Trade openness and the obesity epidemic: a cross-national study of 175 countries during 1975–2016

An, Ruopeng; Guan, Chenghua; Liu, Junyi; Chen, Nan; Clarke, Caitlin

doi:10.1016/j.annepidem.2019.07.002

Cited by 29 publications

(33 citation statements)

References 43 publications

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“…This association suggests that agricultural trade liberalization may have negative health externalities, that is, increasing obesity and overweight (Costa‐i‐Font & Mas, 2016; Miljkovic et al., 2015). This may create an important dilemma for policymakers because agricultural trade liberalization is often promoted as improving food security and reducing poverty (An et al., 2019; Mary, 2019). If the links between agricultural trade liberalization and obesity are indeed causal (rather than coincidental), policymakers should integrate such health externalities into the design of developing countries’ trade policies.…”

Section: Introductionmentioning

confidence: 99%

“…If the calorific (nutritional) value of imported foods is higher (lower) than that of domestic products, this may result in overnutrition. Third, past trade agreements advancing agri‐food liberalization and trade openness widen the acceptance of a Western diet, shaping future preferences, tastes, and demand for obesogenic food products (e.g., An et al., 2019; Fox et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

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Does agricultural trade liberalization increase obesity in developing countries?

Mary

Stoler

2021

Review Development Economics

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Agricultural trade liberalization has been sometimes accused of being one of the main causes of increasing obesity and overweight in developing countries. However, there is no consensus on the impacts of trade on obesity in the literature. We estimate the impacts of agricultural trade openness on the prevalence of obesity and overweight using a sample of 70 developing countries between 1990 and 2013. We find that a 1% increase in agricultural trade openness would decrease obesity prevalence by 0.5%. We find similar results for the prevalence of overweight. Our results are robust to alternative specifications. Our findings suggest that long‐term health concerns related to overnutrition associated with agricultural trade liberalization in developing countries are overstated. Public health interventions should target domestic causes behind overnutrition rather than trade policies and agreements.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does agricultural trade liberalization increase obesity in developing countries?

Mary

Stoler

2021

Review Development Economics

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“…Neuman et al found tariff rates to be inversely associated with BMI among poor and rural residents, whereas no association between trade openness and BMI was identified. Miljkovic et al and An et al reported that trade openness in general was associated with changes in obesity prevalence. Oberlander et al reported a null relationship between trade openness and mean BMI.…”

Section: Resultsmentioning

confidence: 99%

“…The reasons for exclusion were that two articles were not directly related to economic globalization, two articles did not report any outcome pertaining to body weight status, four articles were narrative review, commentary, or study protocol instead of original study, and the other six articles were not data‐driven empirical research. In total, 16 articles met the eligibility criteria and were included in the review …”

Section: Resultsmentioning

confidence: 99%

A scoping review on economic globalization in relation to the obesity epidemic

Shen

Bullard

et al. 2019

Obesity Reviews

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of 16 studies were identified, in which six adopted a cross-sectional study design, nine adopted a longitudinal study design, and the remaining one adopted a casecontrol study design. Thirteen studies assessed the relationship between economic globalization and obesity at the country level, whereas the remaining three analyzed individual-level data. Fourteen studies found at least one aspect and/or measure of economic globalization to be positively associated with overweight/obesity, one found an inverse association, and the remaining one reported a null finding. Through market deregulation, tariff reduction, and investment liberalization, economic globalization tends to accelerate the market entry of modern food manufacturers, supermarket chains, and fast-food restaurants, resulting in substantially increased supply of high-sugar/fat energy-dense foods with enhanced variety and accessibility and reduced price. The potential impact of economic globalization on obesity through the adoption of modern workplace and domestic technologies and motorized transportation and through changes in social norms and culture were hypothesized in the literature but not empirically examined, which warrants future data-driven research.

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“…[1][2][3][4][5][6][7][8][9] These companies and products penetrated low-and middle-income countries (LMICs) in an unprecedented way, [10][11][12][13][14] coinciding with a dramatic increase in the prevalence of obesity and noncommunicable diseases (NCDs) in all LMICs. [15][16][17][18][19] In highincome countries, some NCDs like cardiovascular disease have reduced, but others like obesity and diabetes have increased inexorably. 15,20 Malnutrition in all its forms is now by far the biggest contributor to lost disability-adjusted life years around the world.…”

Section: Introductionmentioning

confidence: 99%

International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition: A Realist Review

Garton

Thow

Swinburn

2020

Int J Health Policy Manag

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Background: Achieving healthy food systems will require regulation across the supply chain; however, binding international economic agreements may be constraining policy space for regulatory intervention in a way that limits uptake of ‘best-practice’ nutrition policy. A deeper understanding of the mechanisms through which this occurs, and under which conditions, can inform public health engagement with the economic policy sector. Methods: We conducted a realist review of nutrition, policy and legal literature to identify mechanisms through which international trade and investment agreements (TIAs) constrain policy space for priority food environment regulations to prevent non-communicable diseases (NCDs). Recommended regulations explored include fiscal policies, product bans, nutrition labelling, advertising restrictions, nutrient composition regulations, and procurement policies. The process involved 5 steps: initial conceptual framework development; search for relevant empirical literature; study selection and appraisal; data extraction; analysis and synthesis, and framework revision. Results: Twenty-six studies and 30 institutional records of formal trade/investment disputes or specific trade concerns (STCs) raised were included. We identified 13 cases in which TIA constraints on nutrition policy space could be observed. Significant constraints on nutrition policy space were documented with respect to fiscal policies, product bans, and labelling policies in 4 middle-income country jurisdictions, via 3 different TIAs. In 7 cases, trade-related concerns were raised but policies were ultimately preserved. Two of the included cases were ongoing at the time of analysis. TIAs constrained policy space through 1) TIA rules and principles (non- discrimination, necessity, international standards, transparency, intellectual property rights, expropriation, and fair and equitable treatment), and 2) interaction with policy design (objectives framed, products/services affected, nutrient thresholds chosen, formats, and time given to comment or implement). Contextual factors of importance included: actors/institutions, and political/regulatory context. Conclusion: Available evidence suggests that there are potential TIA contributors to policy inertia on nutrition. Strategic policy design can avoid most substantive constraints. However, process constraints in the name of good regulatory practice (investor-state dispute settlement (ISDS), transparency, regulatory coherence, and harmonisation) pose a more serious threat of reducing government policy space to enact healthy food policies.

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Trade openness and the obesity epidemic: a cross-national study of 175 countries during 1975–2016

Cited by 29 publications

References 43 publications

Does agricultural trade liberalization increase obesity in developing countries?

Does agricultural trade liberalization increase obesity in developing countries?

A scoping review on economic globalization in relation to the obesity epidemic

International Trade and Investment Agreements as Barriers to Food Environment Regulation for Public Health Nutrition: A Realist Review

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