Globalization, diet, and health: an example from Tonga

The increased flow of goods, people, and ideas associated with globalizatio n have contributed to an increase in noncommunicable diseases in much of th e world. One response has been to encourage lifestyle changes with educatio nal programmes, thus controlling the lifestyle-related disease. Key assumpt ions with this approach are that people's food preferences are linked to th eir consumption patterns, and that consumption patterns can be transformed through educational initiatives. To investigate these assumptions, and poli cies that derive from it, we undertook a broad-based survey of food-related issues in the Kingdom of Tonga using a questionnaire. Data on the relation ships between food preferences, perception of nutritional value, and freque ncy of consumption were gathered for both traditional and imported foods, T he results show that the consumption of health-compromising imported foods was unrelated either to food preferences or to perceptions of nutritional v alue, and suggests that diet-related diseases may not be amenable to interv entions based on education campaigns. Given recent initiatives towards trad e liberalization and the creation of the World Trade Organization, tariffs or import bans may not serve as alternative measures to control consumption . This presents significant challenges to health policy-makers serving econ omically marginal populations and suggests that some population health conc erns cannot be adequately addressed without awareness of the effects of glo bal trade.