Phillip Baker

Processed foods and the nutrition transition: evidence from Asia

This paper elucidates the role of processed foods and beverages in the ‘nutrition transition’ underway in Asia. Processed foods tend to be high in nutrients associated with obesity and diet‐related non‐communicable diseases: refined sugar, salt, saturated and trans‐fats. This paper identifies the most significant ‘product vectors’ for these nutrients and describes changes in their consumption in a selection of Asian countries. Sugar, salt and fat consumption from processed foods has plateaued in high‐income countries, but has rapidly increased in the lower–middle and upper–middle‐income countries. Relative to sugar and salt, fat consumption in the upper–middle‐ and lower–middle‐income countries is converging most rapidly with that of high‐income countries. Carbonated soft drinks, baked goods, and oils and fats are the most significant vectors for sugar, salt and fat respectively. At the regional level there appears to be convergence in consumption patterns of processed foods, but country‐level divergences including high levels of consumption of oils and fats in Malaysia, and soft drinks in the Philippines and Thailand. This analysis suggests that more action is needed by policy‐makers to prevent or mitigate processed food consumption. Comprehensive policy and regulatory approaches are most likely to be effective in achieving these goals.

Role of gut microbiota in Crohn's disease

Crohn’s disease (CD), a form of inflammatory bowel disease (IBD), provides a complex model of host–microbe interactions underpinning disease pathogenesis. Although there is not widespread agreement on the etiology of CD, there is evidence that microorganisms lead to the often severe inflammatory response characteristic of the disease. Despite several microbial candidates, no specific microbe has been considered pathogenic. Instead, the concept of the ‘pathogenic community’ has emerged from the evidence, whereby the stability of the microbial ecosystem of the healthy human gut is disrupted in response to host genetics and destabilized immunity, perhaps through changing public health practices leading to altered microbial exposures over time. We discuss the complex microbial ecosystem of the mammalian gut, the underlying genetic factors that predispose to CD, and how these gene variants may alter host–microbe interactions and propagate inflammation. Over the next 5 years, the increased understanding of genes involved in CD and the way in which individuals with variants of these genes respond differently to nutrients and drugs will enable the rational development of personalized therapies, using pharmacogenomic and nutrigenomic approaches.

Trade and investment liberalization and Asia’s noncommunicable disease epidemic: a synthesis of data and existing literature

BackgroundTrade and investment liberalization (trade liberalization) can promote or harm health. Undoubtedly it has contributed, although unevenly, to Asia’s social and economic development over recent decades with resultant gains in life expectancy and living standards. In the absence of public health protections, however, it is also a significant upstream driver of non-communicable diseases (NCDs) including cardiovascular disease, cancer and diabetes through facilitating increased consumption of the ‘risk commodities’ tobacco, alcohol and ultra-processed foods, and by constraining access to NCD medicines. In this paper we describe the NCD burden in Asian countries, trends in risk commodity consumption and the processes by which trade liberalization has occurred in the region and contributed to these trends. We further establish pressing questions for future research on strengthening regulatory capacity to address trade liberalization impacts on risk commodity consumption and health.MethodsA semi-structured search of scholarly databases, institutional websites and internet sources for academic and grey literature. Data for descriptive statistics were sourced from Euromonitor International, the World Bank, the World Health Organization, and the World Trade Organization.ResultsConsumption of tobacco, alcohol and ultra-processed foods was prevalent in the region and increasing in many countries. We find that trade liberalization can facilitate increased trade in goods, services and investments in ways that can promote risk commodity consumption, as well as constrain the available resources and capacities of governments to enact policies and programmes to mitigate such consumption. Intellectual property provisions of trade agreements may also constrain access to NCD medicines. Successive layers of the evolving global and regional trade regimes including structural adjustment, multilateral trade agreements, and preferential trade agreements have enabled transnational corporations that manufacture, market and distribute risk commodities to increasingly penetrate and promote consumption in Asian markets.ConclusionsTrade liberalization is a significant driver of the NCD epidemic in Asia. Increased participation in trade agreements requires countries to strengthen regulatory capacity to ensure adequate protections for public health. How best to achieve this through multilateral, regional and unilateral actions is a pressing question for ongoing research.

Global Trends and Patterns of Commercial Milk-Based Formula Sales: Is an Unprecedented Infant and Young Child Feeding Transition Underway?

OBJECTIVE The marketing of infant/child milk-based formulas (MF) contributes to suboptimal breast-feeding and adversely affects child and maternal health outcomes globally. However, little is known about recent changes in MF markets. The present study describes contemporary trends and patterns of MF sales at the global, regional and country levels. DESIGN Descriptive statistics of trends and patterns in MF sales volume per infant/child for the years 2008-2013 and projections to 2018, using industry-sourced data. SETTING Eighty countries categorized by country income bracket, for developing countries by region, and in countries with the largest infant/child populations. SUBJECTS MF categories included total (for ages 0-36 months), infant (0-6 months), follow-up (7-12 months), toddler (13-36 months) and special (0-6 months). RESULTS In 2008-2013 world total MF sales grew by 40·8 % from 5·5 to 7·8 kg per infant/child/year, a figure predicted to increase to 10·8 kg by 2018. Growth was most rapid in East Asia particularly in China, Indonesia, Thailand and Vietnam and was led by the infant and follow-up formula categories. Sales volume per infant/child was positively associated with country income level although with wide variability between countries. CONCLUSIONS A global infant and young child feeding (IYCF) transition towards diets higher in MF is underway and is expected to continue apace. The observed increase in MF sales raises serious concern for global child and maternal health, particularly in East Asia, and calls into question the efficacy of current regulatory regimes designed to protect and promote optimal IYCF. The observed changes have not been captured by existing IYCF monitoring systems.

Food systems transformations, ultra-processed food markets and the nutrition transition in Asia

BackgroundAttracted by their high economic growth rates, young and growing populations, and increasingly open markets, transnational food and beverage corporations (TFBCs) are targeting Asian markets with vigour. Simultaneously the consumption of ultra-processed foods high in fat, salt and glycaemic load is increasing in the region. Evidence demonstrates that TFBCs can leverage their market power to shape food systems in ways that alter the availability, price, nutritional quality, desirability and ultimately consumption of such foods. This paper describes recent changes in Asian food systems driven by TFBCs in the retail, manufacturing and food service sectors and considers the implications for population nutrition.MethodMarket data for each sector was sourced from Euromonitor International for four lower-middle income, three upper-middle income and five high-income Asian countries. Descriptive statistics were used to describe trends in ultra-processed food consumption (2000–2013), packaged food retail distribution channels (1999–2013), ‘market transnationalization’ defined as the market share held by TFBCs relative to domestic firms (2004–2013), and ‘market concentration’ defined as the market share and thus market power held by the four leading firms (2004–2013) in each market.ResultsUltra-processed food sales has increased rapidly in most middle-income countries. Carbonated soft drinks was the leading product category, in which Coca-Cola and PepsiCo had a regional oligopoly. Supermarkets, hypermarkets and convenience stores were becoming increasingly dominant as distribution channels for packaged foods throughout the region. Market concentration was increasing in the grocery retail sector in all countries. Food service sales are increasing in all countries led by McDonalds and Yum! Brands. However, in all three sectors TFBCs face strong competition from Asian firms.ConclusionsOverall, the findings suggest that market forces are likely to be significant but variable drivers of Asia’s nutrition transition. The carbonated soft drink market is the most highly concentrated and likely to be most harmful to population nutrition. The grocery retail sector is, in terms of increasing market concentration and thus market power, likely to be the most important driver of ongoing food systems change and ultra-processed food sales in the region. Given its rapid growth, the food service sector will also contribute significantly to ongoing dietary change.

Can the sociology of social problems help us to understand and manage ‘lifestyle drift’?

Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocellas residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it.

Commentary: Moving towards policy coherence in trade and health

International trade has brought economic benefits to many countries, but the association of trade and investment liberalisation with poor health outcomes concerns the public health community. The need to secure more ‘healthy’ trade is a recognised priority, especially as countries move from global to regional/bilateral trade agreements – with greater public health risks. However, a transition towards ‘healthier trade’ may be hindered by worldview differences between the trade and health communities. There is a tendency for health actors to perceive trade as a threat to population health, and for trade actors to view health as a constraint to trade objectives of reducing barriers to cross-border commercial flows and economic growth. Unless such differing worldviews can be aligned, finding ways forward for addressing public health in trade policy is likely to be difficult. Moving forward will involve understanding the values and drivers of the respective groups, and developing solutions palatable to their various interests. Given the power imbalances between the two areas, it is likely that the health community will have to make the first moves in this respect. This article outlines the key issues involved and suggests areas where such moves have been, and may be made.

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review

Background: Despite decades of evidence gathering and calls for action, few countries have systematically attenuated health inequities (HI) through action on the social determinants of health (SDH). This is at least partly because doing so presents a significant political and policy challenge. This paper explores this challenge through a review of the empirical literature, asking: what factors have enabled and constrained the inclusion of the social determinants of health inequities (SDHI) in government policy agendas? Methods: A narrative review method was adopted involving three steps: first, drawing upon political science theories on agenda-setting, an integrated theoretical framework was developed to guide the review; second, a systematic search of scholarly databases for relevant literature; and third, qualitative analysis of the data and thematic synthesis of the results. Studies were included if they were empirical, met specified quality criteria, and identified factors that enabled or constrained the inclusion of the SDHI in government policy agendas. Results: A total of 48 studies were included in the final synthesis, with studies spanning a number of country-contexts and jurisdictional settings, and employing a diversity of theoretical frameworks. Influential factors included the ways in which the SDHI were framed in public, media and political discourse; emerging data and evidence describing health inequalities; limited supporting evidence and misalignment of proposed solutions with existing policy and institutional arrangements; institutionalised norms and ideologies (ie, belief systems) that are antithetical to a SDH approach including neoliberalism, the medicalisation of health and racism; civil society mobilization; leadership; and changes in government. Conclusion: A complex set of interrelated, context-dependent and dynamic factors influence the inclusion or neglect of the SDHI in government policy agendas. It is better to think about these factors as increasing (or decreasing) the ‘probability’ of health equity reaching a government agenda, rather than in terms of ‘necessity’ or ‘sufficiency.’ Understanding these factors may help advocates develop strategies for generating political priority for attenuating HI in the future.

Trans-disciplinary education and training for NCD prevention and control

Non-communicable, chronic diseases (NCDs) account for 70% of morbidity and over 60% of mortality worldwide [1]. Previously thought to be simply a normative consequence of aging, NCDs are largely preventable through maintenance of healthy behaviors and optimizing risk factors such as smoking, body weight, blood pressure, cholesterol, and glucose throughout the lifespan. However, in current modern environments, few individuals are able to maintain an ideal set of health behaviors and the subsequent optimal risk factor profile throughout their lives. In fact, precursors of cardiovascular disease, diabetes, and certain cancers are increasingly common in children, adolescents, and young adults [2]. Upstream social determinants that influence behaviors which can lead to NCDs are complex and include individual-level drivers such as gender, education, and socioeconomic position; populationlevel drivers such as the level of urbanization, the built environment, and the food system; and macro-level drivers such as trade agreements and taxation policies [3]. Given such complex inputs, there is growing realization that NCD prevention and control requires trans-disciplinary efforts to achieve real change [4]. This awareness, particularly the realization that NCD burdens are an overlooked barrier to development towards achieving the Millennium Development Goals [5], has prompted the United Nations to schedule a

Knowledge-based monitoring and control of plasma processes using chromaticity measurements

Chromatic monitoring techniques have been developed to provide rapid feedback on the state of electrically induced plasmas. These techniques have been used to provide diagnostic information, based on the plasma emissions, and also to give rapid feedback on the thickness of insulating films while being processed. It is also possible that the chromatic technique could be used to monitor other important aspects of plasma systems, such as the concentration of particulates in plasmas and substrate temperature. The chromatic monitors provide information to a knowledge based system, which also has access to data from the conventional gas flow, pressure and rf power meters. The knowledge base consists of a set of rules, obtained by interviewing processing experts, and a statistical model of the plasma chamber. As well as being able to diagnose coarse errors in the plasma chamber equipment, the knowledge based system can compensate for undesirable variations during process runs.