Make your own free website on Tripod.com

INTD Team Project: Health in the Developing World

Modernization and Urbanization

Home
The International Response to Health Crises
The Spread of Diseases as a Result of Globalization
Modernization and Urbanization
The Effects of Industralization
Bibliography

Modernization and Urbanization: The International Development of Health Problems

 

Modernists and economists often describe the developed world as the epitome of global success - the beacon for developing states to strive for.  Developed status may refer to any number of factors improving quality of life such as higher per capita GDP, increased civil rights, mass education and political enfranchisement.  Nevertheless, as spectators of global interactions - both internal and external - 'we' must not be blind to problems encouraged by -if not inherent in- development.  Health problems occurring primarily and/or predominantly in the West should be analyzed and taken heed of, in particular, as more states enter the "developed" circle. 

 

Ironically, many of the hallmarks of development are intrinsically linked to these problems.  Increased industrialization, high-technology and increased disposable income are but a few examples.  This relationship should set off alarm bells, especially as the adverse effects of development are infiltrating still developing countries creating a perplexing compound of both the problems of development and developing in transitional economies.  Thus, before these countries have established the mechanisms, institutions or infrastructure of developed protocol, or are free of the challenges of developing or underdevelopment, they are faced with yet another set of hurdles - those of development itself.  This can be seen in the exemplary case of increasing obesity prevalence in the South Pacific and parts of Africa.

 

In this study I have chosen to investigate the incidence of diabetes and obesity, asthma, and drug use (including tobacco, alcohol and other psychoactive drugs) in the developed world and, attempted to draw connections between "developed life" and these conditions.  Furthermore, I have touched on simple recommendations for prevention of these conditions to promote awareness globally, regardless of developmental stage.

 

More Food, Less Activity

 

Obesity is hitting the world harder than ever before.  Deemed a "socio-environmental disease" by the WHO, obesity is sounding national and international alarms.  While certainly not limited to the developed world, lifestyle trends in Western countries may be significant to the advent of obesity elsewhere.

 

Increased development is often coupled, inversely, with decreased leisure time.  Developed societies typically have longer and more frequent/consistent work days.  This relationship has been highlighted as contributing to a decrease in quality of life.  Perhaps corollary, or perhaps in spite of this, people in these societies tend to spend more of their leisure time on sedentary activities.  This is coupled with increasingly sedentary work environments due to high technology generating a vast array of computer or supervision based jobs.  Lack of physical activity - and increase in both occupational and leisure activities involving computers and televisions - provides a considerable risk factor, contributing to a variety of health problems including weight gain and cardio-respiratory complications.  To further these conditions, despite greater national wealth, diets are deteriorating.  Unmatched food processing and fast food availability are dominating many "developed diets", producing a type of malnutrition starkly contrasting the traditional malnutrition plaguing the underdeveloped world.  This phenomenon is paradoxical in that the more developed the society, the more access to good food, and the money per person to exchange for food.  This relationship should suggest that people in developed societies are more likely to be well nourished, and, while perhaps fewer are going hungry, developed diets have overshot nourishment.  Many diet related health problems in the developed world are caused by excess nutrients, and excess of what the Canada Food Guide would classify as "other".  That is to say, in common terms, junk food: highly processed foods primarily containing simple sugars and saturated fats, as well as chemical preservatives and additives.  This combination has proved explosive.  Waste bands and health expenses alike have expanded putting greater and greater pressure on both biological and social systems

Left to Right Headings
Global, Least Developed Countries, Developing Countires, Economies in Transition, Developed Countries

obese1.jpg

Vertical Axis: Population Affected (millions)
Orange: underweight. Peach: obesity

Conditions of overweight and obesity are defined by an excess of stored fat and a body mass index (BMI), a number derived form a height – weight equation, of above 25 or 30 respectively.  Morbid and malignant obesity form a subset of obesity where BMI reaches above 40 or 50 respectively.  Worldwide obesity has established epidemic status as the new term “globesity” gains popularity.  While hereditary obesity, and “obesity genes”, has been explored, their legitimacy has been considerably discounted.  Analysts cannot deny the evidence that the phenomenon has emerged on the global health radar only in recent history.  This timeline falls short of demonstrating a genetic shift towards obese individuals. The conclusion is consistent: lifestyle choices are the driving force behind world weight gain. Statistics show that prevalence in the developed world is setting the trend for many developing countries.  

obese2.gif

Most Recent Obesity Statistics for the United States

  • 58 Million Overweight; 40 Million Obese; 3 Million morbidly Obese
  • Eight out of 10 over 25's Overweight
  • 78% of American's not meeting basic activity level recommendations
  • 25% completely Sedentary
  • 76% increase in Type II diabetes in adults 30-40 yrs old since 1990

Obesity and Disease

  • 80% of type II diabetes related to obesity
  • 70% of Cardiovascular disease related to obesity
  • 42% breast and colon cancer diagnosed among obese individuals
  • 30% of gall bladder surgery related to obesity
  • 26% of obese people having high blood pressure

Obesity in Children

  • 4% overweight 1982 | 16% overweight 1994
  • 25% of all white children overweight 2001
  • 33% African American and Hispanic children overweight 2001
  • Hospital costs associated with childhood obesity rising from $35 Million (1979) to $127 Million (1999)
  • 60% already have one risk factor for heart disease

SOURCE: Wellness International Network Ltd - web.winltd.com

obese3.gif

obese4.gif

obese5.gif

Moreover, the costs of excess weight and obesity are many fold.  The emergence of diabetes as a global epidemic can not considered separately from the decline in Western nutrition and activity levels. 

 

Ranked fourth or fifth leading cause of death in most developed states, diabetes is demanding the attention of governments and health care officials around the globe.  With 194 million diabetics world wide - this figure is expected to double in the next twenty years - diabetes is one of the top ranked non-communicable diseases.  While the developed world, North America in particular, leads the pack in terms of percentage, the greatest relative and absolute increases are projected to occur in the developing, and newly industrialized world, caused especially by the growing emergence of malnutrition (the new "type", not the traditional type), sedentary work and leisure activities, overweight and obese individuals, urbanization and a growing - and aging- population.  This prevalence trend is especially problematic as insulin is considered unaffordable and/or is often unavailable in developing counties.  Furthermore, diabetes is expected to occur in younger age brackets in the developing world (45-65), than in the developed world (65+).  Such a pattern will take a significant toll socially and economically as diabetic people are forced - either fully or partly - out of the labour pool earlier than anticipated or desired.

diab1.gif
IGT: Impaired Glucose Tolerance

IGT: Impaired Glucose Tolerance

diab2.gif

diab3.gif

Diabetes occurs in two principal forms.  Type 1, insulin-dependant, primarily affects youth (although recent evidence has shown the contrary), and is caused by a malfunction in the pancreas where insulin is produced.  Genetic patterns have been identified in relation to type 1 that cause an autoimmune attack on the pancreas' beta cells -the site of insulin production.  Type 2 diabetes, non-insulin-dependent, or adult-onset, accounts for 90% of today's cases.  Traditionally occurring in adults, type 2 has been increasingly detected in children and adolescents in recent years.  A strong familial correlation exists between type 2 cases, however, the driving forces are obesity, unhealthy diet and low levels, or lack, of physical activity.  In addition, higher numbers in ethnic populations have been noted.

diab4.gif

According to the International Diabetes Federation (IDF), 45% of adult diabetics are between the ages of 40 and 59, accounting for 88 million cases.  IDF's projection for 2025 expects 146 million cases in this age group, and 147 million aged 60 or above.  Females tend to comprise an average of 10% more cases than males, this may be due to a higher rates of female obesity compared to males.  Diabetes prevalence in children has brought about especial alarm as it reaches previously unimaginable levels.  For example, in 1990 in the United States, four percent of child diabetics were type 2; today twenty percent are type 2.  Moreover, 85% of type 2 child diabetics are obese, and one in four overweight children exhibit signs of type 2 diabetes.

 

Diabetes prevalence in urbanized societies consistently outpaces prevalence in rural areas with 78 and 44 million cases respectively.  Estimates for 2025 show an over 130% increase in urban populations - 182 million -, and approximately 40% in rural populations -61 million.  This connection is likely due to greater frequency of sedentary jobs, convenience technology and processed, fast food that so pointedly mark "developed city life".  The advent of fast/processed food in developing urban centres may be especially disturbing.  Studies show that indigenous populations that are exposed to processed food for the first time are not physiologically equipped or genetically capable of coping with its effects.  That is to say that people who have not been incrementally exposed to such foods for generations (as is the case for most Westerners) do not possess the digestive mechanisms to metabolize the nutrients, thereby causing extreme reactions in their blood sugar levels and digestive organs.  This effect has contributed to soaring rates of obesity and diabetes prevalence in newly urbanized centres of the developing world.  As traditional diets continue to be swallowed up by the globalization of Golden Arches, Burger Kings and Dairy Queens, this problem does not appear to be waning despite rising concern analysts and nutrition specialists.   

 

The rise and spread of type 2 diabetes is undeniable.  Its connection with obesity and lifestyle choices paints both a foreboding and hopeful picture for the future.  On the one hand, as more societies adopt, or are transformed by, developed lifestyles, social and environmental factors may create a feedback mechanism that will only further encourage these health problems.  That is to say, if fast food becomes the norm and sedentary jobs and leisure activities are preferred to physical activities, a potentially less nutritionally healthy and more overweight and out of shape population will result.  Such a population is likely to make less healthy choices in the future as their norms and lifestyles become rooted in unhealthy practices.  Someone that eats fast food every day is increasingly unlikely to choose a walk over a television program as they become increasingly malnourished and unable to cope with physical demands, especially as the effects of obesity and diabetes are diverse.

 

Diabetes has been recognized as a leading catalyst for stroke, neuropathy, blindness, renal failure, 'diabetic foot' - often leading to amputation, and cardiovascular disease.  Cardiovascular disease, in fact, accounts for 70-80% of diabetic deaths.  The social and economic costs or mortality and morbidity effecting younger and younger populations are also considerable.  IDF estimates a 7-13% expenditure of the world's health care funds to be devoted to diabetes by the year 2025.  

diab5.gif

Urbanization & Industrialization - A Need to Clear the Air

 

More development typically means more cars, more factories and more people.  As urbanization and industrialization flourish, so do pollution and air particulates.  Asthma affects 100 to 150 million people globally, accounting for economics costs greater than the cumulative Tuberculosis and HIV/AIDS combined.  Asthmatics have doubled in number in Western Europe in the last decade.  Over 180,000 lives are claimed per year by asthma and this number will continue to rise, as affliction rates increase by 50% per decade. 

 

Scientists have linked urbanization to the increase in asthma prevalence.  Cities consolidate emissions from industry, automobiles, and tobacco smoke into areas of high population density, impregnating the air with irritants, allergens and particulates.  The issuance of smog warnings both more frequently, and in increasing numbers of locations is exemplary of these conditions.   

 

The costs of asthma cannot be overlooked.  Its affects can be socially and economically crippling for both individuals and societies.  Absence from, or decreased ability at, the workplace cause governments, employers and asthmatics to pay.  Britain for example, currently spends in the neighbourhood of 1.8 billion USD on asthma health care and due to days absent caused by illness.  The United States and Australia spend 6 billion USD, and 460 million USD respectively on direct and indirect costs of asthma.

 

While asthma consistently plagues the developed world, its presence in the developing world is irregular.  This is due in part to variable stages of industrialization and urbanization.  Heavy industry, pollution and highly dense populations set the stage for asthma and other respiratory problems.

 

One must only look to Beijing, China for evidence of these effects.  Experiencing the greatest vehicle emmision pollution in the world, and placing one of the two most sulfur dioxide contaminated environments worldwide, Beijing’s citizens feel the effects.   Dizziness, sore throats and lung/respiratory problems have been only a handful of the symptoms suffered by residents of the largest centre of vehicle exhaust sediment.

More information is available on this website on the page titled “The Effects of Industrialization”.

 

 

Increased Disposable Income: Money to Burn

 

Development and economics are inextricably linked.  Many development specialists claim that development is contingent on economic growth within a country.  This is corollary with increased per capita GDP creating, once a critical income is surpassed, disposable income.  This ‘surplus’ is used to purchase consumer goods and services such as property, entertainment or travel.  While this consumption can admittedly bring pleasure, it can also be destructive.  Drug and alcohol use and trafficking - while in some respects timeless – is an area of mounting concern in the world today. 

Consumption of alcohol has increased globally, with especial concentration of increase in the developing world.  This phenomenon may be linked to an influence of Western trends as many countries where alcoholism is increasing have little history of use.  When alcohol is relatively modern development, countries lack the regulatory systems to control distribution or provide treatment.  There are currently 76.3 million cases of alcohol use disorders.

alchmap.gif
DALY: Disability Adjusted Life Years

Richer societies able to afford the “luxury” of drug use have created an irresistible market for drug production in the developing world.  When the market value of growing or selling drugs is higher than that of a minimum wage job, and regulatory and/or punitive mechanisms are inconsistent or inadequate, the cost-benefit analysis of the drug trade is clear.  Nevertheless, developed societies are not the only drug users.  Producer countries are often heavily populated with users as availability is high and punitive measures are low or easily avoided.  Moreover, in many countries where the drug trade is prominent, governments are frequently corrupt, turn a blind eye, or are overcome by guerilla forces.  Colombia is a famous example where there are very few opportunities with a lucrative equivalent to coca farming, and guerilla forces dominate the agenda.

 

The societal costs of drug use are myriad as the effects of production, trafficking and use permeate many facets of society.  With 15.3 million diagnoses of disordered drug use reported in 2003, the time for treatment and prevention investment is now.  Studies by the World Health Organization show that for every one dollar invested in treatment, seven dollars in social and health care costs are saved.  This is especially pertinent as, of 136 countries reporting intravenous drug use, 93 of them also reported having cases of HIV/AIDS it citizens.

drugmap.gif
DALY: Disability Adjusted Life Years

The number one enemy of health around the world, tobacco stands its ground.  The world’s 1.1 thousand million smokers, accounting for about 33% of the over fifteen population, are continuing to smoke despite global public health alarms.  While number of daily cigarettes and number of smokers is greater in the developed world, the World Health Organization recognizes an equalization on the horizon as increased take home income in the developing world permits higher cigarette consumption.  Also relevant to the developing world, World Bank data highlights a correlation between low levels of education and greater prevalence of smokers. 

smokinged1.jpg

Responsible for over 90% of lung cancer in men and 70% in women in the industrialized world, as well as significantly contributing to chronic respiratory diseases and cardiovascular disease (56-80%, and 22% respectively), tobacco is estimated to cause almost 9% of global mortality – that’s 4.9 million lives.  If today’s trends continue, deaths will double – 10 million – in the next 20-25 years, with the majority – 70%- occurring in the developing world. 

smokingdev2.jpg

The adverse health effects of tobacco use are now highly publicized in developed countries.  This public health campaign has raised awareness and been the menace to big tobacco companies like Phillip Morris or Malboro.  As a result relative numbers of smokers in high income countries has declined.  Corollary to this, rates of quitting in high income countries are substantially higher.  In the early 1990s, approximately 30% of high income male populations were ex-smokers, whereas only 2% of Chinese males and 5% of Indian males were.  Moreover, the original demographic has shifted, a decline in male smokers has occurred simultaneously along an increase in female smokers and males in low income countries.  Despite bad publicity, tobacco companies continue to push their products ever searching for new markets, most notably targeting the developing world.  Marketing cigarettes as developed status symbols or to children have been dominant strategies.  This relocation has been furthered by free trade agreements opening developing markets to cigarette companies.  The World Bank estimated that, for Japan, Thailand, Taiwan and South Korea, cigarette consumption was ten percent higher than it would have been had the markets not been opened to American trading partners1.  What is more, World Bank estimates calculated 14,000 – 15,000 youth starting smoking per day in the developed, high-income world, significantly dwarfed by the 68,000 – 84,000 in the developing middle and low income world.  In sum, this estimate suggests a staggering 82,000 – 99,000 new youth smokers around the world per day, exposing themselves to the perils and addictive nature of tobacco and nicotine.

 

Learning from our Mistakes: Brightening the Shadow of the Future

 

The picture painted for the developing world in this paper is not only sobering, but downright frightening.  With such a great population following heavily in the developed world’s footsteps, especially considering questionable abilities to grapple with such problems and their inherent magnitude, declining economies and climbing morbidity and mortality seem inevitable.  However, all hope is not – and perhaps should never be – lost.  Combating these health problems requires an international effort.  Advances already made, or cures already discovered, in the West must be shared, breaking down boundaries like medication availability and/or cost barriers.  Equally, if not more importantly, should be universal lessons of prevention.  The safest and most cost effective form of healthcare, preventative measures can steer the world – the developing world in particular- clear of the shadow of statistical analysis extrapolated for the future.  Moreover, preventative measures for obesity and diabetes for instance, are typically easy and accessible by all socio-economic classes.  The first, safest and most beneficial line of defense is a healthy diet and moderate exercise.  Mass anti-drug, alcohol and tobacco campaigns have demonstrated positive effects in the developed world, and can be easily adapted to other countries.  Advances in alternative energy technology reducing the necessity of oil and gas for energy should be widely publicized and marketed.  (There is, admittedly, an inherent difficulty in this statement, as companies will want monopoly rights and prices on such technology.)  While today’s problems are unavoidable, tomorrow’s may be.  However, this process will be by no means automatic.  World leaders must take a liberal stance towards global health, collaborating to achieve absolute, mutual gains.          

 

 

1. “Global Trends in Tobacco Use”. World Bank Publication. Page 14. http://www1.worldbank.org/tobacco/book/pdf/02-Tobacco-Chap1.pdf

For further information on the global distribution of diabetes and other health problems follow links below to interactive maps

Current and predicted Diabetes distribution

Global Health Atlas