Missing Links: The centrality of globalization and trade in the development of NCDs in low-income countries

The normative discourse for the promotion of health and the prevention of non-communicable diseases (NCDs) reduces understandings of causality and public health interventions to the micro-level of the individual and their health behaviors. However, this discourse assumes that any individual can foster and promote such behavioral changes regardless of their environment. Yet in research conducted at community levels in Guatemala, the Philippines and Tanzania, built-environments were identified to negatively affect such changes in individual health behaviors. Just as an obesogenic environment can provide a breeding ground for obesity, so to can built environments foster non-communicable diseases. Using mixed-methods research this comparative analysis in Guatemala, the Philippines, and Tanzania identifies myriad complex social determinants that impact the development of NCDs particularly at international/global levels of trade, Foreign Direct Investment and globalization processes that affect local health beliefs and behaviors. Thus, to focus primarily on individual health behavior is to assume that the individual is somehow partitioned from these other influences. This paper concludes that in order to effectively engender change, the discourse of health policy and health promotion and management needs to consider the full complexity of factors, particularly the macro-level factors of trade and globalization, that have led to the current rapid exponential increase in NCDs in low- and middle- income countries.