Globalization, diet, and health: an example from Tonga

The increased flow of goods, people, and ideas associated with globalization have contributed to anincrease in noncommunicable diseases in much of the world. One response has been to encourage lifestyle changeswith educational programmes, thus controlling the lifestyle-related disease. Key assumptions with this approachare that people’s food preferences are linked to their consumption patterns, and that consumption patterns can betransformed through educational initiatives. To investigate these assumptions, and policies that derive from it, weundertook a broad-based survey of food-related issues in the Kingdom of Tonga using a questionnaire. Data on therelationships between food preferences, perception of nutritional value, and frequency of consumption weregathered for both traditional and imported foods. The results show that the consumption of health-compromisingimported foods was unrelated either to food preferences or to perceptions of nutritional value, and suggests thatdiet-related diseases may not be amenable to interventions based on education campaigns. Given recent initiativestowards trade liberalization and the creation of the World Trade Organization, tariffs or import bans may not serveas alternative measures to control consumption. This presents significant challenges to health policy-makersserving economically marginal populations and suggests that some population health concerns cannot beadequately addressed without awareness of the effects of global trade.