File Name: discus the impact of globalization on food and nutrition policy in developing countries .zip
Nutrition transition is the shift in dietary consumption and energy expenditure that coincides with economic, demographic , and epidemiological changes. Specifically the term is used for the transition of developing countries from traditional diets high in cereal and fiber to more Western pattern diets high in sugars , fat, and animal-source food.
The search strategy and document flow diagram are included as supporting data. 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.
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. The online version of this article This increased exchange of goods and services has occurred as part of a wider process of globalization, encompassing inter-related economic, social and cultural components [ 2 ]. Trade policies and globalization processes are deeply transforming societies, shaping political institutions, economic and social relationships, modes of production, consumption patterns and lifestyles.
These structural factors are increasingly recognized as important drivers of nutrition and health outcomes [ 3 — 5 ]. In particular, trade reforms and liberalization have often been linked to both under-nutrition and the rapid rise in overweight and obesity and spread of diet-related non-communicable diseases NCDs in low- and middle-income countries LMICs [ 6 , 7 ].
Increased prevalence of overweight, obesity and NCDs, however, often coexists with persistent undernutrition and micronutrient deficiency, leading to what is known as a double or triple burden of malnutrition [ 9 ]. Debate on the links between trade liberalization and nutrition can be traced back to the controversial implementation of structural adjustment programmes by the World Bank and International Monetary Fund IMF in the s [ 10 , 11 ].
This has led to the recent surge of publications that approach the issue, and increasingly so from different angles, providing new and updated evidence on the subject. Several recent reviews have mapped the pathways between trade agreements and food-related aspects of public health, including related to food environments [ 12 ], and the nutrition transition [ 13 ]. Studies have synthesized existing evidence of the impacts of agricultural trade liberalization on food security in LMICs [ 14 ], and analysed the effect of trade and investment liberalization on prevalence of NCDs in Asia [ 15 ].
There is a wide variation in terms of quality and design of the studies included in these reviews, ranging from case-studies to quantitative multi-country and natural experimental designs.
In addition, Barlow et al. To our knowledge, however, there has not been a systematic analysis and synthesis of the empirical evidence on the associations between economic globalization and liberalization processes and nutrition outcomes. The specific focus on malnutrition in all its forms is in line with recent literature calling for integrated approaches to address the growing double or triple burden of malnutrition [ 18 , 19 ].
Malnutrition in all its forms is understood to include undernutrition, micronutrient deficiencies, overweight and obesity and related NCDs [ 20 ].
This approach allows us also to explore evidence of the overlapping processes of dietary convergence-divergence that take place as food systems become increasingly integrated. This definition focuses on economic globalization, concerned with changes taking place to world trade and investment, but adopting the view that economic forces underlie and shape the overall globalization process, connecting what are sometimes described as different aspects of globalization, including socio-cultural changes and information flows [ 2 ].
We have developed a framework, shown in Fig. The framework, informed by existing theoretical works and published conceptual frameworks, [ 2 , 4 , 6 , 12 , 22 ] includes the main sub-components of globalization and the trade and investment policies underpinning the process. It depicts the impact of globalization processes on nutrition outcomes as linked through changes in food systems and food environments, as well as through impacts on national policy and regulatory space, and through the transformation of broader socio-economic factors.
Socio-economic factors also play an important role as mediators of the effect of food environment changes, resulting in heterogeneous effects across population sub-groups. Before proceeding to a description of the method used and our study findings, we will briefly describe each of the domains in Fig. Conceptual framework of the relationship between globalization, nutrition and related health outcomes.
Synthesised based on the frameworks of [ 2 , 12 , 14 ]. This pathway is shown at the top and to the right in our conceptual framework. International trade is generally understood to encompass the exchange of both goods and services across countries.
Although most of the papers included in this review tend to focus their discussion on trade in goods rather than services, perhaps implicitly assuming more relevant linkages between trade in goods and dietary and nutrition outcomes, many use composite indices that include trade in services, such as the economic component of the KOF index for globalization or its sub-components. The creation of a global market for food products has important effects on the availability and prices of food commodities.
On the production side, global markets encourage specialization in export crops, which tends to create economies of scale in agricultural and food production, leading to increased global output, but also to homogenization in the availability of food products [ 7 , 23 , 24 ].
On the demand side, countries can increase their access to a variety of goods through imports, including essential foodstuffs [ 25 ] and healthy foods [ 26 ] as well as potentially unhealthy processed and ultra-processed products [ 27 , 28 ]. The relationship between international trade and food prices is complex.
Access to international commodity markets can reduce food price volatility by diminishing the effect of local shocks. On average, trade openness has been found to lower the relative price of calorie-dense foods and animal feed [ 30 ]. Foreign direct investment FDI is an investment by which a foreign company acquires control over a new or pre-existing business.
This is to distinguish FDI from portfolio investments where investors are not involved in or have control over the day to day operations of a business [ 31 ] Like trade, FDI is also thought to play an important role in transforming food systems.
It is FDI, rather than trade, that is considered to be the currently preferred method for Transnational Food Companies TFC to enter new markets for processed foods, allowing multinationals to advertise and market their products more efficiently, creating a demand while, simultaneously, adapting to consumer characteristics [ 32 ]. Additionally, retail and marketing strategies contribute to market segmentation, which is believed to lead to a divergence in dietary patterns within countries, even as diets converge across countries.
Increased global flows of information and people can transform cultural norms, social relations, and consumption patterns. The spread of communication technology and infrastructure makes it possible for information to be shared more widely and faster, but it does not in itself explain the content, influence and directionality of the information exchange.
These are thought to be driven by economic forces operating through the expansion of large multinationals in media, communications and marketing [ 35 ]. The globalization of marketing and promotion, aided by the expansion of TFC and global marketing companies, are thought to play an important role in the integration of food markets, changing consumption patterns, and creation of a demand for new products and brands [ 36 ].
The creation of progressively integrated global markets is underpinned by trade and investment agreements and policies. The World Trade Organization WTO remains the main international organization responsible for the global rules of trade between countries. Some authors have specifically argued that trade and investment agreements can negatively affect nutritional outcomes by directly reducing the regulatory and policy space for health-promoting initiatives [ 40 , 41 ].
We have found a small number of studies that quantitatively analysed aspects of political globalization alongside measures of economic dimensions.
However, these are very partial and non-specific measures of the potential impacts of trade agreements on the policy space.
It is important to bear in mind that some of the most influential literature on this topic [ 39 , 41 ] is qualitative and was not included in this review as our focus is specifically on quantitative studies. This literature, however, does suggest that the impact of restrictions to the policy space, associated with trade liberalization processes, should not be underestimated, as it can curtail the capacity of governments to protect public health [ 42 ].
Market integration and trade and investment agreements not only affect nutrition outcomes through their impacts on the food sector. Globalization processes deeply transform all aspects of society, in ways which can indirectly affect nutrition outcomes.
Globalization has been found to be associated with GDP and income growth [ 43 , 44 ], but also to increased income inequality [ 45 ], as well as to [ 46 ] urbanization [ 47 , 48 ]. Although some mechanisms are better understood than others, all of these structural socioeconomic changes have been linked to changes in dietary patterns and should be taken into account when assessing the links between globalization and nutrition outcomes.
Systematic review methods have recently been subject to criticism regarding their inflexible application to social sciences. Critics have pointed out the considerable degree of subjectivity in the interpretation, definition and use of concepts in social sciences, as well as the importance of context, which is often ignored in traditional systematic reviews [ 17 , 52 ].
Similar arguments have been made specifically concerning reviews in public health [ 53 , 54 ]. Thus, we adhered to the principles of rigour, transparency and replicability at the core of the systematic literature review process, but followed a process that also allows for flexibility and reflexivity [ 17 ]. Importantly, in our analysis we acknowledge the subjectivity in interpretation of concepts and thus emphasise the importance of context in the interpretation of the studies and their significance for policy-making.
Type of evidence. We searched for studies containing terms related to economic globalization, trade and investment liberalization, food and food environments, and nutrition and related health outcomes as well as terms related to quantitative research methods. We complemented this with a general search on Google and Google Scholar. Searches were carried out in March We checked the reference lists of articles selected for full text review for further relevant publications.
The references were screened by two authors and any disagreements were resolved through discussion. In the first round of screening, potentially relevant articles were selected based on the general focus of the study as judged by the title and abstract. The criteria take into account the overall focus of the paper, methods, definition of globalization and nutrition outcomes, and the year and language of the publication.
Articles meeting the inclusion criteria were recorded in an Excel database including key information on context country, time frame , globalization processes observed including definitions of the processes , type and source of data analysed, statistical methods applied, and main findings and conclusions from the study. The analysis of the studies included examining findings against existing conceptual frameworks and theoretical evidence, as well as with the findings of previous reviews on similar topics.
Seven hundred fourteen articles were identified from five different databases, another 64 were retrieved from institutional websites, and 16 from additional searches on Google or Google scholar. The abstracts of all studies were screened and the full texts of 63 studies which were found to be relevant were downloaded for screening.
In addition, four relevant review studies were identified. Of the 24 articles included, 11 look at diet-related health outcomes or biomarkers, including underweight, overweight, obesity, diabetes, CVD prevalence and BMI.
A further 13 articles used context-relevant proxies of nutrition outcomes, including energy kcal intake per day, dietary diversity, and markers of dietary quality such as consumption of unhealthy food commodities, fat intake, consumption of protein and animal protein.
Half of the studies 12 out of 24 focussed on LMICs. Most studies used country level data, while only three studies used multi-level models to account for effects occurring at different levels of aggregation.
Natural experiments or difference-in-difference designs were used in three studies, and one study relied on single-country time series data. Two studies used less conventional approaches such as non-parametric correlation or structural equation modelling. Given the complex nature of the topic and the intrinsic impossibility in carrying out intervention studies, we found that rating the quality of studies was not only extremely difficult but also potentially risked over-simplification.
We present the results following the structure of the framework Fig. We also comment on the differential results across population groups, defined by the main socioeconomic variables, which moderate the impacts of globalization. Six of the studies reviewed used index measures of economic globalization [ 55 — 58 ] [ 51 , 59 ], which include flows of goods, services and investment as well as barriers to trade and investment.
Three of these studies find that economic globalization tends to reduce obesity and overweight [ 51 , 55 , 56 ] as well as caloric and fat intakes [ 56 ] although the effects are small [ 55 ] or non-significant after controlling for additional variables such as urbanization, food prices, female participation in the workforce or number of McDonalds per capita [ 56 ], which can reflect potential confounding but might also be capturing partial impact mechanisms [ 55 ].
The remaining three studies find that economic globalization has a negative impact on nutrition-related health outcomes, leading to increased diabetes [ 57 ], overweight and obesity [ 59 ] and increased BMI [ 57 , 58 ]. Oberlander et al.
The apparently contradictory findings can most likely be attributed to a certain extent to differences in the data. Moreover, studies differ in terms of the approach to estimation and methods chosen to deal with potential confounding effects.
Schram et al. Finally, while some key control variables such as income, inequality and urbanization are included in all studies, there are differences in terms of additional control variables, which can modify the interpretation of results for example, Schram et al.
In a "nutrition transition", the consumption of foods high in fats and sweeteners is increasing throughout the developing world. The transition, implicated in the rapid rise of obesity and diet-related chronic diseases worldwide, is rooted in the processes of globalization. Globalization affects the nature of agri-food systems, thereby altering the quantity, type, cost and desirability of foods available for consumption. Understanding the links between globalization and the nutrition transition is therefore necessary to help policy makers develop policies, including food policies, for addressing the global burden of chronic disease. While the subject has been much discussed, tracing the specific pathways between globalization and dietary change remains a challenge.
Not a MyNAP member yet? Register for a free account to start saving and receiving special member only perks. This chapter covers what is being done to reorient U. Department of State, U. Although these are interesting and challenging times, the issue of ending hunger must take on a renewed sense of importance and urgency.
The search strategy and document flow diagram are included as supporting data. 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.
We need greater clarity in our understanding of the globalisation process, including the distinct changes involved and their relation to human health. The health impacts of globalisation are simultaneously positive and negative, varying according to factors such as geographical location, sex, age, ethnic origin, education level, and socioeconomic status. Globalisation is not an unstoppable force. Our key challenge is to create socially and environmentally sustainable forms of globalisation that provide the greatest benefits and least costs, shared more equitably than is currently the case.
Globalization — what is it?
The nutrition transition, implicated in the rapid rise of obesity and diet-related chronic diseases worldwide, is rooted in the processes of globalization. Globalization affects the nature of the food supply chain, thereby altering the quantity, type, cost, and desirability of foods available for consumption. Understanding the links between globalization and the nutrition transition can thus help policy makers develop policies, including food policies, for addressing the global burden of chronic disease.
Повернувшись в полном отчаянии, она ожидала услышать шум смертельной борьбы на полу, но все было тихо. Все вдруг сразу же смолкло: как если бы Хейл, сбив коммандера с ног, снова растворился в темноте. Сьюзан ждала, вглядываясь во тьму и надеясь, что Стратмор если и пострадал, то не сильно.
Чатрукьян мертв. - Да неужели. Ты сам его и убил. Я все .
Превозмогая шум в голове, Беккер представил себе грязные улицы Трианы, удушающую жару, безнадежные поиски в долгой нескончаемой ночи. Какого черта. Он кивнул.
- Все смогут скачать, но никто не сможет воспользоваться. - Совершенно верно. Танкадо размахивает морковкой. - Вы видели этот алгоритм. Коммандера удивил ее вопрос.
Беккер понимал, что, как только дверь за Меган закроется, она исчезнет навсегда. Он снова попробовал ее позвать, но язык отказывался ему подчиняться. Девушка почти уже добралась до двери. Беккер поднялся на ноги, пытаясь выровнять дыхание. Попробовал добрести до двери.
Он усмехнулся. Просто надо уметь задавать вопросы… Минуту спустя незаметная фигура проследовала за Беккером по калле Делисиас в сгущающейся темноте андалузской ночи. ГЛАВА 29 Все еще нервничая из-за столкновения с Хейлом, Сьюзан вглядывалась в стеклянную стену Третьего узла. В шифровалке не было ни души. Хейл замолк, уставившись в свой компьютер.
- Он, казалось, все еще продолжал сомневаться в том, что Хейл оказался вовлечен в планы Танкадо. - Я полагаю, Хейл держит этот пароль, глубоко запрятав его в компьютере, а дома, возможно, хранит копию.
Шифр не поддается взлому, - сказал он безучастно. Не поддается. Сьюзан не могла поверить, что это сказал человек, двадцать семь лет работавший с шифрами.
Или это ненависть. Они буквально пожирали ее тело. Новая волна паники охватила Сьюзан. Хейл всей тяжестью своего тела придавил ее ноги, холодно следя за каждым ее движением. В сознании Сьюзан промелькнуло все то, что она читала о приемах самозащиты.
И в тот же миг ей открылась ужасающая правда: Грег Хейл вовсе не заперт внизу - он здесь, в Третьем узле. Он успел выскользнуть до того, как Стратмор захлопнул крышку люка, и ему хватило сил самому открыть двери. Сьюзан приходилось слышать, что сильный страх парализует тело, - теперь она в этом убедилась.
Его слова встретило гробовое молчание.