Will China's Nutrition Transition Overwhelm Its Health Care System And Slow Economic Growth?

Carolina Population Center, University of North Carolina, Chapel Hill, USA.
Health Affairs (Impact Factor: 4.97). 07/2008; 27(4):1064-76. DOI: 10.1377/hlthaff.27.4.1064
Source: PubMed


Rapid social and economic change is transforming China, with enormous implications for its population and economy. More than a fifth of China's adult population is overweight, related to changing dietary and physical activity patterns. Overweight and poor diets are becoming a greater burden for the poor than for the rich, with subsequent large increases in hypertension, stroke, and adult-onset diabetes. The related economic costs represent 4-8 percent of the economy. Public investments are needed to head off a huge increase in the morbidity, disability, absenteeism, and medical care costs linked with this nutritional shift.

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Available from: Barry M Popkin, Jan 27, 2015
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    • "This leads to questions related to the degree that children incorporate their parents' judgments and heuristics related to food safety to avoid perceived risks. With changes in the food supply and traditional consumption patterns, China has transitioned from health issues associated with under-nutrition to nutrition-related chronic diseases (Popkin, 2008). Global and domestic companies that sell packaged and prepared foods and beverages, such as Uni-President, Want Want, Nestlè, McDonalds, KFC, Wahaha, Coca-Cola and Kraft, have steadily increased their presence in China (Economist, 2012). "
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    ABSTRACT: Purpose – This study aims to examine the major influences of food choices of Chinese teenagers within a dynamic food marketing environment. Design/methodology/approach – The paper reports findings from semi-structured interviews with high school students which examine teenagers’ guidelines for selecting food, along with their actual eating behavior. Findings – The results reflect on how four major influences – personal, family, peer and retailer – may intersect to affect the eating behaviors of Chinese adolescents, as they navigate an intense education schedule during a time of rapidly changing cultural values. Different norms of food choice – nutrition, food safety, taste, body image, price, convenience, sharing, friendship and fun – are evoked according to the social context and concurrent activities of the teenagers. Social implications – The findings offer tentative insights related to the potential for promoting healthier eating habits for adolescents in urban areas of China. Originality/value – The study demonstrates how, within this rapidly changing food environment, food retailers are creating alliances with teenagers to meet needs of convenience, speed, taste and social interaction.
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    • "High-income countries in East Asia have faced serious burdens of chronic diseases, such as diabetes, hypertension and cardiovascular diseases, and extended life expectancy. Although this study did not find a time lag effect of dietary changes, the trend of western diet does increase the risk of non-communicable diseases and may therefore increase the prevalence of dementia in older age [10] [11] [12]. Although we report the prevalence of dementia in China to be stable over the last 20 years, it is expected that the prevalence could increase substantially due to the increasing burden of non-communicable diseases. "
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    ABSTRACT: Background: Western diets are associated with obesity, vascular diseases, and metabolic syndrome and might increase dementia risk in later life. If these associations are causal, those low- and middle-income countries experiencing major changes in diet might also see an increasing prevalence of dementia. Objective: To investigate the relationship of dietary supply and the prevalence of dementia in mainland China, Hong Kong, and Taiwan over time using existing data and taking diagnostic criteria into account. Methods: Estimated total energy supply and animal fat from the United Nations was linked to the 70 prevalence studies in mainland China, Hong Kong, and Taiwan from 1980 to 2012 according to the current, 10 years, and 20 years before starting year of investigation. Studies using newer and older diagnostic criteria were separated into two groups. Spearman's rank correlation was calculated to investigate whether trends in total energy, animal fat supply, and prevalence of dementia were monotonically related. Results: The supply of total energy and animal fat per capita per day in China increased considerably over the last 50 years. The original positive relationship of dietary supply and dementia prevalence disappeared after stratifying by newer and older diagnostic criteria and there was no clear time lag effect. Conclusion: Taking diagnostic criteria into account, there is no cross-sectional or time lag relationship between the dietary trends and changes in dementia prevalence. It may be too early to detect any such changes because current cohorts of older people did not experience these dietary changes in their early to mid-life.
    Journal of Alzheimer's disease: JAD 11/2014; 44(4). DOI:10.3233/JAD-141926 · 4.15 Impact Factor
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    • "Food trade liberalisation has recently attracted increased attention because of rising obesity and growing global chronic disease burdens such as heart disease and diabetes (WHO 2003). The shift from traditional dietary patterns and health behaviours, including from breastfeeding, is creating a 'double burden' of health costs of under-nutrition as well as over-nutrition (Khan and Talukder 2013; Popkin 2008), which is a growing threat to the sustainability of health systems in rapidly developing countries such as China (Popkin et al. 2001). "
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    ABSTRACT: Breastfeeding is rarely seen as an economic policy issue. Many view the idea of placing a dollar value on mothers’ milk as repugnant. Breastfeeding cannot be framed as simply an economic relationship. It is a complex, physiological, emotional and social relationship between mother and child, intricately related to the nature of the society, community and family in which they live. Furthermore, the ‘costs’ and ‘benefits’ of breastfeeding fall both on individuals and on society as a whole. Yet in a world where not valuing something in dollar terms means it is not valued at all, this economic invisibility can have major consequences for the ‘market’ for mother’s milk, for infant and maternal health and wellbeing, and for appropriate public policy. In recent years, aspects of international trade and investment agreements have raised concerns that trade policy priorities may adversely affect governments’ ability to protect public health and nutrition (Gleeson and Friel 2013; Lopert and Gleeson 2013). Trade liberalisation stimulates demand, through increasing competition, lowering prices and triggering greater product promotion. When the increased demand is for products like tobacco and unhealthy food, opening up markets raises serious concerns for public health. Thirty years ago, the World Health Organisation (WHO) negotiated a pioneering agreement called the WHO International Code of Marketing of Breastmilk Substitutes (henceforth, the International Code) to regulate the unethical marketing of infant formula and baby foods (WHO 1981). The 1981 International Code was one of the earliest international initiatives to address global regulation of food safety standards and misleading health claims and marketing, and a precursor to the 2003 Framework Convention on Tobacco Control (FCTC). Among other things, the International Code regulated direct-to-consumer (DTC) advertising of breastmilk substitutes, and limited marketing to hospitals and health professionals, as well as promoting regulatory measures for safe feeding of children fed on infant formula. The International Code was based on recognition of the importance of protecting breastfeeding, and of the unique vulnerability of mothers and their infants and young children to inappropriate marketing and promotion of commercial baby foods. The World Health Organisation/UNICEF Global Strategy for Infant and Young Child Feeding (WHO/UNICEF 2003) (henceforth, the WHO/UNICEF Global Strategy) recommends exclusive breastfeeding to 6 months, and continued breastfeeding to 2 years and beyond. Global sales growth of 10-20 per cent a year in commercially-produced baby foods far exceeds the birth rate (Euromonitor International 2013). This growth is at the expense of breastfeeding. A recent Lancet study shows that 800,000 babies die each year, mainly in Asia, simply because they are prematurely weaned from breastfeeding (Black et al. 2013). In developed countries, it adds significantly to national health costs (Bartick and Reinhold 2010; Bartick et al. 2013; Renfrew et al. 2012; Smith, Thompson and Ellwood 2002). In both settings aggressive industry marketing of substitutes for breastmilk is an important contributing factor. Industry reports reveal that the Asia Pacific region is now the main growth market for the baby food industry, accounting for over US$20 billion of the US$36 billion global growth since 2003 (Euromonitor International 2013). UNICEF has warned that in East Asia and China, breastfeeding rates are falling at an ‘alarming rate’ (UNICEF 2012). In some countries, constraints on unethical marketing are weakening. The 2012 review of the International Code concluded that its global implementation remains inconsistent (WHO 2012b). Despite the alarming trend, there is a surprising silence about the implications of expanding formula exports for breastfeeding practices in the Asia Pacific region (Galtry 2013a). As well as affecting public health in importing countries such as China, protecting breastfeeding creates significant policy conflicts for developed countries in the Asia Pacific region. Australasia presently leads the ‘white gold boom’ in formula exports to China and the Asia Pacific region (Correy 2013). The recent corporate manoeuvring to share in the vast profits from liberalised formula exports to China (Greenblatt 2013; Hemphill 2013; King 2013; Urban 2013; Whitley and Stronger 2013) begs a number of important questions about the net benefits of trade liberalisation in this area, including: 1. To what extent do policymakers value breastfeeding as food production by women, and integrate this into economic policy priorities? 2. How do expanding markets in baby food affect breastfeeding, health and human rights in the Asia Pacific region? 3. Do trade agreements allow undermining of breastfeeding in the region by facilitating market expansion efforts by baby food companies? 4. Do global and national policies adequately protect optimal infant and young child feeding (IYCF)? How effectively is the International Code applied to baby food product promotion and marketing? We begin by addressing the extent to which policymakers acknowledge and integrate the economic value of breastfeeding into economic policy, and incorporate public health recommendations on IYCF into trade and regulatory policy development. We then examine the extent to which trade policy may be reducing breastfeeding in both Australasia and China, and how effectively the International Code and related regulation is applied to baby food marketing in these countries. We conclude on the way ahead by urging the public health community to seek greater prominence for IYCF issues in trade negotiations and regulatory policy. Current deliberations by WHO technical advisors to strengthen the International Code (WHO 2013a) prompts consideration of whether the WHO/UNICEF Global Strategy should be strengthened along the lines of the WHO FCTC.
    Journal of Australian Political Economy 10/2014; 73(73). · 0.11 Impact Factor
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