World Health Organization Globalization, Diets and Noncommunicable Diseases World Health Organization Globalization, Diets and Noncommunicable Diseases Noncommunicable Diseases and Mental Health (NMH) Noncommunicable Disease Prevention and Health Promotion (NPH) Globalization, Diets and Noncommunicable Diseases WHO Library Cataloguing-in-Publication Data Globalization, diets and noncommunicable diseases. 1. Diet 2. Nutrition 3. Food 4.Chronic disease – prevention and control. 4. Marketing 5. Developing countries. I. World Health Organization ISBN 92 4 159041 6 (NLM classification: QT 235) © World Health Organization 2002 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. The named authors alone are responsible for the views expressed in this publication. Printed in Switzerland Globalization, Diets and Noncommunicable Diseases Contents Preface Dietary Transition in Developing Countries: Challenges for Chronic Disease Prevention: Ulla Uusitalo, Pirjo Pietinen, Pekka Puska Globalization and Food: Implications for the Promotion of “Healthy” Diets: Mickey Chopra The Impact of Economic Globalization on NCDs: Opportunities and Threats: Tereso S. Tullao, Jr. Can Functional Foods Make a Difference to Disease Prevention and Control?: Mark Wahlqvist, Niayana Wattanapenpaiboon Marketing Activities of Global Soft Drink and Fast Food Companies in Emerging Markets: a Review: Corinna Hawkes Annex: Indaba Declaration Globalization, Diets and Noncommunicable Diseases Preface Noncommunicable diseases have become a major heath problem not just in developed countries but also in developing countries. Already 79% of the deaths attributed to the noncommunicable diseases occur in developing countries. The rising trends are a consequence of the demographic and dietary transition, and the globalization of economic processes. Scientific evidence shows that unhealthy diet and physical inactivity as well as tobacco use, recently highlighted in the World Health Report 2002, are major global determinants of noncommunicable diseases. Examples from several countries show that changing these determinants is possible and can have a strong effect on the trends in noncommunicable diseases. Although national responses are crucially important, international work and global perspectives are badly needed. For this, WHO is, in response to the request from its Member States in the World Health Assembly 2002, preparing a global strategy on diet, physical activity and health. This work emphasizes integrated prevention by targeting the three main global risk factors: unhealthy diet, physical inactivity and tobacco use. In this process, WHO is looking at a number of issues related to globalization and global nutrition transition. This publication is a collection of papers written by experts in the fields of nutrition, epidemiology, economics, and marketing. We hope that this report will make a valuable contribution to the discussion on nutrition transition, globalization and noncommunicable diseases. The views expressed in these papers are those of the authors. We are grateful to the authors for their effort. Geneva, November 2002 Dr Derek Yach Dr Pekka Puska Executive Director Director Noncommunicable Diseases and Mental Health Noncommunicable Disease Prevention and Health Promotion Globalization, Diets and Noncommunicable Diseases Ulla Uusitalo Dietary Transition in Developing Countries: Challenges for Chronic Disease Prevention 1Ulla Uusitalo, 2,3Pirjo Pietinen, 3Pekka Puska 1) Division of Nutritional Sciences, Cornell University, Ithaca , New York, USA 2) Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland 3) Department of Noncommunicable Disease Prevention and Health Promotion, World Health Organization, Switzerland Correspondence: Ulla Uusitalo, Ph.D Division of Nutritional Sciences MVR Hall Cornell University Ithaca, New York 14850 USA Email: [email protected] Fax: +1-607-255 0178 Globalization, Diets and Noncommunicable Diseases Ulla Uusitalo Introduction During the entire human history populations have experienced changes in ecological relationships that have modified their diet and physical activity and eventually altered their disease pattern. Early human populations were hunter-gatherers. Population growth was low and stable at the time of their existence. However, there was a dramatic shift to domestication of plants and animals for agricultural food production about 10,000 years ago and subsequent changes in disease profiles [1]. In the beginning of the agricultural period population size and density increased significantly. The reasons for the increase are complex. It was assumed that the abundance of food would have led to a better-nourished and healthier population with a reduced rate of mortality and a continuous and steady increase in population size. The empirical evidence suggested that this did not happen [1]. The shift from gathering and hunting to agriculture also produced an increase in infectious and nutritional disease rates. It is assumed that the more sedentary way of living related to agriculture increased parasitic diseases that were spread by contact with human waste and by a steady supply of disease vectors due to domesticated animals [1]. Also Cohen [2] came to the conclusion that farmers suffered more from infection and more from chronic malnutrition in comparison to their forebears living on wild resources and had reduced life expectancies. Diet tied to cultivation of only a few crops lacked diversity and therefore also lacked the full range of nutrients [3]. Although episodes of hunger were less frequent among farmers than among hunter-gatherers, they were more severe. Farmers, however, were exposed to fewer physical demands on the skeleton, in terms of peaks of mechanical stress, than hunters and gatherers. Infectious diseases have been the leading cause of death throughout most of human existence. During the last centuries and especially during the last decades, however, many demographic, social, economic, ecological and biologic changes led gradually to a decrease in occurrence of communicable diseases [4]. This development included the expansion of education, rising incomes, industrialization, urbanization, and improved medical and public health technology. Due to a varying pace in these processes, the health transition is not occurring uniformly in all countries [5]. An epidemiological transition model that was introduced 30 years ago is often applied to explain the differences in occurrence of diseases within and between countries. It proposes that disease patterns shift over time so that infectious and parasitic diseases are gradually, but not completely, displaced as noncommunicable diseases (NCDs) become the leading causes of death [4]. A concept of dietary transition is used to describe the changes in production, processing, availability, and consumption of foods as well as changes in nutrient intake. A nutrition transition model is extended to consider also anthropometrical measures and physical activity [6,7]. The role of nutrition in epidemiological transition Concurrent with epidemiological, dietary and nutrition transitions, including change in physical activity pattern, a demographic shift occurs, yielding longer life expectancy and reduced fertility [8]. This change is associated with an increase in the proportion of deaths occurring in older people. However, the emergence of NCDs as important causes of morbidity and mortality is not only due to reductions in infectious disease mortality and population ageing; it is also due to real increases in the age-specific incidence and mortality of several noncommunicable conditions [9,10]. An etiological model for adult chronic diseases emphasizes the influence of adult risk factors e.g. unhealthy diet and lack of physical activity [11]. Studies have revealed that there is a consistent relationship between unhealthy diet and the emergence of a range of chronic non-infectious diseases – including coronary heart disease, cerebrovascular disease, various cancers, diabetes mellitus, dental caries, and various bone and joint diseases [12].