impact of globalization on food consumption, health and nutrition in urban areas

DRAFT – NOT FOR QUOTATION

Impact of globalization on food consumption, health

and nutrition in urban areas

Luis F. Fajardo

Paper prepared for the FAO technical workshop on

“Globalization of food systems: impacts on food security and

nutrition”

8-10 October 2003, Rome, Italy


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Information on the Author: Luis F. Fajardo Universidad Javeriana – Colombia E-mail [email protected]

Disclaimer: Ideas expressed in the paper are those of the author(s). Mention of any firm or licensed process does not imply endorsement by FAO. The designations employed and the presentation of material do not imply the expression of any opinion on the part of FAO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.


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Impact of globalization on food consumption, health and nutrition in urban areas

Luis F. Fajardo

1. Introduction: trends and change. Colombia's population, estimated at 40.8 million, occupies an area of just over

1 million square kilometers. About one-quarter of the population lives in rural areas. Natural resources are plentiful, and include agricultural land, water for irrigation, energy resources (oil, natural gas, and coal), and minerals such as nickel, gold, and emeralds. Colombia has a significant advantage in terms of its location: it is close to North America with coasts on both the Pacific and Atlantic Oceans. Mountainous terrain, however, makes internal transportation costly and slows physical and social integration. A wealth of physical resources, a literate and dependable work force, a robust private sector, competent macroeconomic management, and political stability are major factors that have explained Colombia's good record of economic development and social improvements over the last 30 years. Nevertheless, the growth of the illegal drug industry in Colombia and the presence of active insurgent groups and the pressure of external shocks, have had an increasingly negative impact on the overall economic performance of the country.

Trends in urbanization and demographic pyramid

In the 20th century Colombia experienced formidable growth of its population. Estimated population by year 2000 was 44,000,000. In the second half of the 20th century Colombia also experienced an intensive process of internal migration from rural to urban areas. In 1938, 70% of population lived in rural areas, table one shows the evolution of the percent population living in urban areas up until the present estimate 75%. (ENDES 2000). The rural population increased from 6 million in 1938 to 10 million in 1990 whereas the urban population increased from 2.7 million in 1938 to 22.9 million in 1990. The growth of individual cities has also been important. In 1985, thirty two percent of the population resided in 8 main cities. By 2003 an estimated one quarter (25.2%) of the population lives in Bogotá and another 8 million live in either Cali or Medellín.

Table No 1 Percent Distribution of Population by Urban & Rural location

Year % Urban %Rural 1938 30 70 1951 43 57 1964 52 48 1973 61 39 1985 65 35 1993 75 25 2000 75 25 Source – DANE 1941, 1973, 1985, 1993


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Equally important have been changes in demographic factors. Total fertility

rate for the period 1997-2000 was 2.6 children per woman, indicating a decade of relatively constant fertility. Previous fertility rates were 6.8, 3.2 and 3 in 1965, 1984-1986, and 1993-1995, respectively. In urban communities fertility rates decreased from 2.7 in 1985 to 2.3 in the year 2000 (Ojeda, Ordoñez, Ochoa Encuesta Nacional de Demografía y Salud ENDES 2000). The achievements in this field are thought to be the results of family planning programs, and the increased role of women in the labor force. As a result of the decrease in fertility rate the period 1995-2000 is estimated to have a rate of natural growth of 18% and a projected growth rate of 17 % (DANE 2003). The crude birth rate and crude mortality have also decreased and were estimated at 24 ‰, and 5.9% (1990-1995), Life expectancy has increased from 67/87 (men/women) in 1985 to 70/66 for the 1995-2000 period.

Population Pyramid has evolved from a wider base pyramid to a narrower one

as result of changes described previously.(Figure No 1) Two important facts characterize the evolution of the family in the second half of the twentieth century, and they are highly relevant to food security and nutrition. The first factor is a preponderance of urban zones as the preferred place of residence, leaving no place for subsistence agriculture or production of food by the family unit and favoring life styles considered urban. The second factor is a constant decrease in the fertility rate which translates in fewer children per family.

Figure 1: Changes in Population Pyramid. (National Department of Statistics )

1951-1993

-3,000,000

-2,000,000

-1,000,000

0 1,000,000

2,000,000

3,000,000

0-4

9-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

1993

1993

1951

1951

MALE FEMALE

Indicators of globalization

“Globalization is viewed as a reduction in barriers to the cross-border movement of goods, services and capital with accelerated integration of world markets and increased the flow of commodities, technologies, information, financial capital, modes of distribution and marketing, and, to an extent, migration of peoples


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and labour. A common feature of this process of globalization is a convergence, though at differing speeds, of many institutional, legal, economic, social and cultural practices and processes across different countries”

FAO’s views of globalization express many of our own opinions on the

subject, and some detail of how this happen and to what extension it was implemented could set an scenario for the discussions related to food and nutrition.

A new government took office for the period 1990-1994 and immediately undertook the initiative of economic opening and globalization, in combination with more democratization of the political system. Reforms were carried out by means of issue of new laws, constitutional changes, administrative decisions that soon translate in a new set of rules for the economy which marked a break with traditional way of doing things and with old government institutions. The new government wanted to abandon the old interventionist model preached by CEPAL, and start a new economic model characterized by economic opening, been competitive, more equitable and with greater opportunities for the citizens. During this process the National Department of Planning and the Ministry of Treasury shares objectives. The idea was to design and implement neutral incentives between sectors, and regions and direct the government to preserve a stable macroeconomic environment and give incentives to technological change and increased competitiveness. Agriculture was included in the general strategy of institutional reforms and opening. For this specific case, trade liberalization translates into elimination of traditional government intervention of control to imports, and guaranteed prices of main crops.

Communications, transportation and Infrastructure

As illustrated in Figures 2a and 2b, and table two, telephone lines and other goods and services flourished the 90’s. Land transportation evaluated as new cars per/capita, also experienced a major increase in the 90’s, although in the 70’s the number of cars increased fourfold (Dirección General de Transporte Terrestre Automotor 2000) Other signs which characterize Globalization, such as increasing number of businesses are illustrated in Figure 3. Figure 2 a. Telephones and Mobil Phones (WDI)

Telephone Lines & Mobil phones

0

50

100

150

200

250

300

350

1960 1980 2000

Years

x 1

000

peop

le

Lines

Lines Cities

Mobil


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Figure 2 b. New Cars

New Cars per year per 1000 person

0

1

2

3

4

5

6

7

1950 1960 1970 1980 1990 2000 2010

Years

Car

per

100

0 pe

rson

s

Table 2: Technology and Infrastructure

1997 2000 2001 Fixed lines and mobile telephones (per 1,000 people) 166.2 223.3 246.8 Personal computers (per 1,000 persons) 30.3 35.4 42.1 Internet users 208000 878000 1.2 million New Cars per 1000 persons 4.74 1.6 1.7 Roads Km 109800 112988 112988 Paved roads (% of total) 12 .. 12 12.. Figure 3:. Number of incorporated domestic companies listed in the stock

exchange, before and during globalization. (WDI)

Domestic companies

Total Inc. Listed on the exchange

0

50

100

150

200

1985 1990 1995 2000 2005

Years

Nu

mb

er o

f C

om

pan

ies


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2. Role of globalization and urbanization on dietary change and the impact of globalization on lifstyles

Evolution of the Urban Food Supply

From previous section it is clear that Columbia has experienced both urbanization and many features which characterize globalization, particularly since 1990. The paper will now focus on the changes in the food supply and the impact of these changes on nutritional status. Changes in production and availability of food items that account for most of the calories available to the population, changes in ways foods are marketed, changes in food prices, and changes in food preferences will be reviewed.

Changes in Food Production

The crop production index is used as a measure of agricultural production relative to a base period (1989-91). It includes all edible crops, but not fodder. The figure shows a steady increase from the 1960’s until 1990, when the index plateau’s. For the past ten years levels of crop production have remained stable. Figure No 4

Governments in the period 1970-1990 placed a central role for agriculture in the recovery of the country’s economy and consolidation of development. They tried to offer plentiful foods at low cost. Also governments wanted a modernization of the agricultural sector and implemented incentives for private inversion in the sector, such as restructure of prices for agricultural inputs, increase of prices to farmers, and subordination of the import policies to the protection of the country production of foods. Also by 1988 the production policy was explicitly directed towards the achievement of food self sufficiency (sovereignty), and a food stocks that would regulate the market forces. The plan was centered in a few food items important in the diet. These interventions of the government coupled with some research and technology transfers, (seeds, irrigation, credits, etc.) was associated with the sustained growth in productivity seen prior to globalization.

Figure 4: Crop Production Index1 prior and during Globalization - WDI

Crop production index (1989-91 = 100)

0

20

40

60

80

100

120

1960 1970 1980 1990 2000

Cropproductionindex(1989-91 =100)

1 (Crop production index shows agricultural production for each year relative to the base period 1989-91. It includes all crops except fodder crops)


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Vegetable Products

Staple Food Production The main energy sources in the Colombian diet are potatoes, rice, plantain,

pulses, sugar, oil and wheat (Figure 5). Most of these products are produced in country except wheat which is primarily imported. Before 1990’s there was a trend towards the increase in production of potatoes, plantain, sugar and vegetable oils. The production of pulses was low and has remained the same over the past 20 years. During the globalization period there were no further gains in production of potatoes (growth for the decade 1.2%) and plantain which level off at the highest yearly production in history. During the 90’ refined sugar production increased 3.6% (Ministry of Agriculture and Rural Development –Observatorio de Agrocadenas Colombia 2003). (FAOSTAT figures for 2001 production is 1.165.211 TM, while Government figures for the same year is 2.241.559 TM)

Rice production although initially decreased, soon recovered and experienced

a substantial growth during 1990 to 2002. The production of vegetable oils has maintained steady growth since 1990. Wheat production in the country has always been limited, although the population consumes 33 % of Dietary Energy supply (DES) from wheat. In the 70’s the imports more than double the maximum yearly production ever reached. During the globalization period the amount of wheat imported increased from 600000TM in 1990 to nearly 1200000 TM in 1999

Figure 5: Yearly production of basic foods (metric Tons) (FAO FAOSTAT 2003)

Production of Basic Foods (Veg)

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

1980 1985 1990 1995 2000 2005

Years

MT

Rice Milled (TM)

Potatoes

Plantain

Pulses

Sugar

vegetable oils

Panela, register by FAOSTAT as not centrifuged sugar, is a special item, since

its social importance to the rural popula tion. It is estimated that 12% of economic active population of the rural zone, (some 350,000 rural people work in activities related to panela). Culturally panela consumption has been linked to rural way of life, and hence given the rural to urban migration and globalization, one could guess its


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production would decline during globalization. However panela production has increased by 31% during the period.

Figure 6:. Panela Production during globalization in MT (Martínez H, Acevedo

X. 2003)

Panela Production In MT

1,000,000

1,100,000

1,200,000

1,300,000

1,400,000

1,500,000

1988 1990 1992 1994 1996 1998 2000 2002

Years

Mt

Livestock: Beef, Poultry, Milk, Eggs

Beef, poultry, milk and eggs constitute an important part of today’s Colombian diet, both in terms of nutritional value as well as share of household food budget.

During the globalization period inventory of Cattle increased by some 30 million animals, whereas the number of chicken went from 21million to more than 110 millions birds. (Others estimate the production in 375 million birds –Salomón Kalmanovitz – La Agricultura en Colombia 1950 -2000, Julio 2003 ). Modernization of the Poultry and Pork industries, are one of the successful examples of Globalization, decreases in trade barriers led to improved availability of animal feeding (Table 3), which in turn made it possible to increase the total production and availability for human consumption. Production of chicken meat was 172973 MT in 1982, 348507 MT in 1990, and 539760 MT in 2001, or a 54.8% increase during the globalization period Production of Eggs also increased by 36%. (Table 4)


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Figure 7: Livestock (FAO FAOSTAT 2003)

Live Stock

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

1980 1985 1990 1995 2000

Years

Cat

tle

and

Ch

icke

ns

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000Pigs

Cattle

Chickens

Pigs

Table 4: Increases in egg production

Years Productión1

(MT) Availability Per capita (Kg/P)

1991 264,471 7.4

1992 273,251 7.5

1993 299,538 8.1

1994 328,204 8.7

1995 343,794 9.0

1996 355,761 9.1

1997 379,140 9.5

1998 394,504 9.7

1999 401,641 9.7

2000 386,399 9.3

2001 425,872 10.1

growth.(%) 4.6% 2.9% 1. Federación Nacional de Avicultores - FENAVI.

Anuario Estadístico del Sector Agropecuario 2001. Ministerio de Agricultura y Desarrollo Rural.2002

Within the category of animal source foods, milk, cheese and other milk products, represent those with highest production and consumption volumes. In Colombia the source of milk are almost exclusively of bovines. Prior to1990, the production of whole milk was growing at 8.2%, after which it slowed to 3.6%. The production of liquid milk has increased from 2million liters in 1980 to 5.8 million liters in 2001.


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Production of key foods during the past ten years has been mixed. In general the rate of growth for production has decreased, although the actual amount in metric tons of food was as high as in the previous decade. Wheat production almost halted and was replaced by ever increasing imports. Gains in poultry production provide a good example of increases resulting from changes in trade barriers and liberalization. Production of vegetable oils also has continued to grow. Figure 8 Production of Cows Milk – Whole(FAO FAOSTAT)

Production of Cows Milk, Whole in MT

1,000,0001,500,0002,000,0002,500,0003,000,0003,500,0004,000,0004,500,0005,000,000

1980 1985 1990 1995 2000 2005

Years

MT

Current role of imported foods and role of traditional foods

Globalization means liberalization of trade, therefore massive importation of foods would have been expected. This not the case for key food items such as potatoes, sugar, plantain, beef and liquid milk, where the percentage of imports in relation to production was minimal since the lifting of trade restrictions in 1990 (table 5) .

However in terms of available energy, the imported foods represented near 40% of total Dietary Energy Supply (DES) in the year 2000, ,. Cereals and fats represent over 43% of DES . Therefore dependency on imported energy sources is concentrated around wheat, vegetable oils and products for animal feeding (Tables No5, No 6) . Rice and powder milk are imported according to the perception of what would be the local production

Table 5: Imported Food as percent of available (Import/(production +

imports)*100)

Potatoes Plantain Rice Sugar Wheat Oil Marg Years % % % % % %

1990. 0.00 0.00 87.55 8.52 1991 0.01 0.00 0.02 87.25 10.65 1992 0.02 0.00 5.06 91.99 30.66 1993 0.13 0.00 3.17 89.85 44.44 1994 0.20 0.00 17.31 88.98 43.76 1995 0.43 0.78 8.08 93.04 40.16 1996 0.31 0.76 10.87 93.83 52.83


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1997 1.02 0.37 12.25 95.32 52.68 1998 1.60 0.34 18.96 0.19 96.60 50.39 1999 0.91 0.07 2.58 0.48 96.35 45.43 2000 2.49 0.40 3.70 0.52 96.24 54.23 2001 1.28 2.11 9.18 2.49 97.84 57.31

FAO FAOSTAT, Table 6: Production and Importation of Powder Milk and cheese

MILK MILK MILK CHEESE CHEESE CHEESE

Year Production

(Tm) Import(Tm) %imported Production

(Tm) Import(Tm) %imported

1993 32,140 4,441 12.14 12,821 489 3.68

1994 36,105 1,269 3.40 16,869 410 2.37

1995 40,710 4,073 9.09 17,407 486 2.72

1996 40,972 5,111 11.09 17,099 996 5.50

1997 54,498 14,746 21.30 22,440 836 3.59

1998 53,475 16,535 23.62 22,181 599 2.63

1999 68,159 4,496 6.19 25,193 398 1.56

2000 72,577 8,605 10.60 23,146 187 0.80

. ENCUESTA ANUAL MANUFACTURERA. DANE.

. Bases de Datos de Comercio Exterior. DANE.

The diversity of food items available, locally produced and imported

In terms of diversity of food items available, it is no doubt that globalization and urbanization has made it possible to expand the choice of foods. As will be presented below, big supermarkets linked to world wide operations have made such a variety of foods possible. However the percentage of households actually buying in these new products and shopping in these markets is remarkable low, especially of the lower income stratum.

We have no data, yet on the quantitative effect on the food habits by this

avalanche of new products, however the table below provides an example of the variety currently available on supermarket shelves. Supermarkets in Columbia contain many of the same products one would find in any supermarket in a developed country. It is even possible to shop for food via the internet. Table No 7

Table 7: Types and origin of Salami and sliced turkey, in a supermarket in

Bogotá

Salami Turkey

Salami Smoked DON DIEGO Oven roasted

Salami German CARULLA smoked

Salami Turkey DELIPAVO fat free honey Mesquite

Sala mi Italiano Milano PECOLINA New England maple


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Salami Italiano Napolitano PECOLINA Fat free brown sugar

Salami Toscano CARULLA Lemon dill

Salami Italiano VILASECA Smokey mountain pepper

Salami Milan DON DIEGO Rio Grande hot pepper

Salami Milan Taco DON DIEGO Honey

Salami Millan CARULLA Kentucky Gold

Salami Romano Natural BOCCATO DI NARDI Garlic Pepper

Salami Romano Picante BOCCATO DI NARDI Fat Free Cajun

From traditional open market (plazas de mercado) to traditional neighbourhood stores, supermarkets and big transnational supermarkets

The marketing and purchase of foods is changing dramatically in larger cities. In the first half of the 20th century food was bought at the “Plaza de Mercado”

open market in business once a week. Then as cities grew there were the “tiendas”, small enterprises usually run by families as a way of subsistence and located in every corner of the townships. Self service and supermarkets were introduced in the 70’s and 80’s and some wholesale centers in the major urban centers. In the 90’s the large national and transnational chains appeared in the supply side. Currently, there is a growing concern in the government to begin comprehensive planning for food supply in large cities taking into account the physical aspects of food access and supply as well as the operational infrastructure.

Corabastos is the name of the largest wholesale market in Bogotá. It handles

6700 metric tons of food daily. In its area of 420,000 m2 (square meters) there are 137000 m2 of storage area, 33 warehouses, 9 banks, several automatic money teller machines, cafeterias, bakeries, one public notary and cold storage facilities. It is only 30 years old, but has become the largest wholesale center in Colombia. It supplies food to 7 million people in Bogotá and its surroundings areas. It is one the places where prices are set for both farmers and consumers

The importance of changes in the way foods are marketed can be assessed by

comparing the sales by different r types of selling facilities. Sales of large supermarkets represented near 41% of sales in Colombia (In Spain the sales by big stores represent 35%). By contrast in Colombia 46.4% of the value of sales correspond to traditional stores, while in Spain only 10% of the value of sales corresponds to traditional stores. Table 8

Table 8: Percent of total sales by size of facility in Colombia and Spain 1998

COLOMBIA SPAIN

Big supermarkets 20.5 34.8 1000 – 2499 m2 20.8 14.5


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400 – 999 m2 8.3 17.8

100 – 399 m2 4 22.9

Traditional stores 46.4 10 España Rafael Presente y Futuro del Mercado – Fenalco 1999 (Fuente: Nielsen 1998)

However less than 7% of households buy food in big supermarkets (Table 9),

and the role of traditional stores and small self service markets continue to be the preferred place to buy foods. In other words this aspect of globalization of the food system, seems to have only reached the wealthy population which has enough purchasing power.

Table 9: Percent Distribution of Households buying foods by type of selling

facility 1999

City name Traditional

Stores Small Self-

service market Big

supermarkets Cooperatives and similar

Bogotá 16.1 32.5 6.5 38.6 Medellín 46.6 30.5 0.6 9.1 Cali 31.9 42.1 1.8 3.7 Barranquilla 38.6 34.1 0.9 4.9

España Rafael– Fenalco 2000 Fuente: Cálculos de Fenalco con base en DANE 1999

But not only small traditional stores and self service markets survive, the open

market – plaza de Mercado- is still used by more than half households to obtain their vegetables, meat and other perishable fresh foods. Despite the presence of big transnational market chains, people still use the traditional stores and markets to buy essential foods. The role of these new actors in price formation and food habits should be further studied

Table 10: Distribution of households buying vegetables, meat or other

perishables food in the open market (Plaza de Mercado)

Selected Cities % of households Buying

perishable food in Open market

PASTO 75 BUCARAMANGA 67 VILLAVICENCIO 54 CUCUTA 53 BOGOTA 31 España Rafael– Fenalco 2000


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Importance of street foods and emergence of fast food chains

Eating outside the home, is one of the major changes observed in during thelast decade. Factors such as distances within larger cities, mothers entering the labor force and government programs giving food assistance to both preschool and school age children, reinforce the pattern of eating at least some meals outside the home. Decisions about what family members eat, now are in hands of restaurants, fast food chains and catering services. The choice of foods to offer should be balanced by nutritional guidelines, although managerial and economic realities are also considered.

With increasing numbers of people living in cities, city boundaries can either

expand, or the fixed areas become more densely populated. Bogotá and other Colombia cities have done both. Time from one end to downtown Bogotá, takes more than one hour. Bogotá and Medellín are the only cities with some sort of rapid transit system. For many workers, the time it would take to get home and back, would be longer than the allocated work break.. Equally important is the amount of money needed for transport, which is increasing, reflecting the need to travel greater distances, and also decreasing the amount of money to buy foods.

The figure below illustrates the growing participation of women in labor force.

While some workers do take their midday meals at work, the practice of carrying foods to working seems no to be very extended, but we do not have reliable data. So number of men and women taking foods outside home constantly increases.

Figure 11 Employments in Bogotá. Percentage of Economic Active – by Gender

1976 – 1999 (magenta: female – Blue male)


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Many children receive part of their meals in day care centers or school. With the vision to guarantee the rights of children, and alleviate the social effects of mother leaving the home to enter the labor force, the government has implemented one of the most successful social programs. Both national and local branches of the government have implemented programs to provide childcare and meals to children. In 2003 the Instituto Colombiano de Bienestar Familirar ICBF (Colombian Institute for Family Wellbeing) is expected to give assistance for over 2,500,000 children.

Tables 11 and 12 describe total household and itemized food expenditures

over the past twenty years. While the percent of household budget spent on food has decreased, the following table reveals shifts in food purchasing.

Table 11: Expenditure Structure in Colombia 1979- 1999

Year 1979 1985-1989 1995-1999 % % % Food 48.9 34.8 29.5 Housing 28.4 32.6 29.4 Clothing 6.3 9.2 7.3 Others 16.4 Health 3.8 4.0 Education, culture and recreation

6.7 8.4

Transport y communications

6.8 13.5

Other Expenses 6.1 7.9 23.4 33.8

Total 100 100 100 DANE

Table 12: Food expenditure by income levels 1995-1999 % of budget for food on

each item

Low income National Bogotá Barranquilla Cali Medellín Pereira

Cereals 12.60 11.52 14.77 13.12 12.56 14.70 Tubers 7.76 8.14 6.20 6.51 7.36 7.51 Greens 7.54 7.70 6.50 7.93 8.14 7.42 Fruits 3.60 3.74 2.50 4.59 2.65 2.28 Meat 20.93 18.57 19.59 22.56 24.35 26.70 Fishes 1.90 1.44 3.78 2.25 0.85 1.49 Milk products 16.50 16.92 17.65 13.85 19.85 16.96 Other 12.11 10.12 12.95 12.70 14.68 14.11 Food eat outside home 17.05 21.84 16.08 16.55 9.57 8.82

Middle Income Cereals 10.50 9.50 11.98 11.60 10.51 11.61


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Tubers 5.38 4.81 5.53 5.21 5.37 4.84 Greens 6.01 5.43 5.88 6.48 6.67 6.79 Fruits 4.50 4.54 2.84 5.40 3.92 4.73 Meat 20.99 18.14 22.11 22.56 24.83 25.69 Fish 2.16 1.84 4.24 2.38 1.25 1.68 Milk products 15.21 15.23 15.55 13.28 17.75 16.63 Other 11.11 9.47 11.60 11.26 14.09 12.43 Food eat outside home 24.13 31.03 20.28 21.85 15.62 15.60

High Income Cereals 8.69 7.51 10.38 8.48 10.79 8.03 Tubers 3.34 2.67 3.82 3.27 3.61 3.26 Greens 4.96 3.72 6.75 5.88 5.99 5.24 Fruits 5.35 4.50 5.59 7.00 5.10 6.70 Meats 18.35 13.71 21.09 21.52 22.00 21.69 Fish 2.23 1.98 2.92 2.96 1.07 1.34 Milk Products 13.52 12.71 15.67 12.73 15.65 13.32 Others 10.36 9.13 11.12 10.12 15.09 8.48 Food eat outside home 33.18 44.08 22.66 28.08 20.71 31.94

Source: DANE. Table No 13 Percent differences in food expenditure by foods groups for

Colombia and Bogotá 1994/95 – 1984/85

Food group National Bogotá Cereal -3.10 -1.98 Tuber -1.52 0.06 Greens -2.16 -1.53 Fruits -1.27 -0.99 Meats -4.84 0.53 Fish -0.12 0.36 Milk and products -3.31 -2.94 Others -2.51 -1.51 Meals outside home 18.84 8.01

Source: DANE. Calculations of: Corporación Colombia Internacional

From data in tables No 12 and no 13, it is evident that there has been a major change in buying practices related to food, the amount of money allocated to buy food to be consumed outside home amounted in 1995 to over 20%. Without any doubt, today this figure is much greater.


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We are beginning to assimilate the effects of these changes in the nutritional wellbeing of population, in terms of habits, life styles, obesity and other specific nutritional disorders.

From home prepared meals to mass services. Fast food chains, restaurants and catering services, have replaced the

dedication of mothers and families in the selection and preparation of foods. Practically in all socioeconomic strata there are varying presence of facilities for or selling chicken, pizzas and hamburgers as well as means to attract customers or encourage them to form habits. Some facilities are quite unsanitary and have poor food handling practices. A new kind of restaurant now exist to offer mid day meals at low cost. They are located in every corner and reflect the need of workers to have a place to buy an inexpensive meal with a home sensation rather than a restaurant type of meal.

Globalization and increased urbanization was associated with important

changes in the way foods are selected, bought and prepared. Near 30% of budget allocation for food in families are devoted to buy food outside homes. Instead of the housewife figure in charge of food selection and distribution, this role has been replaced by specialized organizations, of food services and restaurants. Many informal family enterprises have used selling food as a way to increase their income, however, they have little or no technical expertise to differentiate between preparing food for family and preparing food for a substantial number of people.

In any case, nutritional and or health considerations must compete with commercial considerations.


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3. Prevalence of malnutrition in urban areas Table 14: Trends in Malnutrition

Source Place Sample Percent MalnutritionYear Survey

Size Sex Age years

Ponderal Insuficiency Growth retardation Wasting

%weight/ age % Height/ Age % Weigth / height

< - 3 DE < - 2 DE < - 3DE < - 2DE <- 3 DE < - 2 DE

ENDS, 2000 National 4060 < 5a 0.8 6.7 2.8 13.5 0.1 0.8

2071 M 0.9 6.6 2.9 13.5 0.2 0.71988 F 0.6 6.9 2.8 13.5 0.0 0.9

Bogotá 572 " 0.9 5.4 2.5 14.4 0.0 0.5Urban 2784 " 0.6 5.7 2.3 10.8 0.1 0.7Rural 1276 " 1.1 8.9 4.1 19.4 0.1 1.0

ENDES, 1995 National 4408 M/F <5a 0.9 8.4 3.5 15.0 0.3 1.42231 M 1.1 9.1 3.7 16.2 0.2 1.4

2176 F 0.7 7.6 3.3 13.7 0.3 1.3

Bogotá 542 " " 0.4 6.0 3.1 16.5 0 0.1Urban 2777 " " 0.6 6.6 2.4 12.5 0.1 1.0Rural 1631 " " 1.4 11.4 5.3 19.1 0.6 2.1

Percentil Percentil Percentil Percentil Percentil Percentil<P3 P3-P10 <P3 P3-P10 <P3 P3-P10

Mora 19881986-89 National 1973 M/F <5a 2 10.0 5.2 16.6 0.5 2.9

Bogotá 12.4 16.9 4.6 Soruce: FAO Perfil Nutricional Colombia

Trends for children

Malnutrition decreased during the second half of 20TH century. National prevalence of wasting (% of children below two standard deviation for height for age) has decreased from near 5% in the 70’s to less than 1 % in year 2000. Similar reductions in other indicators are also observed. Table 14. However the reduction has not been uniform. Bogotá the largest city with more urbanite population have the lowest preva lence of malnutrition.


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Figure 12: Prevalence of growth retardation during the second half of 20th

Century. Note the differences between Urban Rural prevalence

Nutritional Status - Growth RetardationHeight \ Age

22.4

18.916.6 16.9

15.016.5

12.5

19.1

13.5 14.4

10.8

19.4

0.0

5.0

10.0

15.0

20.0

25.0

National Bogotá Urban Rural

Region

% <

-sd

Mora 1982

Mora 1988

ENDES, 1995

ENDS, 2000

Figure 13: Prevalence of wasting during the second half of XX Century. Note the

differences between Urban Rural prevalence

Nutritional Status - WastingWeight / height

4.95.3

2.9

4.6

1.4

0.1

1.0

2.1

0.80.5 0.7 1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

National Bogotá Urban Rural

Region

% <

-2s

d Mora 1982

Mora 1988

ENDES, 1995

ENDS, 2000

Also at national level, the differences in malnutrition rates between urban and

rural populations are maintained with a greater prevalence of malnutrition among the rural population.

As expected socioeconomic differences do have an effect on the rate of

malnutrition. In Bogotá the prevalence of malnutrition in children of low socioeconomic status, is five times greater that those for total Bogotá Table No 15. Today level of wasting in children of low socioeconomic stratum living in Bogotá, are similar to those recorded for the 70’s


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Table 15: Prevalence of Malnutrition in children of low socioeconomic status. Data from the Nutritional Surveillance System in Bogotá

1997 1998 1999 2000 2001 2002

% height/age <2 15.5 14.9 15.1 16.1 14.7 15.3% weight/height 5.1 5.5 5.2 5.2 5.7 6.2 Secretaria de Salud de Bogotá .Programa de Vigilancia Nutricional – Bogotá Junio 31 2003

Malnutrition in children has decreased, although there is no evidence of the

influence of globalization in the process. However, urbanization is associated with less malnutrition in children. As expected children of families of low socioeconomic stratum living in urban centers, have much higher rates of malnutrition.

Table 16: Nutritional status of women child bearing age

Source/ year

Place

Survey Size sex ageChronic Energy Deficiency

Overweight

mean DE mediana % with BMI % BMI<18,5 > 25

ENDES National 3070 F 15-49 24.7 … … 3.2 40.72000 Urban 2210 " " 24.7 … … 3.2 40.8

Rural 860 " " 24.6 … … 3.1 40.5Region

Atlántica 687 " " 24.3 … … 6.7 37.4Oriental 593 " " 24.8 … … 3.2 43.2Bogotá 470 " " 24.7 … … 1.7 39.1Central 800 " " 24.8 … … 2.1 40.4Pacífica 519 " " 25 … … 1.4 44.3

ENDES National 3156 F 15-49 24.5 4 … 3.8 40.31995 Urban 2133 " " 24.5 … … 3.8 …

Rural 1023 " " 24.5 … … 3.9 …Region

Atlántica 799 " " 23.9 … … 7.9 …Oriental 536 " " 24.7 … … 3.6 …Bogotá 422 " " 24.4 … … 1.5 …Central 841 " " 24.8 … … 2.1 …Pacífica 588 " " 24.7 … … 2.6 …

Sample Nutritional Satuds

Body Mass Index (Kg/m2)

Source: Adapted from FAO Nutrition Country Profile – Columbia

Transition form the epidemiologic point of view has been associated to the

presence of both malnutrition and obesity. Unfortunately we do not have national data on obesity among adults. However data on women of child bearing age shows that overweight does exist. Table No 16 shows for the years 1995 and 2000 national surveys, a prevalence of over 40% of women of child bearing age having Body Mass Index above 25. Women without formal education or only primary school and women with higher education have similar prevalence of overweight.


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4. Trend in health status in the urban environment Trends in health status

Bogotá during the globalization period greatly improve the health condition of the population, for example mortality in children less than 1 year of age improves from to 26.8 per 1000 to 20 per 1000 (Table 17) and in other larges cities infant mortality in 2000 was Cartagena 33.8, Ibagué 19.5 Medellín 17.4.

Table 17: Mortality in children less 1 year old in Bogotá

Year Number Rate1986 2361 26.841987 2246 25.021988 2266 24.251989 2317 24.241990 2289 24.821991 2663 27.231992 2629 26.891993 2619 25.861994 2620 23.781995 2856 21.741996 2828 21.271997 2627 19.311998 2683 19.231999 2923 20

. Tasa por 1.000 menores de un año Secretaría Distrital de Salud Fuente: Registros de defunción, Área de Análisis y Políticas en Salud Pública, Secretaría Distrital de Salud 2000

Infectious diseases

Colombia has improved its situation of infectious diseases especially for immuniable diseases. However malaria, dengue and tuberculosis still are prevalent. Table 18 shows the number of cases detected for year 2002


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Table No 18 Infectious Diseases - Colombia 2002

0 02 00 0

577 1.315 1.3

1,004 0.9933 2.3

0 00 00 08 0.02

55,282 180.1205,924 766.511,292 26.27,906 70%2,001 4.6

Malaria (14)Tuberculosis (16)Tuberculosis Positive smear ( Baciloscopy) Leprosy

Human Rabies Peste (14)Yellow FeverDengue(14)

Tetanus neonatorum Siphilis congenital AIDS (17)Cholera (14)

Poliomelitis Meseals (11)Difteria in child < 5 yearsWhooping cough

INFECTIOUS DESEASES MORBIDITYCases

Incidence rateNo of cases and rates per 100000 people

TB positive refers to % cases with positive smear aover total number of cases

Indicadores de Salud Año 2002 Vigilancia Epidemiológica – Ministerio de Salud

AIDS. The program for the prevention and control of AIDS and STDs reported 933 cases of AIDS in 1992 and 1,042 in 1996, with a cumulative total of 7,776 diagnosed cases and a cumulative mortality of 41.5% (3,226 cases). Of all the cases diagnosed, 85% were in men, and 40.5% of those were in the group aged 25 to 34. Only 2.1% of the cases affected the population under 15 years of age. Heterosexual transmission accounted for 44.0% of the cases and homosexual transmission for 27.4%.The highest percentages of diagnosed cases were in Bogotá (46.4%) and the district of Antioquia (15%). In 2002 the number of new cases was 933. (2002 Pan American Health Organization -“Country Profile)

Chronic non communicable diseases

Cardiovascular Diseases. These diseases are the leading cause of death in women, the second leading cause in men, and the primary cause of death in the group aged 45 to 64. In 1994, 44% of deaths attributed to this cause were due to ischemic heart disease, 93% of them were in persons aged 45 and older, and 56% were in men. Cerebrovascular diseases represented 28% of deaths from cardiovascular conditions, 91% of which occurred in the over-45 age group and 54% in women.

Arterial hypertension is the most important risk factor for cardiovascular diseases. According to the 1987 national health study, the prevalence of arterial hypertension in Colombia as a whole was 11.6% in the population over 15 years of age. However, a study conducted in 1995 in the population of Quibdó revealed a prevalence of 35% in all persons over the age of 18 and a prevalence of 39% in the Colombian population of African ancestry—percentages significantly higher than those observed in the rest of the population (21%).The prevalence rates varied by age, from 10% in young persons to 50% in those aged 49 and over. No differences were noted according to sex. Only 16% of the persons surveyed said that they participated in some form of exercise in their free time. Somatometry showed that 50% were at least 10% overweight. A comparison between body mass index (BMI) means showed


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that hypertensive individuals were more obese than those who were not hypertensive (P < 0.0001). (2002 Pan American Health Organization -“Country Profile"). On the other hand Diabetes increase its rate of incidence by 30% (Table 19)

Table 19: Incidence of Diabetes and Hypertension Bogotá 1987 - 1998

Cases rate per 10000 Diabetes High Blood pressure Diabetes High Blood pressure

1987 392 693 0.92 1.63 1988 433 699 0.9 1.45 1989 490 826 1.02 1.72 1990 525 813 1.06 1.65 1991 517 854 1.01 1.67 1992 582 873 1.11 1.67 1993 600 934 1.1 1.72 1994 635 938 1.14 1.69 1995 700 899 1.23 1.58 1996 620 946 1.07 1.63 1997 823 833 1.39 1.49 1998 829 781 1.37 1.29 1999 2000

Secretaria Distrital de Salud de Bogotá Diagnóstico Distrital de Salud 2000 Rate of incidence of type II Diabetes in Bogotá has increased, reaching a level

30% higher than previously; perhaps reflecting the changes in increasing sedentary behavior, coupled with dietary habits.Table 19 We belong to typical transition country, still have infectious diseases such as malaria and tuberculosis, but we have great problems with cardiovascular diseases, diabetes and AIDS.

5. Programs which have tried to address food and nutrition issues There are two types of programs being carried out by the government in order

to address the effects emerging in the globalization – urbanization period. As mentioned before food assistance is given to nearly 2.500.000 children,

both at the school and in special day care centers. Their focus is children belonging to families of the lower socioeconomic strata. Equally, pregnant and lactating women of the same socioeconomic strata receive some food assistance.

On the other hand government is also starting to implement programs aimed at

creating healthier life styles, promoting nutritional guides, promoting healthy schools, and promoting regular exercise. However this programs are new or are functioning at the pilot level


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