TY - JOUR
T1 - World trade organization membership and changes in noncommunicable disease risk factors
T2 - A comparative interrupted time-series analysis, 1980–2013
AU - Cowling, Krycia
AU - Stuart, Elizabeth A.
AU - Neff, Roni A.
AU - Magraw, Daniel
AU - Vernick, Jon
AU - Porter, Keshia Pollack
N1 - Publisher Copyright:
© 2019, World Health Organization. All rights reserved.
PY - 2019/2
Y1 - 2019/2
N2 - Objective To investigate the relationship between joining the World Trade Organization (WTO) and the availability of several commodities with both harmful and protective effects for the development of noncommunicable diseases. Methods We used a natural experiment design to compare trends in the domestic supply of tobacco, alcohol and seven food groups, between 1980 and 2013, in 21 countries or territories joining WTO after 1995 and 26 non-member countries, using propensity score weights. We applied a comparative interrupted time-series framework, by using multivariate random-effects linear models, adjusted for gross domestic product per capita, the percentages of urban population and female labour force participation. In the tobacco model, we controlled for Member States that had ratified the Framework Convention on Tobacco Control and in the alcohol model, the percentage of the population identifying themselves as Muslim. Findings Following accession to WTO, member states experienced immediate increases in the domestic supply of fruits and vegetables of 55 g per person per day on average, compared to non-member countries. The analysis showed gradual increases in the geometric mean of the supply of tobacco and alcohol of 6.2% and 3.6% per year, respectively. We did not detect any significant changes in the availability of red meats and animal fats; seafood; nuts, seeds and legumes; starches; or edible oils; and results for sugars were inconsistent across model variations. Conclusion The results suggest that WTO membership may lead to increases in both harmful and protective factors for noncommunicable disease, but further exploration of country-specific variation is warranted.
AB - Objective To investigate the relationship between joining the World Trade Organization (WTO) and the availability of several commodities with both harmful and protective effects for the development of noncommunicable diseases. Methods We used a natural experiment design to compare trends in the domestic supply of tobacco, alcohol and seven food groups, between 1980 and 2013, in 21 countries or territories joining WTO after 1995 and 26 non-member countries, using propensity score weights. We applied a comparative interrupted time-series framework, by using multivariate random-effects linear models, adjusted for gross domestic product per capita, the percentages of urban population and female labour force participation. In the tobacco model, we controlled for Member States that had ratified the Framework Convention on Tobacco Control and in the alcohol model, the percentage of the population identifying themselves as Muslim. Findings Following accession to WTO, member states experienced immediate increases in the domestic supply of fruits and vegetables of 55 g per person per day on average, compared to non-member countries. The analysis showed gradual increases in the geometric mean of the supply of tobacco and alcohol of 6.2% and 3.6% per year, respectively. We did not detect any significant changes in the availability of red meats and animal fats; seafood; nuts, seeds and legumes; starches; or edible oils; and results for sugars were inconsistent across model variations. Conclusion The results suggest that WTO membership may lead to increases in both harmful and protective factors for noncommunicable disease, but further exploration of country-specific variation is warranted.
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U2 - 10.2471/BLT.18.218057
DO - 10.2471/BLT.18.218057
M3 - Article
C2 - 30728615
AN - SCOPUS:85061125224
SN - 0042-9686
VL - 97
SP - 83A-96A
JO - Bulletin of the World Health Organization
JF - Bulletin of the World Health Organization
IS - 2
ER -