Diabetes in Pakistan

In 2019, Pakistan ranked sixth globally for the prevalence of diabetes. The recent increase in the prevalence of diabetes in Pakistan is associated with lifestyle changes. Citizens have been adapting their diets due to the industrialization and economic development within the country.

Diabetes in Pakistan

Obesity increases the likelihood of developing diabetes. Experts at the Pakistan Diabetes Leadership Forum in 2014 cited dietary changes that include consuming more saturated fats and less fiber as a cause of increased obesity and diabetes. Physical inactivity associated with economic changes in the country also contributes to the increased pervasiveness of diabetes. These diabetic risk factors decrease both insulin sensitivity and glucose tolerance.

Estimates believe that more than 6.7 million people in Pakistan have diabetes, which equates to 7.6% of the overall population. Despite its prevalence, diagnosis and treatment of diabetes in Pakistan is still limited. Only half of the estimated cases have been formally diagnosed and half of those diagnosed receive treatment. Recognizing the need for better, more accessible treatment options, organizations are combatting diabetes in Pakistan.

Diabetic’s Institute of Pakistan

Diabetic’s Institute of Pakistan (DIP) was founded in 1996. It has become the “leading organization for diabetes management, treatment, education and counseling” in the country. DIP focuses on three main aspects of fighting diabetes: prevention, treatment and management. To date, DIP has helped more than 100,000 patients.

The facility runs a diabetes awareness program and publishes educational materials in both English and Urdu. DIP also provides counseling and consultation services. The organization focuses heavily on psychological services due to its belief in emotional strength and the importance of “hope and happiness” for successful prevention and treatment of diabetes. Mental health services include an all-day helpline and counseling services that deal with stress and anger management. More traditional counseling is also available through DIP.

World Diabetes Foundation Project WDF15-947

The World Diabetes Foundation (WDF) started Project WDF15-947 to make diabetes treatment more widely accessible, especially focused on helping low-income individuals and areas. WDF supports three treatment clinics in Islamabad and Rawalpindi through training and education initiatives.

Between 2015 and 2018, WDF trained more than 300 nurses, doctors and paramedics in proper prevention, diagnostic and treatment practices in order to better serve the needs of the communities. In the same three years, nearly 13,000 screening tests were conducted. Individuals diagnosed with diabetes were referred to diabetes specialists for proper treatment. WDF also undertook an awareness campaign that included billboards, media programs for both TV and newspapers and the distribution of educational materials about diabetes in Pakistan.

The Diabetes Centre

The Diabetes Centre (TDC) is a nonprofit organization in Islamabad. It aims to improve access to diagnostic screenings and treatment for diabetes in Pakistan by providing these services for free to low-income individuals. The organization has 12 clinics that respond to specific complications of the disease, such as kidney, cardiac and eye care facilities. Since 2014, TDC treated almost 112,000 patients, of which only around 30% had to pay for treatment.

Diabetes in Pakistan remains an issue with low awareness and limited access to diagnosis and treatment services. However, these three organizations as well as many others, are working to increase educational initiatives and make treatments more accessible to combat diabetes.

Sydney Leiter
Photo: Flickr

Healthcare in Samoa
Samoa consists of nine volcanic islands in the South Pacific with a population of about 196,000. The country’s healthcare system provides the Samoan people with access to routine medical treatment. However, the country relies on outside assistance to provide aid and education to supplement people’s knowledge regarding anything more than standard medical practices. In recent decades, healthcare in Samoa has focused primarily on combating the increase of Type 2 diabetes, but several factors have hindered these efforts.

Lifestyle and Eating Choices

After World War II, the Samoan population grew dramatically, and the Samoan people’s lifestyle and eating choices began to mimic a more Western way of life. Samoa now faces some of the highest diabetes and obesity rates in the world. The United Nations Development Program, which measures countries’ well-being based on income, education and health factors, ranked Samoa 111th out of 189 countries in its 2019 report. About 20% of the people fall below the poverty line.

Many Samoans feel the need to appear as well-off as their neighbors. Bringing processed foods to social and family gatherings conveys an image of wealth. Many Samoans choose these products over local foods like fresh fruit and fish that are healthier and more nutrient-dense. As a result, many Samoans struggle not only with obesity but also anemia because they do not receive enough iron. In a 2017 study, 16% of Samoan toddlers were overweight or obese. Being able to provide more expensive, imported foods can also denote status. As a result, more Samoans eat less-healthy, processed foods that increase their risk of developing Type 2 diabetes.

Increased Need for Education 

A 2010 study funded by the National Institute of Diabetes, Digestive and Kidney Disorders found that many Samoans do not consider diabetes a major contributor to poor health. Because diseases like obesity, diabetes and hypertension are newer to their country, many Samoans do not recognize their severity. Educational efforts related to the study helped Samoans learn about the management and prevention of these diseases. Simple flip charts with large pictures and minimal text helped illustrate basic preventative measures. Although these measures were not especially thorough, they gave the people the first steps toward being more aware of the effects of their lifestyles and having better healthcare in Samoa.

In 2018, a small group of students from the Pacific Islands attending U.S. universities joined a Yale research project to learn more about solutions to these health problems so they could bring this knowledge back to their homes. With both local and overseas efforts, Samoans are becoming more educated about these diseases. This should, in turn, result in better healthcare in Samoa.

Lack of Local Health Professionals

Healthcare in Samoa is free, and several hospitals are available for people needing services. However, the country does not have enough medical professionals. From 1997- 2010, there were only 48 doctors per 100,000 people. Many of the specialists who primarily treat diabetes do not live in the country but travel there for a limited time. Although over 21% of adults have Type 2 diabetes, there is no established endocrinologist in the country. Healthcare staff have expressed a desire for more training for themselves, as well as outreach programs for their patients.

For decades, Samoans have been asking for the placement of full-time physicians in district hospitals. Just in 2020, full-time doctors were finally assigned to all of the hospitals in Samoa. Although this is a huge improvement, the community needs to continue to focus on adapting its social and cultural practices to prevent the disease from spreading. With limited healthcare staff available, an increase in knowledge and a sharing of that knowledge is the best bet for success.

Type 2 diabetes cases will continue to increase as long as Samoans make choices that increase their risk. Until they can get more support from medical professionals, the most effective way to combat diabetes seems to rely on increased education and understanding. Without adequate medical staff and proper education about nutrition, healthcare in Samoa will likely continue to focus on obesity and the diabetes epidemic.

– Tawney Smith
Photo: Flickr

Ending the Cycle of Poverty and Obesity
The McDonald’s Big Mac, one of the most famous burgers around the world, has a fair list of tempting qualities. It comes with two pure beef patties, the special Big Mac sauce, lettuce, onions, pickles and melted American cheese, sandwiched between two sesame seed buns. Its taste is well-known and for many, a tempting meal choice. But, perhaps the most tempting quality of the Big Mac is its price. All 550 calories of the Big Mac come to a total of about $5.70 in the U.S. That price is even lower around the world. In fact, the Big Mac can cost as low as $1.86 in South Africa. That stands in stark contrast to the price of more healthy food options. For example, a gallon of organic whole milk costs $6.98 at Walmart, about 22% more than an entire Big Mac. Price differences in healthy versus processed foods lead to a difficult decision for the consumer, especially if they are from a low-income household. The healthy choice becomes hard. Does their economic position sentence them to Big Macs and processed food? It is time to end the cycle of poverty and obesity.

Why is Eating Healthy is Hard?

According to most recent estimates, about 734 million people live on less than $1.90 a day. Additionally, about four out of five Americans will experience poverty or economic hardship at some point in their lives. Hundreds of millions of people are struggling every day to make ends meet and the all too common casualty of their struggle is their health.

According to the Harvard School of Public Health, eating healthy food costs about $1.50 more per day than eating a heavily processed diet. This number may seem small at first glance but adds up to an extra $2,200 per year for a family of four. They must choose between organic or conventional chicken, which can be a price difference of at least 50%. People living in poverty are simply unable to afford healthy food, resulting in a lack of nutrients, a diet lacking in energy-dense foods and even higher obesity rates.

The Link Between Poverty and Fitness

Food and exercise go hand in hand when it comes to overall physical health. Unfortunately, there is also a relationship between poverty and a lack of exercise. Nationwide studies have found that sedentary lifestyles are more prevalent in the poorest counties in the U.S. The correlation between inactivity and poverty is due to a myriad of reasons. For one, finances limit non-essential expenses like gym memberships, sports participation or paying for exercise equipment. Parks and sports facilities are also more regularly in affluent, not poor neighborhoods. One must even take safety into account because poor neighborhoods may have higher crime rates. The possibility of crime discourages parents from allowing their kids to play outside, discourages joggers and forces people to stay inside. Healthy food and sufficient exercise is a luxury. Many cannot afford such an expense to the detriment of their well-being.

The Cycle

Poverty can lead to obesity. Obesity can lead to poverty. The cycle of poverty and obesity together is a dangerous trap that imprisons many. For example, poverty leads to no access to healthy food and exercise, eventually leading to obesity. Obesity leads to further health complications and illnesses which may leave a person saddled with expensive medical bills. Lack of health, in general, leads to lower energy levels and even worsening mental health so that a person is unequipped with the energy and confidence to change their economic standing. Thus, obesity perpetuates poverty. The question is, how can society help break this dangerous cycle? Thankfully, some organizations are coming up with answers.

Unilever

Unilever is an organization that both identified the problem and produced solutions. Its recognition of the cyclical relationship between obesity and poverty encouraged the organization to release meal plans and brands affordable to all types of incomes around the world. Unilever has dedicated itself to making food that is nutritious and delicious so that making a healthy choice is easy. Unilever’s brands include Knorr, Hellmann’s, Lipton and more. Its options are sustainable and affordable with prices below the market average. Unilever also sells food through discount channels and donates to food banks to expand healthy meals to all populations.

Low-income communities often do not receive the chance to be healthy. The lack of gyms and affordable food traps them in the cycle of poverty and obesity. Thankfully, other food brands, gyms and organizations reaching out to low-income communities have joined Unilever. They are expanding health to all demographics, pointing people away from poverty and towards health.

Abigail Gray
Photo: Flickr

Homeless in Chile
Chile is one of the wealthiest nations in Latin America, yet as of 2018, half the country’s median monthly income was less than $600. Comparing the salaries of the top 20% to the poorest, 20% of top earners make 14 times the amount of the severely impoverished. The pandemic has created new obstacles for the homeless in Chile to obtain any type of nutrition. In the middle of a crisis, however, a citizen dressed up as Batman armed with a face mask and bags of food for the homeless.

Inequality In Wealth

Although the income gap is common in most countries, Chile’s gap is 65% higher than the average of all OECD (Organization for Economic Cooperation and Development) countries. Unlike many homeless populations, 77% of homeless Chileans have jobs but cannot find affordable housing. A standard one-bedroom apartment costs around $660 a month in Santiago meaning that the average salary of $400-$550 USD a month is not enough to afford housing let alone the bills, utilities and food. During the winters, many of the homeless in Chile use the money they saved up by living on the streets in the summer to afford housing to avoid the harsh winter weather.

Food Shortages and Obesity

The majority of the country lives off a scarce monthly salary leaving the bare minimum amount to purchase food for an individual let alone for families of three or more. Within the last 50 years, nutritional change has spread through the country. Twice as many Chileans from low-income families suffer obesity in comparison to those with access to higher education and salary.

As of 2016, obesity is the number one cause of death in Chile and nearly half of children aged 2 to 4 are obese. This is a direct result of the country’s increased consumption of food containing processed sugars, fats and salt.

When COVID-19 spread to Chile, the country went on strict lockdown like the rest of the world. High food prices have been a long-standing issue but the strain on food-supply chains has prompted price increases. Environmental factors and an extreme drought already put Chile’s food supply in crisis mode before the pandemic. Now, Chile’s poorest are struggling to eat for days at a time.

COVID Adds To The Issue

Similar to the rest of the world, COVID-19 has shut down many businesses, factories and other non-essential work. Factories are a massive part of the Chilean job market but demand for products decreased exponentially when COVID-19 hit the Americas in March 2020. Around 80% of companies providing service and industrial companies reported drops in sales. Factories have either closed or laid off employees due to the pandemic. Nearly half of the offices in Chile have had to close resulting in job loss. The homeless in Chile who previously had employment now cannot afford food or save money to rent shelter for the winter months.

Chile’s Food Monopoly

In early May 2020, protestors took to the streets amid growing food shortages and extreme class inequality. Sebastian Pinera, Chile’s president, responded by promising the delivery of over two million food baskets to the country’s poorest. The backlash from protestors pointed to the fact that this would only further serve large chain grocery stores and severely impact the small local shops already struggling.

Fruit exports already power Chile’s food market. These frequently take up farming power where grains and legumes suffer creating a reliance on the import of those highly useful products. Only 5% of local farmers have permission to sell their produce in supermarkets. The few rich individuals that monopolize selling mass amounts of food to supply chains dominate the rest of the market. This keeps class division extreme and makes it impossible for local farmers to lower prices without risking going under completely.

Batman Makes A Difference

The majority of homeless in Chile live in the capital city of Santiago, sleeping on bus stop benches, sidewalks or on the ground in the park. Among them, a caring citizen dresses in DC’s Batman costume donning a medical mask and handing out bags of food to those in need. The anonymous man provides the homeless of Chile hot food regularly, delivering a few dozen meals each day around the capital. The costume choice was to both keep his anonymity and bring happiness while doing his rounds.

Along with food, Chile’s pandemic Batman tries to be a source of positivity and basic human interaction that can help uplift the spirits of people suffering in the streets. Human kindness is a necessity for those who are suffering from a lack of food and housing. The anonymous Batman of Santiago, Chile is doing what he can for his fellow Chileans.

– Amanda Rogers
Photo: Flickr

Hunger in FijiFiji is an upper-middle-income country located in the Pacific Islands. In Fiji, the agricultural sector has been steadily declining over the last several decades, resulting in hunger concerns. Here is everything you need to know about hunger in Fiji.

Background of Hunger in Fiji

Traditionally, countries struggling with hunger are thought to be plagued with food insecurity and starvation. This is not the case in Fiji, where food availability is adequate — especially in comparison with other Pacific Islands. Fijians even have above-average access to energy-dense foods. Rather than food security, concerns surrounding hunger in Fiji stem from the double burden of over-nutrition and under-nutrition, caused by obesity and deficiencies in micronutrients. Trade policies, poverty and climate change are further causes of hunger in Fiji.

Main Causes of Hunger in Fiji

  1. Trade Policy: Fiji’s poor nutrition largely stems from increased dependence on cheap imported food, resulting in a decreased intake of traditional Fijian food. This decline in demand has resulted in traditional food being grown for export, thus increasing domestic prices. Consequently, families above the poverty line spend 18% of their income on food, and families below the poverty line spend 29% of their income on food.
  2. Poverty: Although extreme poverty is uncommon in Fiji, according to the World Bank, 35.2% of Fijians live in poverty. Furthermore, the per capita purchasing power parity in Fiji is significantly below the global average. Thus, not only do Fijians generally struggle with poverty, but food is also disproportionately expensive.
  3. Climate Change: Fiji is extremely vulnerable to climate change, experiencing frequent storms, cyclones, floods and droughts — all of which can be detrimental to the agricultural sector. Additionally, 25,700 people in Fiji are annually pushed into poverty as a result of climate change, further exacerbating the problem of poverty leading to hunger.

Traditional Fijian Diet

Traditionally, Fijians consumed a diet of fish, seafood, root crops, fruit, wild plants and legumes. In recent years, this traditional diet has been abandoned. In 2014, 50% of the population ate rice daily, 43% ate roti daily and 15% ate instant noodles daily. These unhealthy choices became popular while fruit and vegetable consumption declined, with only 15% of adults getting the recommended five servings daily.

Health Consequences

The major health consequences that arise from hunger in Fiji stem from obesity. One-third of adult Fijians are obese, and the rate of non-communicable diseases (NCDs) such as type-2 diabetes is correspondingly high. Obesity increases the risk of NCDs, thus increasing the risk of mortality. Consequently:

In comparison to its Pacific Island neighbors, Fiji possesses great food security. However, Fiji’s problems with poverty, trade policy and climate change perpetuate hunger. For Fijians to be able to afford and consume healthy foods once again, Fiji will need to invest in climate action, limit trade tariffs and promote native crops.

Lily Jones
Photo: Flickr

Obesity and Malnutrition in JamaicaCountries in the Caribbean, specifically Jamaica, are experiencing severe obesity and malnutrition rates. Since 1999, both Jamaican men and women have shown increasing rates of diabetes and obesity. According to the Jamaica Observer, childhood obesity rates have doubled between 2013 and 2018. This drastic growth has seen a particular prevalence between the ages of 13 and 15. The Global School-based Student Health Survey (GSHS) found that within that age group, 18.1% of boys and 25.2% of girls are overweight. In the same survey, obesity rates in girls increased from 6.7% to 9.9% between 2010 and 2017. Furthermore, The Caribbean and Latin American regions show that more than 50% of women in the population are overweight or obese as of 2013, according to the World Health Organization. In addition, according to a 2016-2017 survey, 54% of Jamaicans older than 15 were deemed either overweight or obese.

Considering these data, obesity rates in Jamaica are a concern no matter what the demographic is. Every day, Jamaicans are unable to maintain healthy, nutritionally-dense diets. So, what is causing obesity and malnutrition in Jamaica?

The Causes

There are many factors to these growing numbers. However, one of the main causes of malnutrition in Jamaica is the lack of availability of essential, whole foods for all citizens. The New York Carib News states that Jamaica produced 144,319 tons of yams, 72,990 tons of oranges and 64,815 tons of bananas in the year 2017. All of this nutrient-dense food, however, is not necessarily supplied for Jamaicans; a mere 2% of Jamaicans consume a sufficient amount of essential foods like fruits and vegetables.

The global average consumption of protein-filled red meat is around 25 grams, whereas in Jamaica, the average is close to 10 grams as of 2016. Adequate protein intake results in stronger bones and muscles and aids in hormone production; Jamaicans are simply not given the opportunities for these benefits.

Moreover, grain and soybean milling facilities, two of the most popular crops in Jamaica, have a large portion of their shareholding with the United States. Such crops are used for many U.S. milk substitutes like soy milk, for example. This is a glaring problem regarding obesity and malnutrition in Jamaica as Jamaicans are not given healthier options for themselves like in the United States.

Sugar intake is also a large reason for malnutrition in Jamaica. In 2012, the Global Nutrition Report found that 61% of calories consumed by Jamaicans come from non-staple food items, or items that are not nutritionally rich (legumes, grains, fruits, vegetables). Jamaica’s consumption of sugar-sweetened drinks, like Coca Cola, was 191 grams in 2016. Globally, the average was 95 grams, while the suggested midpoint is a meager 2.5 grams.

A high sugar diet is detrimental leading to many health problems like fatty liver disease, and such is apparent in Jamaica in the form of diabetes and obesity. In an article by Vital Strategies, 87% of Jamaicans feel that sugary drinks are a large reason for the country’s obesity rates, calling for policy proposals.

The Solutions

Some solutions to this problem include the potential tax on sugary drinks. In other Latin American and Caribbean countries, like Barbados, a tax on sugary drinks has shown positive effects. Within the first year of the tax, Barbados’ consumption of these drinks decreased by 4.3%, while bottled water sales increased by 7.5%. If implemented, obesity and malnutrition in Jamaica may see a decline from said tax as well.

In regards to Jamaican export policies, there has been some attention to the issues that CARICOM (Caribbean Common Market) raises, including completing the intraregional integration scheme as well as creating ways to implement CARICOM into its relations with the United States. With the resolution of these issues, Jamaica may be able to better its relationship with the U.S. foreign economy. This may then create more opportunities for more nutrient-dense imports.

Not only this, but there have been school policy proposals put forth in an effort to decrease these numbers, according to the Jamaican Information Service (JIS). Such proposals being the National School Nutrition Policy. This policy promotes physical activity and nutrient-enriched meals as a priority in schools across Jamaica. Not only will these focuses benefit students’ long-term physical health, but Jamaican Senator Reid asserts that they too will improve psychological and social development.

This model emulates Brazil’s efforts for similar concerns with childhood obesity. According to the U.N. Food and Agriculture Organization (FAO), Brazil has experienced one of the most successful school feeding programs created more than 50 years ago. The program managed by the National Fund for Education Development (NFED) and the Ministry of Education has provided staple, nutrient-rich foods to 45 million children across Brazil. With hopes for similar results, the Jamaican National School Nutrition Policy was set to be finalized during the 2019-2020 school year.

In a country with a lack of readily available staple foods, malnutrition in Jamaica continues to be a problem across the country. Through efforts like school feeding programs and a tax on sugary drinks though, young children and adults alike will see long-term physical benefits. Perhaps through these reforms, Jamaica will continue with more policy changes in its imports and exports to reverse the growing numbers of obesity and malnutrition in Jamaica across the country.

– Anna Hoban
Photo: Pixabay

poverty and obesity
The fact that both poverty and obesity simultaneously rose amid the COVID-19 pandemic, possibly tipping 130 million people into chronic malnutrition by the end of 2020, may initially come across as surprising. Yet, researchers have long documented the paradox of how impoverished individuals experiencing food insecurity are more likely to suffer from obesity than the wealthy. Poverty and obesity often go hand in hand as signs of food unavailability and a lack of healthy eating, respectively, but these conditions of malnutrition also carry more subtle risk factors like unemployment, lower education levels and limited social networks.

The Problem: Food Access, Not Just Food Availability

Food insecurity manifests itself in many ways beyond undernourishment from an insufficient quantity of food — the prominent of which is unreliable access to nutritious, healthy options. With COVID-19 exacerbating pre-existing inequities and inadequacies in global food systems, poor diets and their resultant boosting of obesity present an urgent problem for vulnerable populations in developing countries. “The pandemic is creating a problem not of food availability, but of food access because people will have less income because of the recession,” explained Maximo Torero, chief economist of the UN’s Food and Agriculture Organization.

UN Data further showed that if the trend of limited food access continues, the world’s hungry will surpass 840 million by 2030 — the very same year 193 countries have set as their target by which they will have eliminated all forms of malnutrition. And with disruptions to agricultural supply chains due to COVID-19, governments face growing pressure to take unprecedented action to tackle the worldwide spikes in food prices if they are to meet this target. It is also no coincidence that nearly all of the 50 countries with the most risk for sustained food-price swings have developing economies, according to Nomura’s Food Vulnerability Index.

Healthy eating emphasizes fresh produce and lean meats, ideally locally-sourced with minimal processing and preservatives. However, the agricultural and meat industries were the first and most affected when governments implemented COVID-19 quarantines and travel restrictions. The successive disruptions meant it was more difficult for farms to receive agriculture inputs of seeds, fertilizer and equipment, further delaying production of healthy eating staples: rice, maize, wheat, vegetables and other produce. Producers of unhealthier, more processed foods don’t face the same problem of financial losses from rotting food. Thus, during this time, those foods are more accessible and affordable at the expense of poorer consumers’ health.

The Effects: COVID-19 and Obesity

Unfortunately, the connection between COVID-19, poverty and obesity works in reverse as well. Obesity is a major risk factor for a more severe infection, resulting in higher hospitalization and death rates once one has caught the virus. Most recently, a number of studies and anecdotes have noted obesity as the predominant risk factor in youth, with cardiologist David Kass concluding “in populations with a high prevalence of obesity, COVID-19 will affect younger populations more than previously reported.” The CDC has incorporated these findings by specifying that obesity is just as significant a risk factor for severe COVID-19 illness as a suppressed immune system or chronic lung disease.

Though researchers have mostly focused on the link between COVID-19 and obesity in high-income countries, it may have more devastating effects in the developing world. Not only does evidence show “over 70% of the world’s 2 billion overweight and obese individuals live in low or middle-income countries,” obesity also leads to higher health care costs and lower work productivity, which go hand-in-hand with greater consumption of cheaper, unhealthy food options. The created feedback loop is referred to as the “double burden of malnutrition.” Moreover, as Kass’s findings suggested, the victims of COVID-19 in developing countries are younger. In India and Mexico respectively, less than 12% and 17% of deaths were of individuals older than 75, and both of these countries report much more deaths of middle-aged and younger individuals than the U.S. and Europe do.

Solutions to Improve Global Food Security

One estimate of how much governmental spending is needed to combat COVID-19’s effects on hunger and obesity was $10 billion, put forth by the International Food Policy Research Institute. However, even this amount may be insufficient when considering that food insecurity will only continue compounding if addressing poverty isn’t a cornerstone of the solutions put forth. The World Food Programme has prioritized this need for financial safety nets and social protection programs until investment in nutrition and expansion of social protections. Their Executive Director David Beasley plans to allocate $1.9 billion of already pledged funding to build food and cash stockpiles as a “life-saving buffer,” protecting the world’s poor from food shortages and food-price hikes. They also requested a further $350 million to set up transportation systems, limiting shortages and disruptions in the agricultural industry from occurring in the first place.

In combination with these correctional measures, governments should adopt a preventative approach to addressing obesity. “One of the most effective ways to address obesity and other non-communicable diseases is by ramping up investments in affordable, quality primary health care,” says Dr. Muhammad Pate, Global Director for Health, Nutrition and Population at the World Bank. “This makes sense both from a health and an economic perspective. Putting more resources on the front lines to detect and treat conditions early, before they become more serious, saves lives, improves health outcomes, reduces health care costs and strengthens preparedness.” With these efforts in place, the paradoxical relationship between poverty and obesity may begin to ease.

– Christine Mui
Photo: PXFuel

Double Burden of Malnutrition
Typically, obesity and being generally overweight are thought of as problems exclusive to higher-income countries, while undernourishment is believed to be only within low- and middle-income (LMI) countries. However, LMI countries disproportionately face both obesity and undernourishment, which is known as the double burden of malnutrition (DBM).

More than one-third of LMI countries are facing the double burden of malnutrition. This rise in the prevalence of DBM is attributed to dramatic changes within our food systems. Globally, our diets have experienced a shift towards greater consumption of ultra-processed and high caloric foods. This includes things such as sugar-sweetened beverages and fast-foods.

The Double Burden and Poverty

LMI countries disproportionately deal with the double burden of malnutrition because they experience this shift in diet on top of pre-existing undernourishment. Poverty creates a tremendous strain on one’s ability to access proper nutrition. Impoverished individuals experiencing food insecurity may resort to purchasing ultra-processed foods because they are cheaper. This means that they are either not getting enough food to begin with causing undernourishment or eating unhealthy foods, which can cause obesity and undernourishment due to micronutrient deficiencies.

Undernourishment and obesity are health risks that interact and lead to one another. For example, mothers that are either underweight or overweight during pregnancy can face health risks themselves, such as anemia or gestational diabetes. They can also put their child at risk; being underweight could lead to a low-birth-weight for the baby, and being overweight could increase the likelihood that the child will be overweight later in life. The DBM directly impacts health and places a strain on the healthcare system, but it affects countries’ economic growth as well.

An Economic Burden

In 2017, the World Food Program (WFP) released a report examining the economic cost of the double burden of malnutrition in Latin America. Undernutrition and obesity undermine individuals’ productivity. Undernourishment hinders physical and brain growth, while being overweight or obesity causes non-communicable diseases like diabetes or heart disease. These health conditions create situations where it may be difficult for adults to work consistently, or children may be too ill to go to school. Losses in productivity can hinder economic growth, which maintains poverty and only worsens the double burden of malnutrition. The report claims that economic losses from productivity are “estimated at 500 million in Chile, 4.3 billion in Ecuador and 28.8 billion in Mexico.”

In Latin America, rates of obesity and undernourishment are increasing significantly. About 25% of adults are obese, and 7.3% of children under five years old are overweight. The Food and Agriculture Organization’s Regional Representative, Julio Berdegué, states that “obesity is growing uncontrollably. Each year we are adding 3.6 million obese people to this region.” Additionally, rates of undernourishment are rising. 39.3 million people in Latin America and the Caribbean are experiencing hunger. In Venezuela, there are 3.7 million people hungry. There are 4.8 million people hungry in Mexico.

Combatting Malnutrition

The double burden of malnutrition is detrimental in this region and is causing great concern. However, many countries have implemented strategies to combat this:

  • Chile has approved front-of-pack-labeling (FOPL) that warns consumers if the product is high in sodium, saturated fats or sugars. It has also imposed a tax on sugar-sweetened beverages.
  • Brazil has increased infant breastfeeding by 32.3% and reduced children-under-five stunting by 30%.
  • Mexico is the first Latin American country to impose a tax on sugar-sweetened beverages. It has also created a social welfare program called conditional cash transfer (CCT), which aims to make families food secure and use education and supplements to improve nutrition.

The double burden of malnutrition is a complex and multifaceted issue, which will require comprehensive interventions. It is crucial to target early-life nutrition, ensure that hunger programs provide nutrient-rich foods, and begin managing the production and distribution within larger food systems. While this task is daunting, it is essential to correctly address all forms of malnutrition in order to make the most impact.

Paige Wallace
Photo: Unsplash

Healthcare in Chile
Healthcare in Chile primarily comes from the state-funded insurance National Health Fund (Fondo National de Salud – FONASA) or from private companies collectively known as Las Instituciones de Salud Previsional (ISAPRE). According to a 2019 report from the Organization for Economic Cooperation and Development (OECD), 78% of the population participate in FONASA and around 17-18% enroll in ISAPREs, while 3-4% receive coverage from the armed forces insurance program. A number of newly implemented government reforms in Chile have challenged healthcare inequity to ensure universal healthcare for all.

Morbidity and Mortality

In the 1980s, a series of successful reforms decreased infant mortality rates (from 33 per 1,000 live births in 1980 to only eight per 1,000 in 2013) and improved communicable disease rates, nutrition and maternal and child health. While the health status of Chileans consistently fell below average among OECD nations in recent decades, the life expectancy in Chile in 2015 rose to 79.1 years in the last 40 years, nearly on par with its OECD peers. Determinants of health status include life expectancy, avoidable mortality rates, morbidity rates from chronic diseases and percentage of the population in poor health.

Non-communicable diseases (NCDs), such as high blood pressure, diabetes and heart diseases are identified as the burden of disease in Chile, accounting for 85% of all deaths. Key risk factors include high obesity rates, heavy tobacco use and increasing rates of alcohol consumption. The infant mortality rate is improving but remains high, as are mortality rates from cancer compared to cancer incidence.

Some Effective Government Measures

The Chilean government has undertaken effective measures to address the nation’s most urgent issues through a multi-intervention strategy that targets different population groups and settings:

  • Obesity: According to a 2016 WHO report, 39.8% of the Chilean population was overweight, and another 34.4% was obese. Childhood overweight and obesity rate is particularly problematic at 45%, with no reduction in prevalence over the past 15 years. Chile has implemented nationwide policies to tackle behaviors that cause obesity, especially inadequate physical inactivity and unhealthy diets. At the national level, mass media, such as websites, Twitter, TV and radio adverts, educates the public on healthy food choices and emphasizes the consumption of vegetables and fruits. The government has also mandated labels on packed foods that indicate high caloric content in salt, sugar and fat.
  • Tobacco Use: Tobacco consumption rates in Chile in 2016 stood at 37% (41% among men and 32% among women) of the adult population. Adult smoking rates have declined from 45.3% in 2003 and 39.8% in 2009, a percentage below average in comparison to other nations. Since joining the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2005, Chile has implemented various tobacco control policies, such as prohibiting smoking in public spaces, requiring health warnings on tobacco products and raising taxes on these products.
  • Cancer Care: The OECD projected that cancer could soon become the leading cause of mortality in Chile. Among men, prostate, stomach, lung, colorectal and liver cancer have the highest mortality rates. In women, breast, colorectal, lung, stomach and pancreas cancer account for high mortality rates. To lessen the burden of cancer, Chile has reinforced its cancer care system and launched nationwide programs focused on cervical and breast cancer and cancer drugs for adults and children. From 2011 to 2015, Chile reduced cancer by 4.1%.

Challenging Inequity

The establishment of the National Health System (NHS) in 1952, subsequent expansions and reforms together enabled Chile’s move towards universal coverage with more than 98% of the population having some kind of health insurance. However, inequality remains one of the main challenges in Chile’s two-tier healthcare system, mainly due to the unequal distribution of resources between the underfunded public facilities and the elitist private clinics. Equity monitoring shows less insurance coverage for less educated people, low-income quintiles, residents from rural areas and those with state insurance.

Significant inequalities due to socioeconomic position and residence area persist. According to a study that PLOS Medicine published, the infant mortality rate among the highest educated women was 2.3 times lower than the least educated, while the ratio was 1.4 between urban and rural residence. Risk factors like obesity, alcohol use disorders and cardiovascular risks also disproportionately affected the least educated segment of the population.

Moving Forward

Despite tremendous challenges, healthcare in Chile has improved thanks to the government’s effort to prioritize health reforms. In 2005, Chile launched Universal Access with Explicit Guarantees (AUGE) program that sought to improve access, timeliness and quality of care in the public sector. The OECD assessed that the system of healthcare in Chile is overall “well-functioning, well-organized and effectively governed,” with a particularly robust public healthcare program that operates efficiently on both the central and regional levels. Although challenges such as rising rates of certain NCDs and inequities between sectors and populations persist, the country’s ambitious reforms demonstrate its preparedness to tackle these issues.

– Alice Nguyen
Photo: Flickr