BMS3058 IPHN

Global Nutrition Transition

Dr Laura Tripkovic
laura.tripkovic@surrey.ac.uk

Learning outcomes
You should be able to:

Explain the concept of nutrition provision for

a developing global population
Understand what we mean by developing
countries and countries in transition
Explain the relationship between
development and health
Identify the key factors contributing to poor
nutrition in a country in economic transition
Identify the key actions and organisation
relating to tackling global nutrition issues

Population growth

Global Food Sustainability

Can the world sustain a growing population?

Location Vs Quantity

The distribution of food production is not

balanced
Abundant agricultural regions vs Barren desert
lands

Global Food Supply Issues

Rome Food Summit 2008
Global Food crisis
seen as a priority
A human fundamental need

Increased food prices impact on

developing countries?
Developing 60% income on food
Developed, buy in poverty 15%
income on food

Riots/unrest in food scarcity - Africa

World by income

Death distribution
Death distribution by age and
income
More than 8
million deaths
in 2008 were
among children
under five
99% in lowand middleincome
countries.

Millennium Development Goals

September 2000, Millennium Declaration. setting out goals to be reached by 2015.
The eight Millennium Development Goals
(MDGs) represent commitments in:
Improving health systems
reduce 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

Organisation
Functions:
The WTO

The 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 members
2/3 are developing countries
Special focus for least developed
improved market access;
more technical assistance;
support for agencies working on the
diversification of least-developed
countries economies;
speedier membership for LDC to join

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 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 - developed

Lowest income - undeveloped
Middle developing

Economy
Emerging economies are developing countries

Countries in transition, CIT

Included eastern Europe, Former Soviet
Union/central asia
These are now included in the term DC

Newly developed:
Developed Asia, Malta, Cyprus, Israel, Slovenia

What is a developing
Country?

Developed, UK, US, EU, AU etc

Developing/emerging economies
WTO members announce their status!
Has advantages, benefits, assistance etc
Trade preferences, zero/low import
duties/reciprocal arrangements

Countries in transition
Underdeveloped countries / LEDC
Not 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 countries

Designated as such by the UN the
following three criteria were used
low 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
Madagascar

Bangladesh
Benin
Burkina Faso
Burundi
Cambodia
Central African
Republic
Chad
Congo, Democratic
Republic of
Djibouti
Gambia
Guinea
Guinea Bissau
Haiti
Lao (Peoples
Democratic Republic)
Lesotho

Malawi
Mali
Mauritania
Mozambique
Myanmar
Nepal
Niger
Rwanda
Senegal
Sierra Leone
Solomon Islands
Tanzania
Togo
Uganda
Vanuatu
Zambia

Nine more leastdeveloped

countries are
negotiating to join
the WTO. They are:
Afghanistan
Bhutan
Comoros
Equatorial Guinea
Ethiopia
Liberia
Sao Tom &
Principe
Sudan
Yemen

Least
developed
countries

Afghanistan

Madagascar

Angola

Malawi

Bangladesh

Maldives

Benin

Mali

Bhutan

Mauritania

Burkina Faso

Mozambique

Burundi

Myanmar

Cambodia

Nepal

Cape Verde

Niger

Central African Republic

Rwanda

Chad

Samoa

Comoros

Sao Tome and Principe

Congo (Democratic Republic of the)

Senegal

Djibouti

Sierra Leone

Equatorial Guinea

Solomon Islands

Eritrea

Somalia

Ethiopia

Sudan

Gambia

Timor-Leste

Guinea

Togo

Guinea-Bissau

Tuvalu

Haiti

Uganda

Kiribati

United Rep. of Tanzania

Lao People's Democratic Rep.

Vanuatu

Lesotho

Yemen

Liberia

BMS 3058 IPHN 2014 M.GIBBS

Zambia

Landlocked developing countries

Afghanistan

Malawi

Armenia

Mali

Azerbaijan

Moldova (Rep. of)

Bhutan

Mongolia

Bolivia

Nepal

Botswana

Niger

Burkina Faso

Paraguay

Burundi

Rwanda

Central African Republic

Swaziland

Chad

Tajikistan

Ethiopia

Turkmenistan

Kazakhstan

Uganda

Kyrgyzstan

Uzbekistan

Lao People's Democratic Republic

Zambia

Lesotho

Zimbabwe

Macedonia (Former Yugoslav Rep. of)

BMS 3058 IPHN 2014 M.GIBBS

Factors affecting food

security

Infrastructure
Population density
Land quality & Geology
Geography
Climate/weather
Economy
Stability
Trade & transport

Urbanisation &
Globalisation

Agro-economic development increased demands change the supply

mechanisms
People moving from rural to urban areas
for work and access to desirable
goods and technology
Impact on food production and access
Food inequalities
Example: CHINA is it a DC or CIT ?
Tesco moves into china 2004
Spread of fast food chains
Changes in health? obesity and diabetes
(OW 19%)

What is a Country in
transition?

Countries in transition

Middle income countries

health transition
economic transition
Nutrition transition

OR
Between stability and instability, Eg
Haiti disaster zone
Iraq war zone
Greece? - economic change

What risk does retrograde transition

bring?

Demographic transition
Less developed
high birth rate, high death rate
slow population growth

in developmental transition
High birth rate, lower death rate
Fast population growth

Developed
Low birth rate, low death rate
Stable population/ small growth

Governmental transition
Less developed
Low democratic infrastructure
Dictatorships/localised power/
Little public policy or support

in developmental transition
Clear power hierarchy
Governemental guidance developing
developing stability and infrastructure

Developed
Established stable democratically selected
government
Established infrastructure
Established support system/education

Economic transition
Less developed
Low income.
Low industry
Low trade

in developmental transition
Growing industry /trade
Rising income

Developed
Established industry
internal and external trade
High income (by global comparison)

Health transition
Less developed
Infectious disease
Malnutrition

In transition
Infectious disease Malnutrition
NCDs rising rapidly

Developed
Low ID and Mal-N
High NCDs

Developing Countries
The 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 BMI
Global 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.jsp
Global BMI interactive Map

Table 1: The International Classification of adult

underweight, overweight and obesity according to BMI
Classification

BMI(kg/m? )

Principal cut-off Additional cutpoints

off points
Underweight
<18.50
<18.50
Severe thinness
<16.00
<16.00
Moderate thinness 16.00 - 16.99
16.00 - 16.99
Mild thinness
17.00 - 18.49
17.00 - 18.49
18.50 - 22.99
Normal range
18.50 - 24.99
23.00 - 24.99
Overweight
? 25.00
? 25.00
25.00 - 27.49
Pre-obese
25.00 - 29.99
27.50 - 29.99
Obese
? 30.00
? 30.00
30.00 - 32.49
Obese class I
30.00 - 34-99
32.50 - 34.99
35.00 - 37.49
Obese class II
35.00 - 39.99
37.50 - 39.99
Obese class III
? 40.00
? 40.00
Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004.

PHN Action - Programmatic

priorities

Developing 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

Summary
Nutritional health is related to wealth /economy and
development of a country
Poorest nations greatest malnutrition
Emerging economies double burden of disease
Developed countries predominantly NCDs
Developed countries support development via the WTO
and Worldbank:

strategic guidance,

Projects

We need a global strategy for action

to improve nutrition in all populations as they
develop
Fair trade and Aid
Education

Worldbank
The 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
countries
the 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.

Worldbank
Worldbank Film on food security and
nutrition issues in regions of Africa
http://go.worldbank.org/7GJSLGJMW0

INFORMATION POINT: Prevalence and incidence

Prevalence 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 incidence
of 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)