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Prog Cardiovasc Dis. 2013 Nov-Dec;56(3):281-301. doi: 10.1016/j.pcad.2013.09.016.

Urbanization and international trade and investment policies as determinants of noncommunicable diseases in Sub-Saharan Africa.

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  • 1Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.


There are three dominant globalization pathways affecting noncommunicable diseases in Sub-Saharan Africa (SSA): urbanization, trade liberalization, and investment liberalization. Urbanization carries potential health benefits due to improved access to an increased variety of food imports, although for the growing number of urban poor, this has often meant increased reliance on cheap, highly processed food commodities. Reduced barriers to trade have eased the importation of such commodities, while investment liberalization has increased corporate consolidation over global and domestic food chains. Higher profit margins on processed foods have promoted the creation of 'obesogenic' environments, which through progressively integrated global food systems have been increasingly 'exported' to developing nations. This article explores globalization processes, the food environment, and dietary health outcomes in SSA through the use of trend analyses and structural equation modelling. The findings are considered in the context of global barriers and facilitators for healthy public policy.

© 2013.


AIDS; AMOS; Acquired Immunodeficiency Syndrome; Analysis of Moment Structure; BIPAs; BMI; Bilateral Investment Promotion and Protection Agreements; Body Mass Index; CFI; CIA; CVD; Cardiovascular Disease; Central Intelligence Agency; Comparative Fit Index; EIU; Economist Intelligence Unit; FAO; FDI; FIML; Food and Agricultural Organization (United Nations); Foreign Direct Investment; Full Information Maximum Likelihood; GAP; GATS; GDP; General Agreement on Trade in Services; Global Action Plan; Globalization; Gross Domestic Product; HIV; Human Immunodeficiency Virus; KOF; Konjunkturforschungsstelle [Institute for Business Cycle Research]; LICs; Low-income countries; NCDs; Noncommunicable Diseases; Noncommunicable disease; OECD; Organization for Economic Co-operation and Development; RMSEA; Root Mean Square Error of Approximation; SAPs; SEM; SSA; Structural Adjustment Programs; Structural Equation Modelling; Sub-Saharan Africa; TFCs; TLI; Trade and investment; Transnational Food Corporations; Tucker–Lewis Index; UN; UNCTAD; USD; Unhealthy diet; United Nations; United Nations Conference on Trade and Development; United States Dollar; Urbanization; VAT; Value Added Tax; WHO; WTO; World Health Organization; World Trade Organization; YOY; Year on Year

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