Geopolitics, Obesity, Diabetes: The Brazilian, Chinese, and Indian Responses
Gomez, Eduardo J., Harvard International Review
Though different in their history, political institutions, and cultures, in recent years the emerging nations of Brazil, China, and India have witnessed a burgeoning growth--of obesity and diabetes cases. The product of ongoing economic growth, trade, increased consumption of fatty foods, and sedentary lifestyles, the presence of these epidemics support the notion that the rise of obesity and diabetes cases correlates with economic growth and prosperity.
Despite their similar health challenges, these nations have varied in how they have responded, in terms of both prevention as well as access to medicine and treatment. Brazil was the only nation to pursue prevention, access to medicine and treatment for obesity and diabetes, while China and India, in contrast, have only recently begun to address obesity prevention. With respect to diabetes, China and India's governments still fall short of ensuring access to medications as well as treatment.
But why was Brazil so successful? The case of Brazil shows that successfully responding to obesity and diabetes requires that nations simultaneously strive to increase their international reputation as governments capable of eradicating disease and build upon preexisting institutions and policies guaranteeing the universal distribution of medicine while working closely with civil society. Geopolitical aspirations, historical institutions and a rich history of social health movements therefore constitute important contextual factors facilitating this process. Geopolitically, Brazil has always been sensitive to international criticisms and pressures when it came to health. When international agencies and the media began to pressure Brazil for a stronger response to obesity and diabetes, the government escalated its policy response in order to strengthen the government's reputation as a modern state capable of eradicating disease; China shared similar views and incentives, but India did not. In contrast to these other nations, moreover, Brazil had a long history of creating a centralized bureaucratic and policy response to epidemics while dovetailing this with constitutional commitments guaranteeing access to medication as a human right. These preexisting institutional traditions and commitments were absent in China and India.
In Brazil, obesity began to emerge as an epidemic by the late-1980s, mainly as a result of heightened economic growth, the import of processed foods, changes in dietary habits, and increased migration to urban centers. By the mid-2000s, the number of obese burgeoned, growing from 11.4 percent of the population in 2006 to 15.8 percent in 2011. Interestingly this occurred amidst ongoing malnutrition, causing a "dual nutrition" problem. But by 2010 Brazil's Health Minister, Jose Temporao, commented that, "the problem of Brazil is no longer malnutrition but childhood obesity and the increase in weight." According to research conducted by Maria Teresa Torquato in 2003, diabetes--primarily Type 2--as a health ailment also began to emerge during this period and was generally attributed to obesity. By 1998, researcher Sandhi Barreto found that 4.9 million adults had diabetes, with a projected increase to 11.6 million by 2025.
Despite a transition back to democracy in 1986, the government was slow to respond. The presence of multiple diseases, preexisting commitments to decentralization, and limited funding for nutritional programs generated a lack of attention and policy response. Despite the Congress organizing several hearings on better nutrition and education through The National Congress of Nutrition (No Congresso Nacional de Nutricao) and the National Policy on Nutrition (Politica Nacional de Alimentacao) in 1999, endeavors which improved the provision and quality of foods, accurate data and reporting, promotion of healthy eating and research, there were no prevention and treatment policies for obesity and diabetes. …