BMS3058 IPHNGlobal Nutrition Transition

Dr Laura Tripkoviclaura.tripkovic@surrey.ac.uk

Learning outcomesYou should be able to:Explain the concept of nutrition provision for a developing global populationUnderstand what we mean by developing countries and countries in transitionExplain the relationship between development and health Identify the key factors contributing to poor nutrition in a country in economic transitionIdentify the key actions and organisation relating to tackling global nutrition issues

Population growth

Global Food SustainabilityCan the world sustain a growing population?

Location Vs QuantityThe distribution of food production is not balancedAbundant agricultural regions vs Barren desert lands

Global Food Supply IssuesRome Food Summit 2008 Global Food crisis seen as a priorityA human fundamental needIncreased food prices impact on developing countries?Developing 60% income on foodDeveloped, buy in poverty 15% income on foodRiots/unrest in food scarcity - Africa

World by income

Death distributionDeath distribution by age and incomeMore than 8 million deaths in 2008 were among children under five99% in low- and middle-income countries.

Millennium Development GoalsSeptember 2000, Millennium Declaration. - setting out goals to be reached by 2015. The eight Millennium Development Goals (MDGs) represent commitments in:Improving health systemsreduce poverty and hunger, gender inequality, Primary education, Child mortality environmental degradation and sustainability. Developed countries - through trade, development assistance, debt relief, access to essential medicines and technology transfer.

The World Trade OrganisationFunctions: Administering WTO trade agreements Forum for trade negotiations Handling trade disputes Monitoring national trade policies Technical assistance and training for developing countries Cooperation with other international organizations The WTOThe World Trade Organization (WTO) is the only international organization dealing with the global rules of trade between nations. Its main function is to ensure that trade flows as smoothly, predictably and freely as possible

159 members2/3 are developing countriesSpecial focus for least developedimproved market access; more technical assistance; support for agencies working on the diversification of least-developed countries economies; speedier membership for LDC to join

The World map by quartiles of Human Development Index in 2013.

Human Development Index (HDI) is a composite statistic of life expectancy, education, and income indices to rank countries into four tiers of human development : Very High, High, Medium, Low Data unavailable in grey

What is a developing Country? DC - definitions vary!Income highest income - developedLowest income - undevelopedMiddle developingEconomyEmerging economies are developing countriesCountries in transition, CITIncluded eastern Europe, Former Soviet Union/central asiaThese are now included in the term DCNewly developed:Developed Asia, Malta, Cyprus, Israel, Slovenia

What is a developing Country? Developed, UK, US, EU, AU etcDeveloping/emerging economiesWTO members announce their status!Has advantages, benefits, assistance etcTrade preferences, zero/low import duties/reciprocal arrangementsCountries in transitionUnderdeveloped countries / LEDCNot a universally popular term!Little differentiation in development, does not suit all models: eg Cuba declined to be labelled!< Lower income/capita> literacy and infant survival

Least developed countriesDesignated as such by the UN the following three criteria were usedlow income, a three-year average estimate of the gross national income per capita (under $750 for cases of addition to the list, above $900 for cases of graduation) weak human assets, as measured through a composite Human Assets Index; economic vulnerability, as measured through a composite Economic Vulnerability Index.

LDCs

Least-developed countries 2013 Angola Bangladesh Benin Burkina FasoBurundi Cambodia Central African Republic Chad Congo, Democratic Republic of DjiboutiGambiaGuineaGuinea BissauHaitiLao (Peoples Democratic Republic)Lesotho MadagascarMalawiMaliMauritaniaMozambiqueMyanmarNepalNigerRwanda Senegal Sierra LeoneSolomon IslandsTanzaniaTogoUgandaVanuatuZambiaNine more least-developed countries are negotiating to join the WTO. They are: AfghanistanBhutan ComorosEquatorial Guinea Ethiopia Liberia Sao Tom & Principe Sudan Yemen

BMS 3058 IPHN 2014 M.GIBBSLeast developed countries

BMS 3058 IPHN 2014 M.GIBBS

BMS 3058 IPHN 2014 M.GIBBSLandlocked developing countries

BMS 3058 IPHN 2014 M.GIBBS

Factors affecting food securityInfrastructurePopulation densityLand quality & GeologyGeographyClimate/weatherEconomyStabilityTrade & transport

Urbanisation & GlobalisationAgro-economic development - increased demands change the supply mechanismsPeople moving from rural to urban areas for work and access to desirable goods and technologyImpact on food production and accessFood inequalitiesExample: CHINA is it a DC or CIT ?Tesco moves into china 2004Spread of fast food chainsChanges in health? obesity and diabetes (OW 19%)

What is a Country in transition? Countries in transitionMiddle income countries health transitioneconomic transitionNutrition transition ORBetween stability and instability, Eg Haiti disaster zoneIraq war zoneGreece? - economic changeWhat risk does retrograde transition bring?

Demographic transitionLess developed high birth rate, high death rate slow population growth in developmental transitionHigh birth rate, lower death rateFast population growth DevelopedLow birth rate, low death rateStable population/ small growth

Governmental transitionLess developed Low democratic infrastructureDictatorships/localised power/Little public policy or support in developmental transitionClear power hierarchy Governemental guidance developing developing stability and infrastructure DevelopedEstablished stable democratically selected government Established infrastructureEstablished support system/education

Economic transitionLess developed Low income. Low industryLow trade in developmental transitionGrowing industry /tradeRising incomeDevelopedEstablished industry internal and external tradeHigh income (by global comparison)

Health transitionLess developedInfectious diseaseMalnutritionIn transitionInfectious disease Malnutrition NCDs rising rapidlyDevelopedLow ID and Mal-NHigh NCDs

Developing CountriesThe 2003 WHO report:States that NCDs are rapidly becoming a significant issue in developing countries with 79% of global deaths attributable to NCDs already occurring in developing countries (why so high?)

Projects that communicable diseases will still be a major issue in developing countries until 2020

Projects that NCDs will contribute around 75% of all deaths in developing countries by 2020

Projects 60% of the global burden of NCDs will occur in developing countries at this time

Global BMIGlobal Database on Body Mass Index an interactive surveillance tool for monitoring nutrition transition

GBMI database provides both national and sub-national adult underweight, overweight and obesity prevalence rates by country, year of survey and gender. The information is presented interactively as maps, tables, graphs and downloadable documents.

http://apps.who.int/bmi/index.jspGlobal BMI interactive Map

PHN Action - Programmatic prioritiesDeveloping and implementing national policies /plans of action : monitoring and implementing national nutrition plans and household food and nutrition security, caring for the nutritionally vulnerable.

Protecting and promoting sound infant and young child feeding practices:breastfeeding (implementing the Baby-friendly Hospital Initiative and the International Code of Marketing of Breast-milk Substitutes), HIV and infant feeding, and appropriate complementary feeding.

Managing nutrition in emergencies: emergency preparedness and nutritional assessment, management, monitoring, and evaluation in emergencies.

Food aid for development: health and nutrition technical assessment, evaluation and guidance to food-assisted development projects worldwide, particularly those of the World Food Programme (WFP).

Nutrition education comes into every category

SummaryNutritional health is related to wealth /economy and development of a countryPoorest nations greatest malnutritionEmerging economies double burden of diseaseDeveloped countries predominantly NCDsDeveloped countries support development via the WTO and Worldbank:,strategic guidance, ProjectsWe need a global strategy for action to improve nutrition in all populations as they developFair trade and AidEducation

WorldbankThe World Bank - financial and technical assistance to developing countries Our mission is to fight poverty to help people help themselves and their environment by providing resources, sharing knowledge, building capacity and forging partnerships in the public and private sectors.

Not a bank in the common sense; - made up of two unique development institutions owned by 186 member countries: the International Bank for Reconstruction and Development (IBRD) The IBRD aims to reduce poverty in middle-income and creditworthy poorer countriesthe International Development Association (IDA). IDA focuses on the world's poorest countries.

Together, provide: low-interest loans, interest-free credits and grants to developing countries for investments in education, health, public administration, infrastructure, financial and private sector development, agriculture, and environmental and natural resource management.

WorldbankWorldbank Film on food security and nutrition issues in regions of Africahttp://go.worldbank.org/7GJSLGJMW0

INFORMATION POINT: Prevalence and incidencePrevalence is a frequently used epidemiological measure of how commonly a disease or condition occurs in a population. Prevalence measures how much of some disease or condition there is in a population at a particular point in time. The prevalence is calculated by dividing the number of persons with the disease or condition at a particular time point by the number of individuals examined. For example, in the study above 6139 individuals completed the questionnaire (were examined). Of these 6139 people, 519 currently suffered incontinence and so had the condition at the particular time point of the study. Thus the prevalence of incontinence was 519/6139 = 0.085.Prevalence is often expressed as a percentage, calculated by multiplying the ratio by 100. The above study expresses prevalence as a percentage, thus the prevalence of incontinence is 8.5% (or rounded is 9%). Another common way of expressing prevalence, particularly if the prevalence is low, is as the number of cases per 100,000 of the population. For example, it is easier to state the result as `66 cases per 100,000 people' than to say the prevalence is 0.00066.

The incidence of a disease is another epidemiological measure. Incidence measures the rate of occurrence of new cases of a disease or condition. Incidence is calculated as the number of new cases of a disease or condition in a specifed time period (usually a year) divided by the size of the population under consideration who are initially disease free. For example, the incidenceof meningitis in the UK in 1999 could be calculated by finding the number of new meningitis cases registered during 1999 and dividing by the population of the UK. As this incidence rate would be very small again we tend to consider number of cases per 100,000 people.

NICOLA CRICHTON John Wiley, Chichester. Le and Boen (1995)

*Global Database on Body Mass Index an interactive surveillance tool for monitoring nutrition transition The global epidemic of overweight and obesity - "globesity" - is rapidly becoming a major public health problem in many parts of the world. Paradoxically coexisting with undernutrition in developing countries, the increasing prevalence of overweight and obesity is associated with many diet-related chronic diseases including diabetes mellitus, cardiovascular disease, stroke, hypertension and certain cancers. This database provides both national and sub-national adult underweight, overweight and obesity prevalence rates by country, year of survey and gender. The information is presented interactively as maps, tables, graphs and downloadable documents. These can be accessed by clicking on the respective tabs above; then the data can be displayed after selecting the country, year and indicator required