Economic globalization, nutrition and health: a review of quantitative evidence

Abstract

Background Unhealthy dietary patterns have in recent decades contributed to an endemic-level burden from non-communicable disease (NCDs) in high-income countries. In low- and middle-income countries rapid changes in diets are also increasingly linked to malnutrition in all its forms as persistent undernutrition and micronutrient deficiencies continue to coexist with a rising prevalence of obesity and associated NCDs. Economic globalization and trade liberalization have been identified as potentially important factors driving these trends, but the mechanisms, pathways and actual impact are subject to continued debate. Methods We use a ‘rigorous review’ to synthesize evidence from empirical quantitative studies analysing the links between economic globalization processes and nutritional outcomes, with a focus on impact as well as improving the understanding of the main underlying mechanisms and their interactions. Findings While the literature remains mixed regarding the impacts of overall globalization, trade liberalization or economic globalization on nutritional outcomes, it is possible to identify different patterns of association and impact across specific sub-components of globalization processes. Although results depend on the context and methods of analysis, foreign direct investment (FDI) appears to be more clearly associated with increases in overnutrition and NCD prevalence than to changes in undernutrition. Existing evidence does not clearly show associations between trade liberalization and NCD prevalence, but there is some evidence of a broad association with improved dietary quality and reductions in undernutrition. Socio-cultural aspects of globalization appear to play an important yet under-studied role, with potential associations with increased prevalence of overweight and obesity. The limited evidence available also suggests that the association between trade liberalization or globalization and nutritional outcomes might differ substantially across population sub-groups. Overall, our findings suggest that policymakers do not necessarily face a trade-off when considering the implications of trade or economic liberalization for malnutrition in all its forms. On the contrary, a combination of nutrition-sensitive trade policy and adequate regulation of FDI could help reduce all forms of malnutrition. In the context of trade negotiations and agreements it is fundamental, therefore, to protect the policy space for governments to adopt nutrition-sensitive interventions. Electronic supplementary material The online version of this article (10.1186/s12992-019-0456-z) contains supplementary material, which is available to authorized users.

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“…There is a limited literature of systematic reviews and analyses of specific trade agreements identify various ways in which trade liberalization can affect food systems [11][12][13][14][15][16][17][18][19][20][21][22] . Three key pathways emerge from this literature: trade in raw or finished food commodities; increased foreign investment in domestic production, manufacturing and distribution of foods; and influence on regulatory policy space.…”

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“…4 5 However, since the 2008 food crisis—which saw a surge in international cereal prices—and in the context of the growing global prevalence of obesity, the possible harmful impacts of trade on diet and nutrition have gained attention from researchers and policy makers. 6 …”

“…9 This impact results from changes relating particularly to the import and export of agricultural and food products, foreign direct investment, and the effects on domestic policy. 6 10 …”

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