globalisation Flashcards
Globalization
Globalization describes the process by which regional
economies, societies, & cultures have become integrated
through a global network of communication,
transportation, and trade.
a historical process, the result of human innovation &
technological progress. is it new?
is ……………….development, its ………. has increased with
the advent of new technologies, especially in the area of
telecommunications
nutrrition related non communicable diseases -chronic diseases
diabetes, cancer osteoporosis,
Globalization &
its impacts on nutrition pattern
Changes in the world food economy due to
globalization: shifting nutrition patterns.
Improved standards of living & ↑ access to
services, consequences?
significant negative consequences: inappropriate
dietary patterns, ↓ physical activities, & ↑ in
nutrition related non-communicable diseases
What is Nutrition Transition?
Two historic processes of change occur to or
precede the Nutrition Transition
Demographic transition
Epidemiologic transition
Demographic transition: function of time &
socioeconomic development
Demographic Transition
The shift from the pattern of ↑ fertility &↑ mortality to one of ↓ fertility & ↓ mortality Stage I : Preindusterial Stage II: Transitional Stage III: industrial Stage IV: post industrial
Demographic Transition
Focus on healthy aging
High Fertility/Mortality Rate
Reduced Mortality, Changing age Structure
Focus on Family Planning,
Infectious diseases control
Reduction fertility, ageing Chronic Diseases Predominance
Epidemiologic Transition
Shift: ↑prevalence of infectious diseases associated with
malnutrition, & periodic famine & poor environmental sanitation
to a pattern of ↑ prevalence of chronic & degenerative diseases
Stage 1: Pestilence & famine
Stage 2: Receding pandemics
Stage 3: Degenerative & man-made diseases
Stage 4: Age of delayed degenerative diseases
Epidemiologic Transition Focus on healthy aging Focus on medical intervention, policy Initiatives, and behavioral change High Prevalence Infectious diseases Receding Pestilence, poor environmental conditions Focus on Family Planning, Infectious diseases control Focus on famine Alleviation/prevention Chronic Diseases Predominance
Nutrition Transition
The shifts in the way we eat and move & subsequent effects on our body composition over the history of man
In the last 20–30 years, the world has reduced its water intake, shifted towards sugar-sweetened beverages, increased its proportion of food that is sweetened and ultra processed and reduced its intake of many health
components of our diet, including legumes, fruits and vegetables
Nutrition Transition Focus on medical intervention, policy initiatives, and behavioral change High prevalence under nutrition Nutrition-related non-communicable Diseases predominance Receding Famine Focus on famine Alleviation/ prevention
Nutrition Patterns
- Collecting food (hunter gatherers), Paleolithic man
- Settlements begin/Monoculture period/ Famine emerges
- Industrialization/Receding Famine
- Nutrition related non-communicable diseases (NR-NCD)
- ……………………….
Eating habits
Aboriginals vs. Non aboriginals
Aboriginal 19 to 30 year-old women consume:
More energy from food between meals (snacks)
More snacks from the other food category (63% of snacks
calories vs43% of snacks calories)
Energy from snacks also different.for 31 to 50 year-old
women
no differences in men
Regular soft drinks: the main source of calories from the
“other food” category:
Aboriginal men & women aged 31 to 50 drink more regular soft
drinks
Aboriginal women aged 19 to 30 years
• Consumed more reg. soft drinks the day prior to the interview
(62% vs 26%)
• Consumed 450 g. per day on average to 139 g. per day on
average for for non aboriginal women.in same age group
Overweight/ Obesity
Overweight & obesity rates higher in off reserve
aboriginal people than in non-aboriginal people
– Significant differences in women
– Bigger impact of inactivity in aboriginal people
– Level of education plays a different role
Emerging public health issues with crisis proportions
within the First Nation population . . .
- Nutritional Status, physical inactivity & related diseases
2.Cancers: in particular lung & reproductive - Sexual health
- Substance abuse
- Mental Health
- Injuries “leading cause of death first half of First Nations life”
- Community Violence
- Problem gambling
- Infectious Diseases
- Environmental issues: clean water, healthy housing, safe food sources
& exposure to environmental contaminants”
Stages of Nutrition Transition
3 4 5
Urbanization, economic growth, technological changes for work, leisure, and food processing, globalization of mass media MCH deficiencies, Weaning disease, stunting Patten 3 Industrialization Receding Famine •Starchy, low variety, low fat, high fiber •Labor-intensive work Slow mortality decline Pattern 4 Non-communicable diseases •Increases fat, sugar, Processed foods •Shift in technology of Work & leisure Obesity emerges, Bone density problems Pattern 5 Behavioral Change •Reduced fat, increased fruit, veg, fiber •Replace sedentariansim with purposeful changes in recreation. Reduced body fatness, Improved bone health S
A 100,000(S) of generations: ……………………….. 50 generations: depended on agriculture 10 generation: …………………………… Only two generations: grown up with highly processed fast foods & high intake of energy from beverages The problem is: our genes don’t know it. They are programming us today in much the same way they have been programming humans for at least 40,000 years
d
Globalization and Nutrition Transition
Nutrition Transition in developed countries
The standard of living of most people: ↑considerably
during the last two generations
Change from insufficiency to sufficiency to a great variety
of food, Western diet
Figures on the prevalence of excess weight in US and
Canada
57%of Canadian young people: so sedentary,
harming their health
Eating pattern shifts that accompany
the nutrition transition
In higher-income, Developed countries
increased portion sizes,
away from home food intake,
Snacking
High intake of energy from …………… (%17-25)
Nutrition Transition in Developing Countries
Double burden of disease
infection diseases remain the major unresolved health
problems
Emerging non-communicable diseases relating to diet
and lifestyle have been increasing over the last two
decades
Prevalence for type 2 diabetes mellitus & CVD:
In sub-Saharan Africa have seen a 10 fold increase increase in
the last 20 years.
In Persian Gulf current rates are between 25 to 35% for
the adult population, while evidence of the metabolic
syndrome is emerging in children and adolescents.
accelerated nutrition transition
in developing country is worse becasue happening faster with less health care and no regulation
Nutrition Transition in developing countries
rapid shifts in dietary, activity & body
composition
The joint presence of under-nutrition & overweight
The politics: different
Nutrition Transition in developing countries
Rapid shifts in dietary, activity & body composition Obesity trends Dietary changes Physical activities Rapid social changes: • Urbanization • Globalization of Mass Media
Nutrition Transition in developing countries
Dietary changes: shifts in the overall structure over time
The diets of the developing world: shifting rapidly
Traditional, low cost diet, rich in fiber & grain:
replaced by high-cost diets include greater
proportions of sugars, oils, & animal fats.
Results: obesity & associated chronic diseases
The joint presence of under-nutrition and over-weight
Poor people are malnourished because they do
not have enough to feed themselves, & they
are obese because they eat poorly (Aguirre)
Nutrition Transition In developing countries
The politics are different in developing world (dilemma !)
The capacity to address the rapid increase in NR-NCDs does not exist
Politicians have focused on hunger (malnutrition) & infectious
diseases (AIDS,TB, New Viral diseases such as Ebola)
The NR-NCDs are increasing in prevalence more rapidly
Medical systems have not enough time to adjust to
the needs
Public health systems are not able to begin
addressing the situation
The nutrition transition to 2030 11/23/2016 41 Schmidhuber & Shetty, 2005 Why developing countries are likely to bear the major burden?
Population growth to slow
Urbanization to accelerate
Rapid income growth globally, but with considerable regional
differences
Economic disasters, (2008),
Radical change in the food marketing and distribution system.
Ageing populations & ‘‘little emperors’’
Foetal Programming ‘‘The thrifty phenotype’’
Childhood undernutrition, stunting and central obesity
Ethnic differences in disease risk: Interactions of genetic
predisposition and environmental change
Infections and chronic disease (if you survive malnutrition and disease are most likely to get chronic diseases when your old
Dietary Acculturation
Immigration at a young age makes children more likely to
assimilate to a new culture
• Traditional food items: expensive or unavailable
• Western foods=high fat, sugar & salt, appeals to:
• Newcomer children: easily influenced
• Newcomer parents: value convenience & easy prep
• Results in predisposition to ……………conditions
Acculturation and Health
Acculturation to the majority culture in Western countries
increases the likelihood of
– Becoming obese, – Increased blood cholesterol levels – Likelihood of developing hypertension – Heart disease – developing type 2 diabetes – Some cancers – Adolescent pregnancy – Smoking, alcohol consumption, illegal drug use – Decreased fiber consumption; calcium, Iron, protein – Increased fat and sodium intake – Depressive symptoms
Health issues…, overweight & obesity
The prevalence of overweight & obesity: higher among
long-term (11 yrs or more) than more recent immigrants
• Obesity rates have been shown to increase in refugee
children with the length of time following resettlement.
• The increase in rate of overweight & obesity, may result
from transition away from cultural diets & lifestyle
pattern to a more “western” diet & sedentary lifestyle
(Nutrition Transition)
• Men not women
Historical factors Impacting Health & Identity
in Aboriginals
- Loss of aboriginal identity
- Relocation or displacement
- Experience of Residential School
- Influence of Religion and/or Churches
- Loss of Parenting Skills
- Experience with Violence or Abuse
- Loss of Traditional Teaching
- Loss of Access to Hunting, Fishing, Trapping
- moving away from indigenous food
Enabling factors for maintaining traditional dietary habits
• Celebrating the ……………………………… – Promoting the sense of identity – Traditional healthy behavior • Healthy Eating • Learned cooking skills, • Taste preferences • Health knowledge • ……………………….. of foods
osteoporosis
certain ethnicities have been found to be at greater risk for osteoporosis
chinese from asia
africain american
how culturally appropriate are our prevention
Health issues among immigrants
• Declines in self‐assessed physical and mental
health are observed amongst immigrants in as little as two years after arrival
• Within 4 years after arrival, the proportion of
immigrants reporting fair or poor health almost
triple.
• Objective measurements show declining health
among immigrants after arrival (e.g. chronic
conditions, prevalence obesity)
Chronic conditions
The ‘healthy immigrant effect’ indicates a
need for preventive strategies to decrease:
– Obesity
– Cardiovascular disease
– Hypertension
– Diabetes
– Lifestyle changes
• Nutrition, Over /Under, Nutrient deficiencies
• Less physical activity
Health issues…, overweight & obesity
• The prevalence of overweight & obesity: higher among
long‐term (11 yrs or more) than more recent immigrants
• Obesity rates have been shown to increase in refugee
children with the length of time following resettlement.
• The increase in rate of overweight & obesity, may result
from transition away from cultural diets & lifestyle
pattern to a more “western” diet & sedentary lifestyle
(Nutrition Transition)
• Men not women
42
Health issues…, overweight & obesity
Tremblay MS et al. 2005 BMC Public Health. 2013 May 10;13:458. doi: 10.11
Health issues…, overweight & obesity
• Factors that affect obesity – age, • younger age are more likely to assimilate the new culture vs. older age – ethnicity • Latin Americans and Caribbean: highest • Asian: lowest – education, • undergraduate degree are less likely to be obese VS. lower levels of education – diet, • Adopting western diet – exercise • Adopting sedentary lifestyle
Health issues…, cardiovascular diseases
• Immigrants have lower rates of heart disease mortality than the
Canadian‐born population
• Risk factors:
– obesity,
– hyperlipidemia,
– hypertension,
• Exposure to fast foods, high in sodium
associated with acculturation
• Immigrants are hesitant to be screened for CVD as they are fearful of
finding they have a disease which means they will also not get treatment
for such diseases
• Rates of heart disease were reportedly high among South Asian
immigrants
Health issues…, diabetes
• South Asians are the fastest growing immigrant population in
Canada
• They also develop diabetes up to ten years earlier, and at a
lower BMI than Caucasians in Canada, the US and the UK
– genetic predisposition,
– insulin resistance,
– higher levels of visceral/abdominal adipose tissue,
– traditional diets high in fats and sugars
• South Asians: receive inadequate treatment
– language barriers,
– low rates of literacy,
– poor compliance with necessary lifestyle changes
Health issues…, diabetes
Misra & Ganda,
Health issues…, Osteoporosis
• Certain ethnicities have been found to be at
greater risk for osteoporosis
– Chinese from Asia
– African Americans
– How culturally appropriate are our
prevention/health promotion initiatives?
• low vitamin D, calcium, & protein levels as
well as lifestyle & socioeconomic conditions
Health issues…, Cancer
• Immigrants’ cancer rates shifted toward rates of the host
population.
• Breast cancer mortality rates from rare in home country to the rate in
native population (Canada and Australia)
• Dramatic increase in cancer risk among second‐ and third‐
generation Japanese
• Acculturation explains the findings from generational studies
demonstrating increases in cancer rates among the offspring of
migrants and subsequent generations
• Inadequate screening of cervical cancer
• Cultural, linguistic & systemic barriers to cancer prevention,
screening and treatment programs have been identified for
immigrant populations, particularly newcomers
Tuberculosis
• Individuals born in countries with high TB
prevalence represent a high‐risk group
• TB develops post‐migration during the early
resettlement years
– psychological distress
– substandard housing
– failure to use health care services
Mental Health
After an initial risk period, immigrant mental health improved
over time and often persisted into the second generation.
• Certain sub‐groups experienced an increased
mental health risk following migration.
– Refugees
• experienced traumatic events such as war, famine and forced
migration are at an increased risk of mental health problems, such
as lasting depression, PTSD and suicide
– Seniors
– Women
• high rate of depression among women of four ethnic groups
(Chinese, Vietnamese, Portuguese & Latin American
Perinatal Health
No evidence that immigrant women &
children experience worse health outcomes
than their Canadian‐born counterparts,
– exception of refugee women
• Immigrants, especially newcomers, were more
likely to experience barriers to preventive
services (e.g. immunization and prenatal care)
Oral Health
• Little research on dental health of immigrants or immigrant
sub‐groups.
– Factors:
• knowledge,
• cost
• perceived discrimination
– Our preliminary data from Healthy Immigrant Children
Study
• Low dental health literacy in refugee families
• Not a priority
• Higher rate of decay and loss in refugee children than in immigrant
children
5
Concluding remarks
• Newcomers, particularly refugees, might be at greater risk of
experiencing health issues
• Nutrition‐related non‐communicable diseases
• Mental health issues
• Newcomer children, particularly refugees:
• a high risk of food insecurity,
• a high prevalence of vitamin D deficiency & inadequacy
• their current dietary practices do not provide adequate intake of key nutrients and put them at risk of obesity and obesity related
diseases
• There is no one recipe for all when providing services to newcomers
why is health canada data so different
exclude all people who cant speak english or french. dont seperate refugee and immigrant
vitamin d in refugees
21% were deficient, 42% had inadequate bone health
imagrant girls are much more at risk
Newcomers’ Health
Newcomers, particularly refugees, might be at
greater risk of experiencing health issues
• Nutrition-related non-communicable diseases
• Newcomer children, particularly refugees:
• a high risk of food insecurity,
• a high prevalence of vitamin D deficiency & inadequacy
• their current dietary practices do not provide adequate
intake of key nutrients and put them at risk of obesity
and obesity related diseases
