Cardiovascular disease (CVD), a non-communicable disease, is the primary cause of mortality worldwide, leading to 32% of the total deaths in 2013 (Roth et al., 2015). In emerging countries specifically, which increased from 10% in 1900 to over 50% in 2010, CVD has increased prominently, with China and India being two of the emerging countries with very high CVD rates (Pradeepa, Prabhakaran, & Mohan, 2012; Kearney, 2010). Although cardiovascular disease is often linked to lifestyle factors, there are other very important factors that should also be considered such as globalization of food and its market, and the change in the physical and built environment in modernized countries. Through this paper, the role urbanization plays on globalization of food and its market, and the physical and built environment will be presented, showing how they are linked to rise in CVD.
To begin with, one of the reasons for CVD rise in modernized countries is the globalization of food and its market. Urbanization has allowed transnational food corporations (TNCs) to enter and dominate the market of those emerging countries due to the improved media, technology and marketing, leading to an increased availability and accessibility of imported foods in the market (Black, 2016; Kearney, 2010). These foods became associated with modernization and sophistication among people and resulted in a shift in preferences from traditional foods to cheap, convenient non-traditional and processed ones, which are energy-dense, high in saturated fats, refined carbohydrates, salt, and sugar and low in fiber, whole-grains, vitamins and minerals (Black, 2016; Kearney, 2010). These non-traditional foods are known to be related to increased risk of CVD (Black, 2016). All of this has led to unjustly restricting the choices of the individual to only what is found in the market, which is in control of the individual’s food choices (Black, 2016) and as a result, unjustly increasing the risk of CVD. For example, in China, a rapidly urbanized country, the leading cause of morbidity and mortality is CVD, causing 45% of total deaths, due to the shift from the traditional diet, among other factors (Shen, Goyal, & Sperling, 2011; World Health Organization WHO, 2014). Another example of a rapidly urbanizing region is the Arab gulf. CVD rates have increased due to the increased adoption of unhealthy foods, among other factors, and has become the primary cause of death among non-communicable diseases with 46%, 41%, 33%, 30%, 26%, and 24% of total deaths respectively in KSA, Kuwait, Oman, UAE, Bahrain and Qatar (Aljefree & Ahmed, 2015; WHO, 2014).
Another reason for the rise in CVD incidence in modernized countries is the change in the physical and built environment. Changes in the physical environment are caused by the increased level of air pollution and metals found in the air (Cosselman, Navas-Acien, & Kaufman, 2015). These levels are affected by the increase in the number of industries, motor vehicles and other sources of pollutants (Schmale, Shindell, von Schneidemesser, Chabay, & Lawrence, 2014). Exposure to air pollution has been linked to increasing CVD rate and as identified by the WHO, over 80% of the people living in urban cities are exposed to levels surpassing the accepted ones (Chow et al., 2009; WHO, 2016). This evidence shows that the individual is not always to blame for exposing him/herself to harmful substances. Here one’s personal choices are affected and greatly limited by the surrounding. Through research, Chow et al. found that with modernization, there have been great increases in urbanization and thus the physical space left outdoors for individuals to exercise is decreased. They related the amount of space to walk in to the amount of physical activity an individual gets per day. The less space there is, the less time people spend walking or exercising (Chow et al., 2009). A study conducted in China linked urbanization to a decrease in physical activity among adults in China due to the shift in the types of jobs people have (Ng, Norton, & Popkin, 2009). There have been improvements in the services available such as distance to markets and community infrastructures. These reasons caused the amount of physical activity undertaken by the individuals to decrease. Urbanization of cities and the consequent decrease in physical activity individuals in a city engage in increase the burden of chronic diseases on the community which include CVD (Ng et al., 2009).
In conclusion, although the rise of CVD is often linked to individual lifestyle, urbanization plays a significant role in increasing its risk, through globalization of food and its market, and the physical and built environment. This shows that the role urbanization plays on newly modernized countries and how it affects the individual must not be overlooked. Urbanization indirectly exacerbates the risk of CVD in individuals in a multifactorial way, whether it is through restricting their food choices or changing the environment they live in.