THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| 1- Some definitions … | |
| 2- Conceptual framework | |
| 3- Empirical evidence | |
| 4- Policy implications | |
| NCDs are chronic, non-infectious diseases. They include cardiovascular diseases, cancers, obesity, diabetes and other endocrine disorders, respiratory diseases, digestive diseases, bone diseases, mental diseases, etc. | |
| NR-NCDs are NCDs whose causality involves nutritional risk factors, particularly unbalanced diets, sedentary life-style, and obesity. They include obesity itself, most CVDs, some cancers, diabetes, dyslipidaemia, musculoskeletal diseases,etc. |
THE SOCIAL DISTRIBUTION OF NR-NCDs IN THE DEVELOPING COUNTRIES
| 2- Conceptual framework | |
DETERMINANTS OF OBESITY AND OTHER NR-NCDs
DETERMINANTS OF OBESITY AND OTHER NR-NCDs
DETERMINANTS OF OBESITY AND OTHER NR-NCDs
DETERMINANTS OF OBESITY AND OTHER NR-NCDs
THE SOCIAL DISTRIBUTION OF NR-NCDs IN THE DEVELOPING COUNTRIES
| The social distribution of obesity and other NR-NCDs in a society essentially reflects differences in the physical, economic and socio-cultural environment surrounding the poor and the rich, but these differences are dynamic and dependent on the society stage of economic development. |
The dynamic link between economic development, environment and social distribution of NR-NCDs.
| The empirical question we intend to answer here is: | |
| at what stage of economic development (and/or economic globalization) the poor and the rich start to be equally exposed to obesity and other NR-NCDs and at what stage the burden shifts toward the poor? |
THE SOCIAL DISTRIBUTION OF NR-NCDs IN THE DEVELOPING COUNTRIES
| 3- Empirical evidence | |
THE SOCIAL DISTRIBUTION OF NR-NCDs IN THE DEVELOPING COUNTRIES
| Data sources: anthropometric national surveys* of women at reproductive ages | |
| (n=157, 844) conducted from 1992 to 2000 in 37 developing countries of Africa, Asia and Latin America | |
| * Macro-DHS, World Bank-LSMS, Mexico and China Health and Nutrition Surveys | |
THE SOCIAL DISTRIBUTION OF NR-NCDs IN THE DEVELOPING COUNTRIES
| Analyses: | |
| a) country age-adjusted prevalence of obesity by SES (country-specific women education quartiles) | |
| b) pattern of association between obesity and SES according to the country per capita GNP | |
| c) predicted prevalence of obesity by SES at different GNP levels | |
WOMEN’S
OBESITY AND SES
Sub-Saharan Africa: 1992-1999
WOMEN’S
OBESITY AND SES
Sub-Saharan Africa: 1992-1999
WOMEN’S
OBESITY AND SES
Southeast/South/East Asia: 1996-1999
WOMEN’S
OBESITY AND SES
Central Asia:
1996-1999
WOMEN’S
OBESITY AND SES
Middle East:
1992-1998
WOMEN’S
OBESITY AND SES
Latin America and
Caribbean: 1995-2000
"Pattern of association between obesity..."
| Pattern of association between obesity and SES according to the country per capita GNP | |
WOMEN’S OBESITY AND SES AT DIFFERENT LEVEL OF ECONOMIC DEVELOPMENT (1992-2000)
"Predicted prevalence of obesity by..."
| Predicted prevalence of obesity by SES at different GNP levels in a model with an interaction term between individual SES and country GNP level. | |
OBESITY
AND INEQUITIES IN HEALTH
IN THE DEVELOPING WORLD
| In sum: cross-sectional studies undertaken in the 90’s indicate that only at earlier stages of economic development the poor are protected against obesity and at intermediate stages (GNP per capita from US$ 1,500) the risk of obesity is actually higher for the poor than for the rich. |
OBESITY
AND INEQUITIES IN HEALTH
IN THE DEVELOPING WORLD
| But, due to the cross-sectional nature of the analyses, the hypothesis of the shifting of obesity toward the poor was not directly tested - this requires comparable cross-sectional surveys on obesity and SES repeated over time in the same population. |
THE
SHIFTING OF OBESITY TOWARD THE POOREST WOMEN
Southeastern Brazil: 1975-1997
THE
SHIFTING OF MALE OBESITY TOWARD THE MIDDLE INCOME GROUPS
Southeastern Brazil: 1975-1997
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| 4- Policy implications | |
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| 4- Policy implications | |
| The equity issue | |
| Targeting of interventions | |
| The content of interventions | |
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| The equity issue | |
| Fighting obesity and other NR-NCDs in the developing world will contribute to reduce inequities in health in some countries and to prevent them in others. | |
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| Targeting of interventions | |
| Public policies to fight obesity and other NR-NCDs in the developing world will fail if they don’t effectively reach the poor. |
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| The content of interventions | |
| To reduce or prevent obesity and other NR-NCDs and the inequities in health generated by them it is essential to narrow the gap between the poor and the rich concerning not only the information needed to decide for healthier behaviours but also the environment that makes possible the adoption of these behaviours. |
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| Example of physical environment constraints to promote the consumption of fruits and vegetables among the poor in Brazil. |
FRUITS
AND VEGETABLES:
a typical upper middle class
selling point in Sao Paulo city
FRUITS
AND VEGETABLES:
a typical lower middle class
selling point in Sao Paulo city
THE
SOCIAL DISTRIBUTION OF NR-NCDs
IN THE DEVELOPING COUNTRIES
| Example of economic environment constraints to promote the consumption of fruits and vegetables among the poor in Brazil |
RELATIVE
CONSUMPTION OF FRUITS AND VEGETABLES BY INCOME DECILES
Brazil
1997
FAMILY
FOOD BUDGET SPENT WITH
FRUITS AND VEGETABLES.
Brazil 1997
FAMILY
INCOME SPENT WITH
FRUITS AND VEGETABLES.
Brazil 1997
COST
PER CALORY OF SELECTED FOOD
GROUPS FOR THE FIRST INCOME DECILE
.
Brazil 1997