Asia’s nutrition time bomb

Authors: Don Gunasekera and David Newth, CSIRO

An important nutrition and health transition is unfolding alongside Asia’s economic transformation. Continuing income growth and changing patterns of food consumption among Asian economies are creating unintended effects on nutrition and health. These developments, if left unmanaged, will have long-term adverse impacts on health care budgets, labour productivity and economic activity.

A patient receiving massage treatment at a Shanghai hospital. Although nutrition-related chronic diseases are rising, malnutrition remains a problem in Asia. (Photo: AAP).

Economic transformations and rapid income growth in many Asian economies have been accompanied by changes in food consumption patterns and gains in life expectancy, education and living standards. Many consumers in Asia, and particularly those in rapidly growing economies, have gradually shifted away from a predominately starchy staple diet towards one that is rich in fats, meat, dairy products and sugar.

This trend began four to five decades ago in South Korea, Taiwan, Singapore and Hong Kong. It then extended to Malaysia, The Philippines, Indonesia and Thailand and more recently to China and other emerging economies in the region. According to UN Food and Agriculture Organisation (FAO) statistics, Chinese consumption of vegetable oils, meat and sugar has continued to increase dramatically in recent decades.

It seems that regional and global changes in food consumption patterns are happening at earlier stages of economic transformation than in the past. Countries such as China and other emerging Asian economies have been experiencing changed food consumption patterns considerably sooner and at a much lower level of gross national product (GNP) compared with many developed economies. Moreover, the changes in food consumption patterns appear to be occurring at a faster rate among those in middle- and lower-income groups.

Several factors could account for this: rapid urbanisation, trade liberalisation and market reforms, the rise of intensive farming, rising incomes and greater affordability of food, changes in consumer preferences and attitudes, changes in retail trading and the emergence of supermarket chains, the greater availability of many types of food all year round, increases in the shelf life of food products, and expanded food industry marketing and commercial advertising.

It is important to recognise that, in addition to the factors described above, several other factors influence individual food consumption patterns. These include: biological or genetic factors that vary among individuals; personal food choices and preferences underpinned by traditions, custom, religion and beliefs; and the increasing participation of women in the workforce. It seems that income is becoming a weaker determinant of diet and nutrition over time. Still, income will remain an important factor influencing changing patterns of food consumption and diet.

In emerging Asian economies, per person food consumption in caloric terms has risen alongside income growth. This has reduced the prevalence of under-nutrition — particularly in comparison with developing regions in Africa and Latin America — and improved child health.

Relatively modest increases in per person consumption of fruits and vegetables and a decline in the consumption of pulses is an important aspect of the shifts in dietary patterns across many rapidly developing countries — including those in Asia. Again, this is in contrast to the continuing substantial increases in per person consumption of fats, meats, dairy and sugar. According to the World Health Organisation (WHO), per person consumption of fruits and vegetables needs to be around 150 kilograms per year for a healthy and balanced diet. But in most Asian countries vegetable and fruit consumption per person is around half what the WHO recommends, with considerable differences across the region and between different socio-economic groups.

Changes in food consumption patterns (and the associated ‘nutrition transition’) are tied up with adverse shifts in dietary patterns, physical activity and human health risks. There are shifts towards more sedentary lifestyles and changing patterns of leisure, such as extensive television viewing and lengthy engagement in computer games. This transition has sparked an epidemiological transition as infectious diseases are giving way to chronic diseases.

In emerging Asian economies, and across the world, this is seen in the rising prevalence of such nutrition-related non-communicable chronic conditions as obesity, diabetes and cardiovascular diseases.

It is important to recognise that the main contributor to the regional and global burden of disease is still malnutrition. One of the key challenges for governments in emerging Asian economies is to continue resolving under-nutrition while seeking to prevent nutrition-related non-communicable diseases.

The Asia Pacific Cohort Studies Collaboration (APCSC) has estimated that the combined prevalence of overweight and obesity increased by 414 per cent in China — from 3.7 per cent in 1982 to 19 per cent in 2002. According to the Milken Institute in the US, the prevalence of obesity in China in 2010 for ages 15 years and over was 4.1 per cent for males and 3.6 per cent for females.

The rates of obesity in economies such as China and India are relatively small in comparison with those of developed economies such as the US and Australia, although the absolute number of obese people is much higher due to population size. India currently has the largest population of people living with diabetes, an example of an obesity-related chronic disease.

Domestic policy regimes in developing countries that are focused on economic growth are double-edged. Economic growth helps to reduce poverty and bring down malnutrition rates, resulting in increased life expectancy and future income earning potential. On the other hand, in some instances, it spurs harmful nutrition transitions and related future health risks.

There are several health and economic related implications — for individuals in particular and nations in general — resulting from the growing risks of nutrition-related non-communicable disease conditions. Individuals, living longer than before, are becoming relatively more obese, and hence suffering more chronic diseases. This places additional burdens on health care budgets while reducing labour input to the economy and labour productivity. The highest economic burden will be for treatment in countries that today spend less than US$10 per person on all forms of health care as well as the cost associated with disability and loss of life in future generations.

In Asia some emerging economies’ health systems are facing growing challenges in coping with an ageing population. This is in the context of the rapid transition from infectious to chronic diseases on the one hand and nutrition-related chronic conditions — including the growing incidence of childhood obesity and diabetes — on the other.

A host of intellectually challenging and important practical questions require greater attention in addressing the mixed blessings of economic growth. They include: what kind of market and regulatory initiatives are needed to have optimal net impacts on poverty, nutrition and health? How do agricultural policies and food systems affect obesity? How do food prices shape long-term food consumption habits? Should food, nutrition and health sectors work together within a multidisciplinary framework against obesity? How could this multidisciplinary approach be achieved?

To answer these questions, there is an increasing need for evidence-based multidisciplinary analysis covering economic, health, agriculture and food system sciences. Such analysis could provide insights into what could be done to minimise or prevent some of the adverse nutrition and health-related effects of economic transformations.

Policy actions taken in isolation — whether in food, nutrition or health sectors — are unlikely to achieve the cross-sectoral outcomes that are essential to sustainable economic growth and development. Interactions between the food, nutrition and health sectors are complex and require more investigation, including the involvement of public and private sectors.

Societal transitions, accompanied by sustained economic transformation, will require governments to avoid the assumption that with higher economic growth other unintended and adverse nutritional and health outcomes will take care of themselves.

Don Gunasekera is a Senior Economist at Australia’s Commonwealth Scientific and Industrial Research Organisation (CSIRO).

David Newth is a Senior Research Scientist at the CSIRO.

This article appeared in the most recent edition of the East Asia Forum Quarterly, ‘A Japan that can say ‘yes’‘.