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The Impact of U.S. Free Trade Agreements on Calorie Availability and Obesity: A Natural Experiment in Canada.

ABSTRACT: INTRODUCTION:Globalization via free trade and investment agreements is often implicated in the obesity pandemic. Concerns center on how free trade and investment agreements increase population exposure to unhealthy, high-calorie diets, but existing studies preclude causal conclusions. Few studies of free trade and investment agreements and diets isolated their impact from confounding changes, and none examined any effect on caloric intake, despite its critical role in the etiology of obesity. This study addresses these limitations by analyzing a unique natural experiment arising from the exceptional circumstances surrounding the implementation of the 1989 Canada-U.S. Free Trade Agreement. METHODS:Data from the UN (2017) were analyzed using fixed-effects regression models and the synthetic control method to estimate the impact of the Canada-U.S. Free Trade Agreement on calorie availability in Canada, 1978-2006, and coinciding increases in U.S. exports and investment in Canada's food and beverage sector. The impact of changes to calorie availability on body weights was then modeled. RESULTS:Calorie availability increased by ?170 kilocalories per capita per day in Canada after the Canada-U.S. Free Trade Agreement. There was a coinciding rise in U.S. trade and investment in the Canadian food and beverage sector. This rise in calorie availability is estimated to account for an average weight gain of between 1.8 kg and 12.2 kg in the Canadian population, depending on sex and physical activity levels. CONCLUSIONS:The Canada-U.S. Free Trade Agreement was associated with a substantial rise in calorie availability in Canada. U.S. free trade and investment agreements can contribute to rising obesity and related diseases by pushing up caloric intake.

SUBMITTER: Barlow P

PROVIDER: S-EPMC5906641 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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The Impact of U.S. Free Trade Agreements on Calorie Availability and Obesity: A Natural Experiment in Canada.

Barlow Pepita P McKee Martin M Stuckler David D

American journal of preventive medicine 20180326 5

<h4>Introduction</h4>Globalization via free trade and investment agreements is often implicated in the obesity pandemic. Concerns center on how free trade and investment agreements increase population exposure to unhealthy, high-calorie diets, but existing studies preclude causal conclusions. Few studies of free trade and investment agreements and diets isolated their impact from confounding changes, and none examined any effect on caloric intake, despite its critical role in the etiology of obe ...[more]

PMID: 29598857

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Project description:ObjectivesRegular breast cancer screening is a widely used cancer prevention strategy. Important quality indicators of screening include cancer detection rate, false positive rate, benign biopsy rate and post-screen invasive cancer rate. We compared quality indicators of community radiology clinics to those of 'Screen Test', which feature centralised batch reading and quality control processes. Both types of providers operated under a single provincial Breast Cancer Screening Programme.SettingCommunity radiology clinics are operated by independent fee-for-service radiologists serving large and small communities throughout the Canadian province of Alberta. Launched by the provincial cancer agency, the Screen Test operates two physical clinics serving metropolises and mobile units serving remote regions. Eligible women may self-refer to any provider for screening mammography.ParticipantsWomen aged 50 to 69 years who had at least one screening mammogram between July 2006 and June 2010 in Alberta were included. Women with missing health region information or prior breast cancer diagnosis were excluded.ResultsA total of 389 788 screening mammograms were analysed, of which 12.7% were performed by Screen Test. Compared with Screen Test during 2006 to 2008, community radiology clinics had a lower cancer detection rate (3.6 vs 4.6 per 1000 screens, risk ratio (RR): 0.81, 95% CI: 0.67 to 0.98) and a much higher false positive rate (9.4% vs 3.4%, RR: 2.72, 95% CI: 2.55 to 2.90). Most other performance indicators were also better in Screen Test overall and across all health regions. These performance indicators were similar during 2008 to 2010, showing no improvement with time.ConclusionsScreen Test has a quality assurance process in place and performed significantly better. This provides empirical evidence of the effectiveness of a quality assurance process and may explain some of the large differences in breast cancer screening indicators between provinces and countries with formal programmes and those without.

Dataset Information

The Impact of U.S. Free Trade Agreements on Calorie Availability and Obesity: A Natural Experiment in Canada.

Publications

The Impact of U.S. Free Trade Agreements on Calorie Availability and Obesity: A Natural Experiment in Canada.

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