, Cardiff University, Cardiff, UK.
- Department of Earth System Science, Tsinghua University, Beijing, China.
| | - Zhu Liu
- Department of Earth System Science, Tsinghua University, Beijing, China.
- Institute for Climate and Carbon Neutrality and Department of Geography, University of Hong Kong, Pok Fu Lam, Hong Kong.
| | - Giovanni Baiocchi
- Department of Geographical Science, University of Maryland, College Park, MD, USA
| | - Dabo Guan
- Department of Earth System Science, Tsinghua University, Beijing, China
- The Bartlett School of Sustainable Construction, University College London, London, UK
| | - Yan Bai
- School of Public Affairs, Zhejiang University, Hangzhou, China
- Development Data Group, the World Bank, Washington, DC, USA
| | - Klaus Hubacek
- Integrated Research on Energy, Environment & Society (IREES) at the Energy Sustainability Research Institute Groningen (ESRIG), University of Groningen, Groningen, the Netherlands
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Tian X, Lin F. Trade liberalization and nutrition transition: Evidence from China. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101304. [PMID: 37716138 DOI: 10.1016/j.ehb.2023.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/18/2023]
Abstract
We examine the impact of trade liberalization on the nutrition transition between 1997 and 2011. Our findings demonstrate that the reduction in tariff rates has had a significant effect on the dietary patterns of both rural and urban residents in the country. With the decrease in tariffs, there has been a noticeable increase in the consumption of animal products (such as meat and aquatic products), vegetables, beans and nuts, as well as packaged and processed foods. Simultaneously, there has been a decrease in the demand for staple foods, fruits, and dairy products. Consequently, there has been an increase in the proportion of overall calories derived from fat and protein, while the proportion from staple foods has declined. As a result, trade liberalization has led to increased food expenditure, while reducing the cost of maintaining a healthy diet. Furthermore, trade liberalization has also contributed to a growing risk of obesity. Additionally, our study identifies rising incomes, specialization in agricultural production, changing food prices, and shifting food preferences as the primary mechanisms of the trade-diet relationship.
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Affiliation(s)
- Xu Tian
- Academy of Global Food Economics and Policy & College of Economics and Management, China Agricultural University, China
| | - Faqin Lin
- Academy of Global Food Economics and Policy & College of Economics and Management, China Agricultural University, China.
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Townsend B, Tenni BF, Goldman S, Gleeson D. Public health advocacy strategies to influence policy agendas: lessons from a narrative review of success in trade policy. Global Health 2023; 19:60. [PMID: 37612767 PMCID: PMC10463651 DOI: 10.1186/s12992-023-00960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Despite accumulating evidence of the implications of trade policy for public health, trade and health sectors continue to operate largely in silos. Numerous barriers to advancing health have been identified, including the dominance of a neoliberal paradigm, powerful private sector interests, and constraints associated with policymaking processes. Scholars and policy actors have recommended improved governance practices for trade policy, including: greater transparency and accountability; intersectoral collaboration; the use of health impact assessments; South-South networking; and mechanisms for civil society participation. These policy prescriptions have been generated from specific cases, such as the World Trade Organization's Doha Declaration on TRIPS and Public Health or specific instances of trade-related policymaking at the national level. There has not yet been a comprehensive analysis of what enables the elevation of health goals on trade policy agendas. This narrative review seeks to address this gap by collating and analysing known studies across different levels of policymaking and different health issues. RESULTS Sixty-five studies met the inclusion criteria and were included in the review. Health issues that received attention on trade policy agendas included: access to medicines, food nutrition and food security, tobacco control, non-communicable diseases, access to knowledge, and asbestos harm. This has occurred in instances of domestic and regional policymaking, and in bilateral, regional and global trade negotiations, as well as in trade disputes and challenges. We identified four enabling conditions for elevation of health in trade-related policymaking: favourable media attention; leadership by trade and health ministers; public support; and political party support. We identified six strategies successfully used by advocates to influence these conditions: using and translating multiple forms of evidence, acting in coalitions, strategic framing, leveraging exogenous factors, legal strategy, and shifting forums. CONCLUSION The analysis demonstrates that while technical evidence is important, political strategy is necessary for elevating health on trade agendas. The analysis provides lessons that can be explored in the wider commercial determinants of health where economic and health interests often collide.
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Affiliation(s)
- Belinda Townsend
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia.
| | - Brigitte Frances Tenni
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
- Nossal Institute for Global Health, The School of Population and Global Health, The University of Melbourne, Carlton, VIC, 3010, Australia
| | - Sharni Goldman
- Australian Research Centre for Health Equity, School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, 3086, Australia
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Roux N, Kaufmann L, Bhan M, Le Noe J, Matej S, Laroche P, Kastner T, Bondeau A, Haberl H, Erb K. Embodied HANPP of feed and animal products: Tracing pressure on ecosystems along trilateral livestock supply chains 1986-2013. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158198. [PMID: 36028028 DOI: 10.1016/j.scitotenv.2022.158198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The global livestock system puts increasing pressures on ecosystems. Studies analyzing the ecological impacts of livestock supply chains often explain this pressure by the increasing demand for animal products. Food regime theory proposes a more nuanced perspective: it explains livestock-related pressures on ecosystems by systemic changes along the supply chains of feed and animal products, notably the liberalization of agricultural trade. This study proposes a framework supporting empirical analyses of such claims by differentiating several steps of livestock supply chains. We reconstructed "trilateral" livestock supply chains linking feed production, livestock farming, and final consumption, based on the global flows of 161 feed and 13 animal products between 222 countries from 1986 to 2013. We used the embodied Human Appropriation of Net Primary Production (eHANPP) indicator to quantify pressures on ecosystems linked to these trilateral livestock supply chains. We find that livestock induced 65 % of agriculture's pressure on ecosystems, mostly through cattle grazing. Between 1986 and 2013, the fraction of livestock-related eHANPP that was traded internationally doubled from 7.1 % to 15.6 %. eHANPP related to the trade of feed was mostly linked to soybean imported for pig meat production, whereas eHANPP associated to traded animal products was mostly linked to cattle meat. eHANPP of traded animal products was lower but increased faster than eHANPP of feed trade. eHANPP was highest at the feed production level in South and North America, and at the consumption level in Eastern Asia. In Northern Asia and Eastern Europe, eHANPP was lowest at the animal products production level. In Western Europe, the eHANPP was equal at the animal products production and consumption levels. Our findings suggest that options to reduce livestock's pressures on ecosystems exist at all levels of the supply chain, especially by reducing the production and consumption in high-consuming countries and regulating international supply chains.
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Affiliation(s)
- Nicolas Roux
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria.
| | - Lisa Kaufmann
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria.
| | - Manan Bhan
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria.
| | - Julia Le Noe
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria; Geology Laboratory, École Normale Supérieur, PSL University, Paris, France.
| | - Sarah Matej
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria.
| | - Perrine Laroche
- Vrije Universiteit Amsterdam, Environmental Geography Group, Institute for Environmental Studies, Netherlands.
| | - Thomas Kastner
- Senckenberg Biodiversity and Climate Research Centre, Frankfurt am Main, Germany.
| | - Alberte Bondeau
- Aix-Marseille Université, Mediterranean Institute for Marine and Terrestrial Biodiversity and Ecology, France.
| | - Helmut Haberl
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria.
| | - Karlheinz Erb
- University of Natural Resources and Life Sciences, Vienna, Department of Economics and Social Sciences, Institute of Social Ecology, Schottenfeldgasse 29, 1070 Vienna, Austria.
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Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD). Int J Mol Sci 2022; 23:ijms231810814. [PMID: 36142725 PMCID: PMC9504787 DOI: 10.3390/ijms231810814] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.
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Xu P, Ye P. The Impact of Foreign Trade on Health Inequality in China: Evidence From China Family Panel Studies (CFPS). Int J Public Health 2022; 67:1605117. [PMID: 36188752 PMCID: PMC9515319 DOI: 10.3389/ijph.2022.1605117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/31/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: To assess the health inequality caused by foreign trade in China using individual self-rated health data from China Family Panel Studies (CFPS). Methods: The GMM model was used to explore the direct and indirect effects of foreign trade on health level, and the concentration index method was then used to decompose the contribution of foreign trade to health inequality. Results: The direct effect of foreign trade does not contribute to the current health inequality, although the indirect effects of trade contribute to health inequality through inequalities in income and healthcare utilization. The indirect pollution effect of trade does not cause health inequality. Subsequently, the direct effect of trade aggravates the dynamic expansion trend of health inequality, whereas the indirect effects of trade alleviate the increasing trend of health inequality. Conclusion: Although foreign trade improves the overall health level in China, it contributes to health inequality. Optimizing product structure of trade, adjusting income distribution, and enhancing medical securities for low-income groups are necessary to alleviate the health inequality caused by foreign trade.
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Affiliation(s)
- Pei Xu
- Business School, Yangzhou University, Yangzhou, China
| | - Penghao Ye
- School of Economics, Hainan Open Economy Research Institute, Hainan University, Haikou, China
- *Correspondence: Penghao Ye,
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Reeve E, Lamichhane P, McKenzie B, Waqa G, Webster J, Snowdon W, Bell C. The tide of dietary risks for noncommunicable diseases in Pacific Islands: an analysis of population NCD surveys. BMC Public Health 2022; 22:1521. [PMID: 35948900 PMCID: PMC9364577 DOI: 10.1186/s12889-022-13808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island Countries (PICTs). Methods Secondary analysis of data from 21,433 adults aged 25–69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 2002 and 2019. Outcomes of interest were changes in consumption of fruit and vegetables, hypertension, overweight and obesity, and hypercholesterolaemia over time. Also, salt intake and sugar sweetened beverage consumption for those countries that measured these. Results Over time, the proportion of adults consuming less than five serves of fruit and vegetables per day decreased in five countries, notably Tonga. From the most recent surveys, average daily intake of sugary drinks was high in Kiribati (3.7 serves), Nauru (4.1) and Tokelau (4.0) and low in the Solomon Islands (0.4). Average daily salt intake was twice that recommended by WHO in Tokelau (10.1 g) and Wallis and Futuna (10.2 g). Prevalence of overweight/obesity did not change over time in most countries but increased in Fiji and Tokelau. Hypertension prevalence increased in 6 of 8 countries. The prevalence of hypercholesterolaemia decreased in the Cook Islands and Kiribati and increased in the Solomon Islands and Tokelau. Conclusions While some Pacific countries experienced reductions in diet related NCD risk factors over time, most did not. Most Pacific adults (88%) do not consume enough fruit and vegetables, 82% live with overweight or obesity, 33% live with hypertension and 40% live with hypercholesterolaemia. Population-wide approaches to promote fruit and vegetable consumption and reduce sugar, salt and fat intake need strengthening. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13808-3.
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Affiliation(s)
- Erica Reeve
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Prabhat Lamichhane
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Briar McKenzie
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Colin Bell
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
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Pradyumna A, Mishra A, Utzinger J, Winkler MS. Health in Food Systems Policies in India: A Document Review. Int J Health Policy Manag 2022; 11:1158-1171. [PMID: 33904697 PMCID: PMC9808200 DOI: 10.34172/ijhpm.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India. METHODS This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated. RESULTS A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies). CONCLUSION We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.
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Affiliation(s)
- Adithya Pradyumna
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Azim Premji University, Bengaluru, India
| | | | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S. Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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13
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Abstract
SignificanceThe world produces enough food to nourish the global population, but inequitable distribution of food means many people remain at risk for undernutrition. Attainment of Sustainable Development Goal 2 relies on greater attention to distribution processes that match food qualities with dietary deficiencies. We explore this in the context of fisheries. Foreign fishing and international trade divert nutrients caught in marine fisheries from nutrient-insecure toward nutrient-secure nations. Where nutrient-insecure countries do benefit from foreign fishing and trade, there tends to be high vulnerability to future changes in nutrient flows arising from changes to foreign fishing and trade. This research highlights the need for greater transparency around distribution of fish and for nutrition security to be considered more centrally in development of trade agreements.
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Barlow P, Sanap R, Garde A, Winters LA, Mabhala MA, Thow AM. Reassessing the health impacts of trade and investment agreements: a systematic review of quantitative studies, 2016-20. Lancet Planet Health 2022; 6:e431-e438. [PMID: 35550082 DOI: 10.1016/s2542-5196(22)00047-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Abstract
To ensure a high level of health protection, governments must ensure that health and trade policy objectives are aligned. We conducted a systematic review of the health impacts of trade policies, including trade and investment agreements (TIAs), to provide a timely overview of this field. We systematically reviewed studies evaluating the health impacts of trade policies published between Jan 19, 2016, and July 10, 2020. Included studies were quantitative studies evaluating the impact of TIAs and trade policies on health determinants or outcomes. We evaluated methodological quality and performed a narrative synthesis. 21 of 28 067 articles identified via searches met our criteria. Methodologically strong studies found reduced child mortality, deteriorating worker health, rising supplies of sugar, ultra-processed food, tobacco, and alcohol supplies, and increased drug overdoses following trade reforms, compared with the time periods before trade reform. However, associations varied substantially across contexts and socioeconomic characteristics. Our findings show that trade policies, including TIAs, have diverse effects on health and health determinants. These effects vary substantially across contexts and socioeconomic groups. Governments seeking to adopt healthy trade policies should consider these updated findings to ensure that opportunities for health improvement are leveraged and widely shared, while harms are avoided, especially among vulnerable groups.
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Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Rujuta Sanap
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Amandine Garde
- School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - L Alan Winters
- Department of Economics, University of Sussex Business School, Brighton, UK
| | - Mzwandile A Mabhala
- Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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15
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Abstract
AbstractGlobal trade has shaped food systems over centuries, but modern trade agreements are hastening these changes and making them more complex, with implications for public health and nutrition transition. This study aimed to understand the impact of the 2018 Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on the policy space for public health nutrition in Vietnam. We conducted comparative document review and key informant interviews, and our analysis drew on a framework of policy space and the theory of advocacy coalitions. We identified 10 CPTPP sections with potential public health nutrition implications; and 50 Vietnamese policies relevant to nutrition having one or more tensions with one or more CPTPP sections. A majority of policy tensions were in sections of the CPTPP relating to technical barriers to trade and government procurement; most tensions related to protecting policy-making from vested interests. Different groups of policy actors hold different beliefs and interests on these issues, and therefore promote different framings and policy approaches. We identified two advocacy coalitions working very separately on issues affecting nutrition policy space: a trade coalition holding the policy position that free trade improves nutrition by default; and a nutrition coalition holding the policy position that nutrition should be explicitly considered in trade policy. The policy space for nutrition in Vietnam has important potential constraints through written policy, and the trade and nutrition coalitions will need to interact more regularly and constructively in order to foresee where these tensions will arise in practice, and create plans for their mitigation. This study adds to global evidence of free trade agreement impacts on nutrition policy space, and we extend previous work by explaining these actor groupings in the policy space through the theory of advocacy coalitions.
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16
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Carabello M, Wolfson JA. Mexican immigrant health advantage in metabolic syndrome? Examining the contributions of demographic, socioeconomic, and health behavior characteristics. SSM Popul Health 2021; 16:100932. [PMID: 34786450 PMCID: PMC8579146 DOI: 10.1016/j.ssmph.2021.100932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/21/2021] [Accepted: 09/25/2021] [Indexed: 01/28/2023] Open
Abstract
Although Mexican immigrants to the United States (US) have historically held health and mortality advantages over US-born groups, evolving population dynamics in Mexico paired with shifts in Mexico-US immigration patterns and policy regimes have raised new concerns about the metabolic health of recent cohorts of Mexican immigrants. Using a nationally representative sample of adults aged 20-years and older (n = 10,833) from the National Health and Nutrition Examination Study (NHANES, 1999-2016), we assess and seek to explain differences in metabolic syndrome (MetS) risk by race-ethnicity, country of origin, and duration of residence in the US and evaluate whether recent Mexican immigrants continue to exhibit a metabolic health advantage. We decompose the difference in MetS prevalence between US-born whites (45.5%) and recent Mexican immigrants (29.5%) to determine how demographic, socioeconomic, and health behavior characteristics contribute to the patterning of metabolic health. Findings reveal that recent Mexican immigrants hold a metabolic health advantage over all groups, which is accounted for by their younger age structure. Yet recent Mexican immigrants would retain a sizable age-adjusted MetS advantage if they were to achieve parity with US-born whites on education, income, and food security. To ensure that newly-arrived Mexican immigrants continue to experience historically favorable health and mortality prospects, modest policy changes could offer health-promoting protections in the form of increased economic and food security, as well as improved educational opportunities for younger immigrants.
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Affiliation(s)
- Maria Carabello
- Department of Health Management and Policy, University of Michigan – School of Public Health, Ann Arbor, MI, USA
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
- Population Studies Center, Institute of Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Julia A. Wolfson
- Department of Health Management and Policy, University of Michigan – School of Public Health, Ann Arbor, MI, USA
- Center for Human Nutrition, Department of International Health, Johns Hopkins University – Bloomberg School of Public Health, Baltimore, MD, USA
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Schmidt E, Fang P. Papua New Guinea agri-food trade and household consumption trends point towards dietary change and increased overweight and obesity prevalence. Global Health 2021; 17:135. [PMID: 34838072 PMCID: PMC8626949 DOI: 10.1186/s12992-021-00787-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Papua New Guinea (PNG) experienced positive GDP growth at approximately 4.3% per year during the last decade. With increases in overall wealth within the country, PNG is facing a double burden of malnutrition: comparatively high child stunting rates and a growing overweight and obesity epidemic. We focus on the latter by evaluating trends in agri-food import data from 2001 to 2018 and household consumption data from 2018 and 2009/10. Results The analysis presented in this paper raises three red flags. First, international food import data suggest that the demand for ultra-processed, sugar-sweetened beverages and food have increased substantially over time in PNG. Sugar-sweetened beverages dominated the largest growth in processed food imports, increasing by 23% per capita per year between 2001 and 2018. Second, households across the country with a greater food expenditure on sugar-sweetened beverages have a higher probability of an overweight child (under 5 years old). Last, the probability of soft-drink consumption in PNG increases with greater income acquisition and improved market access. While the price of a soft drink is negatively correlated with the quantity consumed, analysis suggests that total household income has a quantitatively larger (and positive) association with soft drink consumption. Conclusions Taxing (or increasing taxes on) sugar-sweetened beverages may not be a sufficient policy mechanism to curb overconsumption of soft drinks in PNG. Education and advocacy programs should be fostered that integrate improved dietary information on packaging, as well as greater access to and understanding of nutrition and diet information of common household consumption items. While increases in household income and market access are crucial to economic growth and transformation, PNG’s economic transition must be dovetailed with programs that expand and enhance health and nutrition information and education to improve household consumption decisions and overall household wellbeing. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00787-0.
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Affiliation(s)
- Emily Schmidt
- Development Strategy and Governance Division of the International Food Policy Research Institute (IFPRI), 1201 Eye St. NW, Washington, DC, 20005, USA.
| | - Peixun Fang
- Development Strategy and Governance Division of the International Food Policy Research Institute (IFPRI), 1201 Eye St. NW, Washington, DC, 20005, USA
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18
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Sobhani SR, Eini-Zinab H, Rezazadeh A. Assessing the Changes in Iranian Household Food Basket Using National Household Budget and Expenditure Survey Data, 1991-2017. Int J Prev Med 2021; 12:148. [PMID: 34912524 PMCID: PMC8631119 DOI: 10.4103/ijpvm.ijpvm_404_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of the present study was assessing the changes in Iranian household food basket. The Households Income and Expenditure Survey (HIES) data of 717,432 of Iranian households from 1991 to 2017 were used in this repeated cross-sectional study. METHODS A cross-classified random-effects modeling (CCREM) specifications of hierarchical age-period-cohort (HAPC) in two models, one without controlling for the effects of key individual characteristics, namely socioeconomic status; household size; place; and household head sex, and another one with controlling for the effect of mentioned variables, was used in the present study. RESULTS The present study showed that the equivalent to an adult male daily consumption of "total calorie" (P value = 0.0001) and "fats, oils, sugars, and sweets" (P value = 0.0002) had an increasing trend from 1991 to 2004 and a decreasing trend from 2005 to 2017 among Iranian households. The daily consumption of "bread, cereal, rice, and pasta" (P value = 0.0001) had a decreasing and "fruits" (P value = 0.0002) had a rising trend during periods. After an increasing trend for the "meat, poultry, fish, eggs, legumes, and nuts" (P value = 0.0002) and "vegetable" (P value=<0.0001) by 2004, there was a decreasing trend from 2004 to 2017, but the share of them in the total calorie consumption increased. The "dairy" (P value = 0.0002) consumption had a decreasing trend in recent years. CONCLUSIONS Iranian household food basket, during these years, had significant changes that some of them (increase in the share of the vegetables and fruits in the total calorie intake) are positive and some of them are negative (decrease in the consumption of dairy).
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Affiliation(s)
- Seyyed Reza Sobhani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hassan Eini-Zinab
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Rezazadeh
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wells JCK, Marphatia AA, Amable G, Siervo M, Friis H, Miranda JJ, Haisma HH, Raubenheimer D. The future of human malnutrition: rebalancing agency for better nutritional health. Global Health 2021; 17:119. [PMID: 34627303 PMCID: PMC8500827 DOI: 10.1186/s12992-021-00767-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/15/2021] [Indexed: 01/11/2023] Open
Abstract
The major threat to human societies posed by undernutrition has been recognised for millennia. Despite substantial economic development and scientific innovation, however, progress in addressing this global challenge has been inadequate. Paradoxically, the last half-century also saw the rapid emergence of obesity, first in high-income countries but now also in low- and middle-income countries. Traditionally, these problems were approached separately, but there is increasing recognition that they have common drivers and need integrated responses. The new nutrition reality comprises a global ‘double burden’ of malnutrition, where the challenges of food insecurity, nutritional deficiencies and undernutrition coexist and interact with obesity, sedentary behaviour, unhealthy diets and environments that foster unhealthy behaviour. Beyond immediate efforts to prevent and treat malnutrition, what must change in order to reduce the future burden? Here, we present a conceptual framework that focuses on the deeper structural drivers of malnutrition embedded in society, and their interaction with biological mechanisms of appetite regulation and physiological homeostasis. Building on a review of malnutrition in past societies, our framework brings to the fore the power dynamics that characterise contemporary human food systems at many levels. We focus on the concept of agency, the ability of individuals or organisations to pursue their goals. In globalized food systems, the agency of individuals is directly confronted by the agency of several other types of actor, including corporations, governments and supranational institutions. The intakes of energy and nutrients by individuals are powerfully shaped by this ‘competition of agency’, and we therefore argue that the greatest opportunities to reduce malnutrition lie in rebalancing agency across the competing actors. The effect of the COVID-19 pandemic on food systems and individuals illustrates our conceptual framework. Efforts to improve agency must both drive and respond to complementary efforts to promote and maintain equitable societies and planetary health.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | | | - Gabriel Amable
- Department of Geography, University of Cambridge, Cambridge, UK
| | - Mario Siervo
- School of Life Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hinke H Haisma
- Population Research Centre, Department of Demography, University of Groningen, Groningen, the Netherlands
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20
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Townsend B, Friel S, Schram A, Baum F, Labonté R. What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership. Int J Health Policy Manag 2021; 10:613-624. [PMID: 32610761 PMCID: PMC9278530 DOI: 10.34172/ijhpm.2020.80] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade domain, this article provides novel insights from policy actors into the range of factors that can enable or constrain attention to health in trade negotiations. METHODS A qualitative case study was chosen focused on Australia's participation in the Trans-Pacific Partnership (TPP) negotiations and the domestic agenda-setting processes that shaped the government's negotiating mandate. Process tracing via document analysis of media reporting, parliamentary records and government inquiries identified key events during Australia's participation in the TPP negotiations. Semi-structured interviews were undertaken with 25 key government and non-government policy actors including Federal politicians, public servants, representatives from public interest nongovernment organisations and industry associations, and academic experts. RESULTS Interviews revealed that domestic concerns for protecting regulatory space for access to generic medicines and tobacco control emerged onto the Australian government's trade agenda. This contrasted with other health issues like alcohol control and nutrition and food systems that did not appear to receive attention. The analysis suggests sixteen key factors that shaped attention to these different health issues, including the strength of exporter interests; extent of political will of Trade and Health Ministers; framing of health issues; support within the major political parties; exogenous influencing events; public support; the strength of available evidence and the presence of existing domestic legislation and international treaties, among others. CONCLUSION These findings aid understanding of the factors that can enable or constrain attention to health issues on government trade agendas, and offer insights for potential pathways to elevate greater attention to health in future. They provide a suite of conditions that appear to shape attention to health outside the biomedical health domain for further research in the commercial determinants of health.
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Affiliation(s)
- Belinda Townsend
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Sharon Friel
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Ashley Schram
- School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Department of Public Health, Flinders University, Adelaide, SA, Australia
| | - Ronald Labonté
- Institute of Population Health, University of Ottawa, Ottawa, ON, Canada
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How food companies use social media to influence policy debates: a framework of Australian ultra-processed food industry Twitter data. Public Health Nutr 2021; 24:3124-3135. [PMID: 33222709 PMCID: PMC9884788 DOI: 10.1017/s1368980020003353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To understand if, and how, Australian ultra-processed food industry actors use Twitter to influence food and health policy debates and produce a conceptual framework to describe such influence. DESIGN Twitter data of prominent industry actors were defined through purposive sampling and inductively coded to investigate possible influence on food and health policy debates. These are described using descriptive statistics and coded extracts. SETTING Australia. PARTICIPANTS Twitter accounts of nine prominent ultra-processed food industry actors, including major trade associations. RESULTS Ultra-processed food industry actors actively used Twitter to influence food and health policy debates. Seven overarching strategies were identified: co-opting public health narratives; opposing regulation; supporting voluntary, co- or self-regulation; engaging policy processes and decision-makers; linking regulatory environments to the need for ongoing profitability; affecting public perceptions and value judgements; and using ignorance claims to distort policy narratives. Each lobbying strategy is underpinned with tactics described throughout and captured in a framework. CONCLUSIONS The current study creates a framework to monitor how food industry actors can use social media to influence food and health policy debates. As such, social media appears to be not only an important commercial determinant of health for brand marketing, but also an extension of lobbying practices to reshape public perceptions of corporate conduct and policy-making.
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Geyik O, Hadjikakou M, Karapinar B, Bryan BA. Does global food trade close the dietary nutrient gap for the world's poorest nations? GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100490] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Janowska-Miasik E, Waśkiewicz A, Witkowska AM, Drygas W, Markhus MW, Zujko ME, Kjellevold M. Diet quality in the population of Norway and Poland: differences in the availability and consumption of food considering national nutrition guidelines and food market. BMC Public Health 2021; 21:319. [PMID: 33563240 PMCID: PMC7871600 DOI: 10.1186/s12889-021-10361-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/31/2021] [Indexed: 12/03/2022] Open
Abstract
Background Adequate nutrition is a public health challenge due to the increase in the incidence of diet-related diseases. The aim of this study was to examine food and nutrient intakes in the light of the current dietary guidelines of Poland and Norway. This is a suitable model for studying the diet quality in countries with different degrees of government intervention in the food market, which may affect food diversity available for citizens. Methods The food diversity on the market was assessed using national food balance sheets. To show the actual food and nutrient intake within countries, data from 24-h recalls from the national surveys, NORKOST 3 from Norwegians and WOBASZ II from Poles, were used. In order to evaluate whether dietary patterns comply with nutritional and dietary recommendations, the Norwegian and Polish recommendations for nutrition and the national food based dietary guidelines (FBDGs) were analyzed. Results Significant differences between the national supplies for most food products were found. Only subtle differences in the national FBDGs and nutritional recommendations were found. Low compliance with the national FBDGs for milk, fish and sugar consumption in Poland was observed. The intakes of most nutrients were in line with the countries’ nutrition recommendations. The intakes of folate and vitamin D by both genders and the intake of iron among women, were inadequate in both countries. Calcium and magnesium intakes were below the recommended intake among the adult population of Poland, additionally, insufficient intake of potassium and thiamine was found among Polish women. Conclusions Despite the limited availability of certain food products on the market, the diet of Norwegians was better balanced in terms of food consumed and micronutrient intakes. The good supply of various groups of food has not, however, reduced the problem of widespread deficiency of vitamin D and folic acid in the diet, and action should be taken at national level to eliminate their inadequacy. In view of increasing risk of non-communicable diseases, low compliance with the dietary guidelines requires educational campaigns aimed at increasing dietary literacy in vulnerable groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10361-3.
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Affiliation(s)
| | - Anna Waśkiewicz
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland
| | - Anna Maria Witkowska
- Department of Food Biotechnology, Faculty of Health Sciences, Medical University of Bialystok, Szpitalna 37, 15-295, Bialystok, Poland
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.,Department of Social and Preventive Medicine, Faculty of Health Sciences, Medical University of Lodz, Hallera 1, 90-001, Lodz, Poland
| | - Maria Wik Markhus
- Institute of Marine Research, P.O. Box 1870, NO-5817, Bergen, Nordnes, Norway
| | - Małgorzata Elżbieta Zujko
- Department of Food Biotechnology, Faculty of Health Sciences, Medical University of Bialystok, Szpitalna 37, 15-295, Bialystok, Poland
| | - Marian Kjellevold
- Institute of Marine Research, P.O. Box 1870, NO-5817, Bergen, Nordnes, Norway.
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24
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Coutinho JG, Delmuè DCC, Recine E. Better nutrition, better lives: Countries' positioning to fight all forms of malnutrition. Rev Panam Salud Publica 2020; 44:e126. [PMID: 33165401 PMCID: PMC7603355 DOI: 10.26633/rpsp.2020.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To identify how countries have positioned themselves to fight against all forms of malnutrition. Methods Qualitative, exploratory, and descriptive study of the statements of 91 out of the 127 (71.7%) countries that issued declarations in the Second International Conference on Nutrition. Results According to the analysis of the official statements from the Conference, countries still responded to nutrition issues in a traditional way. Food systems were part of the narrative and mentioned as part of the problem and solution, but little thought was given to their determinants. Conclusions The Decade of Action on Nutrition is spurred on by the urgent need to coordinate global endeavors in the fight against malnutrition and could aggregate efforts in prioritizing actions to address the determinants rather than the biological outcomes of malnutrition-which requires commitments-; and strengthening the countries' ability to implement robust regulatory measures. These measures could be empowered through efforts across different levels, making use of multilateral spaces, and through strengthening civil society participation, including developing better mechanisms for the recognition and control of conflicts of interest across different political spaces.
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Affiliation(s)
| | | | - Elisabetta Recine
- University of Brasilia Brasília Brazil University of Brasilia, Brasília, Brazil
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25
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Béné C, Fanzo J, Prager SD, Achicanoy HA, Mapes BR, Alvarez Toro P, Bonilla Cedrez C. Global drivers of food system (un)sustainability: A multi-country correlation analysis. PLoS One 2020; 15:e0231071. [PMID: 32243471 PMCID: PMC7122815 DOI: 10.1371/journal.pone.0231071] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/08/2020] [Indexed: 11/29/2022] Open
Abstract
At present, our ability to comprehend the dynamics of food systems and the consequences of their rapid 'transformations' is limited. In this paper, we propose to address this gap by exploring the interactions between the sustainability of food systems and a set of key drivers at the global scale. For this we compile a metric of 12 key drivers of food system from a globally-representative set of low, middle, and high-income countries and analyze the relationships between these drivers and a composite index that integrates the four key dimensions of food system sustainability, namely: food security & nutrition, environment, social, and economic dimensions. The two metrics highlight the important data gap that characterizes national systems' statistics-in particular in relation to transformation, transport, retail and distribution. Spearman correlations and Principal Component Analysis are then used to explore associations between levels of sustainability and drivers. With the exception of one economic driver (trade flows in merchandise and services), the majority of the statistically significant correlations found between food system sustainability and drivers appear to be negative. The fact that most of these negative drivers are closely related to the global demographic transition that is currently affecting the world population highlights the magnitude of the challenges ahead. This analysis is the first one that provides quantitative evidence at the global scale about correlations between the four dimensions of sustainability of our food systems and specific drivers.
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Affiliation(s)
- Christophe Béné
- Decision and Policy Analysis Program, International Center for Tropical Agriculture, Cali, Colombia
| | - Jessica Fanzo
- School of Advanced International Studies, Johns Hopkins University, Washington, DC, United States of America
| | - Steven D. Prager
- Decision and Policy Analysis Program, International Center for Tropical Agriculture, Cali, Colombia
| | - Harold A. Achicanoy
- Decision and Policy Analysis Program, International Center for Tropical Agriculture, Cali, Colombia
| | - Brendan R. Mapes
- Frederick S. Pardee Center for International Futures, University of Denver, Denver, CO, United States of America
| | - Patricia Alvarez Toro
- Decision and Policy Analysis Program, International Center for Tropical Agriculture, Cali, Colombia
| | - Camila Bonilla Cedrez
- Department of Environmental Science and Policy, University of California, Davis, CA, United States of America
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Kummu M, Kinnunen P, Lehikoinen E, Porkka M, Queiroz C, Röös E, Troell M, Weil C. Interplay of trade and food system resilience: Gains on supply diversity over time at the cost of trade independency. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100360] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Friel S, Schram A, Townsend B. The nexus between international trade, food systems, malnutrition and climate change. ACTA ACUST UNITED AC 2020. [DOI: 10.1038/s43016-019-0014-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Predanocyová K, Kubicová Ľ, Kádeková Z, Košičiarová I. Key factors affecting consumption of meat and meat products from perspective of Slovak consumers. POTRAVINARSTVO 2019. [DOI: 10.5219/1198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nowadays, meat and meat products are considered as a part of the daily diet of most people. Therefore, it is necessary to deal with meat and meat products and their consumption according to individual types of meat. Based on the above, the paper is focused on the issue of consumption of individual types of meat in the Slovak Republic and the identification of key factors affecting the consumption of meat and meat products from Slovak consumers' point of view. Secondary and primary data is used to fulfil the aim of the paper. Secondary data is obtained from the Statistical Office of the Slovak Republic, on the basis of which the development of consumption of individual types of meat is predicted by 2020. It can be stated that poultry and pork meat and meat products consumption is constantly increasing and there is a slight change in beef and fish meat and meat products consumption, which is currently at a very low level. In the context of the above, a questionnaire survey is realised and based on its results it could be concluded that the price is a main reason for the inadequate consumption of different types of meat. However, consumers consume meat and meat products mainly because of taste, which can be considered as an aspect of irrationality in the diet of Slovak consumers. Furthermore, a number of factors affecting the purchase and consumption of meat and meat products have been identified. The results show rational and irrational aspects in the decision making of Slovak consumers. The most important factor is the quality of meat and meat products, which consumers perceive differently, mainly on the basis of their own personality and other aspects of meat quality (price, origin, freshness, and sensory characteristics of meat). Other important factors are the perception of composition, freshness, price and country of origin.
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Understanding food systems drivers: A critical review of the literature. GLOBAL FOOD SECURITY 2019. [DOI: 10.1016/j.gfs.2019.04.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Werner M, Isa Contreras P, Mui Y, Stokes-Ramos H. International trade and the neoliberal diet in Central America and the Dominican Republic: Bringing social inequality to the center of analysis. Soc Sci Med 2019; 239:112516. [PMID: 31513933 DOI: 10.1016/j.socscimed.2019.112516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Scholarship on international trade and health analyzes the effects of trade and investment policies on population exposure to non-nutritious foods. These policies are linked to the nutrition transition, or the dietary shift towards meat and processed foods associated with rising overweight and obesity rates in low- and middle-income countries. We argue for expanding the trade and health literature's focus on population exposure through the concept of the neoliberal diet, which centers subnational social inequality as both an outcome of neoliberal agri-food trade policies and a determinant of dietary change. We develop this perspective through a regional analysis of non-nutritious food availability following the implementation of the Dominican Republic-Central America Free Trade Agreement (CAFTA-DR), together with an extended case study, from the late 1990s to the present, of household expenditure and food price changes in the Dominican Republic, the region's largest food importer. Our analysis demonstrates that low-income consumers face increasing household food expenditures in a context of overall food price inflation, in addition to relatively higher price increases for healthy versus ultraprocessed foods. Neoliberal policies not only contribute to restructuring the availability and pricing of healthy food for low-income consumers, but they also exacerbate social inequality in the food system through corporate-controlled supply chains and farmer displacement. Our findings support policy proposals for socially distributive forms of healthy food production to stem the negative effects of the nutrition transition.
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Affiliation(s)
- Marion Werner
- Department of Geography, 105 Wilkeson Quad, University at Buffalo-SUNY, Buffalo, NY 14261, United States.
| | - Pavel Isa Contreras
- Instituto Tecnológico de Santo Domingo (INTEC), Avenida de Los Próceres #49, Los Jardines del Norte 10602, Santo Domingo, Dominican Republic.
| | - Yeeli Mui
- Community of Excellence in Global Health Equity, 220 Hayes Hall, University at Buffalo, SUNY, Buffalo, NY 14214, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
| | - Hannah Stokes-Ramos
- Department of Geography, 105 Wilkeson Quad, University at Buffalo-SUNY, Buffalo, NY 14261, United States.
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Sarfati D, Dyer R, Sam FAL, Barton M, Bray F, Buadromo E, Ekeroma A, Foliaki S, Fong J, Herman J, Huggins L, Maoate K, Meredith I, Mola G, Palafox N, Puloka V, Shin HR, Skeen J, Snowdon W, Tafuna'i M, Teng A, Watters D, Vivili P. Cancer control in the Pacific: big challenges facing small island states. Lancet Oncol 2019; 20:e475-e492. [PMID: 31395476 PMCID: PMC7746436 DOI: 10.1016/s1470-2045(19)30400-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 01/03/2023]
Abstract
This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Filipina Amosa-Lei Sam
- Pathology Department, Tupua Tamasese Meaole Hospital, Private Bag National Health Services, Apia, Samoa
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, NSW, Australia
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Eka Buadromo
- Pathology Department, Vaiola Hospital, Nuku'alofa, Tonga
| | - Alec Ekeroma
- Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa; Department of Obstetrics and Gynaecology, University of Otago, Wellington, New Zealand
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - James Fong
- Obstetrics and Gynaecology Unit, Colonial War Memorial Hospital, Ministry of Health, Suva, Fiji; Department of Obstetrics and Gynaecology, Fiji National University, Suva, Fiji
| | | | - Linda Huggins
- Palliative Care Services, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand
| | - Kiki Maoate
- Department of Paediatric Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | - Ineke Meredith
- Department of Surgery, Capital; Coast District Health Board, Wellington Regional Hospital, Wellington, New Zealand
| | - Glen Mola
- Department of Obstetrics, Gynaecology and Reproductive Health, Port Moresby General Hospital, Port Moresby, Papua New Guinea; School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Viliami Puloka
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand; Health Promotion Forum of New Zealand, Auckland, New Zealand
| | - Hai-Rim Shin
- Non-communicable Disease and Health Promotion, Western Pacific Regional Office, World Health Organization, Manila, Philippines
| | - Jane Skeen
- Starship Blood and Cancer Centre, Starship Children's Health, Auckland, New Zealand
| | - Wendy Snowdon
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Malama Tafuna'i
- Department of Obstetrics and Gynaecology, National University of Samoa, Apia, Samoa
| | - Andrea Teng
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - David Watters
- Deakin University and Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Paula Vivili
- Public Health Division, Pacific Community, Noumea, New Caledonia
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O'Meara L, Williams SL, Hickes D, Brown P. Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji. Nutrients 2019; 11:E1629. [PMID: 31319537 PMCID: PMC6683282 DOI: 10.3390/nu11071629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/04/2019] [Accepted: 07/12/2019] [Indexed: 01/01/2023] Open
Abstract
Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity.
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Affiliation(s)
- Lydia O'Meara
- Department of Medical Sciences, School of Health, Medical and Applied Sciences, CQUniversity, Shield and Abbott Streets, Cairns QLD 4870, Australia.
| | - Susan L Williams
- Department of Physical Research Group, Appleton Institute, School of Health, Medical and Applied Sciences, CQUniversity, Bruce Highway, Rockhampton QLD 4702, Australia
| | - David Hickes
- Secretariat of the Pacific Community, Sigatoka Agriculture Research Station, Sigatoka, Fiji
| | - Philip Brown
- Department of Agriculture, Science and the Environment, School of Health, Medical and Applied Sciences, CQUniversity, 6 University Drive, Bundaberg QLD 4670, Australia
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Boysen O, Boysen-Urban K, Bradford H, Balié J. Taxing highly processed foods: What could be the impacts on obesity and underweight in sub-Saharan Africa? WORLD DEVELOPMENT 2019; 119:55-67. [PMID: 31274950 PMCID: PMC6559279 DOI: 10.1016/j.worlddev.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2019] [Indexed: 06/01/2023]
Abstract
The consumption of highly processed food has been singled out as one of the factors responsible for the rapidly increasing prevalence of obesity and its associated non-communicable diseases and costs. While obesity prevalence is still comparatively low in lower-income sub-Saharan Africa (SSA), development prospects in this region render markets especially attractive for these foods, whose consumption is already growing at higher rates than in developed countries. This might be reflected in the massive rise in obesity prevalence growth rates in SSA over the past decade, while many of these countries are simultaneously struggling with high undernutrition prevalence. Using a newly constructed cross-country panel dataset, this study econometrically investigates the effect of higher import tariffs on highly processed vis-à-vis less-processed foods with respect to their impacts on obesity and underweight prevalence in the adult population. While the analysis is global, the discussion focuses primarily on SSA. The effects of the tariff differences are found to be significant and substantial and to differ by income level of the country as well as by gender. More generally, the results show that policies affecting the consumer price differential between the two food groups are effective in influencing obesity and underweight prevalence and that these two issues cannot be treated separately.
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Affiliation(s)
- Ole Boysen
- School of Agriculture & Food Science and Geary Institute for Public Policy, University College Dublin, Ireland
| | - Kirsten Boysen-Urban
- Department of International Agricultural Trade & Food Security, University of Hohenheim, Stuttgart, Germany
| | - Harvey Bradford
- Foreign Agricultural Service, United States Department of Agriculture (USDA), Ottawa, Canada
| | - Jean Balié
- Agri-food Policy Platform, International Rice Research Institute, Los Baños, Laguna, Philippines
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D'Innocenzo S, Biagi C, Lanari M. Obesity and the Mediterranean Diet: A Review of Evidence of the Role and Sustainability of the Mediterranean Diet. Nutrients 2019; 11:E1306. [PMID: 31181836 PMCID: PMC6627690 DOI: 10.3390/nu11061306] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023] Open
Abstract
Several different socio-economic factors have caused a large portion of the population to adopt unhealthy eating habits that can undermine healthcare systems, unless current trends are inverted towards more sustainable lifestyle models. Even though a dietary plan inspired by the principles of the Mediterranean Diet is associated with numerous health benefits and has been demonstrated to exert a preventive effect towards numerous pathologies, including obesity, its use is decreasing and it is now being supplanted by different nutritional models that are often generated by cultural and social changes. Directing governments' political actions towards spreading adherence to the Mediterranean Diet's principles as much as possible among the population could help to tackle the obesity epidemic, especially in childhood. This document intends to reiterate the importance of acting in certain age groups to stop the spread of obesity and proceeds with a critical review of the regulatory instruments used so far, bearing in mind the importance of the scientific evidence that led to the consideration of the Mediterranean Diet as not just a food model, but also as the most appropriate regime for disease prevention, a sort of complete lifestyle plan for the pursuit of healthcare sustainability.
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Affiliation(s)
- Santa D'Innocenzo
- Prochild Project, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Carlotta Biagi
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
| | - Marcello Lanari
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.
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Nisbett N. Understanding the nourishment of bodies at the centre of food and health systems – systemic, bodily and new materialist perspectives on nutritional inequity. Soc Sci Med 2019; 228:9-16. [DOI: 10.1016/j.socscimed.2019.02.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/23/2019] [Accepted: 02/24/2019] [Indexed: 01/01/2023]
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Using multiple correspondence analysis to identify behaviour patterns associated with overweight and obesity in Vanuatu adults. Public Health Nutr 2019; 22:1533-1544. [DOI: 10.1017/s1368980019000302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveThe present study evaluates the use of multiple correspondence analysis (MCA), a type of exploratory factor analysis designed to reduce the dimensionality of large categorical data sets, in identifying behaviours associated with measures of overweight/obesity in Vanuatu, a rapidly modernizing Pacific Island country.DesignStarting with seventy-three true/false questions regarding a variety of behaviours, MCA identified twelve most significantly associated with modernization status and transformed the aggregate binary responses of participants to these twelve questions into a linear scale. Using this scale, individuals were separated into three modernization groups (tertiles) among which measures of body fat were compared and OR for overweight/obesity were computed.SettingVanuatu.ParticipantsNi-Vanuatu adults (n 810) aged 20–85 years.ResultsAmong individuals in the tertile characterized by positive responses to most of or all the twelve modernization questions, weight and measures of body fat and the likelihood that measures of body fat were above the US 75th percentile were significantly greater compared with individuals in the tertiles characterized by mostly or partly negative responses.ConclusionsThe study indicates that MCA can be used to identify individuals or groups at risk for overweight/obesity, based on answers to simply-put questions. MCA therefore may be useful in areas where obtaining detailed information about modernization status is constrained by time, money or manpower.
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Cuevas García-Dorado S, Cornselsen L, Smith R, Walls H. Economic globalization, nutrition and health: a review of quantitative evidence. Global Health 2019; 15:15. [PMID: 30786909 PMCID: PMC6381642 DOI: 10.1186/s12992-019-0456-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/04/2019] [Indexed: 12/31/2022] Open
Abstract
Background Unhealthy dietary patterns have in recent decades contributed to an endemic-level burden from non-communicable disease (NCDs) in high-income countries. In low- and middle-income countries rapid changes in diets are also increasingly linked to malnutrition in all its forms as persistent undernutrition and micronutrient deficiencies continue to coexist with a rising prevalence of obesity and associated NCDs. Economic globalization and trade liberalization have been identified as potentially important factors driving these trends, but the mechanisms, pathways and actual impact are subject to continued debate. Methods We use a ‘rigorous review’ to synthesize evidence from empirical quantitative studies analysing the links between economic globalization processes and nutritional outcomes, with a focus on impact as well as improving the understanding of the main underlying mechanisms and their interactions. Findings While the literature remains mixed regarding the impacts of overall globalization, trade liberalization or economic globalization on nutritional outcomes, it is possible to identify different patterns of association and impact across specific sub-components of globalization processes. Although results depend on the context and methods of analysis, foreign direct investment (FDI) appears to be more clearly associated with increases in overnutrition and NCD prevalence than to changes in undernutrition. Existing evidence does not clearly show associations between trade liberalization and NCD prevalence, but there is some evidence of a broad association with improved dietary quality and reductions in undernutrition. Socio-cultural aspects of globalization appear to play an important yet under-studied role, with potential associations with increased prevalence of overweight and obesity. The limited evidence available also suggests that the association between trade liberalization or globalization and nutritional outcomes might differ substantially across population sub-groups. Overall, our findings suggest that policymakers do not necessarily face a trade-off when considering the implications of trade or economic liberalization for malnutrition in all its forms. On the contrary, a combination of nutrition-sensitive trade policy and adequate regulation of FDI could help reduce all forms of malnutrition. In the context of trade negotiations and agreements it is fundamental, therefore, to protect the policy space for governments to adopt nutrition-sensitive interventions. Electronic supplementary material The online version of this article (10.1186/s12992-019-0456-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Soledad Cuevas García-Dorado
- Leverhulme Centre for Integrate Research on Agriculture and Health, 36 Gordon Square, London, WC1H 0PD, UK. .,SOAS, University of London, Bloomsbury, London, WC1H 0XG, UK.
| | - Laura Cornselsen
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.,Leverhulme Centre for Integrate Research on Agriculture and Health, 36 Gordon Square, London, WC1H 0PD, UK
| | - Richard Smith
- University of Exeter, Stocker Rd, Exeter, EX4 4PY, UK
| | - Helen Walls
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.,Leverhulme Centre for Integrate Research on Agriculture and Health, 36 Gordon Square, London, WC1H 0PD, UK
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The interface between consumers and their food environment in Myanmar: an exploratory mixed-methods study. Public Health Nutr 2018; 22:1075-1088. [PMID: 30561292 PMCID: PMC6536824 DOI: 10.1017/s1368980018003427] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objective To examine consumers’ perceptions of their food environments, their food consumption patterns and preferences, and to better understand the attributes of foods that are available within food environments in Myanmar. Design An exploratory mixed-methods study using a combination of focus group discussions, market and consumer surveys. Setting Four study settings in Myanmar were included: an upper-income township of Yangon; a lower-income township of Yangon; a middle-income township in the southern Myanmar town of Dawei; and a lower-income village in the country’s dry zone of Magway. Participants Thirty-two women participated in the focus groups discussions, twenty market surveys were conducted and 362 consumers (both men and women) completed food consumption surveys. Results Focus group participants indicated that the availability of a diverse range of foods had increased over time, while the quality of foods had decreased. Health was seen primarily through the lens of food safety and there was an overall lack of knowledge about which foods were more or less healthy. Consumers preferred fruits, vegetables and red meat compared with highly processed snack foods/beverages. Although consumers reported low intakes of highly processed snack foods, Burmese street food was consumed in high quantities. The market surveys suggested that fresh, minimally processed and highly processed foods were available at all markets across the study settings. Conclusions Consumers are exposed to a variety of foods, of varying quality, within their food environments in Myanmar. Interventions aimed at increasing consumer knowledge regarding healthy diets and improving food safety are needed.
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Cantor AR, Chan I, Baines K. From the Chacrato the Tienda: Dietary delocalization in the Peruvian Andes. FOOD AND FOODWAYS 2018. [DOI: 10.1080/07409710.2018.1490376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Allison R. Cantor
- Department of Anthropology, New Mexico State University, Las Cruces, New Mexico, USA
| | - Isabella Chan
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Kristina Baines
- City University of New York, Guttman CC, New York City, New York, USA
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40
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Popkin BM, Reardon T. Obesity and the food system transformation in Latin America. Obes Rev 2018; 19:1028-1064. [PMID: 29691969 PMCID: PMC6103889 DOI: 10.1111/obr.12694] [Citation(s) in RCA: 246] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/01/2018] [Accepted: 03/16/2018] [Indexed: 02/06/2023]
Abstract
The Latin America and the Caribbean (LAC) region faces a major diet-related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less-healthful low-nutrient-density foods and sugary beverages, changes in away-from-home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two-way causality with, changes in the broad food system - the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely 'two ships passing in the night'. This review documents in-depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a 'double-edged sword', showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de-seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long-run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes. We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand-related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.
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Affiliation(s)
- B M Popkin
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Reardon
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA
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Schram A, Ruckert A, VanDuzer JA, Friel S, Gleeson D, Thow AM, Stuckler D, Labonte R. A conceptual framework for investigating the impacts of international trade and investment agreements on noncommunicable disease risk factors. Health Policy Plan 2018; 33:123-136. [PMID: 29106574 DOI: 10.1093/heapol/czx133] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 01/18/2023] Open
Abstract
We developed a conceptual framework exploring pathways between trade and investment and noncommunicable disease (NCD) outcomes. Despite increased knowledge of the relevance of social and structural determinants of health, the discourse on NCD prevention has been dominated by individualizing paradigms targeted at lifestyle interventions. We situate individual risk factors, alongside key social determinants of health, as being conditioned and constrained by trade and investment policy, with the aim of creating a more comprehensive approach to investigations of the health impacts of trade and investment agreements, and to encourage upstream approaches to combating rising rates of NCDs. To develop the framework we employed causal chain analysis, a technique which sequences the immediate causes, underlying causes, and root causes of an outcome; and realist review, a type of literature review focussed on explaining the underlying mechanisms connecting two events. The results explore how facilitating trade in goods can increase flows of affordable unhealthy imports; while potentially altering revenues for public service provision and reshaping domestic economies and labour markets-both of which distribute and redistribute resources for healthy lifestyles. The facilitation of cross-border trade in services and investment can drive foreign investment in unhealthy commodities, which in turn, influences consumption of these products; while altering accessibility to pharmaceuticals that may mediate NCDs outcomes that result from increased consumption. Furthermore, trade and investment provisions that influence the policy-making process, set international standards, and restrict policy-space, may alter a state's propensity for regulating unhealthy commodities and the efficacy of those regulations. It is the hope that the development of this conceptual framework will encourage capacity and inclination among a greater number of researchers to investigate a more comprehensive range of potential health impacts of trade and investment agreements to generate an extensive and robust evidence-base to guide future policy actions in this area.
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Affiliation(s)
- Ashley Schram
- School of Regulation and Global Governance, Australian National University, 8 Fellows Road, Canberra, ACT 2601, Australia
| | - Arne Ruckert
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, 8 Fellows Road, Canberra, ACT 2601, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Ronald Labonte
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Mozaffarian D, Angell SY, Lang T, Rivera JA. Role of government policy in nutrition-barriers to and opportunities for healthier eating. BMJ 2018; 361:k2426. [PMID: 29898890 PMCID: PMC5997034 DOI: 10.1136/bmj.k2426] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA
| | - Sonia Y Angell
- New York City Department of Health and Mental Hygiene, New York City NY, USA
| | - Tim Lang
- School of Arts and Social Sciences, City University of London, UK
| | - Juan A Rivera
- Instituto Nacional de Salud Pública, Mexico City, Mexico
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Cowling K, Thow AM, Pollack Porter K. Analyzing the impacts of global trade and investment on non-communicable diseases and risk factors: a critical review of methodological approaches used in quantitative analyses. Global Health 2018; 14:53. [PMID: 29793510 PMCID: PMC5968469 DOI: 10.1186/s12992-018-0371-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/10/2018] [Indexed: 11/14/2022] Open
Abstract
Background A key mechanism through which globalization has impacted health is the liberalization of trade and investment, yet relatively few studies to date have used quantitative methods to investigate the impacts of global trade and investment policies on non-communicable diseases and risk factors. Recent reviews of this literature have found heterogeneity in results and a range of quality across studies, which may be in part attributable to a lack of conceptual clarity and methodological inconsistencies. Methods This study is a critical review of methodological approaches used in the quantitative literature on global trade and investment and diet, tobacco, alcohol, and related health outcomes, with the objective of developing recommendations and providing resources to guide future robust, policy relevant research. A review of reviews, expert review, and reference tracing were employed to identify relevant studies, which were evaluated using a novel quality assessment tool designed for this research. Results Eight review articles and 34 quantitative studies were identified for inclusion. Important ways to improve this literature were identified and discussed: clearly defining exposures of interest and not conflating trade and investment; exploring mechanisms of broader relationships; increasing the use of individual-level data; ensuring consensus and consistency in key confounding variables; utilizing more sector-specific versus economy-wide trade and investment indicators; testing and adequately adjusting for autocorrelation and endogeneity when using longitudinal data; and presenting results from alternative statistical models and sensitivity analyses. To guide the development of future analyses, recommendations for international data sources for selected trade and investment indicators, as well as key gaps in the literature, are presented. Conclusion More methodologically rigorous and consistent approaches in future quantitative studies on the impacts of global trade and investment policies on non-communicable diseases and risk factors can help to resolve inconsistencies of existing research and generate useful information to guide policy decisions. Electronic supplementary material The online version of this article (10.1186/s12992-018-0371-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krycia Cowling
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 380A, Baltimore, MD, 21205, USA.
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, D17 Charles Perkins Centre, Sydney, NSW, 2006, Australia
| | - Keshia Pollack Porter
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 380A, Baltimore, MD, 21205, USA
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Zhou L, Chen X, Lei L. Intra-Household Allocation of Nutrients in an Opening China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E700. [PMID: 29642513 PMCID: PMC5923742 DOI: 10.3390/ijerph15040700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
This paper uses China Health and Nutrition Survey (CHNS) data to analyze the effect of foreign direct investment (FDI) on nutrient intakes across various family roles to identify the different family roles' heterogeneous nutrition intake responses to economic openness. The empirical evidence shows that FDI enhances labor forces' calorie intake significantly, especially for rural households. The government should continue facilitating more FDI inflows, especially FDI in secondary industries for rural populations. However, the larger the family, the smaller the effect of FDI on nutrient intake for some family roles. The elderly and children may be weaker responders on nutrient intake than other family members in an open economy. This implies the existence of intra-household redistribution and that the level of effectiveness will decrease with family size. The results suggest that family members in rural areas can benefit more in terms of nutrient intake. Our empirical evidence also indicates that female family members' calorie intake from the FDI effect is higher than that of male family members (except for the granddaughter/grandson). Preferential policies should be provided for the FDI, flowing to rural areas and female dominant industries.
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Affiliation(s)
- Li Zhou
- College of Economics and Management, Nanjing Agricultural University, Nanjing 210095, Jiangsu, China.
| | - Xiaohong Chen
- College of Economics and Management, Nanjing Agricultural University, Nanjing 210095, Jiangsu, China.
| | - Lei Lei
- Institute of Developing Economies, Japan External Trade Organization, Chiba 261-8545, Japan.
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Annan RA, Apprey C, Oppong NK, Petty-Agamatey V, Mensah L, Thow AM. Public awareness and perception of Ghana's restrictive policy on fatty meat, as well as preference and consumption of meat products among Ghanaian adults living in the Kumasi Metropolis. BMC Nutr 2018; 4:2. [PMID: 32153866 PMCID: PMC7050906 DOI: 10.1186/s40795-018-0209-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background The nutrition transition, currently observed across the world is driven by trade liberalization, urbanization and more sedentary lifestyles. Ghana implemented a restrictive policy to limit the availability and access to fatty meat in the 1990s. This paper sought to determine public awareness and perception of the policy’s enforcement and impact, as well as the general attitude towards fatty meat, preference and consumption of meat types. Method A cross-sectional qualitative study was carried out among 377 adults, aged ≥18 years, living in Kumasi Metropolis in the Ashanti Region, the second largest city in Ghana. An interviewer administered structured questionnaire and a food frequency questionnaire were used for data collection. Body composition parameters were determined with OMRON body composition analyser and blood pressure was measured with a digital sphygmomanometer. Results Majority of respondents were females (62.9%), aged 18–35 years old (72.1%) and were labourers, traders or teachers (52.5%). Mean Body Mass Index of participants was 25.4 kg/m2 and percent body fat was 30.4%. Over half (58.9%) of the participants were aware of, and most (81.2%) supported the restrictions, although majority (57%) thought there was low public awareness and less than 15% felt the restrictions were well enforced. About 59.4% believed the restriction could improve health, prevent disease and reduce deaths in the long-term. Two thirds (67.1%) of the participants considered the fat content of the meat they bought and related fat to health problems (38.5%) and obesity/stroke (7.4%). Local meat products (meat produced in Ghana) were more preferred due to taste, freshness and healthiness than imported meat, but imported meat types (meat imported from other countries) were more available (56.5%), cheaper (69.5%) and regularly consumed than the local types. Conclusion There was a good level of public awareness, strong support and positive attitude towards Ghana’s restrictive food standards on meat. Although preference for local meat type was greater, imported meat was more consumed due to cost and availability. Policies which limit access to, and availability of ‘unhealthy’ food should be implemented and enforced to improve the food environment in order to help address the growing obesity and non communicable disease trend.
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Affiliation(s)
- Reginald A Annan
- 1Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Charles Apprey
- 1Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Nana Kwasi Oppong
- 1Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Vanessa Petty-Agamatey
- 1Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Laudina Mensah
- 1Department of Biochemistry and Biotechnology, College of Science, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Anne Marie Thow
- 2Menzies Centre for Health Policy, School of Public Health, University of Sydney, Camperdown, Australia
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Thow AM, Reeve E, Naseri T, Martyn T, Bollars C. Food supply, nutrition and trade policy: reversal of an import ban on turkey tails. Bull World Health Organ 2017; 95:723-725. [PMID: 29147046 PMCID: PMC5689196 DOI: 10.2471/blt.17.192468] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/12/2017] [Accepted: 07/04/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anne Marie Thow
- Menzies Centre for Health Policy, D17 Charles Perkins Centre, University of Sydney, New South Wales, 2006, Australia
| | - Erica Reeve
- Centre for Population Health Research, Deakin University, Melbourne, Australia
| | | | - Tim Martyn
- Centre for Pacific Island Studies, University of the Sunshine Coast, Queensland, Australia
| | - Caroline Bollars
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Barlow P, McKee M, Basu S, Stuckler D. Impact of the North American Free Trade Agreement on high-fructose corn syrup supply in Canada: a natural experiment using synthetic control methods. CMAJ 2017; 189:E881-E887. [PMID: 28676578 PMCID: PMC5495638 DOI: 10.1503/cmaj.161152] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND: Critics of free trade agreements have argued that they threaten public health, as they eliminate barriers to trade in potentially harmful products, such as sugar. Here we analyze the North American Free Trade Agreement (NAFTA), testing the hypothesis that lowering tariffs on food and beverage syrups that contain high-fructose corn syrup (HFCS) increased its use in foods consumed in Canada. METHODS: We used supply data from the Food and Agriculture Organization of the United Nations to assess changes in supply of caloric sweeteners including HFCS after NAFTA. We estimate the impact of NAFTA on supply of HFCS in Canada using an innovative, quasi-experimental methodology — synthetic control methods — that creates a control group with which to compare Canada’s outcomes. Additional robustness tests were performed for sample, control groups and model specification. RESULTS: Tariff reductions in NAFTA coincided with a 41.6 (95% confidence interval 25.1 to 58.2) kilocalorie per capita daily increase in the supply of caloric sweeteners including HFCS. This change was not observed in the control groups, including Australia and the United Kingdom, as well as a composite control of 16 countries. Results were robust to placebo tests and additional sensitivity analyses. INTERPRETATION: NAFTA was strongly associated with a marked rise in HFCS supply and likely consumption in Canada. Our study provides evidence that even a seemingly modest change to product tariffs in free trade agreements can substantially alter population-wide dietary behaviour and exposure to risk factors.
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Affiliation(s)
- Pepita Barlow
- Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy.
| | - Martin McKee
- Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy
| | - Sanjay Basu
- Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy
| | - David Stuckler
- Department of Sociology (Barlow), University of Oxford, Oxford, UK; Department of Public Health and Policy (McKee), London School of Hygiene and Tropical Medicine, London, UK; Stanford Prevention Research Center (Basu), Stanford University, Palo Alto, Calif; Department of Policy Analysis and Public Management (Stuckler), Bocconi University, Milan, Italy
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48
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Barlow P, McKee M, Basu S, Stuckler D. The health impact of trade and investment agreements: a quantitative systematic review and network co-citation analysis. Global Health 2017; 13:13. [PMID: 28274238 PMCID: PMC5343316 DOI: 10.1186/s12992-017-0240-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/18/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Regional trade agreements are major international policy instruments that shape macro-economic and political systems. There is widespread debate as to whether and how these agreements pose risks to public health. Here we perform a comprehensive systematic review of quantitative studies of the health impact of trade and investment agreements. We identified studies from searches in PubMed, Web of Science, EMBASE, and Global Health Online. Research articles were eligible for inclusion if they were quantitative studies of the health impacts of trade and investment agreements or policy. We systematically reviewed study findings, evaluated quality using the Quality Assessment Tool from the Effective Public Health Practice Project, and performed network citation analysis to study disciplinary siloes. RESULTS Seventeen quantitative studies met our inclusion criteria. There was consistent evidence that implementing trade agreements was associated with increased consumption of processed foods and sugar-sweetened beverages. Granting import licenses for patented drugs was associated with increased access to pharmaceuticals. Implementing trade agreements and associated policies was also correlated with higher cardiovascular disease incidence and higher Body Mass Index (BMI), whilst correlations with tobacco consumption, under-five mortality, maternal mortality, and life expectancy were inconclusive. Overall, the quality of studies is weak or moderately weak, and co-citation analysis revealed a relative isolation of public health from economics. CONCLUSION We identified limitations in existing studies which preclude definitive conclusions of the health impacts of regional trade and investment agreements. Few address unobserved confounding, and many possible consequences and mechanisms linking trade and investment agreements to health remain poorly understood. Results from our co-citation analysis suggest scope for greater interdisciplinary collaboration. Notwithstanding these limitations, our results find evidence that trade agreements pose some significant health risks. Health protections in trade and investment treaties may mitigate these impacts.
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Affiliation(s)
- Pepita Barlow
- Department of Sociology, University of Oxford, Manor Road Building, Manor Road, OX1 3UQ Oxford, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Basu
- Stanford Prevention Research Center, Stanford University, Stanford, USA
| | - David Stuckler
- Department of Sociology, University of Oxford, Manor Road Building, Manor Road, OX1 3UQ Oxford, UK
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McNamara C. Trade liberalization and social determinants of health: A state of the literature review. Soc Sci Med 2016; 176:1-13. [PMID: 28110222 DOI: 10.1016/j.socscimed.2016.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 12/02/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
The health impacts of trade liberalization are often described in relation to access to medicines, changing dietary patterns, tobacco use and alcohol consumption. The impacts of trade liberalization on the social determinants of health (SDH), are by contrast, less well known. Missing is an account of how liberalizing processes identified across different research areas relate to each other and how the association between trade liberalization and health is conceptualized within each of them, especially with reference to SDH. This paper presents a systematic review which provides a more complete picture of the pathways between trade liberalization and health, with special attention to SDH pathways. This picture captures the interrelationships between different areas of investigation, along with current limitations of our understanding and recommendations for future research.
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Affiliation(s)
- Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Building 9 Level 5, Dragvoll, 7491 Trondheim, Norway.
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50
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Mendez Lopez A, Loopstra R, McKee M, Stuckler D. Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries. Soc Sci Med 2016; 172:21-27. [PMID: 27871042 PMCID: PMC5224188 DOI: 10.1016/j.socscimed.2016.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/26/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022]
Abstract
Does trade and investment liberalisation increase the growth in sales of sugar-sweetened beverages (SSBs)? Here, for the first time to our knowledge, we test this hypothesis using a unique data source on SSB-specific trade flows. We test whether lower tariffs effectively increase imports of SSBs, and whether a higher level of imports increase sales of SSBs. Cross-national fixed effects models were used to evaluate the association between SSBs sales and trade liberalisation. SSBs per capita sales data were taken from EuroMonitor, covering 44 low- and middle-income countries from 2001 to 2014, SSBs import data were from TradeMap, Foreign Direct Investment data were from EuroMonitor, and data on applied tariffs on SSB from the World Trade Organisation tariffs database, all 2015 editions. The results show that higher tariffs on SSBs significantly decreased per capita SSB imports. Each one percent increase in tariffs was associated with a 2.9% (95% CI: 0.9%–5%) decrease in imports of SSBs. In turn, increased imports of SSBs were significantly associated with greater sales of SSBs per capita, with each 10 percent increase in imports (in US$) associated with a rise in sales of 0.36 L per person (95% CI: 0.08–0.68). Between 2001 and 2014, this amounted to 9.1 L greater sales per capita, about 40% of the overall rise seen in this period in LMICs. We observed that tariffs were inversely but not significantly associated with sales of SSBs. In conclusion, lower tariffs substantially increased imports of SSBs in LMICs, which translated into greater sales. These findings suggest that trade policies which lower tariff barriers to SSB imports can be expected to lead to increased imports and then increased sales of SSBs in LMICs, with adverse consequences for obesity and the diseases that result from it. Higher tariffs on SSBs significantly decreased per capita SSBs imports in LMICs. Increased imports of SSBs were significantly associated with greater sales of SSBs. Policies that liberalise trade of SSBs can be expected to lead to the spread SSBs.
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Affiliation(s)
- Ana Mendez Lopez
- Department of Sociology, University of Oxford, OX1 3UQ, United Kingdom.
| | - Rachel Loopstra
- Department of Sociology, University of Oxford, OX1 3UQ, United Kingdom
| | - Martin McKee
- ECOHOST, London School of Hygiene & Tropical Medicine, WC1H 9SH, United Kingdom
| | - David Stuckler
- Department of Sociology, University of Oxford, OX1 3UQ, United Kingdom
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