Epidemiological and nutrition transition in developing countries: impact on human health and development

Whereas common infectious and parasitic diseases such as malaria and the HIV/AIDS pandemic remain major unresolved health problems in many developing countries, emerging non-communicable diseases relating to diet and lifestyle have been increasing over the last two decades, thus creating a double burden of disease and impacting negatively on already over-stretched health services in these countries. Prevalence rates for type 2 diabetes mellitus and CVD in sub-Saharan Africa have seen a 10-fold increase in the last 20 years. In the Arab Gulf current prevalence rates are between 25 and 35% for the adult population, whilst evidence of the metabolic syndrome is emerging in children and adolescents. The present review focuses on the concept of the epidemiological and nutritional transition. It looks at historical trends in socio-economic status and lifestyle and trends in nutrition-related non-communicable diseases over the last two decades, particularly in developing countries with rising income levels, as well as the other extreme of poverty, chronic hunger and coping strategies and metabolic adaptations in fetal life that predispose to non-communicable disease risk in later life. The role of preventable environmental risk factors for obesity and the metabolic syndrome in developing countries is emphasized and also these challenges are related to meeting the millennium development goals. The possible implications of these changing trends for human and economic development in poorly-resourced healthcare settings and the implications for nutrition training are also discussed.

Profitability and the poor: corporate strategies, innovation and sustainability

Based on empirical evidence, the article looks at the implications of private sector participation (PSP) for the delivery of water supply and sanitation to the urban and peri-urban poor in developing countries, with particular reference to Africa and Latin America. More precisely, the article addresses the impact produced by multinational companies’ (MNCs) strategies, in light of the pursuit of profitability, on the extension of connections to the pipeline network. It does so by questioning the assumptions that greater private sector efficiency and innovation, together with contract design, will enable the sustainable extension of service coverage to low income dwellers. The strategies of the major water MNCs are considered both in relation to the global expansion of their operations and the adjustment of local strategies to commercial considerations. The latter might result in identifying proWtable markets, modifying contractual provisions, attempting to reduce costs and increase income, reducing risks and exiting from non-performing contracts. The evidence reviewed allows for re-assessing the relative roles of the public and private sectors in extending and delivering water services to the poor. First, the most far reaching innovative approaches to extending connections are more likely to come from communities, public authorities and political activity than from MNCs. Secondly, whenever MNCs are liable to exit from non-profitable contracts, the public sector has no other option than to deal with external risks aVecting continuity of provision. Finally, market limitations affecting MNCs’ ability to serve marginal populations and access cheap capital do not apply to well-organised, politically led public sector undertakings

The comparative advantage of the public sector in the development of urban water supply

This paper addresses the potential of public water operations in achieving developmental goals such as the Millennium Development Goals, and argues that the public sector has a comparative advantage in developing water services. The global importance of the public sector in urban water supply is examined through a review of current practice in the world's largest cities, including operational presence and distribution and ongoing trends. Empirical evidence shows that, in transition and developing countries, public operators are capable of undergoing successful reform. One explanatory factor is proposed to be the creation through the public sphere of highly interconnected networks among stakeholders. Such accountability networks act as vehicles for the generation and distribution of public knowledge among stakeholders, which in turn inform rational decision making on the reform and management of operations.