Introduction
The period between the year 1980 and 2008 was marked with a desire by states world wide to reduce their involvements in social and economic activities; use of state machinery to deregulate labour and financial markets; elimination of borders and barriers to stimulate commerce and investments. This was intended to allow for labour mobility, capital, goods and services. Application of such policies in health sector implied that the government had to reduce her responsibility for the health of its citizens; there had to be greater need for market diversification; national health services had to be transformed into health care systems that were insurance based; need for privatization of medical care; patients had to be referred to as clients; everyone had to be responsible for their own health; health promotion had to be looked at in the perspective of behavioural change; and personal responsibility had to be increased by addition of social capital to the endowment.Efforts have been made by various administrations to implement such policies. Policies have got greater bearing on the health of the citizens. Social seclusion, early (childhood) life, stress factor, social support, work-life balance and transport (mobility) are among community factor. Problems like unemployment, addiction, and food are also among the highly investigated social determinants of wellbeing (Navarro, 2009 p.3).). This essay will focus on food as a social determinant of health.
Access to healthy food has of late become a political issue due to the fact that the forces of demand and supply greatly determine the availability of food. A person’s general well being is enhanced by good diet and consistent supply of food (Wilkinson and Marmot, 2009 p.26). Lack of variety of food to choose from and food shortages cause malnutrition and occurrence of deficiency diseases. Ingestion of excess amounts of food can also lead to heart and circulatory system infections, diabetes, cancers, eye infections, obesity and tooth complications. Food availability and inadequacy have gross implications on human life. In the public health perspective, availability of healthy and nutritious food as well as their cost is the major concern. Epidemiological change from infectious to chronic diseases has been sanctioned by economic growth and improvements in housing and sanitation. In parts of Western Europe, many people adopted a lifestyle where they took more calories of food that had generous supply of fats and sugars hence an increase in the number of people suffering from obesity. At this point in time obesity became the poor mans disease than the rich. World food trade has of late become a very big business venture. The industry players have come to a consensus on the tariffs too be levied, the trade, and common agricultural policies. However, it is appalling to come to a realization that bodies charged with responsibility of determining food quality and safety standards at times do lack the capacity to undertake their responsibilities. To guarantee food security, it’s pertinent that people embrace local food production. Social and economic situations do exert pressure on the quality of the diet thereby contributing to health complications. The difference between the rich and the poor lies in the sources of nutrients. The poor will normally consume cheaper processed food at the expense of fresh foods. All social groups tend to take more calories of fats. The unemployed, the elderly and young families rarely afford three meals in a day. In order to prevent chronic diseases it advisable that one takes more of fresh vegetables, fruits, legumes and minimally processed starchy foods. Consumption of large amounts of animal fats, refined sugars and salts has to be avoided at all costs. Local authorities, national governments, international agencies, non governmental organizations and producers of food should consider integrating public health issues into food system enable everybody to have access to affordable and nutritious fresh food. The vulnerable groups should be given first priority in this aspect. Food regulation matters should be handled democratically, transparently with some element of accountability. All stake holders, including consumers, should participate in this process. Food production methods and agriculture should be sustainable to help in conservation of natural resources and the larger environment. Education system should consider embracing stronger food culture for health to help enhance knowledge about food and nutrition, growing food, cooking skills and the social value of eating together of prepared food (Ghezan, Mateo and Viteri, 2002 p.309). These agencies should ensure that useful material about food, diet and health is made available to the children. Scientifically based nutrient reference values should be used. There should be food based guidelines to allow for development and implementation of food policies.
Impacts of globalization on Food supply
Changes in food supply and diet in developing countries has been occasioned by urbanization, increasing incomes and foreign direct investment. Entry of women into active employment and sedentary lifestyles also contribute to this. All these have caused changes in nutritional status and disease burden. The relationship between environment, diet and disease is influenced by urbanization, health and nutritional status. Intensive use of agrochemicals and hybrid plants, genetically modified plants, changes in food processing, changes in distribution and marketing system are some of the changes that have occurred in the agricultural and food system. In Colombia the government did away with tariffs levied on imported food. This resulted into market where food supply was determined by market forces. Cheap goods in turn found their way into Colombian market. This included cheap feed grains that resulted into increased livestock production. It is this same year that food retail systems and supermarkets sprung up. Women in gainful employment acquired refrigeration systems hence the emergence of convenience foods. Urbanization greatly affects dietary change and nutritional status. According to United Nations population, 47.7 per cent of the total world population lived in urban centres in 2001. Developing countries witness a wide disparity in urbanization (Haddad, 2003 p.5).
In 2000, Brazil, Chile and Colombia were highly urbanized where as half the population of Fiji, Philippines and South Africa stayed in urban centres. United Nations projected that there was supposed to be greatest increase in urban population in Bangladesh, Tanzania and Nigeria. These countries have the lowest Gross Domestic Product. Countries with greater proportion of its population living in urban centres have the highest GDP per capita. Infant mortality rate in Brazil is estimated to be 31 deaths in 1000 live births. In some circumstances, infant mortality rate in Brazil sometimes hit the 100 mark. Chilean government spends more on health. She has low infant mortality. Nigeria has the lowest government expenditure in heath with highest infant mortality rate. Change in dietary comes in two aspects. These are the dietary convergence and dietary adaptation. Dietary convergence is observed when people over rely on narrow foundation of staple starch food stuff especially grains, increase meat intake, meat products and milk products. Other products with similar impact consist of oils, mineral salts and starches and decreased ingestion of fibre foodstuffs. Consumption of brands that is processed and store bought characterise dietary adaptation. This phenomenon makes many people to develop a habit of eating outside their homes. People also start developing behaviours instigated by appeal of new food products available. Income and price are the major factors that lead to dietary convergence. These two are also affected by supply and availability. Low prices for the renowned world staple foods rice; wheat and maize are maintained by subsidies that are offered to farmers that are producing such staple foods by. Sale of rice was accelerated by the increasing demand of rice in Africa and certain parts of the Asia continent. Dramatic increase in rice production that has necessitated decrease in its price was due to intensive agricultural practices and yield improvements due to globalization. Increased fat consumption from vegetable oils draws its origin from dietary convergence. Even countries with lower gross domestic product experience increased fat intake (King, Aubert and Herman, 1998 p.1444). Changes in lifestyle at times force people to adapt diets that comprises of processed refined foods. Change in life style may come due to time factor, whatever one watch in adverts, and emergence of new retail outlets for foods. The working lot tend to work more so that they may increase their income to enable them pay for their upkeep and other expenses like payment of their children’s school fees. Such people may be working away from home and therefore take a reasonable amount of time commuting to their places of work hence lack time within which to prepare their own foods. Such people will take their meals outside their homes. This is exemplified in Chile, where a working day is made up of ten hours plus an average of 3 hours spent commuting. Work demands have made many people to go for fast food joints rather than making their own meals back at home. Traditional meal times have been substituted by unplanned spontaneous purchase of food in streets. A tradition where one family member was responsible for planning whatever people were supposed to eat has been abandoned in most urban set ups. Child care centres, food kiosks, cafeterias have taken over this mundane role. No attention is therefore paid to diet balancing and quality of food that is consumed. Balancing and quality of our food is now a subject to cultural and external forces. Because of urbanization, all and sundry have opted for street food because they are cheap and quick meal option.
Street Foods
Delicacies served in the streets meet the diverse customer tastes. They range from traditional dishes to modern delicacies. Street vendors are rarely regulated in many countries by the relevant authorities. This may compromise the health and safety requirements. In Tanzania foods that are taken in the streets account for 70 per cent caloric intake of low and middle income earners. Despite the fact that quality and safety are the major concerns cited regarding street foods there are few empirical data that enumerates the number of pathogens found in street foods compared to food that is prepared at home. Study conducted on street food in Ghana on 511 food samples by WHO on bacterial contamination showed that the microbial levels were within the accepted ranges (Lang, 2003 p.5). 26 types of food had bacterial counts that were above accepted limits. Many vendors were green about sanitary requisites, possible pollution of vehicle carrying such food, lack of water for cleaning and preparation may have been the route course of the presence of the bacteria. Street vendors also sell beverages, fruit juices, and snacks that are not so much talked about in nutrition.
Supermarkets
Supermarkets have over the years mushroomed in the developing countries. In the Latin America they were first witnessed in the early 1990s. In Asia, they were witnessed in the years 1995. In Africa, they are steadily rising in number currently. In Brazil, their share in national retail reached a record 75 per cent in 2000. Chile boasts 50 per cent share; where as urban china and Philippines, the share was 48 and 57 per cent respectively for packaged and processed foods. The supermarkets intended to specialize in sale of processed and packaged products and then after some time to divert to sale of frozen meat and fresh produce (Lang, 2004 p.1). Their initial sale of packaged and processed food products exposed many consumers to the use of exotic food products. Some of these goods had long shelf life. A reasonable percentage of processed food products have a generous amount of sodium and sweeteners. They also have high fat content.
Fast food industry
Convenience food markets have of late accessed markets in several countries. By 1985, McDonalds operated more than 9000 restaurants the world over. At the beginning of the 21st century, the number of their stores reached a record 30 000 in 121 countries. The first foreign fast food company in china was Kentucky Fried Chicken that opened its first branch in Beijing in 1987. In 1986, the branches had become 100. In 2002, the outlets had reached 600, with many of them established in the urban centres. In Latin America, McDonald’s outlets were 1581 in 2002 compared to 100 restaurants that it started with 15 years earlier. One third of such outlets were found in the typical urban Brazil set up.
Role of Advertising
Appeal of products that are advertised, information on supermarkets and multinational fast food chains that sell such products influence ones dietary adaptation and convergence. Cost incurred by such companies in advertising do exceed amount of moneys authorities use on health promotion and education. In Brazil, a review of television advertisements on food implicated 58 per cent commercials with promotion of high fat and sugar intake. 9 per cent of them advocated for uptake of meat, beans and eggs. No advertisements catered for uptake of fresh fruits and vegetables.
Changing of Attitude
A study conducted in South Africa showed that residents of urban Johannesburg considered fried foods as a sign of modernity and wealth where as boiled food is inferior and a show of outdated culture. Residents of an informal settlement Khayelitsha loath farming and would only do it to help them get money to use in purchasing food. The individuals working in communal gardens would live as soon as they have accumulated enough money. Whatever is produced from community gardens is majorly used in market gardening.
Consumption of meat, fish, poultry and eggs increased by 26 g/day between 1991 and 1997 in china with dramatic increases witnessed in less urbanized urban areas and urbanized rural areas. Colombia achieved significant gains in poultry production by importation of cheaper animal feeds. Chicken meat production and egg production in Columbia increased by 55 and 36 per cent respectively between, 1990 and 2001. In India consumption of rice and wheat and rice declined marginally in the years 1987-1988 and 1999-2000. Egg and milk production increased significantly. This was sanctioned by consumption of eggs, tea, biscuits and other confectioneries. Embrace of refrigerators and refrigeration technology by many households has transformed food systems. Food processing companies extensively make use of cold storage in their large and small food outlets (Popkin, 2003 p.583). This also used by households hence a change in pattern of food procurement. Large amounts of food can be stood for some period of time without compromising their quality. Consumers are now left with a variety of options to choose from, either to go for frozen or fresh food. Access to reliable source of electricity still frustrate refrigeration initiatives in many developing countries the world over. Studies indicate that a massive 56 per cent of people living in developing countries do not have access to electricity. 87 per cent of the people living in Latin America can access electricity; 41 per cent in southern Asia; and 23 per cent in sub Saharan Africa. Electricity therefore becomes a requisite for adoption of refrigeration as a way of food preservation initiative. However, large supermarket chains have managed to use refrigeration in countries which are still facing challenges related to access to electricity. In Brazil, 80 per cent of households have refrigerators where as the remaining 20 per cent have got freezers.
Health and nutritional challenges occasioned by globalization
Cholesterol levels in ones system; low fruit and vegetable intake; iron, zinc and vitamin A deficiency contribute to low life expectancy. Reduced intake of dietary or energy micronutrients, imbalanced diet, and excess dietary energy is a major cause of health concerns. Dietary deficiencies have far reaching consequences on individual’s life. Blindness is mainly caused by lack of vitamin A in ones system; mental deterioration may be caused by lack of optimal levels of iodine in ones body. Diet is also a major contributing factor to emergence of lifestyle diseases like the type II diabetes; cancers; cardiovascular diseases; infection of the tooth and osteoporosis. Under nutrition in adults and children in developing countries remains a major concern for public health as is obesity in developed world. It is estimated that a massive 1.7 billion people the world over may be suffering from obesity or overweight. Majority of people who are overweight are found in developed world. However, obesity and overweight have recently become very common in the developing countries particularly in Latin America, the Caribbean’s and the northern parts of Africa. Nutrition transition is manifested in 3 stages namely: recess of famine as peoples income rise; changes in diet and activity patterns; behavioural change shown by regulation of intake and activity (Reardon, Trimmer and Berdegue, 2003 p.1). World health organization and Food and agricultural organization are concerned about the prevalence of diseases like diabetes mellitus, cardiovascular diseases like coronary thrombosis and arteriosclerosis, hypertension, strokes and some cancers. In 2000, it was estimated that a total of 171 million people had diabetes. It was projected that by 2030 the number would increase to 366 million. Diabetes is often referred to as a lifestyle disease. It is etiologically linked to diet and exercise.
Importance of food to health
Human body requires nutrition for its normal functioning. Nutrition comes in the form of Vitamins, carbohydrates, fats, proteins and mineral salts. The body cannot do without essential proteins but can continue its operation with or without non essential proteins. Proteins can further be categorised as animal and plant proteins. Proteins have essential and non essential amino acids. Proteins play many roles in the body ranging from repair of warn out body tissues to many other functions. They are a major component of the nervous system. The dendrites and exons are made up proteins. All the hormones found in the body system are made up of protein ranging from the oestrogen to progesterone. Absence of protein in the body system due lack of access to balanced diet would therefore mean that many hormonal changes that take place in the human system will not be facilitated (WHO/FAO, 2003 p.10). In case one sustains an injury there would be no possibility of tissue rejuvenation due to lack of protein in the system. Human sex cells are also made up of protein so its deficiency may lead to cases of sterility. A covert importance of protein can be witnessed in the uptake animal proteins which expose one to atherosclerosis that is characterised by uptake of low density lipoproteins (LDL). Such lipoproteins block the arteries that nourish the heart and brain leading to conditions known as stroke and coronary thrombosis which are very lethal. Carbohydrates carter for all the body energy requirements o. Almost all the energy transduction mechanisms in the body make use of carbohydrates including Embden Meyerhof pathway, Entner duoderoff pathway, and the phosphorylatic pathways. Carbohydrate deficiency may make someone to deplete his or her energy reserves and be in a position where he or she is not able to discharge responsibilities due to lack of energy. Excess uptake of carbohydrates may lead emergence to type II diabetes. Carbohydrates can be converted to fats that are used in insulation of the body against cold. Fats majorly insulate the body against heat loss. There are a variety of vitamins in the body. They majorly play a protective role in the body. Deficiency of vitamins can be so costly to the body. Deficiency of vitamin C exposes one to scurvy, deficiency of vitamin C causes night blindness, deficiency of vitamin D causes scurvy. Mineral salts like sodium and potassium are very essential for maintenance of isotony in the human system.
Conclusion
Malnutrition can be fought educating the people on the aspects of nutrition. It worth noting that countries that experience under nutrition it is insignificant among the educated. This is also true for over nutrition. Healthy food culture should also be considered. In urban set up an average of 2 meals are taken away from home. This implies that majority of meals are taken in day care centres, schools or in food joints. To avert any dangers that may arise, it is imperative that a healthy relationship is created between the urban and rural lots to get fresh supply of foods. It is also very important that households consider eating fruits and vegetables as these are healthy food choices (Wild, Roglic, Green, Sicree and King, 2004 p.1047.. Regulatory measures should also be put in place like levying taxes on certain foods, putting in place advertising restrictions and rewarding certain food production initiatives.
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