Urbanization and International Trade and Investment Policies as Determinants of Noncommunicable Diseases in Sub-Saharan Africa

Schram, Ashley; Labonté, Ronald; Sanders, David

doi:10.1016/j.pcad.2013.09.016

Cited by 46 publications

(73 citation statements)

References 52 publications

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“…Previous research has emphasised the importance of FDI flowing from food and beverage multinational companies based in high-income countries to markets of LMICs in promoting local production and consumption of SSBs (Baker et al., 2016, Clark et al., 2012, Hawkes, 2005, Schram et al., 2015, Schram et al., 2013, Stuckler et al., 2012). The data in Figure A1 shows that at the same time there was also a substantial increase in imports of SSBs into LMICs.…”

Section: Discussionmentioning

confidence: 99%

Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries

Lopez

Loopstra

McKee

et al. 2017

Social Science & Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries

Lopez

Loopstra

McKee

et al. 2017

Social Science & Medicine

View full text Add to dashboard Cite

show abstract

“…Liberalisation of food trade is a crucial element of food systems at different geographical scales, which has impacted on the nutritional quality and range of food available in people's food environments, by opening up domestic markets towards international trade and investment, including provision and advertising from transnational food corporations (65) . Urban residents in Africa are most likely to be exposed to these food imports, although the urban poor can usually only access food and beverage products of a lower nutritional quality (66) , which may be energy dense and nutrient poor. Schram et al (66) conducted an empirical modelling study in sub-Saharan Africa investigating the relationship between globalisation, economic growth and CVD outcomes (metabolic risk factors and deaths attributable to CVD), finding that trade and investment liberalisation impacted on CVD outcomes.…”

Section: Food Tradementioning

confidence: 99%

Urban food environments in Africa: implications for policy and research

Holdsworth

Landais

2019

Proc. Nutr. Soc.

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Africa is currently experiencing rapid urbanisation impacting on people's food environments and dietary habits. Such changes are associated with higher prevalence of obesity coexisting with undernutrition. The present paper provides an overview of the healthiness of African urban food environments. We discuss the ways that food environments can be characterised and summarise the methods that can be used to investigate and intervene in the food environment. Data for Africa over a 50-year period (1961–2013) suggest an increasing availability of energy, animal products, fruit and vegetables, vegetable oils, sugar and sweeteners but a decrease in animal fats. There is a lack of evidence about how social, physical and macro-environments drive dietary habits in urban Africa, as most research has focused on the individual level. Examining how food consumption is embedded in everyday life, by investigating social environments is crucial to developing effective interventions. The informal food sector plays an important role in the retail food environment. Macro-level food price changes are an important factor influencing nutritional quality of African diets. The rapid expansion of food/beverages advertising in Africa threatens traditional food habits. Liberalisation of food trade is already impacting on the nutritional quality of food available. Improving African food environments represents a pressing public health concern and has the potential to prevent all forms of malnutrition. Hence, by conducting research into the role of urban social, physical and macro-environments, emerging interventions and policies are likely to positively impact on nutritional status, thereby enhancing social and economic development.

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“…This competitive edge leads to a situation in which healthier foods can be more expensive than unhealthier foods, as has been reported in urban poor South Africa (50) . The Euromonitor International database shows that Nigeria has been increasing importing most of its foods including beverages, cereal and cereal products, sugar products and honey, dairy products and fruit and vegetables (15) . Steep increases in imports were observed between 1998 and 2009.…”

Section: Trade and Urbanisationmentioning

confidence: 99%

An overview of the nutrition transition in West Africa: implications for non-communicable diseases

Bosu

2014

Proc. Nutr. Soc.

107

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The nutrition landscape in West Africa has been dominated by the programmes to address undernutrition. However, with increasing urbanisation, technological developments and associated change in dietary patterns and physical activity, childhood and adult overweight, and obesity are becoming more prevalent. There is an evidence of increasing intake of dietary energy, fat, sugars and protein. There is low consumption of fruit and vegetables universally in West Africa. Overall, the foods consumed are predominantly traditional with the component major food groups within recommended levels. Most of the West African countries are at the early stages of nutrition transition but countries such as Cape Verde, Ghana and Senegal are at the latter stages. In the major cities of the region, children consume energy-dense foods such as candies, ice cream and sweetened beverages up to seven times as frequently as fruit and vegetables. Adult obesity rates have increased by 115 % in 15 years since 2004. In Ghana, the prevalence of overweight/obesity in women has increased from 12·8 % in 1993 to 29·9 % in 2008. In Accra, overweight/obesity in women has increased from 62·2 % in 2003 to 64·9 % in 2009. The age-standardised proportion of adults who engage in adequate levels of physical activity ranges from 46·8 % in Mali to 94·7 % in Benin. The lingering stunting in children and the rising overweight in adults have resulted to a dual burden of malnutrition affecting 16·2 % of mother-child pairs in Cotonou. The prevalence of hypertension has been increased and ranges from 17·6 % in Burkina Faso to 38·7 % in Cape Verde. The prevalence is higher in the cities: 40·2 % in Ougadougou, 46·0 % in St Louis and 54·6 % in Accra. The prevalence of diabetes ranges from 2·5 to 7·9 % but could be as high as 17·9 % in Dakar, Senegal. The consequences of nutrition transition are not only being felt by the persons in the high socioeconomic class, but also in cities such as Accra and Ouagadougou, where at least 19 % of adults from the poorest households are overweight and 19-28 % have hypertension. Concerted national action involving governments, partners, private sector and civil society is needed to re-orient health systems and build capacity to address the dual burden of malnutrition, to regulate the food and beverage industry and to encourage healthy eating throughout the life course.

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Urbanization and International Trade and Investment Policies as Determinants of Noncommunicable Diseases in Sub-Saharan Africa

Abstract: Schram, A. et al. (2013). Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa.

Cited by 46 publications

References 52 publications

Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries

Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries

Urban food environments in Africa: implications for policy and research

An overview of the nutrition transition in West Africa: implications for non-communicable diseases

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